California hospitals adjust to a new normal as fires rage

When Sutter Health’s Santa Rosa Regional Hospital got the call from county and state officials to evacuate the evening of Saturday, Oct. 26, systemwide coordination efforts to prepare and mobilize patients and staff while wildfires encroached had long been underway.

By 8 a.m. the next morning, employees at the 84-bed hospital had shuttled patients via ambulance and helicopter to other area hospitals including Sutter’s California Pacific Medical Center and Novato Community Hospital, 60 miles and 40 miles south, respectively. As the fires loomed, Sutter convened an emergency management team to identify the facilities in their path and used geolocation to track their team. 

It was a moment that Sutter had spent years preparing for.

Through a multiyear process, Sutter bolstered communication through its electronic health record and patient portal systems, improved its geolocation technology, formed a partnership with Lyft, upped its video consultation services, and scaled its call centers, said Theresa Frei, CEO of the Sutter Valley Medical Foundation, noting that staff called patients for more than three months to inform them about the potential disruption.

They honed the process as fires scorched Sonoma County two years ago and Amador County four years ago. “From the emergency management team to the system COO to people on the front lines, we try to respond in a uniform way to identify what frontline staff needs to care for patients,” Frei said.

California hospitals and their surrounding communities are coping with a new reality of intermittent power outages and evacuations amid more frequent and intense wildfires, among other natural and man-made disasters. This has required a more robust, permanent approach to how to pack up and leave quickly and safely, making sure the right supplies and data follow them.

But no matter the preparation, questions remain as to whether the infrastructure supporting businesses and communities can weather regular disasters and rolling outages.

Preparing for disasters takes a financial toll on the industry. California hospitals are expected to shell out $143 billion to comply with 2030 mandated seismic safety codes, according to a study paid for by the industry. There’s no estimate on how much the most recent fires and blackouts will cost.

“We are really in uncharted territory right now,” said Nicolette Louissaint, executive director of Healthcare Ready, a disaster-response not-for-profit. “There are mitigation efforts that can get us closer to controlling the impact. What it doesn’t do is control the cause. I think all of healthcare infrastructure is in a position where you are responding to an evolving threat. This is not ideal, but very much our reality.”

The situation is precarious for Dignity Health Sierra Nevada Memorial Hospital, a rural facility in Grass Valley.

It recently endured its third power outage of October, the first of which lasted more than 40 hours. That was the longest time the hospital has been without power during Dr. Brian Evans’ more than 20 years with Dignity, now called CommonSpirit Health.

Its outpatient building isn’t hooked up to emergency power, which includes imaging equipment and a linear accelerator. Sierra Nevada doesn’t do elective procedures on emergency power and it had to transfer some surgery patients.

Pacific Gas and Electric Co. set up a so-called “continuity zone” for the third outage, where it brought in large industrial generators to one of its substations in the Grass Valley area. The station supplies electricity to nearly 4,000 customers including the hospital.

The facility has been a “life raft” for those who otherwise wouldn’t have power, Evans said. Others flocked to the hospital to charge their phones, access Wi-Fi or for light.

“I don’t feel like communities have a great long-term solution for this other than hardening the grid to keep the power supply more reliable. But I’m told that could take a long time,” said Evans, adding that housing generators in a substation isn’t a real solution for everyone. “It’s difficult for rural hospitals like ours to manage frequent power outages that are long-lasting—we’re already facing a lot of threats financially.”

The hospital has tried to bring more first responders and community officials into the planning process to shore up communication amid disasters. It has also discussed installing more permanent generators on campus.

“Operational and logistical challenges rural providers face during disasters only compound current challenges,” Louissaint said.

In addition to Sutter’s Santa Rosa hospital, Kaiser Permanente Santa Rosa Medical Center and Healdsburg District Hospital also closed. The hospitals are expected to reopen early this week.

Sutter received 24-hours notice from PG&E on Oct. 8 regarding the first blackout, Frei said. During the shutdown, Sutter Care at Home staff, equipped with headlamps, drove to patients’ homes to make sure they were safe. Some of its clinics in remote areas like Jackson lost power; 16 were affected in total. As of deadline, Sutter said some of the clinics reopened last week and it was cleaning, testing and restocking its Santa Rosa hospital to get it back up and running.

The health system deployed “air scrubbers” at many locations to minimize air pollution. Sutter also set up a call center that around 150 employees have used to get counseling and coordinate financial assistance, Frei said.

“It’s traumatic to be evacuated again,” Frei said, explaining that some staff have post-traumatic stress disorder from previous evacuations. “Hopefully this helps them cope with the situation and get through the immediacy of evacuation.”

Children’s Hospital of Los Angeles briefly closed outpatient clinics in Santa Monica and Valencia due to the air quality, CHLA Chief Clinical Officer Nancy Lee said. Its main campus has been largely unaffected.

CHLA holds annual evacuation drills and about two years ago started using Everbridge, an emergency response notification system that sends calls and texts to every employee amid disasters. It also fashioned its response protocol after a hospital incident command system managed by the California Emergency Medical Services Authority.

Communication has been the biggest focus, both internally and with emergency management authorities and local healthcare organizations, Lee said. “We have more rigor around our disaster planning and response,” she said. “We have involved executive leadership in a much more significant way.”

Long-term strategies to mitigate wildfires is a bigger, broader question though, Louissaint said. “Healthcare has to figure out how to adjust,” she said. “There is a question about the sustainability of withstanding these extreme threats.”