Common Good in the Commonwealth

Ice storm brings out the best of people in Kentucky

It’s Kentucky, for goodness sake. How bad can the weather be? Bad.

Take, for instance, the 75-mile-per-hour winds many citizens of the Commonwealth sustained in the wake of Hurricane Ike last September. That storm downed power lines, tore down trees and left some people without power for days.

That was only Round 1.

Round 2 occurred at the end of January, when an ice storm – which led to an accumulation of more than 2 inches of the stuff – splintered trees, knocked out power lines, and left hundreds of thousands of people without power and running water for a week or more. Many portions of the state were declared disaster areas, making them eligible for federal financial assistance.

A magnet for the stranded
Like many other cities in the state, Madisonville, a town of about 20,000 in western Kentucky, lacked power for a week after the storm, which struck Jan. 26 and Jan. 27. Even two weeks after the storm, 25 percent of the homes and businesses in Madisonville were still awaiting resumption of power. Given that, it’s no surprise that Trover Health System became a magnet for the stranded and the sick.

At 410 licensed beds, Trover is large by any standards. With its acute-care facilities and outpatient clinics, the IDN services a six-county area. The IDN’s materials management director, Tim Ingram, is used to disasters and disaster planning, given his 22-year career in the Air Force. (He retired in 2002.) “Because of my military background, disaster preparedness is an everyday thing for me,” he says. Even so, the events of January and February were startling, even to a guy who’s seen the direct effects of bombings and pipeline explosions, as he had in the military.

“Compared to other storms I’ve been in, I’ve never seen anything like this, as far as the amount of damage ice can cause. You’re driving down roads and you see the tops of all the trees are splintered.” Thousands of telephone and electric poles had to be replaced, many of them erected right next to ones that were still standing, if shakily.

Trover Health, like hospitals throughout the state, did indeed receive a weather warning from the Kentucky Hospital Association prior to Jan. 26. “But in this area, weather is tricky because of the Ohio River,” says Ingram. “It either pushes things away or pulls them in.” Nevertheless, he prepared for the worst, even going so far as to see that his wife and family left for Kansas, where his wife’s family lives. And he got on the phone with his suppliers and his GPO, Premier, which has a disaster response team. “I started calling them and letting them know what our situation was,” he says.

Supplies consumed rapidly
Trover Health keeps 14 to 21 days of stock on hand at all times, says Ingram. “The thing is, supporting day-to-day business and disaster support are two different things.” In other words, in a disaster, there’s a good chance you’ll burn through that 14-day supply much faster than 14 days. And there’s a good reason for that.

Because of its generator, the hospital was the only facility in Madisonville with power and the ability to serve food. So Trover found itself serving soup and sandwiches to hundreds of people. “We had people staying in rooms that weren’t being used, and mattresses in the auditorium for staff who couldn’t make it home,” says Ingram. “We were going through supplies fairly quickly.”

The IDN set up a triage area in its PACU, and another makeshift treatment area for people with minor problems, such as simple wounds. Some people, whose houses lacked heat or running water, were suffering from hypothermia and dehydration.

Another big issue was DME, or durable medical equipment, that is, equipment for home care patients. Trover found itself supporting patients who are routinely serviced by the local pharmacy or home care agency. Moreover, home care patients who rely on oxygen concentrators needed a source of power for their continued operation, and so came to Trover. In fact, many of the supplies Ingram’s staff initially ordered were respiratory-related.

Just as the supply chain team faced a dizzying workload, it did so with a much-diminished staff. “I was only able to get 45 percent of our manpower in,” says Ingram. “Some were stranded. They couldn’t get to work. When you live in a rural area, a lot of people are stuck at home, because the roads aren’t available.” Ingram himself stayed at the hospital seven days straight. His wife had bought an inflatable mattress at Wal-Mart for him before she took their children to Kansas. And that’s what Ingram slept on for the duration. “We had showers that were operational,” he says. “The water wasn’t hot, but it was warm.”

Power down
Although its generators provided power to Trover, they didn’t provide full power. For example, there were lights in the warehouse, but only at about half the normal brightness. Worse, the materials management system was down. For a facility that places as many as half its orders via EDI, that was a problem. In addition, the system lacked email for the first two days of the storm. “When you lose 50 percent of your capability, you’re doing everything over the phone manually with whomever could provide support,” says Ingram. Keeping track of what was coming in and what was going out proved to be a challenge, though a card-based manual system helped.

Reconciling prices and invoices simply had to be placed on the back burner as the emergency unfolded. “You discuss pricing [with vendors] once everybody has been taken care of,” says Ingram. At times like these, people tend to think of patient care first. “Our team did a fantastic job in terms of providing care. [The clinical teams] were hurting for manpower as much as we were. And I saw directors of finance working in the cafeteria. Everybody rolled up their sleeves.” That said, a team of people used manual forms to try to stay on top of patient charging. “It really went a lot smoother than I thought,” he says.

That extended to outside partners as well. Soon after the storm hit, for example, Ingram was on the phone with Premier’s emergency response team, who acted as a communications conduit throughout the ordeal. Premier also helped source a variety of things, including fuel, generators and batteries.

Supplier side
Another partner was Cardinal Health. Even though the Dublin, Ohio-based company is not Trover Health’s prime vendor, it stepped up to fill a service gap in the emergency. It’s not surprising, perhaps, that Cardinal and Ingram found each other. After all, Ingram had worked for Cardinal for two years in pharmaceutical distribution. “So I understand how robust they are,” he says.

The ice storm presented Cardinal with its own set of problems, many of them similar to that facing Trover Health. After four days of running in the dark, the distributor’s Louisville, Ky., distribution center ran another six on generators, says Terry Wiese, operations manager. But Cardinal was prepared.

“Because of our experience [in September 2008] with Hurricane Ike, we implemented our business continuity plan to ensure that the integrity of product was maintained, that people could get to work, and that our drivers [who actually are employed by outsourcing vendor Penske Logistics] were ready,” says Wiese.

On the Monday before the storm, the facility made sure it had a refrigerated trailer on hand for products in need of refrigeration, in case the power were to go out. “Then we started arranging rides for the people who work here,” says Wiese. Thirty-eight people work at the center. The distributor also implemented a plan for finding motel rooms in which workers could stay, in case they were stranded at work.

Preparing for the worst
Meanwhile, in Radcliff, Ky., about 30 miles south of Louisville and home of one of Cardinal’s two customer service centers, the company prepared for the worst. Approximately 500 people work there, serving the eastern half of the United States. (The second customer service center is in Little Rock, Ark.) “Radcliff is a little more remote than Louisville,” says Vice President of Customer Service Management Paul Rogers. “Some of our people come from the backwoods area.” It became essential that the company make sure people could get to the facility and then find a place to stay should they be stranded. The company also wanted to ensure that it would have adequate food on hand, in case people were unable to drive to get something to eat.

“We’re on a backup generator, so we made sure the diesel fuel was topped off and our systems all backed up,” says Rogers. “We knew the weather was coming. But I don’t think any of us were quite prepared for the amount of ice we had. And that’s what caused the most damage.”

The Radcliff facility lost power in mid-afternoon on Tuesday, Jan. 27. And though the generators kept things humming, they couldn’t power the city’s water pumping stations. “All three of the pumping stations, which provide water pressure here, went down,” explains Rogers. “We struggled through Wednesday with the water pressure, making sure we could support our teammates with basic needs.”

Meanwhile, several days into the storm, Cardinal Health Account Management Director Heather Brockwell – who is responsible for a team of sales reps servicing Kentucky, Indiana and West Virginia – learned from the Premier emergency response team that Trover Health was unable to get some much-needed supplies. So she called Ingram. The two had met prior to this, but since Trover did not buy from Cardinal, none of the distributor’s reps called on the health system routinely. As Cardinal was sending a truck to the Henderson and Owensboro areas, Brockwell asked if they could drop anything off at Trover Health. At first, Ingram just asked for some respiratory masks and distilled water, Brockwell explains. Then he called back with a request for 30 more products. Then 40 more.

Since Trover Health was not a customer, Wiese’s team had to do some digging to locate the products or suitable substitutes. What’s more, the distribution facility was facing some stocking issues of its own. Namely, shipments of slower-moving and specialty items – which are normally shipped to Louisville from Cardinal facilities in Cincinnati and Obetz, Ohio – were delayed, due to problems with the roads. “We were missing some things, but we were able to respond to 85 percent of Tim’s needs, with no catalog numbers,” says Brockwell.

“Our drivers know what they’re delivering,” says Wiese. “They really understood the need. So they watched the weather and knew they needed to take their time.” Some were forced to travel 60 or 70 miles out of their way to make their deliveries. “But they did a good job of getting the deliveries out.”

Testing the mettle
Disasters such as Kentucky’s ice storms do, indeed, test the mettle of people.

“It’s a testament to the folks who work here,” says Rogers. “These are people who knew they didn’t have power or hot water at home. So they double-checked to make sure their families were OK and left for work early to get here, because you have to take care of your customers.”

At press time, things had once again settled into a routine at Trover Health. “We went from business unusual to business as usual,” says Ingram. Yes, there are lessons to be learned about how to face future catastrophes. “I think it opened up a lot of peoples’ eyes,” he says. “But I also think the community realized the value of having a community hospital. Sometimes we can be taken for granted.”

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