What happens when hospitals meet extreme weather?

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Overflow from White Oak Bayou spilled onto Interstate 45 near Quitman Street after remnants of Tropical Storm Allison inundated Houston, Texas on June 9, 2001. (AP Photo/Houston Chronicle, SMILEY N. POOL)

Overflow from White Oak Bayou spilled onto Interstate 45 near Quitman Street after remnants of Tropical Storm Allison inundated Houston, Texas on June 9, 2001. (AP Photo/Houston Chronicle, SMILEY N. POOL)

Texas Medical Center in Houston is the world’s largest medical complex. It’s big enough to have its own skyline — dozens of buildings, 106,000 employees who care for some 10 million patients a year.

Back in 2001, it was in the path of a tropical storm, Allison. At first, folks didn’t really think that was such a big deal.

“We have tropical storms all the time on the Gulf Coast, and it’s lots of rain and some minor street flooding and it goes away,” said Claire Bassett, chief communications officer at the Baylor College of Medicine, describing the atmosphere ahead of landfall.  Baylor is basically the nucleus of Texas Medical Center.

“It was just, ‘Oh, it’s another tropical storm. It’s going to be a wet weekend, [then] it’ll be over and done with,’” she said.

But day after day, Allison’s heavy rains simply did not stop. Four days after landfall, the storm wheeled back over the city with intense downpours. The ground was already saturated, leading to widespread flooding.

And Texas Medical Center was in trouble. High water got into a tunnel system and flooded multiple buildings. Patients were evacuated, and several medical facilities closed down.

Bassett made her way to the medical school the day after the rains finally subsided.

“So our entire sub-basement was submerged, and then five feet of the floor above that,” she said. “And we had the vast majority of our animal research in our sub-basement. “

It’s what’s called a vivarium — basically animals in cages with their food and bedding and scientific equipment.

“We actually had, a cow, we had rabbits, we had canines. And all of the large animals were able to be led up to a higher floor by one of our animal care attendants, who had waded through chest-deep water to get here,” Bassett said.

He somehow led the cow up two flights of stairs.

“This gentleman, who I’d never met before, walked up to me and said, ‘I just put a cow in the ladies room,’” said Bassett.  “I said, ‘OK, that’s great. Um, did you put a sign on the door?’”

He had not, that slipped his mind somehow.

“So we put signage on the door, and he said, ‘Is it OK if I put dogs and pigs in a vacant conference room and a vacant office?” she said.

So a cow, dogs, and pigs were all in the clear. But the research mice were not so lucky.

There are photos of the room just after recovery crews got in. Apparent are stacks of these plastic cages, four high, all filled with foggy water. In some, blurry, little, white things are floating.

“We lost about 30,000 research mice,” said Bassett. Many of those mice had been bred over several generations as part of genetic studies.

A bank of breast cancer tissue with 25 years worth of samples also was destroyed. Total losses exceeded $300 million.

But things could have been much worse. The nightmare scenario — losing patients during a crisis — was avoided.

The worst case: New Orleans after Katrina

That wasn’t the case in New Orleans after Hurricane Katrina. Management and urban-planning researchers Lucy Arendt and Daniel Hess traveled there in 2005 just after the storm.

“It was just catastrophic damage. I mean … we wore masks as we walked about the neighborhoods,” recalled Arendt.

The city was still closed off when they arrived.

“It was bizarre, and that it was bright and sunny the whole time that we were there, so bright and sunny, and all of this basically around us decay, high watermarks, vehicles that had been abandoned,” she said.

Their mission was to go to hospital to hospital, to see what went right and what went wrong.

“Hospitals in general are incredibly complex organizations, far more so than most other types of organizations, in that hospitals — typically at least acute-care hospitals — tend to be just like communities,” said Arendt. The closest comparable institutions are universities and colleges, she added.

During extreme weather, these complex little communities have two choices. There’s shelter in place — essentially ride out the storm. Or there’s evacuate — which, Hess says, is even more dangerous.

“Worst-case scenario for hospital administrators is to think about a complete evacuation and having to move everybody,” he said.

Part of the reason why is that likely only the very sickest, most vulnerable patients will still be at a hospital when a storm makes landfall. It can be dangerous to move a patient, for instance, that relies on a complex life-support system or ventilators. Less sick patients will have already been evacuated, and routine surgeries will have been canceled.

After losing electricity and backup generators due to flooding from Tropical Storm Allison, doctors and nurses at Herman Hospital evacuate a critically ill patient down powerless escalator stairs in Houston, in a Saturday, June 9, 2001 file photo.  (AP Photo/Michael Stravato, File)

But New Orleans’ hospitals simply weren’t built for Katrina’s wrath, and the flooding that followed levee failures. They buckled, and were forced to evacuate.

“At Memorial [Medical Center], at, I mean, one after the other. It was the same story over and over. It was just this thing out of some horror movie,” said Arendt.

If Memorial sounds familiar, it’s because dozens of patients died there. Health care workers were accused of euthanizing some amid desperate conditions.

The hospitals became very unsafe places to be, said Hess. “In fact, one hospital administrator, his recollection of the hospital following Hurricane Katrina is that it was like a war zone inside.”

Both researchers say New Orleans was especially vulnerable, but that doesn’t mean hospitals elsewhere are safe. With climate change driving more frequent and more intense storms, experts say more hospital systems have to be better able, essentially, to batten down the hatches.

“Hospitals from outside of the Gulf area are learning the lessons of Katrina,” said Arendt. “In the past, they might not have thought, ‘Oh yeah, that might relate to us,’ but it is becoming pretty self-evident, I think, that in fact those lessons are increasingly relevant to more hospitals.”

Superstorm Sandy, for instance, shut down New York City’s Bellevue Hospital in 2012, after basement fuel pumps flooded. The National Guard stepped in to help staff with fuel and water before finally evacuating everyone.

Arendt said hospitals typically reach their breaking points when they lose either power or water. The engineering that could help ensure that doesn’t happen is incredibly expensive, she said — especially in the context of a hospital.

“When you start talking about changing a building, a hospital structure, for example, we start talking millions of dollars,” she said. “And in a climate where health care costs are already considered pretty extraordinary, starting to talk to people about the need to modify a building so that we can be better prepared for something that may never happen, that can be a pretty tough sell.”

But in Houston, after Tropical Storm Allison, preparedness wasn’t such a tough sell anymore.

After Allison, “We got religion.”

Robert Emery is a professor of occupational health. He’s in charge of risk management at the University of Texas Health Science center.  “Safety Bob” points to a watermark on a Texas Medical Center Building.

“So you can actually see the line right there. This was filled with 33 feet of water when Allison occurred,” Emery said. He specifically had it preserved: “Do not pressure-wash that line off!”

When he talks about Allison, he repeats a curious phrase: “We got religion.”

He means the storm taught everyone a lesson: to respect a kind of higher power.

“Where you’re sitting right now, literally, you could look that way, and then that way,” he said in  the basement of the McGovern Medical School, again part of Texas Medical Center. It was once the largest state-owned building in Texas. “There’s the 185,000 square feet, and you could see all the way through because all of this was cut out, all the walls, all the doors, everything, because it was all underwater.”

Eventually, the ceiling collapsed.

“So I mean it was … shoot, it was actually a sobering experience to get down on your hands and knees and you could look from one end of this building to the other,” Emery said.

After Allison they weren’t going to get caught off guard again. Emery outlined the engineering built up in the years since the storm.

First, a moat.

“If you were looking … from overhead with a drone, you would see that there’s actually, again, almost like a reverse moat around the entire building,” he said.

He’s talking about a hydrostatic wall, about seven feet tall, a mix of granite and a half-inch of glass. And outside that, an earthen berm.

There are pumps in this reverse moat to get rid of any water that makes it over. But then, even if all that fails, there are the flood doors.

A flood door in a Texas Medical Center building. (Elizabeth Trovall/Houston Public Media)

“I guess the best way to describe it is to think of a bank vault door,” said Emery. There are nearly two dozen of these flood doors just around the medical school, in various sizes, up to 16 feet tall.

“But they’re actually balanced in such a way that one person can actually move them and swing them and then put them into place,” he said.

Some pins lock into position, and a pump inflates rubber seals.

A flood door at a Texas Medical Center building. (Elizabeth Trovall/Houston Public Media)


Emery is constantly drilling staff on how to do this, and not long ago, they were put to the test.

Hurricane Harvey made landfall in 2017, and beat out Allison for total rainfall. It devastated the region. But what about  the Texas Medical Center?

“Maybe six inches of water in this loading-dock area compared to 33 feet of water in the past,” Emery said.

The engineering worked. In fact, the only major problem was getting staff to and from these relatively dry little islands in a flooded Houston. Emery’s team is working on a solution to that.

“I forgot the military name for them, but it’s like a deuce and a half or something like that,” he said. “It’s like these two huge military trucks.”

They’re military-surplus M35 series 2½-ton cargo trucks, about 9 feet tall — so good in high water. The staff named them Laverne and Shirley because they come from Wisconsin.

Robert “Safety Bob” Emery stands in front of a military surplus truck Texas Medical Center purchased for high-water operations. (Image courtesy of Robert Emery)

And the research animals? Like generators and critical mechanicals, they’re now kept safely on upper floors.

Bassett, the communications officer who described the chaos at Baylor following Tropical Storm Allison, set up shop at the Texas Medical Center before Hurricane Harvey hit.

“You bring a nice air mattress and you bring water boots, and you bring a couple of changes of clothes,” she said.

This time she didn’t see some Texas Noah leading animals out of a flood. Instead, she just walked the mostly dry halls, checking for broken windows.

Bassett remembers cancer patients worrying about how they would get their regular treatments. 

“One of the things that happened with Harvey was there was such devastation throughout the city that you had a lot of patients that were on chemotherapy that needed to come in for their infusion, and there were some places that had not opened their outpatient facilities yet,” she said. 

Outpatient care was closed at Texas Medical Center facilities during the worst of the storm, but as soon as the roads were clear enough for patients to actually get to there, they found it was ready for them. 

“When we went and saw them, I guess three days after the storm is when we opened, there were people literally in tears,” she said.  “They were so thankful.”


Elizabeth Trovall of Houston Public Media contributed to this report.

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