Q&A: NJ Health System CEO's Post-Sandy Appraisal

Hackensack University Health Network President and CEO Robert C. Garrett spoke with HealthLeaders Media on Wednesday afternoon to offer an update on the three-hospital health system's recovery efforts following Hurricane Sandy.

HLM: How did you fare in the storm?

Garrett: "It's been a busy and stressful time but I have to say our team here has performed magnificently. We started the preparation a week before the storm hit, as soon as the models showed it coming up the East Coast and hitting New Jersey as a direct target.

We had a delivery of fuel for our diesel generators to make sure that if we were on emergency generator for several days we were prepared. Our disaster plan went into effect on Monday.

We had an incident command center set up. We lost power about 6:00 p.m. and we immediately switched to the emergency generators which remained on until late Tuesday night.

About 85% of our power has now been restored, but we still have about 15% out including our ambulatory operating rooms, our diagnostic center, and a breast imaging center which are located in a building with a different power feed. That is still operating on generator power."

HLM: What challenges did the storm present?

Garrett: "A sister hospital, Palisades Medical Center which is located a few miles from here on the Hudson River, started to flood mid-day Monday. By Monday evening they had to evacuate the facility, which was led by the National Guard. The evacuation was completed by about 9 a.m. Tuesday. We received and treated 60 patients from the evacuation; 43 remain here and 17 were sent to an affiliate hospital.

That was a real challenge for us because the patients came over with some of the caregivers from Palisades, but it was in the middle of the night and early morning and we were already pretty full.

We had to make arrangements where we could on where we could take care of them appropriately. Our care team came up with a great contingency plan. We were able to empty out our observation unit and relocate them to another area where we could make room for the patients from Palisades."

HLM: Given Palisades' proximity to the Hudson, did you already have a contingency plan for their evacuation?

Garrett: "They had a similar evacuation, though not quite as big last year when a storm hit one of their clinical buildings. So they were on the radar screen and with the predictions of storm surge and where the storm was hitting and the impact it would have on the Hudson River, we definitely were in close communication with them.

On Monday night when they decided to evacuate, their CEO called me directly and said they were going to put the evacuation plan into effect. We worked all night long on it."

HLM: Who was involved in the evacuation?

Garrett: "We coordinated this with our EMS community and the National Guard as part of the state response. There was good coordination in advance of the evacuation. But even with good coordination when you are evacuating so many patients it is still a very difficult process. But I was proud of our team and the way they responded."

HLM: Is Hackensack University Medical Center in a safe area?

Garrett: "We are on pretty high ground on the top of the hill. In Hackensack there are parts that flood, so our biggest issue is getting around the streets when we need to respond to a particular emergency or situation. One reason why we don't have complete power back is that one of our power lines runs through a substation that is currently under water."

HLM: Have you suspended non-emergency operations?

Garrett: "No. We are moving forward with a full schedule. In fact it is very busy today because there were so many cancellations on Monday and Tuesday. We are fully functional and operational. Most of our operating rooms are on regular power and some of the ambulatory operating rooms are on emergency power but we are able to proceed with a full schedule."

HLM: Was there any damage to your hospital?

Garrett: "Just minor. Here in Hackensack we had a little bit of wind damage. A piece of our cancer center building roof was damaged and a sister hospital at Mountainside got through it well.

There are some branches and down trees but they didn't destroy or damage any hospital assets. It's pretty much the same story up in Pascack Valley; trees and limbs down but not damage to property."

HLM: What areas might be reassessed as you examine HUMC's response to the storm?

Garrett: "The things that can always improve are communications. Not just internally in the medical center, but also the external communications that come to us. That is something I want to review with first responders and the state and federal responders.

There is a lot of information that comes in at the height of a storm and sometimes it is conflicting. Obviously you want to act on good information and that can always be improved."

HLM: Is the full staff back on duty?

Garrett: "We never had an issue with staffing. People stayed if they had to and people came in early to make sure they were here. If they were in doubt, many staff members packed a bag and stayed overnight.

We had cots available for people to sleep in shifts. As a matter of fact, in a couple of areas we had so many volunteers who wanted to stay longer or came in earlier that we had more than enough staff."

HLM: How will you be compensated for treating the patients transferred from Palisades?

Garrett: "With an emergency situation the sending hospital, the receiving hospital and the insurance companies get together to work out a fair settlement. There is nothing really prescribed ahead of time when something like this happens because usually they don't make those contingencies.

Whether it is Medicare or a private insurance company, those will be worked out. With Medicare it will be worked out through a fiscal intermediary and with the private insurance companies it will be worked out directly with those insurance companies—in our case Palisades and Hackensack together."

HLM: There have been some suggestions in the media that New York University Langone Medical Center in Manhattan was not adequately prepared for this disaster.  Is that criticism fair?

Garrett: "It's tough. It is always easy to be the Monday morning quarterback. But these are tough decisions to make. If you overreact, people criticize you as well. You can be accused of disrupting patient care. At NYU they had to move a lot of critical care patients, even patients who'd just had liver transplants.

You can imagine that if they overreacted and the storm didn't come or wasn't as bad as it turned out to be there would be criticism on the other side that you might have endangered patient care by overreacting.

These are difficult decisions. My advice would be, let the dust settle. Once everything gets back to normal in a couple of weeks let's do a fair critique. Let's see what information was available at the time and come to see how we can do things better."

HLM: Do you have advice for other hospital leaders who may someday face a disaster threat?

Garrett: "Always prepare for the worst and get ahead of it. As much as you may think you are ahead of it use the time wisely to really plan and get staff involved. We here have a great team effort and team culture. That helps. If you can build that culture when you have a disaster of this magnitude it is enormously helpful."