When multiple tornadoes swept through the Huntsville, Ala., area on April 27, the Total Sports Care family and sports medicine clinic building was not damaged. But the massive power outage that followed threatened more than a dozen different batches of vaccines the clinic kept cooled in refrigerators. In fact, office staff members discovered after several days that refrigerator temperatures had risen so high that they had to dispose of the vaccines.
"We lost about $15,500 worth of immunizations," said Sharon Alexander, the office manager at Total Sports Care. "This was a large burden on our small practice."
Because the clinic had no structural damage, their business insurance didn't cover the loss. When the clinic's FPs, Darla Cowart, M.D., and Karen Allen, M.D., contacted the Federal Emergency Management Agency for aid, they received the same message. Finally, they contacted the vaccines' manufacturers.
The FPs later discovered that a special insurance rider would have covered this loss. The lessons for family physicians, they say: Take a close look at your business insurance. And be prepared for emergencies -- whether natural or manmade.
Mona Bomgaars, M.D., M.P.H., of Honolulu, a member of the AAFP Disaster Preparedness Member Advisory Panel, agreed.
During a season when tornadoes have devastated northern Alabama -- and, more recently, southwestern Missouri -- when the swollen Mississippi River has spilled over its banks in Vicksburg, Miss., and when the Red River in North Dakota has flooded for the third spring in a row, Bomgaars said family physicians should prepare well in advance of potential disasters to protect their homes, their offices, their records, their equipment and their staff.
"These natural disasters will only increase over time," said Bomgaars, who recently was appointed to the AMA National Disaster Life Support Education Consortium. "Every disaster is local. And that's where family physicians live and work."
According to Bomgaars, addressing insurance issues is important. Family physicians in small practices sometimes don't have the right insurance or enough of it to cover the losses that can occur during a disaster.
In addition, FPs have to prepare to protect their homes, because "if your home or family has been harmed, you're not going to go to work," she told AAFP News Now. She recommends that FPs simultaneously devise a home and family disaster preparedness plan and a practice plan.
"Family physicians should not think these disasters can't happen to them," Bomgaars warned. "They can happen to any one of us. We have to prepare and expect them to happen."
According to Gail Jones, manager of practice management in the AAFP Division of Practice Support, practices sometimes overlook communication and information access issues when they try to prepare for disasters.
Solo family physician John Goff, M.D., worked in the same building on Cunningham Avenue in Joplin, Mo., for 30 years before it was completely destroyed, along with all of the practice's patient health records, by the powerful tornado (rated a "5" on the enhanced Fujita scale) that hit Joplin on May 22.
"It's all rubble," Goff recently told AAFP News Now. "It's just devastated. There's nothing left."
For Goff and other family physicians affected by this or a similar disaster, the AAFP offers this reminder: If patients' medical records have been lost or destroyed, certain actions must be taken under the Health Insurance Portability and Accountability Act, or HIPAA.
Fortunately, according to Gail Jones, manager of practice management in the AAFP Division of Practice Support, the AAFP has information on federal breach of information notification requirements, as well as what FPs should do in the event of a breach.
According to HHS' Breach Notification Rule(www.hhs.gov), HIPAA-covered entities must notify patients -- in written form or via e-mail -- after they discover a breach of protected health information.
The notification should include a description of the breach, the types of information that were involved in the breach and the steps affected patients should take to protect themselves from potential harm. In addition, physicians should provide a description of what the practice is doing to investigate the breach, mitigate any harm and prevent further breaches.
Under certain conditions, the practice may meet the breach notification criteria by posting a notice on the home page of its website or by providing notice in local print and/or broadcast media.
Practices should decide ahead of time how to communicate with their staff members and patients in the event of an emergency or a closure. If a practice will be closed, physicians must decide how they will refer their patients to other physicians and how patients' medical records can be accessed.
"Now, with electronic medical records, it is important to make sure there is a backup somewhere other than the actual practice and that there will be a way to retrieve the information," Jones said. "If the practice still uses paper charts, they need to have a plan for retrieval and for protecting the records."
FPs can do practice drills and so-called tabletop exercises to prepare their staff members for an emergency, she suggested.
In the Fargo, N.D., area, Sanford Health, which encompasses the Sanford Medical Center and 20 clinics, including six family medicine clinics, has made additions to its disaster preparedness plans after the Red River flooded in each of the past three years.
Michelle Reitan, the health system's emergency preparedness manager, told AAFP News Now that their plans include the following elements:
- Refrigerators that store vaccines have alarms indicating when temperatures have gone out of the safe range. If such a signal is sent, it goes to an information technology, or IT, center so that managers are notified to check on the refrigerator.
- If a power failure affects one refrigerator, vaccines are located to another refrigerator. If a system-wide outage occurs, vaccines are put into large coolers with ice packs. The coolers can be moved to clinics that have backup generators or to the hospital, which has multiple levels of generator power.
- The health system has a "trigger list." Managers know the effects of different river heights on the various facilities, including the three clinics that are closest to the river. As the river starts to rise, plans are made to relocate the clinic and its services.
- The IT building, which contains the servers that maintain all electronic health records, or EHRs, is a top protection priority in the event of a flood. A number of measures are taken to avoid flooding in that building.
- Many clinics have basements with drain tile and sump pumps that continue to pump water out throughout the winter.
"We do everything we can to prevent water backup ahead of time," Reitan said.
A number of teams throughout the community -- from both the health system and independent clinics -- collaborate to prepare for flood season and identify the most vulnerable clinics, Reitan explained.
The health system also has been looking at insurance issues more carefully since the massive 2009 flood, including interruption-of-business insurance, she noted.
"We started looking at what accommodations could be met when negotiating with the insurance companies," said Reitan. "We look at that pretty hard now."
Meanwhile, back at Total Sports Care in tornado-stricken Huntsville, Ala., Alexander continues to take an external hard drive that contains a backup of the practice's EHR information home with her each day. She also takes home a kit of practice information, and the practice is considering buying a generator.
The practice's family physicians and staff members also have looked at their insurance options, including adding coverage of vaccine losses as part of their basic policy and interruption-of-business insurance.
"There is probably no way we couldn't have lost our immunizations," Cowart said. "Having the coverage for insurance is the main thing we can do. That's the message to other practices."
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