Hospital operations in Western North Carolina are beginning to stabilize two weeks after Tropical Storm Helene left hospitals to manage overrun emergency departments without power or water.

Now, they deal with supply chain anxieties and overworked staff. Asheville’s hospital, Mission Health, faces the reality that it will be weeks before water is restored.

Hospitals in the hardest-hit counties are managed by either HCA, Duke LifePoint, UNC Health, or AdventHealth.

These parent companies brought in staff and supplies from across and outside the state to keep their rural, mountain hospitals afloat. 

[Subscribe for FREE to Carolina Public Press’ alerts and weekend roundup newsletters]

Seventeen hospitals in Western NC are “critical access hospitals” — a designation the Centers for Medicare and Medicaid give to hospitals that provide services to rural, underserved regions.

Some counties in the disaster area do not have hospitals at all, including Madison, Clay, and Yancey counties. 

HCA hospitals

The Tennessee-based for-profit hospital chain HCA owns Asheville-based Mission Health, which includes Mission Hospital in Asheville, as well as more remote hospitals in Macon, Jackson, Transylvania, McDowell, and Mitchell counties. They also operate urgent care locations, specialty clinics and primary care offices in these counties, along with Haywood, Henderson, Jackson, Rutherford, and Yancey counties. 

HCA is the largest hospital chain in the nation, which means it has a huge network of resources from which to draw in the face of this emergency. More than 400 nurses have arrived from around the country, and tanker trucks bring more than 200,000 gallons of water per day and tens of thousands gallons of fuel. HCA has set up satellite data networks and mobile kitchens, bathrooms and handwashing stations at its Asheville location.HCA’s hospitals throughout the disaster zone remained operational through Helene, and now, many of their smaller care locations have reopened. 

As of Oct. 5, Mission Health had cared for more than 1,800 patients and delivered more than 50 babies since the night the storm hit.

“Given the ongoing water issues in the city of Asheville, it is important (for Mission Hospital) to preserve as much potable water as possible for general hospital use,” HCA spokesperson Nancy Lindell wrote in a statement. 

“We are exploring alternative ways, including the drilling of additional wells, to provide water to cool our HVAC units so we can continue to maintain proper temperatures in our hospital.”

Nurses at Mission Health launched the first-ever nurses union in North Carolina in 2020. The union approved a strike authorization vote last month, and has major concerns about HCA’s management of Mission Health.

“The biggest takeaway from all the stories I heard from nurses who were there (just after the storm) was a lack of preparedness,” Asheville nurse Kerri Wilson told Carolina Public Press. Wilson says she doesn’t recall any emergency drills ever being conducted in the emergency room or the hospital. She said she isn’t aware of any disaster plan whatsoever for Mission.

Wilson wasn’t there in the immediate aftermath of the storm, unlike Hannah Drummond, one of the staff who was asked to sleep over at the hospital Thursday night. Still, Wilson has spent the last few days at Mission Health caring for patients.

“Nurses were caring for 10 to 12 patients at a time,” Wilson said. “It wasn’t safe, but they stepped up and did it. If there was a better plan in place, maybe it wouldn’t have had quite that impact.

The initial emergency room rush was obviously a result of acute injuries due to storm conditions, but locals were also relying on Mission’s ER for oxygen supply, refrigerators for their medications, and other medical concerns that aren’t typically dealt with by emergency departments.

“By midday Saturday, it was clear we were running out of food,” Wilson said. “At that point, they began giving out MREs to staff, basic cold sandwiches like PB&Js. That has gotten better.”

Wilson says another major change in the last few days is that they are beginning to discharge and transfer more patients, so the total number of patients in the hospital has gone down. Also, HCA has enacted more visitor restrictions, which allows nurses to focus on their job.

“We are still in crisis mode,” she said. “We are relying on trucks from out of state to bring us water. Water is our most delicate resource. We are not able to clean equipment as well. Our sterile processing department is running at low capacity.” 

They do have water to flush toilets and wash hands. 

Wilson is thankful for the presence of the National Guard, FEMA and the Army Corps of Engineers at the hospital. She is also thankful that nurses were relieved from extreme work conditions by legions of out-of-state nurses, but she is worried that some Asheville nurses who need to work to support their families are not as likely to be scheduled. 

“We want to make sure we are prioritizing nurses in our community,” Wilson said. “They need that income to rebuild, and we need to make sure that we’re able to contribute to the Asheville economy. This is a storm that will have effects on our economy for years to come. We need to protect our local staff.” 

As for the possibility of a strike, Wilson said: “Things like this highlight problems that were already there and make them more evident. We will always fight, no matter what, to protect our community, our patients and our staff.”

HCA has contributed $1 million toward local disaster relief efforts.

UNC Health

UNC Health operates rural hospitals in Henderson, Burke, Avery, Watauga, and Caldwell counties. Each remained open throughout the storm and its immediate aftermath. More than 300 UNC hospital staff from across the state traveled to Western NC to help relieve their mountain counterparts. Nearly 2,000 volunteered. 

“The resilience I witnessed in this community is unparalleled and hard to imagine without being there,” Julia Barahona, a doctor who left her home in Kinston to work at UNC Appalachian in Boone, wrote in an email. 

“Everyone showed up to work to serve others, doing their best despite being in the midst of tragedy and devastation affecting their families, friends, and community. My heart is so full; it almost seems unfair, as it feels like I received more than I could have ever given in return.”

UNC Health spokesperson Alan Wolf told CPP that operations at hospitals are returning to “something closer to normal.” 

UNC Health has provided around 500 free telehealth appointments since Sept. 28. Many had long-standing doctor’s appointments that were canceled. Some could not leave their homes to seek in-person health care. 

UNC Health, like many health systems across the country, is rationing saline, dextrose, and dialysis solutions after flooding from Helene rendered Baxter Healthcare Corporation in McDowell County nonoperational. The factory provided 60% of the nation’s supply of IV fluids. 

“UNC Health is adopting conservation efforts, seeking alternative products and working to ensure that urgent patient care is not affected,” Wolf wrote.

“We are planning to postpone some elective, non-emergent surgeries starting later this week until the situation is resolved. Our clinical teams will work with any affected patients to reschedule their procedures. We understand this is concerning for our patients who had planned on having surgery to help with a medical condition. We are doing everything within our control to get these cases rescheduled as soon as possible.”

UNC Health Pardee in Henderson County issued their last emergency communication regarding Helene on Oct. 9, saying that conditions have largely stabilized.

Duke LifePoint

Duke LifePoint owns hospitals in Swain, Jackson, Haywood, Rutherford and Catawba counties. All of these facilities remained operational through Helene, and now, all are off generator power and have enough water to serve their patients.

CPP spoke with Duke LifePoint spokesperson Sara Crawford, who lives in Sylva and was working at Harris Regional Hospital in Jackson County immediately following the storm. In the early days, she called staff’s families from her home to let them know they were safe, and relayed similar messages from families to staff.

Crawford told CPP that emergency plans and preparedness for Duke LifePoint’s hospitals rely on hospitals’ partnerships with county emergency management. These plans were not quite sufficient for the circumstances of Helene: all phone or internet communication between the hospital and county governments was completely wiped out. Even satellite phones were hampered by cloud coverage.

Despite challenges, staff and administrators at both the hospital and county level stepped up to the plate, she said. 

“I don’t want to say it was seamless, because I don’t think anything was seamless through this,” Crawford said. “But it was a really great partnership. We never got to a place where we were in dire need of resources”

At Harris, it did not seem to her like the emergency room was overly swamped, she said. 

“I did see that the emergency room was picking up things that weren’t appropriate for an emergency department, but understandable because other resources weren’t there,” Crawford said. “Urgent care wasn’t available. Primary care wasn’t available. Walk-in clinics weren’t available.”

She also witnessed staff give mental health care to patients in emotional distress. 

“Duke LifePoint was really quick to send food for all staff and employers, so that the food that was in the hospital could be used for patients,” Crawford said. “Sometimes when you don’t know what to do, Southerners are quick to say: ‘Here’s some food.’” 

AdventHealth

AdventHealth operates hospitals in Henderson and Polk counties. The organization also has secondary facilities in Buncombe, Haywood, and Transylvania counties. 

Both hospitals have power, though AdventHealth Polk, which the company only recently acquired, endured an extended period without electricity in the early days after the storm.

“The ERs were definitely busy, but we were able to bring in additional nurses and medical technicians to help with the various care we needed to provide, and with any patient transportation we needed to do,” AdventHealth spokesperson Victoria Dunkle told CPP. An EMT strike squad — a mobile team ready to be deployed in the case of disaster — came in from North Georgia last Saturday, and has been aiding hospital operations in both locations ever since.

AdventHealth is not experiencing any shortages of IV fluids, as they do not source them from the McDowell County plant. 

With Hendersonville’s water system back online, AdventHealth Hendersonville no longer has to haul water to the hospital on tanker trucks. The organization has resumed non-emergency surgeries at its Western NC hospitals.

“One thing that kept us from being able to perform some surgeries was the fact that when someone gets surgery, we don’t know what their situation is like at home,” Dunkle said. 

“Do you have power? Do you have water that’s safe to use? We need to check with the patients that they have a safe place to recover.”

AdventHealth last conducted an emergency drill on Sept. 17, Dunkle said, when staff drilled an ice storm. Some of the preparations mapped onto the circumstances that befell them just 10 days later, she said.

Source: This article first appeared on Carolina Public Press and is republished here under a Creative Commons license.

Photo by Pixabay: https://www.pexels.com/photo/close-up-photo-of-a-stethoscope-40568/