No heat, no light, no running water. No telephones, no patient records, no bills paid. Hundreds of canceled patient appointments, dozens of rescheduled surgeries, days of lost staff wages, and tens of thousands of dollars of lost revenue for health centers that run on shoestring budgets.
Those are just some of the costs inflicted on four health care providers in a single California county by the largest intentional power shutdown in American history. A majority of the state’s counties lost power for portions of October, as Pacific Gas & Electric and other California utility companies shut down the grid in an attempt to prevent their infrastructure from sparking wildfires amid strong winds.
The experience of health providers in California’s Mendocino County show how vulnerable our health care system is to power outages.
“It was a wake-up call for everybody,” said Lynn Finley, chief nursing officer of Mendocino Coast District Hospital (MCDH) in Ft. Bragg. “We’re anticipating we will see this frequently, so we need to be better prepared to take care of our communities.”
In late October, Direct Relief surveyed nearly 300 community health centers in California about how they were affected by the power shut-downs. Of the 31 that responded, nearly two in five (39%) said they had lost power during the grid shut-offs, and 29% were forced to close during the outages.
Flashlights and linen: health care in the dark
In Ft. Bragg, a coastal town about 170 miles north of San Francisco, MCDH’s emergency room was swamped by double the typical number of patients, ranging from elderly people injured in falls, to people whose CPAP breathing devices had run out of power, to people simply worried and looking for a warm place to stay, Finley said.
MCDH canceled all elective surgeries scheduled for the week, about 50 in all, performing surgeries only in emergencies. The hospital initially had no heat, relying on extra linens to keep its patients warm. It eventually figured out that its heat circulator wasn’t connected to the backup generator.
A number of elderly people came to the emergency room after falling in the dark and breaking bones. Some needed surgery, but the hospital wasn’t confident it could count on its backup generators for uninterrupted power. Instead, it sent the patients 60 miles away for surgery in a Ukiah hospital with second-level generators that kick in if its first-level generators fail.
While generators allowed MCDH to keep its doors open, its affiliated community health center was hit harder. North Coast Family Health Center (NCFHC), which typically sees 100 to 150 patients each day, was forced to cancel three days of patient appointments. These appointments are difficult to reschedule as doctors are in short supply.
The center was completely closed on the first weekday during the power outage, and then offered limited service the following two days. Staff relied on flashlights and exam rooms with windows to let the daylight in, said NCFHC Practice Administrator Clara Slaughter. “We only saw patients we could safely see with our limited facilities,” she said.
“Everything is electronic now, we don’t have paper charts laying around for us to reference,” Slaughter says. Because the adjacent hospital was open and hosts NCFHC’s patient records, the clinic stationed one nurse in the hospital and another in the clinic, and they relayed patient information back and forth by cellphone, though cellphone service proved highly unreliable during the outage.
Open and shut
Another large health care provider in Ft. Bragg, Mendocino Coast Clinics (MCC), lost power for three workdays in its four clinics. Without power, it had no access to electronic health records, including lab results, prescription information, records of necessary screenings, allergy records, or reports from specialists. It had no lighting, so its doctors worked with camping headlamps on their foreheads.
Without power, MCC had no x-rays, suction or dental drills, so it was forced to close its dental clinic for three days. More than 140 dental appointments were canceled, and the dental clinic alone lost an estimated $25,000 to $30,000 in revenue, said MCC Executive Director Lucresha Renteria.
In the MCC units that remained open, no-shows were rampant. In the reproductive health and obstetric department, only 35% of the patients who had been scheduled showed up for their appointments, while only 44% of behavioral health patients showed up, Renteria said.
“Patients were either canceling because they were in their own chaos, or were no-showing because of assuming we were closed,” Renteria said.
As with most organizations today, the workflows and administrative processes of medical offices are entirely computerized. Without access to its computers and servers, MCC couldn’t set up appointments with specialists, pay bills or record staff hours. MCC’s phone systems reverted to a single analog line in each clinic that was constantly busy, making it almost impossible to get through.
While MCC lost access to electronic health records during the outage, it had received advanced warning that it would lose power, so staff took action the Friday before power went out. They printed out their list of appointments scheduled for the upcoming Monday through Wednesday period, and wrote up “scrub notes” – key facts about each patient – in advance. Fortunately, the power came back on early Thursday morning.
Some of the biggest impacts were on MCC’s staff. Staff members who were sent home—including more than half of the medical assistants—lost days of wages.
Many even lost the ability to bathe. The power outage left many staff members without hot water in their homes for days. The clinic is looking at buying a camp shower so that in future incidents its staff can come in and take hot showers, Renteria said.
As difficult as the situation was for the three Ft. Bragg facilities, it was worse in the southern Mendocino town of Boonville. The PG&E power outage left Anderson Valley Health Center without running water, forcing it to close for three days. The facility gets its water supply from a well drawn by an electricity-powered pump, and it had no backup generator.
Planning for a darker future
In Direct Relief’s late-October survey, 67% of the health centers that lost power reported they had lost access to electronic health records. Under federal and state mandates, most patient data is now stored on computers (often on computer servers in separate locations) and is unobtainable during power outages.
Of the centers that lost power, 83% lost access to lighting, 58% lost refrigeration, and 75% lost use of diagnostic equipment.
A previous Direct Relief survey conducted earlier in October revealed that only 44% of California’s community health centers have a back-up energy source available when the electricity grid fails. Even clinics that had back-up generators found they didn’t provide enough power to operate all their systems, forcing operational triage. They could run the refrigerator to protect their medication supplies, they could power the lights, or they could power a few computers.
Losing access to power is expected to become a recurring challenge for health centers. California’s utility companies plan to continue intentional power shutdowns during periods of extreme fire danger while they address a maintenance backlog that could take a decade to resolve. Meanwhile, climate change is making California’s autumns hotter, drier and longer.
The power outages have prompted health leaders across the state to take a harder look at resiliency. The Mendocino health centers showed an ability to adopt creatively to the challenges and took extraordinary steps to continue serving their patients. With a better understanding of their vulnerabilities, they are now better able to prepare for the next major outage.
“It showed me the things we can do differently in the future,” NCFHC’s Slaughter said. “It’s all a learning experience.”