PUBLIC HEALTH: CREATING GREATER PROTECTION FOR MEDICAL CARE AND HOSPITALS
“The storm damaged many of the island’s more than 100 drug and medical device manufacturers. Puerto Rico produces about $40 billion worth of pharmaceuticals for the U.S. market, according to the Food and Drug Administration — more than any other state or territory.” Alison Kodjak, NPR¹
We are at a critical period where solar+storage solutions can, for the first time, be deployed at scale resulting in significant health benefits while improving economic conditions and addressing issues of equity and climate mitigation. This is the future of more resilient health care: using resilient and clean power systems that do not fail when they are needed, that are supported by renewable power and battery storage, and that help health care delivery systems do their job.
Battery storage paired with distributed generation, such as solar, in the health care system is a pioneering new idea, a breakthrough technology solution to the recurring problem of power outages and adverse health outcomes, both in normal times and in disasters.
In a 2014 global review of electricity outages, a National Institute of Health publication noted that “the impact of power outages on health is varied and far reaching. From the first call for help to the giving of complex clinical treatments, it is evident that healthcare is increasingly dependent on power” (2).
The UK government has recognized electricity as “the most vital of all infrastructure services, because without it most other services will not function” (3). That has certainly been the case with health care and power outages in America over the last two decades, not only during disasters but also during long-duration grid failures.
In 1999, one of the worst blackouts to hit New York City crippled the Columbia University medical research center. Because its two diesel generators failed, the medical research facilities were without power for hours. As the school paper noted:
Researchers were forced to throw away countless samples of bacteria, viruses, tissues and other chemicals after freezers which maintained the samples malfunctioned. Losses include human cell cultures prepared for research on Alzheimer’s disease as well as human research tissue, DNA samples and brain bank tissues collected over the last 15 years (4).
Clean Energy Group wrote a New York Times op-ed about the outage. In it, we asked, “what’s the price of losing a cure for cancer because an outmoded diesel generator failed to work?” (5).
In 2003, the entire Northeastern part of the United States suffered a massive black-out that left 45 million people without power. According to reports, “hospitals had several internal problems, including loss of HVAC and water pressure, inability to sterilize instruments at certain facilities, and loss of refrigeration and cooking…” (6).
Doctors were unable to view X-rays using digital machines, register patients, and there were multiple reports of respiratory failures in community-based patients who lost power to their medical devices. After the outage, scientists reported an increased level of diarrheal illness from the consumption of meat or seafood that spoiled after the power went out (7).
In 2005, Hurricane Katrina swamped New Orleans and knocked out power to the city’s largest hospital, Memorial Medical Center. As reported in the Pulitzer Prize winning book “Five Days at Memorial,” 5,000 people were trapped in the hospital without power when it flooded and its generators failed (8). The hospital was without lights, air conditioning, sewer systems and essential medical equipment. By the fifth day of the crisis, doctors and medical staff reportedly had to make decisions about euthanizing patients, all due to the lack of electricity in the hospital.
In 2008, Hurricane Ike hit Ohio as an extra tropical cyclone, causing the largest electrical failure in the state’s history, and leaving two million people without power. Several of the state’s hospitals lost their main power sources, forcing them on to generators. The population hit the hardest were home-bound people whose medical equipment failed, forcing them to seek alternative emergency housing such as shelters. And without power, many organizations providing home meals for the elderly could not prepare meals.
As a post-disaster report noted:
These widespread multi-day power outages caused thousands of people to seek food and water at shelters, food banks and other charities, in what may have been the most serious public health need from the windstorm (9).
In 2102, Superstorm Sandy knocked out power to eight million people, including all operations at NYU Langone Medical Center where, once again, the diesel generators failed to provide power in the storm (10). It had to halt operations and transfer 215 patients to nearby hospitals. “Things went downhill very, very rapidly and very unexpectedly,” Dr. Andrew Brotman, senior vice president and vice dean for clinical affairs and strategy of NYU told CNN (11).
Residents and neighbors were “helping children in the NICU and PICU down the stairs, triaging patients and building teams of nurses, doctors and therapists to help the babies down nine flights of dark, wet stairs with all their intravenous lines and equipment” (12).
According to a summary of reports after the Langone disaster, “the power failure jeopardized both patient care as well as nurses’ ability to communicate with each other, with leadership, and with their loved ones” (13).
In 2017, three major storms hit the mainland of the United States. Once again, the hurricanes in Florida, Texas, and Puerto Rico exposed the vulnerabilities of the country’s electric grid and sparked nationwide discussion about the implications of power outages for public health and safety.
In a matter of months, Hurricanes Harvey, Irma, and Maria killed more than 250 people and forced thousands from their homes to seek refuge in temporary shelters (14). The storms also damaged a significant portion of the electric grid that supplies power to millions of residents across the country and the U.S. Virgin Islands. In Florida, 160 nursing homes were left without power, including Krystal Bay Nursing and Rehabilitation Center in North Miami Beach, where generators and air conditioners failed, leading to sweltering temperatures and the tragic deaths of at least eight elderly residents (15).
During Hurricane Harvey in Texas, many hospitals had to be evacuated, including the Citizens Medical Center in Victoria; its generators could not provide air conditioning, trapping 80 patients on site. (Several hospitals in Houston did better, with flood waters blocked by submarine doors installed after Hurricane Allison in 2001.) (16)
One month after Hurricane Maria made landfall in Puerto Rico in September 2017, the majority of the island’s 3.5 million residents still did not have access to power (17). Residents in nursing homes, hospitals, and affordable housing units experienced these power outages most acutely when they were left without reliable access to air-conditioning, food and medical refrigeration, and dialysis and oxygen units for several weeks. Those who sought diesel generators to provide emergency power were faced with long waiting lists, while existing emergency diesel generators — when they worked — struggled to meet increasing demand with limited access to fuel supplies.
The hurricanes also crippled the island’s $15 billion pharmaceutical industry, which supplies 10 percent of the United States’ total medicinal production (18). The storms damaged medical refrigeration systems, wiped out internet and phone access, and prevented road access for 100,000 employees.
A week after the disaster, 58 of the 69 hospitals on the island were without power, causing numerous fatalities (19). During the hurricane, the death toll in Puerto Rico rose from an estimated 82 deaths per day to an average of 117 deaths per day during the two weeks following the storm (20).
The power outages also crippled Puerto Rico’s water treatment facilities, which were left inoperable without electricity. The outages caused an increase in waterborne diseases, which disproportionately affected a quarter of the population that was without access to clean drinking water (21).
“Storm damage and power outages remain problems especially in rural areas where access is still difficult… the island’s grid remains shaky and generators still keep one in five hospitals running, according to recent Federal Emergency Management Agency data. [According to FEMA], seventeen hospitals lacked phone service” (22).
As of mid-January 2018, four months after the storm, 467,600 businesses and residences — more than a third of the people in Puerto Rico — were still without power (23).
These outages have led to severe health problems, including illnesses such as diabetes and heart disease. Furthermore, “lack of clean water has led to skin rashes and gastrointestinal illnesses, and mold flourishing in storm-damaged buildings has made it harder to breathe for others” (24).
The disaster of Hurricane Maria in Puerto Rico is just the latest dramatic case study that demonstrates the tangible link between public health and electric power. But, to illustrate the larger problem with disasters and power beyond hurricanes, in the Pacific Northwest, officials are taking seriously the long-term power outage potential associated with the unstable Cascadia Subduction Zone and catastrophic earthquakes that would impact the entire region.
A multi-week or months-long power failure of that magnitude would be especially damaging to health care facilities:
“…health care facilities would have limited backup power and face water shortages, making it difficult for them to treat patients admitted before the event and limiting their capacity to handle new cases” (25).
But it bears repeating that power outages at medical facilities do not occur only after disasters or widespread electricity system failures. The number of power outages continues to increase every year due the country’s aging energy infrastructure, growing energy demand, and the fragility of backup generator systems.
Every day, power outages are a fact of life in America’s health care system.
In the past year alone, multiple hospitals in the Orlando Florida area experienced computer system failures due to power outages. Another recent outage knocked out power to Simi Valley Hospital in California, affecting 1,300 patients. An electrical transformer fire interrupted all phone communications at Washington state’s Coulee Medical Center. A car accident knocked out a power pole, leaving the Richmond Community Hospital to rely on faulty generators. Another outage risked patient care at the Kaiser Permanente Santa Rosa Medical Center, which had to utilize emergency generators. These are the common, power related problems affecting health care throughout the country (26).
As a report from the National Governors Association confirmed:
“…each state has unique threat vectors that could cause prolonged and widespread power outages, and each threat comes with its own unique consequences. Of particular concern are the potential effects on other critical infrastructure sectors like health care and emergency services that rely on electricity to function” (27).
Download this report as a pdf here.
Photo: © Lance Cpl. Tojyea G. Matally/U.S. Marine Corps