With numerous care locations across Florida, Lee Health has endured three major hurricanes over the past two years: Hurricane Ian in the fall of 2022, and more recently, Hurricanes Helene and Milton. In this conversation, Scott Nygaard, M.D., chief operating officer at Lee Health, discusses the impact these natural disasters have had on the organization, and how their emergency preparedness, response and recovery efforts have helped guide continued care for both patients and caregivers.

This podcast was produced through the Convening Leaders for Emergency and Response (CLEAR) initiative. To learn more, visit: https://www.aha.org/aha-clear

Presented as part of Cooperative Agreement HITEP210047, funded by the Department of Health and Human Services’ Administration for Strategic Preparedness and Response (ASPR). The Health Research & Educational Trust, an American Hospital Association 501(c)(3) nonprofit subsidiary, is a proud partner of this Cooperative Agreement. The contents of this publication are solely the responsibility of the Health Research & Educational Trust and its partners and does not necessarily represent the official policies or views of the Department of Health and Human Services or of the Administration for Strategic Preparedness and Response. Further, any mention of trade names, commercial practices, or organizations does not imply endorsement by the U.S. Government.

Tom Haederle

Tom Haederle

Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In this podcast hosted by Ben Wise, senior program manager of communication strategy with AHA Funded Partnerships, we hear from Dr. Scott Nygaard, Lee Health's chief operating officer, about what his organization has learned from dealing with disasters - for example, the importance of taking care of employees as well as patients.

Tom Haederle

This podcast was made possible through the Convening Leaders for Emergency and Response or CLEAR initiative, a funded partnership between AHA's Health Research and Educational Trust and the Administration for Strategic Preparedness and Response.

Ben Wise

Dr. Nygaard, thank you so much for being here today. When we scheduled this conversation with you a couple months ago about the relief efforts from Hurricane Ian, we of course had no idea that two more hurricanes were heading your way to the Florida coast. Just wanted to start and check in to see - how are you, the staff at Lee and the community there?

Ben Wise

How's everyone doing?

Scott Nygaard, M.D.

Yeah, I think, since Hurricane Ian, that was a very traumatic event, dating back to September 28th of '22. And people who had lived here for years had never experienced the type of surge and issues we faced in Ian. And now all of a sudden we've had two additional hurricanes which have caused some significant impact to the Florida marketplace as well,

Scott Nygaard, M.D.

Helene and Milton. So, a bit of a trauma and anxiety each time one of these storms starts coming in at this point.

Ben Wise

Scott Nygaard, M.D.

Yeah, well, coming from the Midwest, I was more used to tornadoes, which are a very sudden event. A hurricane...you have a lot of warning ahead of time, and everybody's tracking the storm and following it. The interesting thing with Ian is kind of at the 11th hour, it took a right hand turn out of the Gulf and headed immediately for our area.

Scott Nygaard, M.D.

Previous to that, we thought it was going to hit more of the northern coast of Florida, more in the Tampa region, as Helene just did. I would say, part of the challenge we faced was a delayed evacuation process, for example. And people who had never experienced surge were probably a bit complacent and chose to even stay in their homes,

Scott Nygaard, M.D.

you know, never having experienced a surge of that magnitude before.

Ben Wise

There are so many needs in those times of crisis. What did you and Lee Health do to support the staff, the patients and even the broader community there?

Scott Nygaard, M.D.

Immediately after the event, there was so much devastation. One of the biggest problems we faced was simply just, communication and trying to track down all of our staff. The cell towers were completely wiped out. There were major outages in electricity. And so the biggest first event was really to track down our staff. Following an assessment of the devastation,

Scott Nygaard, M.D.

we realized a lot of people who had parked on our property had lost their vehicles from the amount of surge and flooding. And long term, we supported them by paying their auto deductibles, to make sure that they were covered in that event. We did provide Rideshare free of charge - about $220,000 in benefit to our employees to get them to work.

Scott Nygaard, M.D.

To their credit, despite all the devastation and personal loss, they were still committed to patient care. We provided childcare free of charge, about $370,000 worth of childcare. We provided direct grants to our employees to try to rebuild or clean up in the aftermath of the hurricane. We directed them to our partner in the United Way. We've got an employee assistance fund.

Scott Nygaard, M.D.

And we paid all staff wages for two weeks, whether they were working or not. Just to make sure that people had a continued income stream to support their family.

Ben Wise

That's incredible. And I can only imagine all the hardships that come along with those sort of things. You know, I heard you in a panel discussion earlier this year, quote the philosopher Mike Tyson: "Everyone has a plan until they get punched in the mouth." I'm sure you had elaborate emergency preparedness, hurricane preparedness plans, but what sort of things

Ben Wise

maybe, surprised you about Hurricane Ian or outside the box?

Scott Nygaard, M.D.

So, like I said, I think, you know, yes, we had a plan, and yes, we had an incident command center and we thought we were ready. And the reason I made that comment, it was just it is true, right? You think you have a plan until things start falling apart. So for example, we had never experienced the devastation of communication.

Scott Nygaard, M.D.

Another thing we had to do post the storm was set up star link communication center since all the cell towers were wiped out so that we could get back to having access, including phone and Wi-Fi access. We also provided that to the public in a number of locations, so they could contact and outreach to their families and, friends and people who were concerned about their well-being.

Scott Nygaard, M.D.

I would say evacuation starts much earlier now. If you look at the Florida map trying to get out of Florida, there's only really two major roads on our side. It's I-75 north. And imagine trying to evacuate millions of people up that corridor. It turns into a parking lot, and then you have issues of gas availability as stations start to run out of gas, because people are anxious and filling their cars, preparing for their generators.

Scott Nygaard, M.D.

So a lot of issues emerge that we had not foreseen. The loss of water was a major issue. Never seen anything like that. Our public utilities, because of all the turned over trees, lost our entire water supply and we had prepared for potable water, but we had not prepared for water pressure for fire suppression. And so our facilities were deemed unsafe.

Scott Nygaard, M.D.

And at one point, our local health care agency decided that we should begin evacuating some of our hospitals. We did fully evacuate our children's hospital, relocated all those patients. And the adult side, you know, we felt like, we could not evacuate and provide needed emergency services. So they allowed us to stay open while we you know, worked to restore our water pressure.

Ben Wise

Scott Nygaard, M.D.

So, one of the things we realize is to have access to water for fire suppression, a method to solve for that would not to be dependent upon the local utilities, but to build deep wells on each one of our hospital campuses. And power those wells with our emergency generators so that we could have adequate water pressure for fire suppression.

Scott Nygaard, M.D.

Our facilities overall were pretty hardened, despite the size and over 100 locations. Relatively speaking, we had little damage to the facilities themselves. About $10 million, which, you know, is real money, but not significant in the grand scheme of things for all the locations we had. We had some clinics out on the barrier islands that were impacted, obviously, and destroyed.

Scott Nygaard, M.D.

But I would say one of the biggest things was that and then the preparation for like a star link service, post, if we had that type of devastation from a communication perspective, so that we could contact and make sure our staff were safe. So there's probably the biggest things.

Ben Wise

It strikes me that as COO, you have to consider all of those infrastructure needs, but there's also a lot of human needs with that. How does something like childcare play into disaster relief planning?

Scott Nygaard, M.D.

So, as you know, I mean, the first thing we all worry about is our families and loved ones. And when you're at work, and you're called in and we have a team A and a team B response, the number one thing people want to know is, is my family safe so I can focus on my work at hand.

Scott Nygaard, M.D.

So making sure that they have adequate care for children is a big need in a time like this, both pre-and-post storm while they're continuing to try to work through the efforts of childcare. It sounds simple, but it's a big deal to our staff, many who are working parents and was critical to the support transportation

Scott Nygaard, M.D.

I spoke about, you know, the importance of that in terms of being able to just to get to work. And a lot of people had problems with their own cars. So if we had the availability to go pick them up, they were willing to, you know, come to work.

Ben Wise

Such a great example of resiliency demonstrated there. And along those lines, even with some of these hardships that these disasters and hurricanes bring, communities often come together during disasters. I wonder if there's any success stories that stand out to you about Lee Health's role in these events and coming together for the community?

Scott Nygaard, M.D.

One of the most amazing things, I think immediately during the storm, we had a physician of ours who lived out on one of the barrier islands, Pine Island, and, weathered the storm out there. But immediately following the storm, took an interest in the community there and set up you know, basically a triage center on the island at the local fire department and provided care to people despite her own personal devastation.

Scott Nygaard, M.D.

And so it was pretty amazing that we had people reach out like that. We had a lot of stories where people just were out helping neighbors and friends in the community, you know, murk out houses. There's a lot of debris and stuff that kind of comes through after that cleanup. I would say, even despite the fact that we're two years later, now we've had a couple other storms.

Scott Nygaard, M.D.

So I've had people in our community who've been now had water intrusion in their home from three different storms.

Ben Wise

Scott Nygaard, M.D.

You know, you do the best you can, right? And despite all your efforts, you still know there's hardship. We've had businesses that have closed permanently, not able to reopen after multiple insults like that. Our United Way is a tremendous agency. Coordinates a lot of resources. We did refer a lot of people to that in terms of two one one.

Scott Nygaard, M.D.

They warehoused a lot of materials during that time and created now a permanent warehousing function for people to have access to simple things like, you know, clothing. We worked with multiple food agencies to make sure that people had food, post the storm. This time we expected a larger surge. We chose not to have people park in our lot knowing that their vehicles would be at risk, like I said, and transported them there.

Scott Nygaard, M.D.

So you do as much as you can, but you know there's still hardship out there.

Ben Wise

You know, with the recent shortage of IV fluid, I was wondering what aspects of conservation and medical supply conservation play into your role and how do you do that during a time of a disaster?

Scott Nygaard, M.D.

So it's interesting that once again, post Hurricane Helene, we saw a single point of failure in IV fluids at of Baxter processing facility, and none of us have really been prepared for that. So we've gone into how do we ration, how do we orally hydrate, how do we use limited hydration fluids? There been systems canceling surgery.

Scott Nygaard, M.D.

I would say one of the things we learned even back from Covid was on basic supplies. We created our own warehouse for things that we knew were going to be high utilization items and have a rotating stock system there to make sure that we have available supplies for things like a pandemic, for example. We can't stock every supply.

Scott Nygaard, M.D.

I don't know what we're going to learn from this most recent issue with IV fluids, but, to have a single point of failure in a country is really not acceptable and I think we're learning it the hard way once again. So that will cause us to have to think differently. We do have some backup ability, because we have a processing center in which we make some of our IV infusion supplies, and I was just talking to our pharmacist the other day about perhaps we need to think about expanding that service or being able to scale it during a disaster.

Ben Wise

So, Dr. Nygaard, looking at some of these past hurricanes and events, what strategies have worked best in recovery, maybe some that other health systems have learned from as well?

Scott Nygaard, M.D.

I think one of the lessons we learned is you can't be prepared enough, and there is a reason, you know, you do have a process in terms of how you communicate in your organization. In the initial Ian storm people's best efforts, I would say we did violate some of those issues of the incident command center as people were trying to, you know, kind of have best effort, some of it brought down because of the challenges with communication and part of our infrastructure. Following that and keeping order in the house, I think is very important in terms of responding appropriately to any type of disaster.

Scott Nygaard, M.D.

There are always things that are unexpected or unplanned that you know you haven't drilled for, you haven't prepared for, so making sure you keep orderly process really does matter. We saw that this last time in Milton, where I could see our whole response was much more organized, much more calm, much more sense of order. And it made a big difference in preparing for the storm.

Scott Nygaard, M.D.

Some of the other things I think, you know, we've talked about just being prepared for major outages like the cellular tower, like water, like having gas available. We did bring in, by the way, gas tankers for our people to have availability for gas if they did have a vehicle that was functioning and were just specifically available for emergency medical staff. I think one thing we tried to also do in our community, we have a lot of special needs people at the Children's Hospital.

Scott Nygaard, M.D.

We tried to make sure we did house and support those families, since they have higher medical needs. We tried to, you know, communicate earlier about getting people evacuated into shelter, not just us, but even I would say our state has been much more rigorous, making sure people take them seriously. You know, in Ian I think we had about 150 deaths in Florida because people didn't take it seriously.

Scott Nygaard, M.D.

But now even people who've been here a long time recognize the potential impact. In Milton, we just had a five foot surge, you know, whereas Ian was 15ft of surge. So, you know, a house at ground level would simply be underwater.

Ben Wise

Dr. Nygaard, thank you so much not only for your time today, but also everything that you do for your staff at Lee Health as well as your community. Really appreciate it.

Scott Nygaard, M.D.

Thank you so much. And I'm blessed that we have such a great staff who cares so deeply about our community and is committed to their service even in light of their own hardship.

Tom Haederle

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