July 11, 2025 • 40 mins
Deanna Mool, Chief Legal Officer, UNC Health Appalachian, and Tom Shanahan, Chief Legal Officer, UNC Health, discuss the impact of Hurricane Helene on their respective health systems in 2024 and offer tips on how to respond to a natural disaster from a legal perspective. They recount their experiences on the ground during and after the storm, including maintaining proper communication, procuring and dispersing essential aid and supplies, providing community and staff support, coordinating grant applications, working with FEMA, and more. They also share lessons learned and how to deal with the next natural disaster.
Watch this episode: https://www.youtube.com/watch?v=ORB8h70-EJY
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:00):
Welcome to this AHLA podcast.
Today, Tom Shanahan and I aregoing
SPEAKER_03 (00:17):
to discuss the our experience during Hurricane
Helene and how a directlyimpacted healthcare facility
paired up and was helped by adistant healthcare facility that
wasn't involved in thisparticular hurricane.
So my name is Deanna Mool andI'm the Chief Legal Officer for
(00:39):
Appalachian Regional HealthcareSystem, which is now UNC Health
Appalachian, and we are amanaged entity by the UNC
Healthcare System.
SPEAKER_00 (00:50):
And I'm Tom Shanahan.
I'm chief legal officer for theUniversity of North Carolina
healthcare system known as UNCHealth.
And we're a statewide healthsystem.
So we have medical center inChapel Hill and various
hospitals throughout the state,some that we own, but some that
we manage.
And so Deanna and I get to worktogether quite a bit as a result
(01:12):
of that relationship.
SPEAKER_03 (01:15):
So we wanted to talk to you about Hurricane Helene
and how, from a legalperspective, you can actually
help your client and your teamin responding to some type of
natural disaster, whether it bea hurricane or tornado or
flooding.
This was a unique experience.
quick occurring event that wedidn't have a lot of time to
(01:36):
prepare for.
And we learned a lot on the backend and we were hoping that that
experience could be helpful toall of you.
Just to set the stage, UNCHealth Appalachian is located in
Watauga and Avery counties andsome services given in Ashe
counties, which is the Northwestcorner of North Carolina and
(01:58):
butts up against Tennessee.
and was not the worst affectedarea in Hurricane Helene.
Certainly our partners at Pardeeand Blue Ridge were more
affected by Hurricane Helenebecause they were close to the
Asheville area, but we are asmaller rural isolated mountain
community.
(02:18):
And so it was a unique challengein getting supplies in and those
types of issues.
we wanted to start off maybetalking about during the storm
and then kind of gochronologically at what happened
after the storm and what we'velearned from that experience.
So I'll give you my perspectiveduring the storm first, and then
(02:39):
Tom will let you talk about whatyou have, what you were doing
actually during the storm.
So
SPEAKER_00 (02:44):
just watching it all unfold
SPEAKER_03 (02:46):
on TV.
Yeah.
During the storm, you know, itwas really interesting because a
lot of one thing that weprobably should do in the future
is keep more staff on site,right?
Some of us were at home near thehospital, but not on site.
And the hospital basicallybecame an island in Watauga
(03:07):
County and in Avery County,where there was flooding all
around, the roads wereimpassable, and very few
vehicles were getting throughfor about probably a 12 hour
period.
We certainly lost power.
We lost potable water.
We were on generator power untilwe found out that the generator
(03:28):
wasn't sized quite big enough atone of our campuses.
And so some of the HVAC wasn'tworking.
And so it became a you know,patients first, staff first
mantra to just kind of getthrough the storm.
And as soon as we could getthrough on the roads, all of our
leadership was in at thehospital and we were immediately
starting to respond.
So we were probably 12 hoursinto the storm before we were
(03:51):
really looking at what's next.
And then as quickly as thewaters came up, they also
subsided and the devastation wasjust left after that.
SPEAKER_00 (04:01):
is this started to unfold.
I mean, you're taking me backnow and I'm remembering more and
more, but so yeah, we havecolleagues and teammates and
partners throughout WesternNorth Carolina, but including in
Hendersonville, the Ashevilleregion, Burke County, Caldwell
County.
And so we were starting toreceive reports in from
(04:22):
Appalachian and the colleaguesfrom around those other areas
and just an incredible impact.
Something like, I'm trying toremember, it was like 30, 30
inches or more of rain over a24-hour period at that point in
late September.
The impacts you're talkingabout, loss of power, loss of
(04:43):
access, obviously, to electronicmedical record and anything
associated with normaloperations, one by one came
down.
And it was from the perspectiveof those of us in the Triangle
and in Chapel Hill, there was aperiod where there was just very
(05:03):
little communication.
We weren't able to get through.
You all weren't able to getthrough.
And so in the center of thestate, we didn't have nearly
that kind of impact, but workhad already started, obviously,
in the...
at our offices at UNC Healthwith our team members there
(05:23):
starting to figure out whatresources are gonna be needed.
What do we need to pulltogether?
What assistance do we need tooffer?
SPEAKER_03 (05:31):
And the thing, I mean, to me, Tom, the thing that
was interesting was that it hit,right?
And it wasn't like everythinghappened at once.
We lost power and then we foundout we didn't have water and
then our communications wentdown.
So it's like, you're slowlybecoming this island.
And it was it was justinteresting then to try and come
(05:53):
and say, OK, how are we going toput these pieces back together
one by one?
Right.
We also had the entrance to ourhospital in Avery County.
Half the road collapsed.
And so we really had to watchtraffic coming in and out of
there.
But keep in mind that the celltowers were down.
The Internet went down.
And so it was very isolatingthere.
at each of our campuses and I'msure that again I think Western
(06:17):
North Carolina had this muchworse than we did and so I don't
I don't want to overstate whatwe experienced because it wasn't
the devastation that theyexperienced.
As we started putting our planback together, we realized we
were working with local countyadministrators to figure out
what roads were open, how wecould get between our two
facilities to bring supplies in,how we could help the community.
(06:42):
And what became very interestingis like my first task was get a
contract in place to run abigger generator, right?
That was the immediate need thatAvery County needed.
Well, we found the generator.
Then we had to figure out, wehad to work with local law
enforcement to figure out how toget the generator to the campus
and get the fuel to the campusbecause no gas stations were
(07:03):
pumping gas.
There was no, No electricity.
They couldn't pump gas.
And so we were trucking in gas.
And when you have roadscollapsing, you can't bring a
big semi in.
You're using smaller trucks.
And so everything became anissue.
How do we get food?
How do we get clean linens?
And The interesting thing thatcame up was people didn't have
(07:26):
prescriptions.
Right.
And so we were getting two andthree day prescriptions,
relabeling out of out of thestock at the hospital to the
community because we didn'treally have a choice.
Oxygen.
There seems to be a lot ofpeople in our area on oxygen.
We ended up know we would havewe had oxygen tents where people
could come and just get oxygenonce a couple of days were up
(07:50):
because they were running out ofoxygen and didn't have power at
home and it was hot right it waslike 80 degrees and very humid
and so it wasn't like a blizzardit was it was the opposite of
that um so tom can you maybetell us how you um helped us get
get those supplies in because weprobably didn't see all the work
(08:12):
that you guys did behind thescenes.
SPEAKER_00 (08:15):
Yeah.
So as it started to unfold,actually, and, you know, so
we'll approach this in part aslawyers, right?
So there was a little bit ofinfrastructure that we paid
attention to almost immediatelyfrom a, you know, from a legal
standpoint, but really from anemergency operations standpoint.
(08:35):
And, you know, Deanna, you and Iworked on this a little bit
together, but we put a series ofinternal contracts in place,
internal agreements in place.
And really what that was to dotwo things it was to leverage
all of the operations of thesystem of the unc healthcare
system so any part of it couldassist any other part of it so
(08:56):
whether you were a managedhospital in eastern north
carolina if you wanted to sendstaff or if you had staff
available that you could send tounc health appalachian we wanted
to make sure we had theunderlying infrastructure in
place so you could do it, wecould track the charges, we
could manage the employees, andfrankly, set ourselves up to be
(09:17):
able to do appropriatereimbursement afterwards and
address all those things thatyou don't want to slow you down
in an emergency like liabilityand malpractice coverage and
supervision and all of thosethings.
So we did a lot of that on thefront end, and honestly, this
(09:40):
was something where the work wehad done during COVID actually
provided a lot of the templatesand a lot of the go-bys.
We were able to repurpose a lotof very similar agreements, at
least from a legal and financialoperations standpoint, just
coming out of COVID, andincluding making the assumption
(10:01):
that eventually there would beyou know, submission for
reimbursement to FEMA.
We needed to have things thatwere auditable and in place.
So all these things that wedon't want our frontline staff
thinking at all about, we don'twant them to worry about this at
all.
There was some of that going onin the background.
We at the center of the statestarted mobilizing in a number
(10:26):
of different areas.
So I would think of this and,you know, probably five or six
buckets, really.
But the first is there was abelief and an assumption that a
lot of emergency staffing wouldbe needed at the hospitals in
the western part of the state.
I will say we had anoverwhelming response from
(10:48):
employees.
Every employee from everyservice area It seemed wanted to
get on a bus and go to WesternNorth Carolina.
So for a little bit, we actuallyhad to tell people, don't go.
Don't don't go out thereimmediately.
And it was a good problem tohave, but actually one that
(11:09):
could have gotten out of handvery quickly if we hadn't been
able to work with our partners,you know, with our hospitals.
You know, Deanna, with yourteam, even to say, tell us what
you need and then we'll help youget it.
And I'll be interested now, youand I haven't necessarily talked
about this, but I'll beinterested to hear what you have
to say about, you know, did youever face difficulties?
(11:32):
And I'm going to say, look,really, I understand 20 people
want to come here, but what weneed is a pharmacist from
midnight until whenever.
So anyway, we put in placesomething to manage all that.
SPEAKER_03 (11:44):
Well, and we got, I think, really good, really fast
at asking just for what weneeded and then kindly saying,
we can't use that right now.
Because the more people you putup here, the more people we have
to feed and find somewhere tosleep.
And basically every hotel intown emptied, they upped their
rates and we started rentingrooms because we had staff that
(12:05):
had no homes.
You know, you're talking aboutvolunteers.
We had our HR folks do twothings, which I thought were
crucial.
Reach out to everyone and findour staff.
Like we knew that we had a nursewhose home had gone down the
mountain and we just didn't theyweren't on shift.
So we didn't know if they werein it or not.
Turned out they had made it to aneighbor's because they heard
(12:26):
the house creaking and ran outthe door with their pets and
lost everything.
Right.
So we had volunteers.
homeless staff because of thehurricane.
And then we also had our HRoffice manage the volunteers.
So anybody that thought theyneeded a volunteer or needed
extra staffing, we set up an HRwar room separate from incident
command where people could justgo and say, I'm going to need
(12:49):
this, this, and this for nextshift, or I'm going to, you
know, we need, we had, we had tohave volunteers help in our
cafeteria because we werefeeding fema and national guard
out of our avery campus rightand so we were you know all that
was coordinating we ended upwith volunteers at offices at
both locations and this you knowi have to say this isn't like
(13:11):
smooth it wasn't like we hadthis checklist and said oh we
need a volunteer office right wewere like okay we have to get we
have to limit who's in here andand who can work there because
the the management just neededto happen at a different level
than the volunteers, right?
You didn't need volunteerssitting in on your, your daily
briefings.
SPEAKER_02 (13:31):
The
SPEAKER_03 (13:31):
other thing that UNC helped system-wide helped us
very much with is we, once wegot the internet back in a
couple of days and we were able,we couldn't reach our Avery
campus initially.
So we were driving back andforth sometimes in squad cars,
sometimes driving, on roads thatwere collapsing and had poles on
trees over the top of them.
I had one perilous journey overto our Avery campus on Monday
(13:53):
after the hurricane hit Fridayand Saturday.
But I probably wouldn't repeatif I didn't have to.
But getting satellite phones inplace, we were very blessed in
that Samaritan's Purse is nearour hospital, their worldwide
headquarters, and they hadsatellite phones.
And so we started borrowingStarlinks from them And and then
(14:17):
eventually UNC arranged for asatellite truck on our campus.
The other thing that, Tom, youroffice was very helpful in was
getting waivers for us.
Right.
We needed to be able to operatein our parking lot.
We needed to not have to haveaccredited locations for the
oxygen tents we needed.
And so I actually, Tom, we hademail the whole time.
(14:40):
I don't.
really know why, but we did.
And from a technologicalstandpoint, I don't know why,
but it was great that we had itbecause Tom was emailing and
saying, you know, okay, thiswaiver came through.
The feds have said this.
And so, because I didn't have,that wasn't my focus right then
was to go find out what waivershad been put in place.
(15:01):
I just needed help knowing whatI could do.
So Tom was able to, Tom's officewas able to do that.
SPEAKER_00 (15:07):
No, and that's true.
Luckily, our partners at thestate were, I would say,
proactive in that way, meaningthat they would start coming up
with, they were good partnersbecause they would start
thinking about what are areaswhere you might need waivers?
What are things you might needhelp with?
Where might you need to connectwith a federal agency to consult
(15:30):
on something like that?
I mean, a few other areas thatwe thought of that we were
working in, you know, you justmentioned it, but IT.
So, you know, we operate asingle IT system across the
entire system.
So our IT team, which is your ITteam, you know, we all work on
(15:51):
this.
A joint one.
A joint IT team, and they wereon this.
And it's difficult to describethe incredible work that they
were able to do.
They got the hospitals by andlarge back up and running as
quickly as they could.
And from our standpoint,certainly before many other
(16:15):
services in the region wereavailable.
And you might be able to commenton this.
I kept hearing that people inthe community would come to the
hospital parking lot so theycould plug into the Wi-Fi and be
able to connect with familymembers.
SPEAKER_03 (16:34):
Right.
We did have, we had that goingon because I think they actually
stood up a cell tower in theparking lot also, but here was
our problem in our Averycampuses with the road half
collapsed, we had to limit thetraffic coming in.
So then we ended up saying,okay, we're going to have to put
security at the end of the roadand only let emergency vehicles
through because the extratraffic was, you know, causing
(16:56):
further degradation of the road.
And so, you know, That did notgo over well with the community
I can share with you.
But we didn't really have achoice because we had to keep
the hospital open.
And arranging for DOT to come toa quick inspection and make sure
that the road wasn't actuallygoing to collapse when people
were on it, that use of half theroad was safe.
(17:17):
And so that really was thelifeline for that campus.
And being in a more rural areaand not having experienced
hurricanes before, it tookprobably a little bit longer for
our county resources to ramp up.
I don't think that would happenagain.
But initially, we startedfeeding the community out of our
(17:38):
Avery campus because it wasnecessary.
The first responders neededsomewhere.
They needed air mattresses tosleep on.
They needed food.
We had one working oven overthere, and we're feeding 100
people a day out of the kitchen.
But again, as you talked aboutearlier, You need that contract
in place that says you'rerequired to do it and you're
willing to help for later FEMAaccounting purposes.
(18:01):
And so it's interesting thateverything you start doing to
help the community, you're like,I need a contract now, right?
And that's really not...
that, you know, that's when thelawyers are looked at like, what
are you talking about?
We just got to get this done.
I'm like, you get it done.
We'll get the contract done, youknow?
SPEAKER_00 (18:16):
And yeah.
And what we try to do is make iteasy, right?
You know, have only what'sessential in there.
Explain it.
It's easy to, it's easy toexecute on.
So.
SPEAKER_03 (18:26):
Right.
So I guess if maybe we move onsort of to a little bit after
the storm, we've kind of startedtalking about how we started
restoring things.
And we actually ended up with aWebEx that lasted, I don't know,
120 hours or something likethat, because that was a way we
could communicate with othercampuses.
UNC administration or theirsystem office had access to
(18:51):
that.
And so that was the easiest way.
Somebody was always an incidentcommand.
And I would recommend this ifyou have the ability to do so,
to open up that way.
WebEx or Teams meeting withvideo, just leave it on in your
incident command offices.
And then you can always unmuteand holler and say, hey, you
know, Avery Campus, we need X,do you need X, Y, and Z?
(19:11):
Or, you know, Walmart's bringingin water.
Where should we have them takeit?
Who could, you know, can you getfive people to unload it?
You know, so there were a lot ofthose kind of coordination that
I think having that open channelmade it really quick and easy to
get answers to those kind ofquestions.
So I thoroughly recommend thatas an approach for your incident
command, if possible.
Um, The other thing that we'vehad to do, which made me a
(19:34):
little bit nervous, is we kepthaving to increase our staff
credit card limits because wewere paying for hotels and
buying air mattresses and allkinds of things on those cards.
So we were calling our creditcard company daily to say, can
you increase the limit on thiscard or that card?
They're all back down now.
But those financial controls,you don't think of, you know,
(19:57):
people want to be paid when youwalk in the door.
They don't want to bill you amonth later a lot.
of them.
So now we continue, Tom, to workwith FEMA on the recovery.
And I think you sort of alludedearlier to the contracts we had
to have in place.
But I don't know if you alsoknow that your accounting office
(20:17):
helped us right away byreopening all the master account
codes that we used during COVIDto track time and all that.
So maybe you can speak to that alittle bit.
SPEAKER_00 (20:28):
Yeah, actually, so the controller for UNC Health,
so the team we built for COVIDhas actually still been working,
even this many years post-COVID,because there are all of the
post-COVID audits that areunderway.
And actually, we've justrecently concluded all of those
(20:49):
now and had gotten additionalreimbursement as a result of
that.
So we had just by happenstance,the controller still had the
team in place, still had thoseaccount codes accessible, and
obviously had a lot of know-howin place already, just in terms
of working with FEMA, what theexpectations would be and what
(21:10):
the documentation requirementswould be.
So that helped some.
the state of north carolina andactually the university system
we are connected to theuniversity system so the state's
university system retained aconsultant while the storm was
still going on and had that hadthat firm in place to provide to
(21:34):
provide some of thatconsultation and help in the
background as well so it's it'snot going to answer all
questions right but Because ofthat, we're able to anticipate
the types of documentation thatwe would need, what expenses
we're going to need to track.
I remember having multipleconversations about how we were
(21:56):
going to track personnelexpenditures, for example, how
that should be recorded.
How do you treat an employee,like I said, at another managed
entity who is coming over to thewestern part of the state?
versus how do we treat someoneemployed directly by UNC Health?
(22:16):
And these are our internalissues, but whatever your
organization is, you're going tohave that set of questions that
you're going to have to thinkthrough.
And you need somebody who's notinvolved in immediate storm
response, who's thinking interms of, okay, from a
reimbursement and auditperspective, what is FEMA going
to need to see?
Or what is the federal agency orstate disaster relief agency
(22:40):
going to need to see from thatstandpoint?
SPEAKER_03 (22:42):
Well, and it was very helpful, Tom, because your
office also sent, you know, wehad time sheets, paper time
sheets right away where westarted tracking our time
working on Helene versus ourregular duties, which, you know,
was kind of a 24-hour thing fora while.
But we immediately starteddocumenting that so that we got
that paperwork in place that wasdone contemporaneously if we're
(23:05):
later audited in the FEMA grantprocess.
And so that expertise, you know,I have to admit, I would have
never known to do that.
do that, right?
I don't know.
Maybe our CFO would have, but Iwouldn't have known to do that.
And so having someone hand youthat and say, you're going to
need this for FEMA.
don't bug your staff, just haveeverybody start filling them out
was exceedingly helpful.
(23:25):
And now we're in the grantprocess.
So maybe we can switch to that.
After the event, FEMA sets updeadlines as far as when you
need to say that you've haddamage.
And I'm not going to be able totell you what all these
deadlines were, but they were, Ithink it was a I think the event
(23:46):
was in September.
I think we had six monthsbecause they extended the
deadlines.
So I think that our initial kindof get into the program was in
April.
And these are extendeddeadlines.
The typical FEMA deadlines areshorter than that.
And then by June 15th, we had tohave all of our damage into the
grants portal system.
(24:08):
And so...
What happens in the middle ofthat is FEMA actually has like a
six step process to pay you backon grants.
And part of it is applying.
You'll know that once you startdigging into this, that there's
different categories ofreimbursement.
And so you need to track thingsseparately for what's emergency
(24:30):
response versus what's long-termresponse versus projects you do
to mitigate future damage.
And they all have a differentcategory.
And then there's theseregulations, which I think, Tom,
they affectionately call thePAPA regulations because that's
the acronym, but I can't tellyou what the acronym is at the
moment.
SPEAKER_00 (24:47):
But- Everything from like, you know, I'm remembering
now, debris removal, emergencymeasures.
There's, you know, there'simmediate response.
That's one stream of fundingversus reimbursement for
post-event response.
It's complicated.
SPEAKER_03 (25:05):
There's like, let's see.
there's A through Gclassifications, and then
there's four or six mitigationresponses.
And so we experienced likewind-driven rain literally
coming through the brick walls.
And we, I think we lost 30patient rooms that had to be
immediately remediated inWatauga.
It was interesting because Averyhad more outside damage, but
(25:28):
maybe inside the hospital wasnot as damaged.
And so We had, you know, weimmediately remediated those
rooms to get them back up andrunning.
We're trying to take pictures ofthings for insurance and FEMA
purposes of the damage.
We didn't get everything.
The insurance claims and theFEMA claims have taken a lot of
(25:48):
time for our risk office, which,you know, reports to me.
And we've been and we're stillworking on business interruption
claims.
know coverage trying to get someof that coverage we're down i
think out of the 10 locations wehad damage we're down with our
insurer property insurance totwo that we're still discussing
(26:09):
now and and got our initialpayment several months
afterwards so this is not likean instant process right it
takes time um yeah as
SPEAKER_00 (26:18):
you're as you're talking about this diana um I'm
reminded too, I mean, early on,we had a number of issues we
were discussing at least inChapel Hill about teammates.
their houses, those who had losthomes, those who homes were,
were damaged.
And that's a, we haven't talkedmuch about that.
(26:39):
And that's not a direct item ofrecovery for us, you know, you
know, is operating ourhospitals, but it's absolutely
critical to, these are ourfriends and neighbors, you know,
your friends and neighbors, andwe want to be able to help.
So I'm wondering if you canspeak to that at all.
SPEAKER_03 (26:58):
Well, it was really interesting because we have an
employee-to-employee fund, whichwe had at the time was pretty
generous.
But once we started, we had tobuy...
clothes and bedding and airmattresses and stuff just to
get, we had to take care of ourstaff so they could take care of
our patients.
Right.
And that the people were thefirst thing, right.
(27:18):
The patients and the staff, ourteammates were the first two
things we had to take care of.
Right.
So what Tom and I are doing inthe background is important in
the long run, but certainly notjob one, right.
Job one is taking care of, ofwhat we do and how we take care
of people.
We ended up buying, I thinkabout 80 generators for our
staff that, um, We had donationsfrom the Cannon Foundation and
(27:42):
some other foundations that arevery involved in our area.
Significant, wonderfulcontributions.
And we were able to help outwith Christmas gifts because
people still didn't have houses.
We were able to help out withgenerators so that they could
get to work.
Because the other thing that weheard a lot from the feds is
that people in the mountainsare...
(28:05):
the land is important to themand they don't want to leave the
land that's been in theirfamilies for generations.
And so we, we tried to make itpossible for them to stay and
that's still happening, right?
We're putting the Eric ChurchFoundation is putting up, I
think it's 50 houses right nowin Avery County to, to be more
long-term housing and to allowpeople to get into those.
(28:28):
But you're right.
I, I do have a funny story, ifyou want to hear it, is that
when you sent nurses up fromOnslow to help us with night
shift, and I don't know ifyou've heard about this, but
when they came in, they came inon a party bus and it had a pole
in the middle of it.
We greeted them and we're askingthem about their trip up on the
(28:49):
party bus because the bus driverdrove the party bus regularly
and he was quite the character.
So, you know, there's thoselittle moments in the middle of
the crisis that kind of make itmemorable, I guess.
SPEAKER_00 (29:04):
I did hear that story.
I did hear that story.
And that was a bit of ingenuitythat got everyone out to Watauga
as quickly as they could.
So
SPEAKER_03 (29:19):
I...
We've talked, you know, we werekind of talking about FEMA.
I don't know how much more, butwe want to discuss that.
But you, I don't know.
We've also used the systemoffice to help us do all the
accounting and those grantapplications.
And so they're able to help usby looking at our financials,
(29:40):
prove our business interruptionloss.
They've been able to, you know,we've been you know, it's so
nice to have electroniccooperation when it works
properly, right?
So we're uploading receipts andthey're putting them in the
right category and getting theminto the right grant
application, whether it's, youknow, emergency.
So your receipts are gonna becategorized with FEMA as an
(30:02):
emergency response issue or along-term restoration or, you
know, whatever category they areputting in so that you can try
and get recovery.
The one thing that I foundinteresting is we had an
introductory meeting with FEMAand they indicated from the
historic preservation side thatwe were going to need the
latitude and longitude of alllost tree root balls.
(30:25):
And I was like, I can't give youthe latitude and longitude of
either where we took our trashor the tree root balls that were
upended during the storm becausethere were I don't know, 50,000,
probably not necessarily all onour property.
But so some of the requests youget just kind of make you laugh.
SPEAKER_00 (30:46):
Yeah.
I mean, that's that's that'sincredible there.
I know for one of the universitycampuses, I think in Asheville,
the Army Corps of Engineers sentan entire team.
large tree crew up there becausethey were adept at being able to
take down and move, you know,just large amounts of timber.
(31:09):
But you're right.
I mean, it was tens of thousandsof trees.
Right.
So
SPEAKER_03 (31:14):
I just said, take the latitude and longitude of
everything around the hospitaland just say that's where they
were.
But evidently, waste haulers aresupposed to be able to tell FEMA
where they take your materialswaste when you're building, you
know, when you've had buildingdamage.
And I had never experienced thatbefore, too, to need to know the
latitude and longitude of thedump that we were using.
(31:38):
So there are things in the FEMArules that if you have some
expertise around can be veryhelpful in these situations, I
would say.
Maybe let's talk about movingforward, Tom, what we would do
differently.
SPEAKER_00 (31:51):
Yeah.
So I think what I would say,maybe it's not so much what we
would do differently, but nowthe opportunity.
So first of all, this providedan opportunity to do after
action.
We've all done that.
I'm sure you've done that.
And it's almost, I feel likeit's an ongoing conversation.
(32:11):
So I feel like it is nowinforming the way we look at our
daily operations right now.
UNKNOWN (32:20):
Yeah.
SPEAKER_00 (32:21):
So hurricane season is already upon us or soon to be
upon us.
Normally, we think of this assomething affecting eastern
North Carolina and sometimescentral North Carolina.
This was a good reminder thatthe same sorts of events, when
they come up through the centerof the country, can impact the
western part of the state aswell.
So we now have large numbers ofstaff who think in those terms.
(32:48):
But I mean, a few things.
First of all, this called outthe need to even further develop
our emergency operationscapacity.
That means having the rightleadership and the right
staffing at what we think of asat the system level, meaning
(33:09):
able to look across the stateand coordinate across the state.
So we're moving to adjust thatand beef up our leadership
structure so we can provide moresupport and more coordination.
A lot of things went well.
However, we would have liked tohave been faster, more
responsive.
(33:31):
We would have liked toanticipated some of the
challenges more.
The challenges with water andpower were very difficult.
They created some majorchallenges I know for you and
your team, Deanna, but we wereconcerned.
that a couple of the hospitalswould be down for a very long
period of time and it just wouldnot have been tolerable.
(33:55):
So the way I think of this isit's important to do after
action reviews of smallerincidents, to look to other
parts of the country that areexperiencing hazards and
disasters and how they'reresponding and have a way in
your organization to internalizesome of those learnings I think
(34:17):
what this has taught us as wellis we almost can never do enough
to build interconnection andcollegiality among staff across
entities because it was thoserelationships that people really
turned to.
It was, well, I know thisperson.
Somebody at Appalachian knowsthis person over at Blue Ridge
(34:40):
or this person over atSoutheastern.
Those are the relationships thatreally pay off.
So what I think it means is weneed to really encourage our
teams in doing those informalthings that help build
relationships, both internally,but also with your local
(35:01):
community, your local partners,certainly at the state level and
at the national level.
Those are just huge and key.
We've talked a lot here aboutcontracting.
I don't know the way you thinkabout this.
I started to think abouteverything during this disaster
(35:23):
response as what's animpediment?
What is a roadblock that has tobe removed?
That's our job is to remove thatroadblock.
A long contracting process or acomplex answer is an impediment.
So we needed to provide from alegal and governance standpoint,
(35:44):
it's incumbent on us to come upwith simple, straightforward
processes that are gonna meetregulatory needs going forward.
That's our job is to look downthe road, but make those simple,
crisp, easy to understand.
Do this, here's the template.
You don't have to negotiateanything.
That's the sort of crispresponse that everybody needs.
(36:07):
I think the final thing that Ithink about here You talked
about incident command, incidentresponse.
It seemed to me like we almosttook what we would normally do
in a large hospital in terms ofdaily huddles and things like
that, and more or less repurposethat into an incident response.
(36:29):
And of course we were usingtypical hospital risk
management, emergency responseprotocols in many ways.
But at the system level, forexample, we had a daily, We had
a daily meeting.
We had one person in charge.
She made sure she spoke with theCEOs of each hospital.
She was probably talking to themconstantly, but by the time she
(36:50):
came into that daily meeting at8.30, she had already talked
with all the CEOs and theirteams.
So there was a full report at8.30 every morning, and not just
to know what's going on, but itwas, and then we need the
following things.
Everybody was tasked as a resultof that.
That worked well, but I think welearned some things from that as
(37:13):
well about how thosecommunications should go and
then how to task everybodycoming out of it.
So it was clear and we had oneline of communication for
everybody.
SPEAKER_03 (37:25):
That really was key.
We noticed that too.
We changed our leader huddletime so that it would be before
your system meeting because wefigured out pretty quickly we
couldn't meet at the same timeand be helpful in getting what
we needed from you because wewere having our huddle at the
same time you were having yoursystem huddle.
(37:45):
There's got to be someflexibility.
If you like 9 o'clock, fine, butinstead we're going to do it at
9.30 or 8 because that needs tohappen.
That kind of coordination has tohappen we also identified that
we are going to train a lot morefolks this year in incident
command and emergency operationsyou know we're looking towards
the FEMA trainings that arestill in existence and and
(38:07):
saying identifying the rightpeople so we have a lot of
redundancy in these situationsum because you know you just
don't know what's going tohappen next right and um and And
the other thing, and I think wekind of touched on this a little
bit, Tom, but that localconnection to your emergency
management and emergencyoperations folks, because if we
(38:30):
couldn't get it from the systemand we needed to go either to
the state or federal governmentto get something, it has to go
through your county emergencyoperations coordinator to get it
done.
Like we were, you know, we had alot of choppers come in because
we had to transport folks.
We had you know, there was justa lot going on.
They were talking to us, youknow, unfortunately about things
(38:53):
like how many body bags weshould get.
And so, There's a lot of two-waycommunication there that has to
happen.
And so you have to have a goodrelationship with that local
emergency management office andtheir coordinators and get their
cell phones ahead of time.
Like this is not, you need thatphone tree list or that phone
list has to come out right awayif you haven't already done it.
(39:14):
I would suggest that you go getit now before something, you
know, before the next tornado,hurricane, flood or blizzard.
SPEAKER_00 (39:22):
Absolutely.
That's how people are going tocommunicate.
Sell and text and people theyknow that those relationships
are just critical.
SPEAKER_03 (39:31):
Right.
Well, thanks for talking to me,Tom.
SPEAKER_00 (39:36):
I enjoyed it.
Not all of it is great torelive, but I think you all did
a lot of amazing work and Ithink we're better for it.
SPEAKER_03 (39:46):
We will, uh, we will be better certainly in the long
run.
It's going to, I mean, it's madeeverybody stronger.
It certainly drew our teamtogether and, um, you know,
we're ready to hopefully notface another one of another
challenge like that, but wewill, we'll do it if we need to.
Yeah,
SPEAKER_00 (40:04):
definitely.
All right.
Thanks a lot.
Bye.
SPEAKER_01 (40:12):
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(40:32):
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Daily Podcast.
Welcome to this AHLA podcast.
Today, Tom Shanahan and I aregoing
SPEAKER_03 (00:17):
to discuss the our experience during Hurricane
Helene and how a directlyimpacted healthcare facility
paired up and was helped by adistant healthcare facility that
wasn't involved in thisparticular hurricane.
So my name is Deanna Mool andI'm the Chief Legal Officer for
(00:39):
Appalachian Regional HealthcareSystem, which is now UNC Health
Appalachian, and we are amanaged entity by the UNC
Healthcare System.
SPEAKER_00 (00:50):
And I'm Tom Shanahan.
I'm chief legal officer for theUniversity of North Carolina
healthcare system known as UNCHealth.
And we're a statewide healthsystem.
So we have medical center inChapel Hill and various
hospitals throughout the state,some that we own, but some that
we manage.
And so Deanna and I get to worktogether quite a bit as a result
(01:12):
of that relationship.
SPEAKER_03 (01:15):
So we wanted to talk to you about Hurricane Helene
and how, from a legalperspective, you can actually
help your client and your teamin responding to some type of
natural disaster, whether it bea hurricane or tornado or
flooding.
This was a unique experience.
quick occurring event that wedidn't have a lot of time to
(01:36):
prepare for.
And we learned a lot on the backend and we were hoping that that
experience could be helpful toall of you.
Just to set the stage, UNCHealth Appalachian is located in
Watauga and Avery counties andsome services given in Ashe
counties, which is the Northwestcorner of North Carolina and
(01:58):
butts up against Tennessee.
and was not the worst affectedarea in Hurricane Helene.
Certainly our partners at Pardeeand Blue Ridge were more
affected by Hurricane Helenebecause they were close to the
Asheville area, but we are asmaller rural isolated mountain
community.
(02:18):
And so it was a unique challengein getting supplies in and those
types of issues.
we wanted to start off maybetalking about during the storm
and then kind of gochronologically at what happened
after the storm and what we'velearned from that experience.
So I'll give you my perspectiveduring the storm first, and then
(02:39):
Tom will let you talk about whatyou have, what you were doing
actually during the storm.
So
SPEAKER_00 (02:44):
just watching it all unfold
SPEAKER_03 (02:46):
on TV.
Yeah.
During the storm, you know, itwas really interesting because a
lot of one thing that weprobably should do in the future
is keep more staff on site,right?
Some of us were at home near thehospital, but not on site.
And the hospital basicallybecame an island in Watauga
(03:07):
County and in Avery County,where there was flooding all
around, the roads wereimpassable, and very few
vehicles were getting throughfor about probably a 12 hour
period.
We certainly lost power.
We lost potable water.
We were on generator power untilwe found out that the generator
(03:28):
wasn't sized quite big enough atone of our campuses.
And so some of the HVAC wasn'tworking.
And so it became a you know,patients first, staff first
mantra to just kind of getthrough the storm.
And as soon as we could getthrough on the roads, all of our
leadership was in at thehospital and we were immediately
starting to respond.
So we were probably 12 hoursinto the storm before we were
(03:51):
really looking at what's next.
And then as quickly as thewaters came up, they also
subsided and the devastation wasjust left after that.
SPEAKER_00 (04:01):
is this started to unfold.
I mean, you're taking me backnow and I'm remembering more and
more, but so yeah, we havecolleagues and teammates and
partners throughout WesternNorth Carolina, but including in
Hendersonville, the Ashevilleregion, Burke County, Caldwell
County.
And so we were starting toreceive reports in from
(04:22):
Appalachian and the colleaguesfrom around those other areas
and just an incredible impact.
Something like, I'm trying toremember, it was like 30, 30
inches or more of rain over a24-hour period at that point in
late September.
The impacts you're talkingabout, loss of power, loss of
(04:43):
access, obviously, to electronicmedical record and anything
associated with normaloperations, one by one came
down.
And it was from the perspectiveof those of us in the Triangle
and in Chapel Hill, there was aperiod where there was just very
(05:03):
little communication.
We weren't able to get through.
You all weren't able to getthrough.
And so in the center of thestate, we didn't have nearly
that kind of impact, but workhad already started, obviously,
in the...
at our offices at UNC Healthwith our team members there
(05:23):
starting to figure out whatresources are gonna be needed.
What do we need to pulltogether?
What assistance do we need tooffer?
SPEAKER_03 (05:31):
And the thing, I mean, to me, Tom, the thing that
was interesting was that it hit,right?
And it wasn't like everythinghappened at once.
We lost power and then we foundout we didn't have water and
then our communications wentdown.
So it's like, you're slowlybecoming this island.
And it was it was justinteresting then to try and come
(05:53):
and say, OK, how are we going toput these pieces back together
one by one?
Right.
We also had the entrance to ourhospital in Avery County.
Half the road collapsed.
And so we really had to watchtraffic coming in and out of
there.
But keep in mind that the celltowers were down.
The Internet went down.
And so it was very isolatingthere.
at each of our campuses and I'msure that again I think Western
(06:17):
North Carolina had this muchworse than we did and so I don't
I don't want to overstate whatwe experienced because it wasn't
the devastation that theyexperienced.
As we started putting our planback together, we realized we
were working with local countyadministrators to figure out
what roads were open, how wecould get between our two
facilities to bring supplies in,how we could help the community.
(06:42):
And what became very interestingis like my first task was get a
contract in place to run abigger generator, right?
That was the immediate need thatAvery County needed.
Well, we found the generator.
Then we had to figure out, wehad to work with local law
enforcement to figure out how toget the generator to the campus
and get the fuel to the campusbecause no gas stations were
(07:03):
pumping gas.
There was no, No electricity.
They couldn't pump gas.
And so we were trucking in gas.
And when you have roadscollapsing, you can't bring a
big semi in.
You're using smaller trucks.
And so everything became anissue.
How do we get food?
How do we get clean linens?
And The interesting thing thatcame up was people didn't have
(07:26):
prescriptions.
Right.
And so we were getting two andthree day prescriptions,
relabeling out of out of thestock at the hospital to the
community because we didn'treally have a choice.
Oxygen.
There seems to be a lot ofpeople in our area on oxygen.
We ended up know we would havewe had oxygen tents where people
could come and just get oxygenonce a couple of days were up
(07:50):
because they were running out ofoxygen and didn't have power at
home and it was hot right it waslike 80 degrees and very humid
and so it wasn't like a blizzardit was it was the opposite of
that um so tom can you maybetell us how you um helped us get
get those supplies in because weprobably didn't see all the work
(08:12):
that you guys did behind thescenes.
SPEAKER_00 (08:15):
Yeah.
So as it started to unfold,actually, and, you know, so
we'll approach this in part aslawyers, right?
So there was a little bit ofinfrastructure that we paid
attention to almost immediatelyfrom a, you know, from a legal
standpoint, but really from anemergency operations standpoint.
(08:35):
And, you know, Deanna, you and Iworked on this a little bit
together, but we put a series ofinternal contracts in place,
internal agreements in place.
And really what that was to dotwo things it was to leverage
all of the operations of thesystem of the unc healthcare
system so any part of it couldassist any other part of it so
(08:56):
whether you were a managedhospital in eastern north
carolina if you wanted to sendstaff or if you had staff
available that you could send tounc health appalachian we wanted
to make sure we had theunderlying infrastructure in
place so you could do it, wecould track the charges, we
could manage the employees, andfrankly, set ourselves up to be
(09:17):
able to do appropriatereimbursement afterwards and
address all those things thatyou don't want to slow you down
in an emergency like liabilityand malpractice coverage and
supervision and all of thosethings.
So we did a lot of that on thefront end, and honestly, this
(09:40):
was something where the work wehad done during COVID actually
provided a lot of the templatesand a lot of the go-bys.
We were able to repurpose a lotof very similar agreements, at
least from a legal and financialoperations standpoint, just
coming out of COVID, andincluding making the assumption
(10:01):
that eventually there would beyou know, submission for
reimbursement to FEMA.
We needed to have things thatwere auditable and in place.
So all these things that wedon't want our frontline staff
thinking at all about, we don'twant them to worry about this at
all.
There was some of that going onin the background.
We at the center of the statestarted mobilizing in a number
(10:26):
of different areas.
So I would think of this and,you know, probably five or six
buckets, really.
But the first is there was abelief and an assumption that a
lot of emergency staffing wouldbe needed at the hospitals in
the western part of the state.
I will say we had anoverwhelming response from
(10:48):
employees.
Every employee from everyservice area It seemed wanted to
get on a bus and go to WesternNorth Carolina.
So for a little bit, we actuallyhad to tell people, don't go.
Don't don't go out thereimmediately.
And it was a good problem tohave, but actually one that
(11:09):
could have gotten out of handvery quickly if we hadn't been
able to work with our partners,you know, with our hospitals.
You know, Deanna, with yourteam, even to say, tell us what
you need and then we'll help youget it.
And I'll be interested now, youand I haven't necessarily talked
about this, but I'll beinterested to hear what you have
to say about, you know, did youever face difficulties?
(11:32):
And I'm going to say, look,really, I understand 20 people
want to come here, but what weneed is a pharmacist from
midnight until whenever.
So anyway, we put in placesomething to manage all that.
SPEAKER_03 (11:44):
Well, and we got, I think, really good, really fast
at asking just for what weneeded and then kindly saying,
we can't use that right now.
Because the more people you putup here, the more people we have
to feed and find somewhere tosleep.
And basically every hotel intown emptied, they upped their
rates and we started rentingrooms because we had staff that
(12:05):
had no homes.
You know, you're talking aboutvolunteers.
We had our HR folks do twothings, which I thought were
crucial.
Reach out to everyone and findour staff.
Like we knew that we had a nursewhose home had gone down the
mountain and we just didn't theyweren't on shift.
So we didn't know if they werein it or not.
Turned out they had made it to aneighbor's because they heard
(12:26):
the house creaking and ran outthe door with their pets and
lost everything.
Right.
So we had volunteers.
homeless staff because of thehurricane.
And then we also had our HRoffice manage the volunteers.
So anybody that thought theyneeded a volunteer or needed
extra staffing, we set up an HRwar room separate from incident
command where people could justgo and say, I'm going to need
(12:49):
this, this, and this for nextshift, or I'm going to, you
know, we need, we had, we had tohave volunteers help in our
cafeteria because we werefeeding fema and national guard
out of our avery campus rightand so we were you know all that
was coordinating we ended upwith volunteers at offices at
both locations and this you knowi have to say this isn't like
(13:11):
smooth it wasn't like we hadthis checklist and said oh we
need a volunteer office right wewere like okay we have to get we
have to limit who's in here andand who can work there because
the the management just neededto happen at a different level
than the volunteers, right?
You didn't need volunteerssitting in on your, your daily
briefings.
SPEAKER_02 (13:31):
The
SPEAKER_03 (13:31):
other thing that UNC helped system-wide helped us
very much with is we, once wegot the internet back in a
couple of days and we were able,we couldn't reach our Avery
campus initially.
So we were driving back andforth sometimes in squad cars,
sometimes driving, on roads thatwere collapsing and had poles on
trees over the top of them.
I had one perilous journey overto our Avery campus on Monday
(13:53):
after the hurricane hit Fridayand Saturday.
But I probably wouldn't repeatif I didn't have to.
But getting satellite phones inplace, we were very blessed in
that Samaritan's Purse is nearour hospital, their worldwide
headquarters, and they hadsatellite phones.
And so we started borrowingStarlinks from them And and then
(14:17):
eventually UNC arranged for asatellite truck on our campus.
The other thing that, Tom, youroffice was very helpful in was
getting waivers for us.
Right.
We needed to be able to operatein our parking lot.
We needed to not have to haveaccredited locations for the
oxygen tents we needed.
And so I actually, Tom, we hademail the whole time.
(14:40):
I don't.
really know why, but we did.
And from a technologicalstandpoint, I don't know why,
but it was great that we had itbecause Tom was emailing and
saying, you know, okay, thiswaiver came through.
The feds have said this.
And so, because I didn't have,that wasn't my focus right then
was to go find out what waivershad been put in place.
(15:01):
I just needed help knowing whatI could do.
So Tom was able to, Tom's officewas able to do that.
SPEAKER_00 (15:07):
No, and that's true.
Luckily, our partners at thestate were, I would say,
proactive in that way, meaningthat they would start coming up
with, they were good partnersbecause they would start
thinking about what are areaswhere you might need waivers?
What are things you might needhelp with?
Where might you need to connectwith a federal agency to consult
(15:30):
on something like that?
I mean, a few other areas thatwe thought of that we were
working in, you know, you justmentioned it, but IT.
So, you know, we operate asingle IT system across the
entire system.
So our IT team, which is your ITteam, you know, we all work on
(15:51):
this.
A joint one.
A joint IT team, and they wereon this.
And it's difficult to describethe incredible work that they
were able to do.
They got the hospitals by andlarge back up and running as
quickly as they could.
And from our standpoint,certainly before many other
(16:15):
services in the region wereavailable.
And you might be able to commenton this.
I kept hearing that people inthe community would come to the
hospital parking lot so theycould plug into the Wi-Fi and be
able to connect with familymembers.
SPEAKER_03 (16:34):
Right.
We did have, we had that goingon because I think they actually
stood up a cell tower in theparking lot also, but here was
our problem in our Averycampuses with the road half
collapsed, we had to limit thetraffic coming in.
So then we ended up saying,okay, we're going to have to put
security at the end of the roadand only let emergency vehicles
through because the extratraffic was, you know, causing
(16:56):
further degradation of the road.
And so, you know, That did notgo over well with the community
I can share with you.
But we didn't really have achoice because we had to keep
the hospital open.
And arranging for DOT to come toa quick inspection and make sure
that the road wasn't actuallygoing to collapse when people
were on it, that use of half theroad was safe.
(17:17):
And so that really was thelifeline for that campus.
And being in a more rural areaand not having experienced
hurricanes before, it tookprobably a little bit longer for
our county resources to ramp up.
I don't think that would happenagain.
But initially, we startedfeeding the community out of our
(17:38):
Avery campus because it wasnecessary.
The first responders neededsomewhere.
They needed air mattresses tosleep on.
They needed food.
We had one working oven overthere, and we're feeding 100
people a day out of the kitchen.
But again, as you talked aboutearlier, You need that contract
in place that says you'rerequired to do it and you're
willing to help for later FEMAaccounting purposes.
(18:01):
And so it's interesting thateverything you start doing to
help the community, you're like,I need a contract now, right?
And that's really not...
that, you know, that's when thelawyers are looked at like, what
are you talking about?
We just got to get this done.
I'm like, you get it done.
We'll get the contract done, youknow?
SPEAKER_00 (18:16):
And yeah.
And what we try to do is make iteasy, right?
You know, have only what'sessential in there.
Explain it.
It's easy to, it's easy toexecute on.
So.
SPEAKER_03 (18:26):
Right.
So I guess if maybe we move onsort of to a little bit after
the storm, we've kind of startedtalking about how we started
restoring things.
And we actually ended up with aWebEx that lasted, I don't know,
120 hours or something likethat, because that was a way we
could communicate with othercampuses.
UNC administration or theirsystem office had access to
(18:51):
that.
And so that was the easiest way.
Somebody was always an incidentcommand.
And I would recommend this ifyou have the ability to do so,
to open up that way.
WebEx or Teams meeting withvideo, just leave it on in your
incident command offices.
And then you can always unmuteand holler and say, hey, you
know, Avery Campus, we need X,do you need X, Y, and Z?
(19:11):
Or, you know, Walmart's bringingin water.
Where should we have them takeit?
Who could, you know, can you getfive people to unload it?
You know, so there were a lot ofthose kind of coordination that
I think having that open channelmade it really quick and easy to
get answers to those kind ofquestions.
So I thoroughly recommend thatas an approach for your incident
command, if possible.
Um, The other thing that we'vehad to do, which made me a
(19:34):
little bit nervous, is we kepthaving to increase our staff
credit card limits because wewere paying for hotels and
buying air mattresses and allkinds of things on those cards.
So we were calling our creditcard company daily to say, can
you increase the limit on thiscard or that card?
They're all back down now.
But those financial controls,you don't think of, you know,
(19:57):
people want to be paid when youwalk in the door.
They don't want to bill you amonth later a lot.
of them.
So now we continue, Tom, to workwith FEMA on the recovery.
And I think you sort of alludedearlier to the contracts we had
to have in place.
But I don't know if you alsoknow that your accounting office
(20:17):
helped us right away byreopening all the master account
codes that we used during COVIDto track time and all that.
So maybe you can speak to that alittle bit.
SPEAKER_00 (20:28):
Yeah, actually, so the controller for UNC Health,
so the team we built for COVIDhas actually still been working,
even this many years post-COVID,because there are all of the
post-COVID audits that areunderway.
And actually, we've justrecently concluded all of those
(20:49):
now and had gotten additionalreimbursement as a result of
that.
So we had just by happenstance,the controller still had the
team in place, still had thoseaccount codes accessible, and
obviously had a lot of know-howin place already, just in terms
of working with FEMA, what theexpectations would be and what
(21:10):
the documentation requirementswould be.
So that helped some.
the state of north carolina andactually the university system
we are connected to theuniversity system so the state's
university system retained aconsultant while the storm was
still going on and had that hadthat firm in place to provide to
(21:34):
provide some of thatconsultation and help in the
background as well so it's it'snot going to answer all
questions right but Because ofthat, we're able to anticipate
the types of documentation thatwe would need, what expenses
we're going to need to track.
I remember having multipleconversations about how we were
(21:56):
going to track personnelexpenditures, for example, how
that should be recorded.
How do you treat an employee,like I said, at another managed
entity who is coming over to thewestern part of the state?
versus how do we treat someoneemployed directly by UNC Health?
(22:16):
And these are our internalissues, but whatever your
organization is, you're going tohave that set of questions that
you're going to have to thinkthrough.
And you need somebody who's notinvolved in immediate storm
response, who's thinking interms of, okay, from a
reimbursement and auditperspective, what is FEMA going
to need to see?
Or what is the federal agency orstate disaster relief agency
(22:40):
going to need to see from thatstandpoint?
SPEAKER_03 (22:42):
Well, and it was very helpful, Tom, because your
office also sent, you know, wehad time sheets, paper time
sheets right away where westarted tracking our time
working on Helene versus ourregular duties, which, you know,
was kind of a 24-hour thing fora while.
But we immediately starteddocumenting that so that we got
that paperwork in place that wasdone contemporaneously if we're
(23:05):
later audited in the FEMA grantprocess.
And so that expertise, you know,I have to admit, I would have
never known to do that.
do that, right?
I don't know.
Maybe our CFO would have, but Iwouldn't have known to do that.
And so having someone hand youthat and say, you're going to
need this for FEMA.
don't bug your staff, just haveeverybody start filling them out
was exceedingly helpful.
(23:25):
And now we're in the grantprocess.
So maybe we can switch to that.
After the event, FEMA sets updeadlines as far as when you
need to say that you've haddamage.
And I'm not going to be able totell you what all these
deadlines were, but they were, Ithink it was a I think the event
(23:46):
was in September.
I think we had six monthsbecause they extended the
deadlines.
So I think that our initial kindof get into the program was in
April.
And these are extendeddeadlines.
The typical FEMA deadlines areshorter than that.
And then by June 15th, we had tohave all of our damage into the
grants portal system.
(24:08):
And so...
What happens in the middle ofthat is FEMA actually has like a
six step process to pay you backon grants.
And part of it is applying.
You'll know that once you startdigging into this, that there's
different categories ofreimbursement.
And so you need to track thingsseparately for what's emergency
(24:30):
response versus what's long-termresponse versus projects you do
to mitigate future damage.
And they all have a differentcategory.
And then there's theseregulations, which I think, Tom,
they affectionately call thePAPA regulations because that's
the acronym, but I can't tellyou what the acronym is at the
moment.
SPEAKER_00 (24:47):
But- Everything from like, you know, I'm remembering
now, debris removal, emergencymeasures.
There's, you know, there'simmediate response.
That's one stream of fundingversus reimbursement for
post-event response.
It's complicated.
SPEAKER_03 (25:05):
There's like, let's see.
there's A through Gclassifications, and then
there's four or six mitigationresponses.
And so we experienced likewind-driven rain literally
coming through the brick walls.
And we, I think we lost 30patient rooms that had to be
immediately remediated inWatauga.
It was interesting because Averyhad more outside damage, but
(25:28):
maybe inside the hospital wasnot as damaged.
And so We had, you know, weimmediately remediated those
rooms to get them back up andrunning.
We're trying to take pictures ofthings for insurance and FEMA
purposes of the damage.
We didn't get everything.
The insurance claims and theFEMA claims have taken a lot of
(25:48):
time for our risk office, which,you know, reports to me.
And we've been and we're stillworking on business interruption
claims.
know coverage trying to get someof that coverage we're down i
think out of the 10 locations wehad damage we're down with our
insurer property insurance totwo that we're still discussing
(26:09):
now and and got our initialpayment several months
afterwards so this is not likean instant process right it
takes time um yeah as
SPEAKER_00 (26:18):
you're as you're talking about this diana um I'm
reminded too, I mean, early on,we had a number of issues we
were discussing at least inChapel Hill about teammates.
their houses, those who had losthomes, those who homes were,
were damaged.
And that's a, we haven't talkedmuch about that.
(26:39):
And that's not a direct item ofrecovery for us, you know, you
know, is operating ourhospitals, but it's absolutely
critical to, these are ourfriends and neighbors, you know,
your friends and neighbors, andwe want to be able to help.
So I'm wondering if you canspeak to that at all.
SPEAKER_03 (26:58):
Well, it was really interesting because we have an
employee-to-employee fund, whichwe had at the time was pretty
generous.
But once we started, we had tobuy...
clothes and bedding and airmattresses and stuff just to
get, we had to take care of ourstaff so they could take care of
our patients.
Right.
And that the people were thefirst thing, right.
(27:18):
The patients and the staff, ourteammates were the first two
things we had to take care of.
Right.
So what Tom and I are doing inthe background is important in
the long run, but certainly notjob one, right.
Job one is taking care of, ofwhat we do and how we take care
of people.
We ended up buying, I thinkabout 80 generators for our
staff that, um, We had donationsfrom the Cannon Foundation and
(27:42):
some other foundations that arevery involved in our area.
Significant, wonderfulcontributions.
And we were able to help outwith Christmas gifts because
people still didn't have houses.
We were able to help out withgenerators so that they could
get to work.
Because the other thing that weheard a lot from the feds is
that people in the mountainsare...
(28:05):
the land is important to themand they don't want to leave the
land that's been in theirfamilies for generations.
And so we, we tried to make itpossible for them to stay and
that's still happening, right?
We're putting the Eric ChurchFoundation is putting up, I
think it's 50 houses right nowin Avery County to, to be more
long-term housing and to allowpeople to get into those.
(28:28):
But you're right.
I, I do have a funny story, ifyou want to hear it, is that
when you sent nurses up fromOnslow to help us with night
shift, and I don't know ifyou've heard about this, but
when they came in, they came inon a party bus and it had a pole
in the middle of it.
We greeted them and we're askingthem about their trip up on the
(28:49):
party bus because the bus driverdrove the party bus regularly
and he was quite the character.
So, you know, there's thoselittle moments in the middle of
the crisis that kind of make itmemorable, I guess.
SPEAKER_00 (29:04):
I did hear that story.
I did hear that story.
And that was a bit of ingenuitythat got everyone out to Watauga
as quickly as they could.
So
SPEAKER_03 (29:19):
I...
We've talked, you know, we werekind of talking about FEMA.
I don't know how much more, butwe want to discuss that.
But you, I don't know.
We've also used the systemoffice to help us do all the
accounting and those grantapplications.
And so they're able to help usby looking at our financials,
(29:40):
prove our business interruptionloss.
They've been able to, you know,we've been you know, it's so
nice to have electroniccooperation when it works
properly, right?
So we're uploading receipts andthey're putting them in the
right category and getting theminto the right grant
application, whether it's, youknow, emergency.
So your receipts are gonna becategorized with FEMA as an
(30:02):
emergency response issue or along-term restoration or, you
know, whatever category they areputting in so that you can try
and get recovery.
The one thing that I foundinteresting is we had an
introductory meeting with FEMAand they indicated from the
historic preservation side thatwe were going to need the
latitude and longitude of alllost tree root balls.
(30:25):
And I was like, I can't give youthe latitude and longitude of
either where we took our trashor the tree root balls that were
upended during the storm becausethere were I don't know, 50,000,
probably not necessarily all onour property.
But so some of the requests youget just kind of make you laugh.
SPEAKER_00 (30:46):
Yeah.
I mean, that's that's that'sincredible there.
I know for one of the universitycampuses, I think in Asheville,
the Army Corps of Engineers sentan entire team.
large tree crew up there becausethey were adept at being able to
take down and move, you know,just large amounts of timber.
(31:09):
But you're right.
I mean, it was tens of thousandsof trees.
Right.
So
SPEAKER_03 (31:14):
I just said, take the latitude and longitude of
everything around the hospitaland just say that's where they
were.
But evidently, waste haulers aresupposed to be able to tell FEMA
where they take your materialswaste when you're building, you
know, when you've had buildingdamage.
And I had never experienced thatbefore, too, to need to know the
latitude and longitude of thedump that we were using.
(31:38):
So there are things in the FEMArules that if you have some
expertise around can be veryhelpful in these situations, I
would say.
Maybe let's talk about movingforward, Tom, what we would do
differently.
SPEAKER_00 (31:51):
Yeah.
So I think what I would say,maybe it's not so much what we
would do differently, but nowthe opportunity.
So first of all, this providedan opportunity to do after
action.
We've all done that.
I'm sure you've done that.
And it's almost, I feel likeit's an ongoing conversation.
(32:11):
So I feel like it is nowinforming the way we look at our
daily operations right now.
UNKNOWN (32:20):
Yeah.
SPEAKER_00 (32:21):
So hurricane season is already upon us or soon to be
upon us.
Normally, we think of this assomething affecting eastern
North Carolina and sometimescentral North Carolina.
This was a good reminder thatthe same sorts of events, when
they come up through the centerof the country, can impact the
western part of the state aswell.
So we now have large numbers ofstaff who think in those terms.
(32:48):
But I mean, a few things.
First of all, this called outthe need to even further develop
our emergency operationscapacity.
That means having the rightleadership and the right
staffing at what we think of asat the system level, meaning
(33:09):
able to look across the stateand coordinate across the state.
So we're moving to adjust thatand beef up our leadership
structure so we can provide moresupport and more coordination.
A lot of things went well.
However, we would have liked tohave been faster, more
responsive.
(33:31):
We would have liked toanticipated some of the
challenges more.
The challenges with water andpower were very difficult.
They created some majorchallenges I know for you and
your team, Deanna, but we wereconcerned.
that a couple of the hospitalswould be down for a very long
period of time and it just wouldnot have been tolerable.
(33:55):
So the way I think of this isit's important to do after
action reviews of smallerincidents, to look to other
parts of the country that areexperiencing hazards and
disasters and how they'reresponding and have a way in
your organization to internalizesome of those learnings I think
(34:17):
what this has taught us as wellis we almost can never do enough
to build interconnection andcollegiality among staff across
entities because it was thoserelationships that people really
turned to.
It was, well, I know thisperson.
Somebody at Appalachian knowsthis person over at Blue Ridge
(34:40):
or this person over atSoutheastern.
Those are the relationships thatreally pay off.
So what I think it means is weneed to really encourage our
teams in doing those informalthings that help build
relationships, both internally,but also with your local
(35:01):
community, your local partners,certainly at the state level and
at the national level.
Those are just huge and key.
We've talked a lot here aboutcontracting.
I don't know the way you thinkabout this.
I started to think abouteverything during this disaster
(35:23):
response as what's animpediment?
What is a roadblock that has tobe removed?
That's our job is to remove thatroadblock.
A long contracting process or acomplex answer is an impediment.
So we needed to provide from alegal and governance standpoint,
(35:44):
it's incumbent on us to come upwith simple, straightforward
processes that are gonna meetregulatory needs going forward.
That's our job is to look downthe road, but make those simple,
crisp, easy to understand.
Do this, here's the template.
You don't have to negotiateanything.
That's the sort of crispresponse that everybody needs.
(36:07):
I think the final thing that Ithink about here You talked
about incident command, incidentresponse.
It seemed to me like we almosttook what we would normally do
in a large hospital in terms ofdaily huddles and things like
that, and more or less repurposethat into an incident response.
(36:29):
And of course we were usingtypical hospital risk
management, emergency responseprotocols in many ways.
But at the system level, forexample, we had a daily, We had
a daily meeting.
We had one person in charge.
She made sure she spoke with theCEOs of each hospital.
She was probably talking to themconstantly, but by the time she
(36:50):
came into that daily meeting at8.30, she had already talked
with all the CEOs and theirteams.
So there was a full report at8.30 every morning, and not just
to know what's going on, but itwas, and then we need the
following things.
Everybody was tasked as a resultof that.
That worked well, but I think welearned some things from that as
(37:13):
well about how thosecommunications should go and
then how to task everybodycoming out of it.
So it was clear and we had oneline of communication for
everybody.
SPEAKER_03 (37:25):
That really was key.
We noticed that too.
We changed our leader huddletime so that it would be before
your system meeting because wefigured out pretty quickly we
couldn't meet at the same timeand be helpful in getting what
we needed from you because wewere having our huddle at the
same time you were having yoursystem huddle.
(37:45):
There's got to be someflexibility.
If you like 9 o'clock, fine, butinstead we're going to do it at
9.30 or 8 because that needs tohappen.
That kind of coordination has tohappen we also identified that
we are going to train a lot morefolks this year in incident
command and emergency operationsyou know we're looking towards
the FEMA trainings that arestill in existence and and
(38:07):
saying identifying the rightpeople so we have a lot of
redundancy in these situationsum because you know you just
don't know what's going tohappen next right and um and And
the other thing, and I think wekind of touched on this a little
bit, Tom, but that localconnection to your emergency
management and emergencyoperations folks, because if we
(38:30):
couldn't get it from the systemand we needed to go either to
the state or federal governmentto get something, it has to go
through your county emergencyoperations coordinator to get it
done.
Like we were, you know, we had alot of choppers come in because
we had to transport folks.
We had you know, there was justa lot going on.
They were talking to us, youknow, unfortunately about things
(38:53):
like how many body bags weshould get.
And so, There's a lot of two-waycommunication there that has to
happen.
And so you have to have a goodrelationship with that local
emergency management office andtheir coordinators and get their
cell phones ahead of time.
Like this is not, you need thatphone tree list or that phone
list has to come out right awayif you haven't already done it.
(39:14):
I would suggest that you go getit now before something, you
know, before the next tornado,hurricane, flood or blizzard.
SPEAKER_00 (39:22):
Absolutely.
That's how people are going tocommunicate.
Sell and text and people theyknow that those relationships
are just critical.
SPEAKER_03 (39:31):
Right.
Well, thanks for talking to me,Tom.
SPEAKER_00 (39:36):
I enjoyed it.
Not all of it is great torelive, but I think you all did
a lot of amazing work and Ithink we're better for it.
SPEAKER_03 (39:46):
We will, uh, we will be better certainly in the long
run.
It's going to, I mean, it's madeeverybody stronger.
It certainly drew our teamtogether and, um, you know,
we're ready to hopefully notface another one of another
challenge like that, but wewill, we'll do it if we need to.
Yeah,
SPEAKER_00 (40:04):
definitely.
All right.
Thanks a lot.
Bye.
SPEAKER_01 (40:12):
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