Disaster Preparedness: Preliminary Observations on the Evacuation of Hospitals and Nursing Homes Due to Hurricanes (16-FEB-06, GAO-06-443R). During disasters, administrators of health care facilities are faced with decisions about how to operate and care for patients, including when and how to evacuate patients if the facility becomes unable to support adequate care, treatment, or services. Hospitals and nursing homes are required to have plans in place that describe how they will operate during emergencies. Hurricanes Katrina and Rita were incidents of national significance that highlighted the challenges involved in evacuating vulnerable populations, including those in hospitals and nursing homes. Federal officials used the National Disaster Medical System (NDMS) to help evacuate patients due to Hurricane Katrina--the first time the system has been used to evacuate such a large number of patients. Formed in 1984, NDMS is a partnership among the Department of Defense (DOD), the Department of Health and Human Services (HHS), the Department of Homeland Security (DHS), and the Department of Veterans Affairs (VA). We have begun work to assess the evacuation of hospital and nursing home patients due to disasters. We are performing this work under the Comptroller General's authority to conduct evaluations on his own initiative. To conduct our review, we obtained information on (1) who is responsible for deciding to evacuate hospitals and nursing homes, (2) what issues administrators consider when deciding to evacuate hospitals and nursing homes, and (3) what federal response capabilities support the evacuation of hospitals and nursing homes. The Senate Committee on Health, Education, Labor, and Pensions requested a briefing on the preliminary observations of our review. We briefed the committee with other committees of jurisdiction on February 16, 2006. This report documents our preliminary views as presented in those briefings. -------------------------Indexing Terms------------------------- REPORTNUM: GAO-06-443R ACCNO: A47177 TITLE: Disaster Preparedness: Preliminary Observations on the Evacuation of Hospitals and Nursing Homes Due to Hurricanes DATE: 02/16/2006 SUBJECT: Decision making Disaster planning Disaster recovery plans Emergency preparedness Evacuation Evacuation procedures Health care facilities Health care planning Hospitals Hurricane Katrina Hurricane Rita Hurricanes Intergovernmental relations National disaster medical system Natural disasters Nursing homes Program evaluation National Disaster Medical System National Response Plan ****************************************************************** ** This file contains an ASCII representation of the text of a ** ** GAO Product. ** ** ** ** No attempt has been made to display graphic images, although ** ** figure captions are reproduced. Tables are included, but ** ** may not resemble those in the printed version. ** ** ** ** Please see the PDF (Portable Document Format) file, when ** ** available, for a complete electronic file of the printed ** ** document's contents. ** ** ** ****************************************************************** GAO-06-443R * PDF6-Ordering Information.pdf * Order by Mail or Phone February 16, 2006 Congressional Committees Subject: Disaster Preparedness: Preliminary Observations on the Evacuation of Hospitals and Nursing Homes Due to Hurricanes During disasters, administrators of health care facilities are faced with decisions about how to operate and care for patients, including when and how to evacuate patients if the facility becomes unable to support adequate care, treatment, or services. Hospitals and nursing homes are required to have plans in place that describe how they will operate during emergencies. Hurricanes Katrina and Rita were incidents of national significance that highlighted the challenges involved in evacuating vulnerable populations, including those in hospitals and nursing homes. Federal officials used the National Disaster Medical System (NDMS) to help evacuate patients due to Hurricane Katrina-the first time the system has been used to evacuate such a large number of patients. Formed in 1984, NDMS is a partnership among the Department of Defense (DOD), the Department of Health and Human Services (HHS), the Department of Homeland Security (DHS), and the Department of Veterans Affairs (VA). We have begun work to assess the evacuation of hospital and nursing home patients due to disasters. We are performing this work under the Comptroller General's authority to conduct evaluations on his own initiative.1 To conduct our review, we obtained information on (1) who is responsible for deciding to evacuate hospitals and nursing homes, (2) what issues administrators consider when deciding to evacuate hospitals and nursing homes, and (3) what federal response capabilities support the evacuation of hospitals and nursing homes. The Senate Committee on Health, Education, Labor, and Pensions requested a briefing on the preliminary observations of our review. We briefed the committee with other committees of jurisdiction on February 16, 2006. This report documents our preliminary views as presented in those briefings. (See encl. I.) We anticipate completing our work in the summer of 2006 and will issue a final report at that time. To provide this information, we interviewed officials in Florida in areas that experienced hurricanes in 2004, including officials from three hospitals and three nursing homes that experienced Hurricane Charley, state officials, and local emergency management officials in two counties. In addition, we interviewed 131 U.S.C. S: 717(b)(1) (2000). officials from national hospital and nursing home associations, Florida hospital and nursing home associations, and Louisiana nursing home associations. We also interviewed federal officials from DOD, HHS, DHS, the Department of Transportation (DOT), and VA. We also reviewed documents, including emergency management plans from Florida, Louisiana, Mississippi, local governments, hospitals, and nursing homes; federal documents such as the National Response Plan, which describes how the federal government assists in managing incidents of national significance; and other relevant federal documents. Our work was performed from January through February 2006 in accordance with generally accepted government auditing standards. In summary, we found that hospital and nursing home administrators are often responsible for deciding whether to evacuate patients from their facilities due to disasters, including hurricanes or other natural disasters. State and local governments can order evacuations of the population or segments of the population during emergencies, but health care facilities may be exempt from these orders. Hospitals and nursing home administrators told us that they evacuate only as a last resort and that facilities' emergency plans are designed primarily to shelter in place. Administrators consider several issues when deciding to evacuate or to shelter in place, including the availability of adequate resources to shelter in place, the risks to patients in deciding when to evacuate, the availability of transportation to move patients and of receiving facilities to accept patients, and the destruction of the facility's or community's infrastructure. Nursing home administrators must also consider additional factors, including that their residents generally have no other home and cannot care for themselves, and the necessity to locate receiving facilities that can accommodate residents for a long time. Finally, NDMS, a federal system, can provide assistance with evacuation of hospital patients, such as providing transportation from one location to another. Federal officials told us, however, that NDMS was not set up nor is it currently configured to provide assistance evacuating nursing homes. In our ongoing review, we are continuing to examine the vulnerabilities of nursing homes in future disasters, particularly hurricanes. We discussed the facts contained in this report with DOD, HHS, DHS, and VA officials, and they generally agreed with them. - - - - - We are sending copies of this report to congressional committees and to the Secretaries of Defense, Health and Human Services, Homeland Security, Transportation, and Veterans Affairs. We will also make copies available to others upon request. In addition, the report will be available at no charge on GAO's Web site at http://www.gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. If you or your staff have any questions about this report, please contact me at (202) 512-7101 or [email protected]. Major contributors to this report were Linda Kohn, Assistant Director; La Sherri Bush; Nkeruka Okonmah; and William Simerl. Cynthia A. Bascetta Director, Health Care Enclosure List of Committees The Honorable John Warner Chairman The Honorable Carl Levin Ranking Minority Member Committee on Armed Services United States Senate The Honorable Charles E. Grassley Chairman The Honorable Max Baucus Ranking Minority Member Committee on Finance United States Senate The Honorable Michael B. Enzi Chairman The Honorable Edward M. Kennedy Ranking Minority Member Committee on Health, Education, Labor, and Pensions United States Senate The Honorable Susan M. Collins Chairman The Honorable Joseph I. Lieberman Ranking Minority Member Committee on Homeland Security and Governmental Affairs United States Senate The Honorable Larry E. Craig Chairman The Honorable Daniel K. Akaka Ranking Minority Member Committee on Veterans' Affairs United States Senate The Honorable Duncan L. Hunter Chairman The Honorable Ike Skelton Ranking Minority Member Committee on Armed Services House of Representatives The Honorable Joe Barton Chairman The Honorable John D. Dingell Ranking Minority Member Committee on Energy and Commerce House of Representatives The Honorable Tom Davis Chairman The Honorable Henry A. Waxman Ranking Minority Member Committee on Government Reform House of Representatives The Honorable Peter T. King Chairman The Honorable Bennie G. Thompson Ranking Minority Member Committee on Homeland Security House of Representatives The Honorable Steve Buyer Chairman The Honorable Lane Evans Ranking Minority Member Committee on Veterans' Affairs House of Representatives The Honorable William M. Thomas Chairman The Honorable Charles B. Rangel Ranking Minority Member Committee on Ways and Means House of Representatives The Honorable Tom Davis Chairman Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina House of Representatives (290528) GAO's Mission The Government Accountability Office, the audit, evaluation and investigative arm of Congress, exists to support Congress in meeting its constitutional responsibilities and to help improve the performance and accountability of the federal government for the American people. GAO examines the use of public funds; evaluates federal programs and policies; and provides analyses, recommendations, and other assistance to help Congress make informed oversight, policy, and funding decisions. GAO's commitment to good government is reflected in its core values of accountability, integrity, and reliability. 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