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				 

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GAO-06-443R

     

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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)

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