Editor’s Note: Portions of this post previously appeared on Modern Healthcare.
President Obama’s Executive Order 13690 — signed in 2015 — made it the official policy of the U.S. government to improve the resilience of communities against the impact of flooding. This included special requirements for federally-funded healthcare projects, including adding three feet to base flood elevation when building federally-funded hospital facilities in flood-prone areas. But it also extended to other types of projects, including assisted living facilities and even power generation facilities.
Unfortunately, President Trump revoked this policy on August 15, 2017 — ten days before Hurricane Harvey made landfall near Houston, Texas, and shut down at least 21 of the region’s hospitals.
Growing research that shows climate change will cause hurricanes of greater intensity, as well as increased risk for flooding, in coastal communities across the United States. In a flood event, every foot counts. Building three feet above flood elevation — as required by President Obama’s regulations — could mean the difference between full hospital functionality and a complete failure of electrical, plumbing and mechanical systems.
Take, for example, Hurricane Katrina. Flooding during that disaster closed more than half of the region’s hospitals — and all of the hospitals within New Orleans itself — immediately after the hurricane. Over a decade later, some of those facilities remain closed. We saw a similar event after Hurricane Sandy in New York City, which damaged numerous hospitals, including five which remained closed a month after the disaster hit.
Even after these storms — which combined killed at least 1,400 people and caused $183 billion in damage — there are relatively few formal protections in place to safeguard healthcare facilities from storms. We believe the solution to creating more resilient healthcare facilities requires a partnership between healthcare institutions, government agencies and professionals in the building industry. We understand that additional regulations are not always the right answer. But we are concerned with President Trump’s decision to revoke the executive order without adding any protections or considerations in their place.
My firm worked on two major hospital replacement projects in New Orleans after Hurricane Katrina. There, we instituted an “upside-down hospital” design strategy which placed critical infrastructure typically relegated to the basement high above flood stage, in some cases seven floors up. At University Medical Center in New Orleans for example, the first “mission critical” floor is located 21 feet above base flood elevation.
While it’s possible the rollback of President Obama’s regulations will save money in the short term, it will likely cost healthcare systems more in the long run. A study by the National Institute of Building Sciences found that every $1 of public funds spent on disaster mitigation saves society $4. LSU’s Hurricane Center also found that stronger building codes related to wind damage before Katrina would have saved $8 billion alone. It is generally cheaper to retool infrastructure before a disaster hits.
One bright spot: only projects with Federal involvement were covered by President Obama’s executive order — and by President Trump’s rescindment of it. We continue to work with private healthcare institutions, particularly on the Eastern Seaboard, who understand the stakes and are willing to make the necessary investments. And even Federal projects, with client approval, are permitted to exceed the current requirements — but they are no longer required to, and therein lies the danger.
Healthcare systems in the United States face a myriad of challenges, including increased operating costs, switching to a value-based reimbursement model, an uncertain political environment and rapidly advancing technologies. So it’s understandable that hardening against climate-caused disasters may fall to the bottom of the priority list. But we’ve seen what can happen when that is the case.
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