Managing Practitioners During and after a Disaster VAs Experiences from Hurricane Katrina

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Managing Practitioners During and after a
DisasterVAs Experiences from Hurricane Katrina

• Kathryn W. Enchelmayer, MS MHSA
• Director, Credentialing and Privileging
• Office of Quality and Performance
• Veterans Health Administration

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Hurricane Katrina
Landfall August 29th
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State of NOLA Hospitals

• Prior to Hurricane Katrina there were 2,269
  hospital beds
• Post-Katrina
• Emergency Care is available
• 456 Hospital Beds
• 19 City Clinics for indigent care
• Cost to rebuild LSUs Charity Hospital and
  University Hospital estimated at 360M
• Source CNN March 29, 2006

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Veterans Integrated Service Network 16
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VISN 16

• Part or all of 8 states (LA, MS, AK, OK, TX, MO,
  AL, FL)
• 10 Hospitals
• 35 Community Based Outpatient Clinics (CBOCs)
• 3 Mobile clinics for emergency care and first aid
  in post Katrina areas

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Biloxi VAMC - During
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Gulfport VAMC - Before
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Gulfport VAMC - After
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New Orleans VAMC - Before
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VA Medical Center
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VAs Response

• All VAMCs continued to operate with compromised
  communications in some
• Satellite phones in Biloxi
• T1 line in Jackson phone cards issued to
  employees who needed outside communication
• Command Center established in Jackson MS
• Coordination of evacuees, employees and
  responders
• Credentialing of responders

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New Orleans VAMC Evacuation

• Successfully evacuated September 2, 2005
• Convoy from Little Rock to facilitate evacuation
• 650 patients, staff, and family members evacuated
  by air and land
• No loss of life
• No community hostility

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Displaced Veterans

• Toll-free number for Veterans established
• 10 mobile clinics dispatched
• Computerized Patient Record System (CPRS)
• within 1 day access to pharmacy, laboratory, and
  radiology information
• New Orleans records installed at Michael E
  DeBakey Medical Center Houston using back-up
  tapes
• Numerous public service announcements and
  brochures on how to obtain health care and
  benefits
• Armed Forces Retirement Veterans Home (282
  veterans) moved to Washington DC and immediately
  enrolled for care and follow-up at VA Medical
  Center Washington
• Served all who appeared at VA sites regardless of
  eligibility to VA Care

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Displaced Employees

• Established a Toll-Free number for employees
• Reestablished contact with over 1,000 employees
  of New Orleans and Gulf Coast VA medical centers
• Detailed over 1,400 employees from VA medical
  center New Orleans to other VAMCs

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JCAHO Disaster Privileges

• MS.4.110
• The CEO or president of the medical staff or
  their designee(s) may grant disaster privileges
  upon presentation of any of the following
• ? A current picture hospital ID card
• ? A current license to practice and a valid
  picture ID issued by a state, federal, or
  regulatory agency
• ? Identification indicating that the individual
  is a member of a Disaster Medical Assistance Team
  (DMAT)
• ? Identification indicating that the individual
  has been granted authority to render
• patient care, treatment, and services in
  disaster circumstances (such authority having
  been granted by a federal, state, or municipal
  entity)
• ? Presentation by current hospital or medical
  staff member(s) with personal knowledge regarding
  practitioners identity

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Activation of Providers to Disaster Area

• Credentialing of VA providers completed
• VetPro, VAs electronic credentialing system
• Verbal communication with staff at Jackson
  confirming VA medical staff appointments and
  complete, current, credentials.
• VHA CP staff verified current licensure
• VHA CP staff queried NPDB-HIPDB
• Documented credentials verification for
  submission to Jackson
• Non-VA staff utilized in accordance with
  credentialing requirements of VA facility
  disaster plan

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Displaced Providers

• VA staff evacuated, but wanted to continue to
  serve
• Staff contacted closest VA facility to evacuation
  location
• Credential (electronic) files were shared with
  receiving facility by VHA CP staff
• Providers immediately put to work
• VHA CP staff assisted with verifications from
  entities that could not easily verify
• 151 LIPs placed in service

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Complete Credentials

• Education
• Training
• Licensure
• Louisiana Medical Board not functioning
• FSMB assumed responsibility for verifications
  based on data transmitted to them
• VA subscribes to FSMB Disciplinary Alert Service
• References
• DEA and ABMS
• Personal History
• NOLA Medical Staff Office acknowledged for
  completeness of files

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Medical Staff Issues

• Hospital closed offices scattered
• MSO moves to Outpatient Clinic, Baton Rogue
• Sharing a cubicle
• Personal loss and destruction
• Change in mission
• Outpatient
• First Aid in some instances
• Where is the Credentials Committee
• Who is on the ECMS

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Medical Staff Functions

• Reorganization of ECMS
• Privileges for ambulatory care/outpatient
• Reappraisal on return for those who were
  displaced for an extended period of time
• Electronic credentialing file in place of paper
  files that were not removed