By Christina Bennett, MS
Hurricane Irma made landfall in Florida on Sunday, September 10 and then swept north, engulfing the entire state. On Monday, Irma was downgraded to a tropical storm but was still relentless, bringing heavy rain and strong winds. Irma caused damage, flooding, and massive power outages throughout Florida. But in spite of this, Florida Cancer Specialists (FCS)—the largest independent practice in the state — opened their doors on Tuesday, ready to treat patients.
FCS has nearly 100 locations dispersed throughout the state; Irma impacted all of them.
“Who would have thought the storm could have impacted not only the entirety of our practice, but also the entirety of the state of Florida,” said William Harwin, MD, president and managing partner of FCS.
“We’ve had numerous calls from patients who obviously are extremely concerned that they’re going to have their care disrupted,” said Todd Schonherz, Chief Operating Officer of FCS. He said that “a number of patients” are on clinical trials, and maintaining the drug schedule for those patients is “incredibly critical.”
“Because of the plans we had in place and—again, the ability to have clinics available in each of the counties that we operate in—we’ve ensured there’s been very minimal if no disruption to the patient care for those patients that are under curative therapy,” said Mr. Schonherz.
“We’re totally focused on making sure our patients can continue their treatment,” said Dr. Harwin.
On Tuesday, about a third of the staff came in to run the clinics and treat patients; on Wednesday about 80% to 85% of the clinics were open and operating.
FCS consolidated offices throughout the state, moving physicians, nurses, and other staff to locations that have electrical power and are accessible to both patients and practice staff. In Fort Myers, which is on the West Coast of Florida, FCS consolidated four offices to two.
“We have a plan in place where we consolidate offices within a county. That allows us to make sure that patients are able to continue to be treated, just potentially at a different office in a different part of town,” said Mr. Schonherz.
“We’ve had a number of employees whose homes are without power, who live in compromised areas, who have floods around their homes—who basically demonstrated a whatever-it-takes attitude to ensure that they were able to get into the office and help treat patients the day after the storm,” said Mr. Schonherz. “I think that’s probably one of the things I’ve been most impressed with related to how our organization has responded as a whole.”
“I’m so proud of our team. I can’t even tell you how well they managed this very difficult situation,” said Dr. Harwin.
Mr. Schonherz explained that FCS has an emergency procedure plan should situations like a hurricane arise.
“We started monitoring [Hurricane Irma] and putting our plans in place to ensure that we could have continuity of care for our patients if there was any sort of disruption due to severe weather,” said Mr. Schonherz.
The emergency plan has several components, one of which is timely communication to staff and patients before and after a storm.
“If we know offices at a specific location are going to be impacted by a storm, we can automate phone calls to all those patients to let them know that their visit has been canceled, so that they don’t venture out in treacherous conditions to an office that’s not going to be available to treat them,” said Mr. Schonherz. Patients could also check the FCS website and the FCS Facebook page for updates.
In the case of Hurricane Irma, employees were kept informed of office openings and closings via email and social media. Also, employees could call the employee hotline and hear a prerecorded message about office status.
FCS has a care management team of about 50 individuals, most being oncology nurses, that was created about a year ago and stemmed from the healthcare system moving away from fee-for-service and towards value-based payments. The team handled inbound and outbound calls with patients, particularly from those in compromised areas, and helped schedule the patients to other offices that were nearby and open. The team also answered patients’ non-emergency questions.
“That team was incredibly valuable to us,” said Mr. Schonherz.
Oncology Care Model Requirements
FCS is a participating practice in the Oncology Care Model (OCM), which was created by the Centers for Medicaid and Medicare Services. Nearly 200 oncology practices participate in the pilot, which aims to improve the quality of care to patients by requiring practices to execute enhanced services. One such service is providing patients with 24/7 access to care.
“I think being part of the OCM and having a well-set-up care management team has been a big help and boost to us, which gives us a whole other resource to reach out to our patients—and for our patients to be able to reach out to us,” said Dr. Harwin. “I think in that way the OCM has been a real positive through Hurricane Irma.”
Preserving Drugs, Staying Stocked
Another part of the planning was providing instructions to each facility that detailed how to secure an office in the path of the storm and manage any drug inventory, particularly refrigerated drugs, should power go out.
Dr. Harwin said ensuring that refrigerated drugs stay preserved was “critical” because the drugs are “very expensive” and “if a drug goes without refrigeration it has to be disposed.”
Not all the practice locations have generators, so FCS relocated drugs to practices that either had generators or other means to preserve the drugs in the event of a power outage.
“We did not lose a single vial,” said Dr. Harwin.
In addition, FCS had to plan how they would replenish their drug supply after the hurricane.
Mr. Schonherz explained that before the storm they contacted their drug distributer, Oncology Supply, to ensure the distributer would be prepared to help FCS after the storm.
As of Wednesday after the storm, FedEx, who normally delivers drugs to each FCS practice, had halted deliveries to certain markets. Normally, the practice receives a drug shipment every day because, as with most oncology practices, FCS keeps a limited amount of inventory on hand.
To overcome the FedEx issue, Oncology Supply sent two refrigerated trucks to Orlando and Fort Myers. The trucks arrived Thursday at 4:30 am, and from there, FCS used couriers to deliver drugs to markets that FedEx was not delivering. As of Friday, FedEx had not been delivering on a stretch of the West Coast, from Venice to Naples.
Also, extra drugs are being shipped, just to be safe because, Dr. Harwin said, he doesn’t know “when we will be back to normal.”
On Tuesday, a young man with Hodgkin’s lymphoma arrived at an FCS office seeking care. He had journeyed to Florida from out of state to help communities with the aftermath of Irma, but he had an infected port and needed his final dose of chemotherapy by Friday. We’ve been asked to not disclose his name or any identifying information.
“He was supposed to get chemotherapy this week, but being far away from [his home], he thought he was not going be able to get any,” said Ernesto Bustinza, MD, the medical oncologist at FCS who treated the patient.
Dr. Ernesto Bustinza said the patient was driving when he saw the practice’s sign. Then he came inside the office and talked with someone at the front desk. Dr. Bustinza and the team were able to get in touch with the patient’s primary oncologist and promptly obtain his medical records to review prior treatments and other medical history.
Dr. Bustinza gave the patient antibiotics to treat the infected port and referred him to receive a peripherally inserted central catheter (PICC) line because, once infected or compromised, a port cannot be used to administer chemotherapy anymore. The patient was scheduled to receive his final chemotherapy treatment at FCS on Friday.
“I think he actually put his life at risk to help others,” said Dr. Bustinza. “He was so nice and totally willing to help and assist [the community], and he really didn’t think about himself, he was thinking more about the rest of the people.”
“We wanted to be able to provide the same type of kindness and great service to him, and I think we did,” said Dr. Bustinza.
The American Society of Clinical Oncology has resources for patients and providers affected by Hurricane Harvey and Hurricane Irma. They are available at http://www.asco.org/resources-disaster-assistance.