Coping With (Power) Loss: California’s Hospitals, Clinics, Patients Face New Reality

By Mark Kreidler, a journalis and broadcaster. Originally published at KHN.

We all know that when the power goes out, refrigerators, heaters and air conditioners stop running. Homes go dark, and desktop computers shut down.

But those are mere inconveniences. If you need regular dialysis or chemotherapy at a clinic, or you have an infant in a neonatal intensive care unit or a loved one on a hospital ventilator, a loss of power carries far more dire implications.

California’s recurrent power outages this year by Pacific Gas & Electric Co. and Southern California Edison, in response to wildfire threats up and down the state, have forced patients to think about how they get care when the power is cut at hospitals and clinics.

Hospitals that provide critical care are required by state and federal law to have backup generators on-site. In California, hospitals, outpatient clinics and treatment centers have long-standing disaster plans in place, which cover the possibility of temporary power outages.

“But continuous power shut-offs, sometimes lasting for days and then happening again within a week or two, were never what those plans were intended for,” said Jan Emerson-Shea, vice president for external affairs at the California Hospital Association. “This is all very new to everybody.”

Communities in Northern and Southern California have been subjected this year to numerous outages, often with no assurance of when their power would be restored. The utilities’ estimates sometimes miss the mark. The outages are likely to be a long-term problem, given PG&E’s 10-year timetable for fixing power transmission risks.

And the fires are not necessarily finished for this season: The Camp Fire, the most deadly in California history, started in the second week of November last year. And the Thomas Fire, a huge blaze that ravaged swaths of Ventura and Santa Barbara counties, erupted in early December 2017 and burned well into January.

The bottom line: Hospitals and clinics must be prepared for this new reality. And so must patients. The following answers to some critical questions will help readers understand what patients’ options will be the next time a vital treatment is threatened by a loss of power.

Q: We have a family member on a ventilator in the hospital. What happens to her if the power goes out?

She will likely not be affected. All California hospitals must have backup generators and enough diesel fuel on hand to run for 72 hours without electricity. The generators kick in within 10 seconds of a power shut-off, Emerson-Shea said, so all critical functions — ventilators, heart monitors, surgical procedures — can continue without interruption.

Q: Some recent outages have lasted longer than 72 hours. What happens then?

As long as the hospital has access to diesel fuel, it can run on its generators for as long as it needs to (although air quality issues arise from their prolonged use). But even with generators, hospital administrators must decide which services are absolutely critical and which ones are temporarily dispensable.

Q: What are some examples of both?

If you have elective surgery like a knee replacement scheduled, and power is expected to be cut off that day, there’s a chance the hospital will reschedule the operation. The generators are intended primarily to power the critical-care functions of a hospital — operating and emergency rooms; labor centers; the monitoring of patients’ heart rates, breathing and blood pressure — and officials will keep those functions going even if it means turning off the building’s air conditioning or heat.

Q: I have a chemotherapy treatment scheduled on a day when a power shut-off may occur. Should I still go?

That depends on your provider. Many oncology practices are located within or next to hospitals, so they would retain access to power even in a shut-off. The situation changes, though, if your treatments are normally provided at a free-standing health clinic or private care center, where such backup may not exist. A survey by the disaster-preparedness nonprofit Direct Relief found that only 44% of California’s community health centers have a backup energy source in case of electrical failure.

Q: What do clinics without backup energy do, then, if the power goes out?

Phone calls by California Healthline to several such clinics found that most of them had a similar plan: Staffers use their cellphones to contact each patient and cancel his or her session. So be aware that you may see an unfamiliar incoming number that turns out to be your provider. If someone from your treatment team doesn’t call you, call them. And if your treatment is canceled, make sure it is rescheduled for immediately after power is restored. A few of the facilities noted that their doctors have privileges at local hospitals, so in cases where the treatment is indispensable, they can send patients there. Emerson-Shea said several hospitals have reported receiving patients who had been directed there by clinics.

Q: How bad is it if I miss a chemo or radiation treatment?

In many cases, a delay of a few days won’t hurt you. But missing a session altogether is not good. A study published by the National Institutes of Health showed that missed chemotherapy doses correlated with worse prognoses and higher mortality rates among cancer patients. Missed radiation treatments, likewise, have been linked to a greater risk of cancer recurrence. So it’s important to stay on track.

Q: What about dialysis? If my clinic has no power, can I get treatment elsewhere?

Yes. During mandatory fire-related evacuations in Sonoma County last month, some clinics with no formal affiliation functioned as ad hoc cooperatives, cross-referring their patients depending upon which facilities were up and running, said Monica Hannaman, a dialysis social worker at Fresenius Medical Care in Santa Rosa. The goal was to treat patients without having to send them to a hospital, she said, “because the hospitals are already so burdened during emergencies like that.”

Also, keep in mind that if your dialysis center is part of a bigger chain, you can go to one of its other locations. Some Sonoma County dialysis patients of San Jose-based Satellite Healthcare, which has multiple locations in California, went as far as Sacramento for treatment last month, said Lanie Borja, manager of the Satellite clinic in Windsor, Calif.

Q: What else can health care providers do to ensure my well-being in the likely case of future power outages?

Hospitals may start rethinking ways to store backup energy, Emerson-Shea said, especially given the long time PG&E has said it will take before it can stop the precautionary outages. Some free-standing medical clinics in areas with high fire and wind risk are considering buying generators large enough to power their operations, despite the big expense. Hannaman said Fresenius is thinking of putting generators in its two Santa Rosa-area clinics, because “this will be happening more often, we’re afraid.”

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.

22 comments

  1. divadab

    It’s easy to make PG&E the goat in this but the forest conditions are not all their doing. As an example of a similar situation, consider the marginal farmlands of New England and southern Quebec. All have robust infrastructure and an organized workforce. But I’ve had 5 day outages last fall and this fall after storms – almost unprecedented in my forty years of experience. Why is this?

    When the farms were electrified in the 30’s, 40’s and early 50’s, (towns had had electricity since the late 19th century in VT thanks to hydro power – the farms had to wait – the linemen followed the least distance path from farm to farm – which meant pole lines went over hill and under dale and generally through pastures. Fast forward – and where there were pastures there is now second growth woodland, as farmers retreated from their most marginal farmland and let it grow back. Now crowded trees reach out into the electric right of way – and when there is an ice storm weighing down the branches, high winds, trees fall on the lines and take out the power in places where back in the day the pole lines were tree-free.

    Combine this with the reluctance of weekenders to re-route power lines along the road and interfere with their view – and you have a structural problem which guarantees more and longer power outages in foul weather – which due to climate change, is also increasing.

    Anyway – at least forest fires are less of an issue in the northeast – but a generator is pretty much a necessity for rural dwellers now plus a good supply of firewood for backup heat. As a side benefit, better jackpot readiness!

    Reply
    1. typing monkey

      And, of course, the public’s reluctance to actually pay for any of this power, forcing utilities to make do with the budgets that are provided to them through a political/regulatory process.

      There have been many comments on these threads that claim that public utilities would be better–I work for one, and they are not. The shareholders just change to government and the regulators are political appointees, and I can assure you that they pressure the utilities to ignore reality just as hard and as often as private shareholders do.

      Reply
  2. Wukchumni

    We have propane powered refrigerator, lights and heater that don’t care if the grid goes down because a utility decides to shut off the juice.

    …a good plan B

    Reply
    1. a different chris

      There were real geniuses once upon a time. I don’t have a propane powered refrigerator, will likely never have a propane powered refrigerator, but from the moment somebody clarified that it isn’t a “propane engine in place of the compressor” but a whole ‘nother way of doing things, I had to know how they worked.

      Who the heck said “hey I’ll start with a flame and wind up with something that can make ice. And – hold my beer – no moving parts!”.

      Really cool, pardon the pun.

      Reply
      1. Chris

        The refrigeration cycle is an amazing thing. I really don’t know how we figured it out when we did, with the technology we did, based on Gibb’s best ideas about what became thermodynamics. It’s incredible.

        I’m hopeful we’ll find a way to do distributed power generation and storage better to help with what’s going on in California.

        I suspect we’ll all end up appreciating Amish A/C soon. I also expect we’ll see some concepts from The Wind-up Girl become real. The Water Knife, too, for that matter. Paolo Baccigalupi might end up being one of the prophets of this age.

        Reply
  3. Shonde

    Unless all cell towers now have back up generators or other sources of electricity, the plan to call patients using cell phones to cancel or reschedule is not possible since there will be no cell service available once electricity is cut off. I was a resident of San Diego County when the county went black in 2011, The only phone that worked was our landline which was at that time still connected to the copper system in the street.
    The old landlines really need to be a national security concern.

    Reply
    1. kimyo

      i never would have willingly abandoned my trustworthy copper-based phone line but when it became unusable due to scratchy interference verizon refused to fix it. the only choice allowed was to install fiber.

      Reply
  4. human

    Good replies above that consider some of the externalities.

    I’d like to point out a misleading answer:

    The generators kick in within 10 seconds of a power shut-off, Emerson-Shea said, so all critical functions — ventilators, heart monitors, surgical procedures — can continue without interruption.

    There has already been a possibly dangerous interuption and in this age of machine assistance there is additional lag time as any number of monitoring/robotic equipment re-initialize.

    Reply
    1. typing monkey

      There should be battery backup, which enables transfer over those 10 seconds.

      The electronics themselves should also have UPSs that cover the transition from primary AC power to the backup.

      Reply
  5. avoidhotdogs

    Please correct me if I’m wrong but does the issue of storage of liquid petroleum/diesel/etc cause problems here? I recall reading that perfect airtight containers are required for these else they won’t work in a backup generator after a certain amount of time (measured in months) ….. It was in a scientific critique of science fiction films in which cars unused for years are suddenly available for driving.

    It seemed to me that backup liquid fuel supplies must be used or replaced on a fairly frequent basis……$$$ Clever people pipe up?

    Reply
    1. Anarcissie

      Gasoline in storage lasts three to six months. Clean, ‘dry’ diesel fuel will last a year or more. Propane and other gases do not themselves deteriorate, but they may leak out of a container.

      Reply
      1. Wukchumni

        We have a large propane tank that feeds into our cabin, with the aforementioned utilities. We keep the propane on all summer, as the fridge is always stocked, and we’re there on an off and on basis. When it’s time to shut down the cabin, we turn off the fridge and defrost it, and then turn off the propane in the late fall, and can turn it on when visiting in the winter.

        I’ve gotten used to living this way, as electronic tethers aren’t tempting treats, and my book reading ju ju is back.

        A great item to get for those of you powerless to stop P G & E from their appointed rounds, is good old fashioned hot water bottles. The best ones are made in Germany, and will keep warm until the morning. Slept with one last night, in fact.

        Reply
        1. inode_buddha

          Furthermore, they add fuel stabilizers for long-term storage, and replenish it regularly. In addition, the generators are exercised often enough to use up the fuel in a given time frame, so they are always ready to run.

          Reply
    2. Chris

      They do cause other issues, but like any engineered system, you have to plan for them. The most obvious problem in California is earthquakes. Keeping large stores of fuel everywhere can be a real concern. People also need to regularly inspect the pressure vessels that hold the fuel. Lack of maintenance, lack of planning, possible fire and explosion risks…that’s all baked into the equation when you’re talking about this kind of solution.

      Reply
  6. McWatt

    I’d like to second the idea that land lines should not be taken away. This should be re-written into all
    telephone company agreements in the U.S.

    Reply
  7. George Phillies

    One might propose replacing the diesel with something that runs on natural gas, which is close to uninterruptible.

    A more serious issue is that these generators were really not designed to keep running indefinitely. This issue almost arose in a dramatic way some years ago in Montreal, or so friends with many relatives in the area reports. There was an ice storm. All power in a vast area was lost. The generators running the city water system were approaching the point where the city water system would shut down, at which point the city is uninhabitable. Apparently the authorities were struggling with the question of how you evacuate a city of 3 million people in mid-winter. Fortunately, power was restored first.

    Reply

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