Louisville, Tennessee
KFF Health News
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When an enormous storm hits, Peninsula Hospital may very well be underwater.
At this decades-old psychiatric hospital on the sting of the Tennessee River, an intense storm might submerge the constructing in 11 toes of water, slicing off all roads across the facility, in keeping with a complicated laptop simulation of flood danger.
Aurora, a younger lady who was dedicated to Peninsula as a young person, mentioned the hospital sits so near the river that it felt like a moat retaining her and dozens of different sufferers inside. KFF Health News agreed to not publish her full identify as a result of she shared personal medical historical past.
“My first feeling is doom,” Aurora mentioned as she watched the simulation of the river rising across the hospital. “These are probably some of the most vulnerable people.”
Covenant Health, which runs Peninsula Hospital, mentioned in a press release it has a “proactive and thorough approach to emergency planning” however declined to supply particulars or reply questions.
Peninsula is certainly one of about 170 American hospitals, totaling almost 30,000 affected person beds from coast to coast, that face the best danger of great or harmful flooding, in keeping with a months-long KFF Health News investigation based mostly on information supplied by Fathom, an organization thought of a frontrunner in flood simulation. At many of those hospitals, flooding from heavy storms has the potential to jeopardize affected person care, block entry to emergency rooms, and power evacuations. Sometimes there is no different hospital close by.
Much of this danger to hospitals is not captured by flood maps issued by the Federal Emergency Management Agency, which have served because the nation’s de facto software for flood estimation for half a century, regardless of being incomplete and generally a long time old-fashioned. As FEMA’s maps have change into divorced from the fact of a altering local weather, personal firms like Fathom have crammed the hole with simulations of future floods. But a lot of their predictions are behind a paywall, leaving the general public principally reliant on free, considerably restricted authorities maps.
“This is highly concerning,” mentioned Caleb Dresser, who research local weather change and is each an emergency room physician and a Harvard University assistant professor. “If you don’t have the information to know you’re at risk, then how can you triage that problem?”
The deadliest hospital flooding in fashionable American historical past occurred 20 years in the past throughout Hurricane Katrina, when the our bodies of 45 individuals have been recovered from New Orleans’ Memorial Medical Center, together with some sufferers whom investigators suspected were euthanized. More flooding deaths have been narrowly prevented one 12 months in the past when helicopters rescued dozens of people as Hurricane Helene engulfed Unicoi County Hospital in Erwin, Tennessee.
Rebecca Harrison, a paramedic, referred to as her kids from the Unicoi roof to say goodbye.
“I was scared to death, thinking, ‘This is it,’” Harrison advised CBS News, which interviewed Unicoi survivors as a part of KFF Health News’ investigation. “Alarms were going off. People were screaming. It was chaos.”
The investigation — among the many first to investigate nationwide hospital flood danger in an period of warming local weather and worsening storms — comes because the administration of President Donald Trump has slashed federal agencies that forecast and respond to extreme weather and likewise dismantled FEMA applications designed to guard hospitals and different essential buildings from floods.
When requested to remark, FEMA mentioned flooding is a standard, pricey, and “under appreciated” catastrophe however made no assertion particular to hospitals. Spokesperson Daniel Llargués defended the administration’s adjustments to FEMA by reissuing an August assertion that dismissed criticism as coming from “bureaucrats who presided over decades of inefficiency.”
Alice Hill, an Obama administration local weather danger skilled, mentioned the Trump administration’s dismissal of local weather change and worsening floods would waste billions of {dollars} and endanger lives.
In 2015, Hill led the creation of the Federal Flood Risk Management Standard, which required that hospitals and different important constructions be elevated or incorporate additional flood protections to qualify for federal funding.
FEMA stopped enforcing the usual in March.
“People will die as a result of some of the choices being made today,” Hill mentioned. “We will be less prepared than we are now. And we already were, in my estimation, poorly prepared.”
The KFF Health News investigation recognized greater than 170 hospitals going through a flood danger by evaluating the areas of greater than 7,000 services to peer-reviewed flood hazard mapping provided by Fathom, a United Kingdom firm that simulates flooding in areas as small as 10 meters utilizing laser-precision elevation measurements from the U.S. Geological Survey.
Hospitals have been decided to have a major danger if Fathom’s 100-year flood information predicted {that a} foot or extra of water might attain a substantial portion of their buildings, excluding parking garages, or lower off street entry to the hospital. A 100-year flood is an intense climate occasion that has roughly a 1% probability of occurring in any given 12 months however can occur extra typically.
The investigation discovered heightened flood dangers at giant trauma facilities, small rural hospitals, kids’s hospitals, and long-term care services that serve older and disabled sufferers. At least 21 are crucial entry hospitals, with the next-closest hospital 25 miles away, on common.
Flooding threatens dozens of hospitals in coastal areas, together with in Florida, Louisiana, Texas, and New York. Farther inland, flooding of rivers or creeks might envelop different hospitals, notably in Appalachia and the Midwest. Even within the sun-soaked cities and arid expanses of the American West, storms have the potential to encompass some hospitals with a number of toes of pooling water, in keeping with Fathom’s information.
These findings are seemingly an undercount of hospitals in danger as a result of the investigation ignored pockets of potential flooding at some hospitals. It excluded services like stand-alone ERs, outpatient clinics, and nursing properties.
“The reality is that flood risk is everywhere. It is the most pervasive of perils,” mentioned Oliver Wing, the chief scientific officer at Fathom, who reviewed the findings. “Just because you’ve never experienced an extreme doesn’t mean you never will.”
Dresser, the ER physician, mentioned even a small quantity of flooding can shut down an unprepared hospital, typically by interrupting its energy provide, which is wanted for life-sustaining gear like ventilators and coronary heart screens. He mentioned essentially the most weak hospitals would seemingly be in rural areas.
“A lot of rural hospitals are now closing their pediatric units, closing their psychiatry units,” Dresser mentioned. “In a financially stressed situation, it can be hard to prioritize long-term threats, even if they are, for some institutions, potentially existential.”
Urban hospitals can face harmful flooding, too. Fathom’s information predicts 5 to fifteen toes of water round neighboring hospitals — Kadlec Regional Medical Center and Lourdes Behavioral Health — that straddle a tiny creek in Richland, Washington.
By Fathom’s estimate, a 100-year flood might trigger the close by Columbia River to spill over a levee that protects Richland, then loosely comply with the creek to the hospitals. Some of the deepest flooding is estimated round Lourdes, which was constructed on land the U.S. Army Corps of Engineers put aside in 1961 as a “ponding and drainage easement.”
At the time, this land was imagined to be able to storing sufficient water to fill at least 40 Olympic-size swimming swimming pools, in keeping with military documents obtained by the Freedom of Information Act. A psychological well being facility has occupied this spot for the reason that Seventies.
Nearly 200 US hospitals in danger from extreme flooding
Both Kadlec and Lourdes mentioned in statements that they’ve catastrophe plans however didn’t reply questions on flooding. Tina Baumgardner, a Lourdes spokesperson, mentioned authorities flood maps present the hospital is not in a 100-year flood plain.
This is not unusual. Of the greater than 170 hospitals with important flood danger recognized by KFF Health News, one-third are positioned in areas that FEMA has not designated as flood hazard zones.
Sometimes the distinction is stark. For instance, at Ochsner Choctaw General in Alabama — the one hospital for 30 miles in any course — FEMA maps recommend a 100-year flood would overflow a close-by creek however spare the hospital. Fathom’s information predicts the identical occasion would flood a lot of the hospital with 1 to 2 toes of water, together with the ER and the helicopter pad.
Ochsner Health didn’t reply questions on flooding preparations at Choctaw General.
FEMA flood maps have been launched within the ’60s as a part of the National Flood Insurance Program to find out the place insurance coverage is required and constructing codes ought to embrace flood-proofing. According to a FEMA assertion, the maps present solely a “snapshot in time” and usually are not supposed to foretell the place flooding will or gained’t occur.
FEMA spokesperson Geoff Harbaugh mentioned the company intends to modernize its maps by the Future of Flood Risk Data initiative, which is able to allow the company to “better project flood risk” and provides Americans “the information they need to protect their lives and property.”
The program was launched by the primary Trump administration in 2019 however has since acquired sparse public updates. Harbaugh declined to supply an in depth replace or timeline for this system.
Chad Berginnis, government director of the Association of State Floodplain Managers, mentioned it is unknown whether or not FEMA is nonetheless attempting to improve its maps below Trump, because the company has lower off communications with exterior flooding consultants.
“There has been not a single bit of loosening of what I’m calling the FEMA cone of silence,” Berginnis mentioned. “I’ve never seen anything like it.”
Floods are anticipated to worsen as a warming local weather fuels stronger storms, drenching areas which might be already flood-prone and bringing a brand new degree of flooding to areas as soon as thought of decrease danger.
The National Oceanic and Atmospheric Administration has mentioned that 2024 was the warmest 12 months on report — greater than 2 levels Fahrenheit increased than the Twentieth-century common. Scientists throughout the globe have estimated that every diploma of world warming correlates to a 4% enhance within the depth of utmost rainfall.
“Warmer air can hold more moisture, so this leads us to experience heavier downpours,” mentioned Kelly Van Baalen, a sea degree rise skilled on the nonprofit Climate Central. “A 100-year flood today could be a 10-year flood tomorrow.”
Intensifying storms elevate considerations about Peninsula Hospital, which has operated for many years mere toes from the Tennessee River however has no identified historical past of flooding.
Nearly 200 US hospitals in danger from extreme flooding
Peninsula spokesperson Josh Cox mentioned the river is overseen by the Tennessee Valley Authority, which makes use of dams to handle water ranges and generate electrical energy. Estimates supplied by the TVA recommend the dams might hold Peninsula dry even in a 500-year flood.
Fathom, nonetheless, mentioned its flood simulation accounts for the dams and harassed that a big sufficient storm might drop extra rain than even the TVA might management. These predictions are echoed by one other flood modeling agency, First Street, which additionally says an intense storm might trigger greater than 10 toes of flooding within the space round Peninsula.
“It’s a hospital right on the banks of a major American river,” mentioned Wing, the Fathom scientist. “It just isn’t conceivable that such a location is risk-free.”
Jack Goodwin, 75, a retired TVA worker who has lived subsequent to Peninsula for 3 a long time, mentioned he was assured the dams might defend the realm. But after reviewing Fathom’s predictions, Goodwin started to analysis flood insurance coverage.
“Water can rise quickly and suddenly, and the destruction is tremendous,” he mentioned. “Just because we’ve never seen it here doesn’t mean we won’t see it.”
One 12 months in the past, as Hurricane Helene carved a lethal path throughout Southern Appalachia, Angel Mitchell was visiting her ailing mom at Unicoi County Hospital within the tiny city of Erwin, Tennessee.
Swollen by Helene, the close by Nolichucky River spilled over its banks and across the hospital, which was inbuilt a flood plain. Staff tried to bar the doorways, Mitchell mentioned, however the water received in, trapping her and others inside. The lights went out. People fled to the roof, the place the roar of dashing water almost drowned out the strategy of rescue helicopters, Mitchell mentioned.
Ultimately, 70 individuals from the hospital, together with Mitchell and her mom, have been airlifted to safety on Sept. 27, 2024. The hospital stays closed, and the corporate that owns it, Ballad Health, has mentioned its reopening is uncertain.
“Why allow something — especially a hospital — to be built in an area like that?” Mitchell advised CBS News. “People have to rely on these areas to get medical help, and they’re dangerous.”
Beyond Unicoi, KFF Health News recognized 39 inland hospitals — together with 16 in Appalachia — that Fathom predicts might flood when close by rivers, creeks, or drainage canals overspill their banks, even in storms far much less intense than Helene.
For instance, within the Cumberland Mountains of southwestern Virginia, a 100-year flood is projected to trigger Slate Creek to engulf Buchanan General Hospital in additional than 5 toes of water.
Near the Great Lakes in Erie, Pennsylvania, LECOM Medical Center and Behavioral Health Pavilion might change into flooded by a small drainage creek that is lower than 50 toes from the entrance door of the ER.
Neither Buchanan nor LECOM responded to questions on flooding or preparations.
And in West Virginia’s capital of Charleston, the place about 50,000 individuals stay on the junction of two rivers in a large and flat valley, a single storm might probably flood 5 of town’s six hospitals without delay, together with colleges, church buildings, hearth departments, and different services.
“I hate to say it,” mentioned Behrang Bidadian, a flood plain supervisor on the West Virginia GIS Technical Center, “but it has all the elements of a real disaster.”
Nearly 200 US hospitals in danger from extreme flooding
At the biggest hospital in Charleston, CAMC Memorial Hospital, Fathom predicts that the Kanawha River might carry as a lot as 5 toes of flooding to the ER. Across city, the Elk River might encompass CAMC Women and Children’s Hospital, slicing off all exits.
And within the middle of town, the place the overflowing rivers are predicted to merge, Thomas Orthopedic Hospital may very well be besieged by greater than 10 toes of water on three sides.
WVU Medicine, which owns Thomas Orthopedic Hospital, didn’t reply to requests for remark.
CAMC spokesperson Dale Witte mentioned the hospital system is conscious of its flood danger and has ready by elevating electrical infrastructure and buying flood-proofing gear, like a deployable floodwall. CAMC additionally commonly revises and drills its catastrophe plans, Witte mentioned, though he added that hospitals there have by no means been examined by an actual flood.
Shanen Wright, 48, a lifelong Charleston resident who lives close to CAMC Memorial, mentioned many within the metropolis have little fear about flooding within the face of extra speedy issues, just like the opioid epidemic and the decline of producing and mining.
Tugboats and coal barges sail previous his neighborhood as in the event that they have been automobiles on his avenue.
“It’s not to say it’s not a possibility,” he mentioned. “I’m sure the people in Asheville and the people in Texas, where the floods took so many lives, they probably didn’t see it coming either.”
Despite huge scientific consensus that local weather change fuels extra harmful climate, the Trump administration has taken the position that considerations about international warming are overblown. In a speech to the United Nations in September, Trump referred to as local weather change “the greatest con job ever perpetrated on the world.”
The Trump administration has made deep workers and funding cuts to FEMA, NOAA, and the National Weather Service. At FEMA, the cuts prompted 191 present and former staff to publish a letter in August warning that the company is being dismantled from inside.
Daniel Swain, a University of California local weather scientist, mentioned the administration’s rejection of local weather change has left the nation much less ready for excessive climate, now and sooner or later.
“It’s akin to enforcing malpractice scientifically,” Swain mentioned. “Imagine making a medical decision where you are not allowed to look at 20% of the patient’s vital signs or test results.”
Under Trump, FEMA has additionally taken actions critics say will depart the nation extra weak to flooding, particularly:
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FEMA disbanded the Technical Mapping Advisory Council, which had repeatedly pushed the agency to modernize its flood maps to estimate future danger and account for the impacts of local weather change.
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FEMA canceled its Building Resilient Infrastructure and Communities program, which supplied grants to assist communities and very important buildings, together with hospitals, defend themselves from floods and different pure disasters.
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And after stopping enforcement early this 12 months, FEMA intends to rescind the Federal Flood Risk Management Standard, which was designed to harden buildings towards future floods and save tax {dollars} in the long term.
Berginnis, of the Association of State Floodplain Managers, mentioned the administration’s unwillingness to arrange for local weather change and worsening storms would lead to a harmful and expensive cycle of flooding, rebuilding, and flooding once more.
“The president is saying we are closed for business when it comes to hazard mitigation,” Berginnis mentioned. “It bugs me to no end that we have to have reminders — like people dying — to show us why it’s important to make these investments.”
FEMA didn’t reply particular questions on these selections. In the assertion to KFF Health News, spokesperson Llargués touted the administration’s response to flooding in Texas and New Mexico and mentioned FEMA had supplied billions of {dollars} to assist individuals and communities get better and rebuild. He didn’t point out any FEMA funding for safeguarding towards future floods.
Few hospitals perceive this menace greater than the previous Coney Island Hospital in New York City, which has suffered catastrophic flooding earlier than and has ready for it to come back once more.
Superstorm Sandy in 2012 pressured the hospital to evacuate tons of of sufferers. When the water receded, fish and a sea turtle have been discovered within the constructing.
Eleven years later, the ability reopened as Ruth Bader Ginsburg Hospital, reworked by a FEMA-funded $923 million reconstruction venture that added a 4-foot floodwall and elevated affected person care areas and utility infrastructure above the primary flooring.
It is now seemingly one of the crucial flood-proofed hospitals within the nation.
But, to this point, no storm has examined the ability.
Svetlana Lipyanskaya, CEO of NYC Health+Hospitals/South Brooklyn Health, which incorporates the rebuilt hospital, mentioned the query of flooding is “not an if but a when.”
“I hope it doesn’t happen in my lifetime,” she mentioned, “but frankly, I’d be surprised. The water is coming.”