The Supreme Court of the United States (SCOTUS) is the highest judicial body in the United States and leads the judicial branch of the United States federal government.
The court consists of nine Justices: the Chief Justice of the United States and eight Associate Justices. The Justices are nominated by the President and confirmed with the "advice and consent" of the Senate. Appointed to serve for life, they can be removed only by resignation, or by impeachment and subsequent conviction.
The judicial Power of the United States, shall be vested in one supreme Court, and in such inferior Courts as the Congress may from time to time ordain and establish. The Judges, both of the supreme and inferior Courts, shall hold their Offices during good Behavior, and shall, at stated Times, receive for their Services a Compensation which shall not be diminished during their Continuance in Office.
The Supreme Court holds both original and appellate jurisdiction, with its appellate jurisdiction accounting for most of the Court's caseload. The court's original jurisdiction is narrowly focused, as defined in Article III, Section 2 ("In all Cases affecting Ambassadors, other public Ministers and Consuls, and those in which a State shall be Party, the supreme Court shall have original Jurisdiction"). The court's appellate jurisdiction encompasses "all cases" within the scope of Article III, but is subject to limitation by acts of Congress under the Exceptions Clause in Article III and by the discretion of the Court.
The Supreme Court meets in Washington, D.C., in the United States Supreme Court building. The Court is sometimes referred to by the abbreviations SCOTUS (Supreme Court of the United States) and USSC (United States Supreme Court). The Court's yearly terms usually start on the first Monday in October and finish sometime during the following June or July. Each term consists of alternating two week intervals. During the first interval, the court is in session ('sitting') and hears cases, and during the second interval, the court is recessed to consider and write opinions on cases they have heard.
The History of the Supreme Court is frequently described in terms of the Chief Justices who have presided over it.
Initially, during the tenures of Chief Justices Jay, Rutledge, and Ellsworth (1789–1801), the Court lacked a home of its own and any real prestige.
That changed forever during the Marshall Court (1801–1835), which declared the Court to be the supreme arbiter of the Constitution (see Marbury v. Madison), and made a number of important rulings which gave shape and substance to the Constitutional balance of power between the Federal government (referred to at the time as the "general" government) and the states. But Martin v. Hunter's Lessee showed the limits of that federal power—although the U.S. High Court declared itself supreme over the Virginia state court, it had a difficult time enforcing its judgment in a hostile state. The Marshall Court ended the practice of each judge issuing his opinion seriatim, a remnant of British tradition, and instead one majority opinion of the Court was issued. The Marshall Court also saw Congress impeach a sitting Justice, Samuel Chase, who was acquitted. This impeachment was one piece of the power struggle between the Jeffersonians and the Federalists after the election of 1800 and the subsequent change in power. The failure to remove Chase is thought to signal the recognition by Congress of judicial independence.
The Taney Court (1836–1864) made a number of important rulings, such as Sheldon v. Sill, which held that while Congress may not limit the subjects the Supreme Court may hear, the Constitution does not so restrain it where lower courts are concerned. However, it is primarily remembered for its ruling in Dred Scott v. Sandford, the case which may have helped precipitate the Civil War. In the years following the Civil War, the Chase, Waite, and Fuller courts (1864–1910) interpreted the new civil war amendments to the Constitution, and developed the doctrine of substantive due process (Lochner v. New York; Adair v. United States). Under the White and Taft courts (1910–1930), the substantive due process doctrine reached its first apogee (Adkins v. Children's Hospital), and the Court held that the 14th Amendment applied some provisions of the Bill of Rights to the states (Gitlow v. New York).
During the Hughes, Stone, and Vinson courts (1930–1953), the court gained its own accommodation and radically changed its interpretation of the Constitution in order to facilitate the New Deal (West Coast Hotel Co. v. Parrish), giving an expansive reading to the powers of the Federal Government. The Warren Court (1953–1969) made a number of alternately celebrated and controversial rulings expanding the application of the Constitution to civil liberties, leading a renaissance in substantive due process. It held that segregation was unconstitutional (Brown v. Board of Education), that the Constitution protects a general right to privacy (Griswold v. Connecticut), that schools cannot have official prayer (Engel v. Vitale) or mandatory Bible readings (Abington School District v. Schempp), dramatically increased the scope of the doctrine of incorporation (Mapp v. Ohio; Miranda v. Arizona), read an equal protection clause into the Fifth Amendment (Bolling v. Sharpe), held that the states may not apportion a chamber of their legislatures in the manner in which the United States Senate is apportioned (Reynolds v. Sims), and held that the Constitution requires active compliance (Gideon v. Wainwright).
The Burger Court (1969–1986) ruled that abortion was a constitutional right (Roe v. Wade), reached muddled and controversial rulings on affirmative action (Regents of the University of California v. Bakke) and campaign finance regulation (Buckley v. Valeo), and that the death penalty was unconstitutional (Furman v. Georgia) and then later that it was not unconstitutional (Gregg v. Georgia).
The Rehnquist Court (1986–2005) narrowed the focus of the private right of action, the right of labor unions to picket (Lechmere Inc. v. NLRB) and of Roe v. Wade (Planned Parenthood v. Casey) but dramatically circumscribed the ability of states to regulate abortion (Stenberg v. Carhart), gave sweeping meaning to ERISA pre-emption (Shaw v. Delta Air Lines, Inc., Egelhoff v. Egelhoff) thereby denying plaintiffs access to state court with the consequence of limiting compensation for tort like harm to medical patients covered by employer plans to very circumscribed remedies (Aetna Health Inc. v. Davila, CIGNA Healthcare of Texas Inc. v. Calad) and began an instauration of federalism, limiting the scope of Congressional power under the Commerce Clause (United States v. Lopez; United States v. Morrison).
The Roberts Court (2005-present) began with the confirmation and swearing in of John Roberts on September 29, 2005, and is the currently presiding court.
The Justices of the Supreme Court of the United States as of 2007. Top row (left to right): Stephen G. Breyer, Clarence Thomas, Ruth Bader Ginsburg, and Samuel A. Alito. Bottom row (left to right): Anthony M. Kennedy, John Paul Stevens, Chief Justice John G. Roberts, Antonin G. Scalia, and David H. Souter.
The United States Constitution does not specify the size of the Supreme Court; instead, Congress has the power to fix the number of Justices. Originally, the total number of Justices was set at six by the Judiciary Act of 1789. As the country grew geographically, the number of Justices steadily increased to correspond with the growing number of judicial circuits. The court was expanded to seven members in 1807, nine in 1837 and ten in 1863. In 1866, however, Congress wished to deny President Andrew Johnson any Supreme Court appointments, and therefore passed the Judicial Circuits Act, which provided that the next three Justices to retire would not be replaced; thus, the size of the Court would eventually reach seven by attrition. Consequently, one seat was removed in 1866 and a second in 1867. By the Circuit Judges Act of 1869, the number of Justices was again set at nine (the Chief Justice and eight Associate Justices), where it has remained ever since. President Franklin D. Roosevelt attempted to expand the Court (see Judiciary Reorganization Bill of 1937); his plan would have allowed the President to appoint one new, additional justice for every justice who reached the age of seventy but did not retire from the bench, until the Court reached a maximum size of fifteen justices. Ostensibly, this was to ease the burdens of the docket on the elderly judges, but it was widely believed that the President's actual purpose was to add Justices who would favor his New Deal policies, which had been regularly ruled unconstitutional by the Court. This plan, referred to often as the Court Packing Plan, failed in Congress. The Court, however, moved from its opposition to Roosevelt's New Deal programs, rendering the President's effort moot. In any case, Roosevelt's long tenure in the White House allowed him to appoint eight Justices to the Supreme Court and promote one Associate Justice to Chief Justice.
Article II of the Constitution provides the power to appoint Justices belongs to the President, acting with the "advice and consent" of the Senate. As a general rule, Presidents nominate individuals who broadly share their ideological views. However, nominees whose views are perceived as extreme may be blocked by the Senate (see List of Failed Nominations to the Supreme Court of the United States). In many cases, a Justice's decisions may be contrary to what the nominating President anticipated. A famous instance was Chief Justice Earl Warren; President Eisenhower expected him to be a conservative judge, but his decisions are arguably among the most liberal in the Court's history. Eisenhower later called the appointment "the biggest damn fool mistake I ever made".
While the President may nominate anyone (there are no qualifications listed in the Constitution regarding prior legal or judicial experience, nor are there any exclusions of foreign-born nominees), the "advice and consent" of the Senate is required for appointment. The confirmation process often attracts considerable attention from special-interest groups, many of which lobby senators to confirm or to reject. The Senate Judiciary Committee conducts hearings, questioning nominees to determine their suitability. At the close of confirmation hearings, the Committee membership vote on whether or not the nominee is qualifed to be confirmed before the entire Senate. If the Committee votes to recommend that the nomination be confirmed, it proceeds to the full Senate. Alternatively, if a majority of the membership disapprove of the nomination but still believe it should be considered by the full Senate, they can advance the nomination with an adverse report.
If the committee reports out the nomination, the whole Senate considers it; a simple majority vote is required to confirm or to reject a nominee. Rejections are relatively uncommon; the Senate has explicitly rejected only twelve Supreme Court nominees in its history. The most recent rejection of a nominee by vote of the full Senate came in 1987, when the Senate refused to confirm Robert Bork. In 1991, Clarence Thomas's nomination was hampered by allegations of sexual harassment by a former colleague, but the Senate eventually confirmed him by a slim majority vote of 52-48.
Not everyone nominated by the President has received a floor vote in the Senate. Although Senate rules do not allow a negative vote in committee to block a Supreme Court nomination, a nominee may be filibustered once debate on his nomination has begun in the full Senate. A filibuster indefinitely prolongs the debate thereby preventing a final vote on the nominee. It is also possible for the President to withdraw a nominee's name at any time before the actual confirmation vote occurs. This usually happens when the President feels that the nominee has little chance of being confirmed. Most recently, President George W. Bush granted a request by Harriet Miers to withdraw her 2005 nomination before even a committee hearing had been scheduled, citing Miers' concerns about Senate requests during her confirmation process for access to internal Executive Branch documents resulting from her position as White House Counsel. Prior to that, President Ronald Reagan in 1987 withdrew the name of Douglas H. Ginsburg soon after the announcement of his nomination because of allegations of marijuana use.
While senators may attempt to filibuster a Supreme Court nominee in an attempt to thwart confirmation, no nomination for Associate Justice has ever been filibustered. However, President Lyndon Johson's nomination of sitting Associate Justice Abe Fortas to succeed Earl Warren as Chief Justice was successfully filibustered in 1968.
Until the 1980s, the approval process of Justices was frequently quick. From the Truman through Nixon administrations, Justices were typically approved within one month. From the Reagan administration through the current administration of George W. Bush, however, the process took much longer. Some speculate this is because of the increasingly political role Justices are said to play.
When the Senate is in recess, the President may make a temporary appointment without the Senate's advice and consent. Such a recess appointee to the Supreme Court holds office only until the end of the next Senate session (at most, less than two years). To continue to serve thereafter and be compensated for his or her service, the nominee must be confirmed by the Senate. Of the two Chief Justices and six Associate Justices who have received recess appointments, only Chief Justice John Rutledge was not subsequently confirmed for a full term. No president since Dwight Eisenhower has made a recess appointment to the Supreme Court and the practice has become highly controversial even when applied to lower federal courts.
The Constitution provides that Justices "shall hold their Offices during good Behavior" (unless appointed during a Senate recess). The term "good behavior" is interpreted to mean life tenure. However, Justices may resign, retire, or be removed by impeachment and conviction by congressional vote (the last has never occurred; the only Justice ever impeached, Samuel Chase, was acquitted by the Senate and not removed from office). On average, a vacancy arises every two years; however, long stretches without any vacancies occur from time to time. For instance, no vacancy arose for the eleven years between Stephen Breyer's appointment in 1994 and Chief Justice William Rehnquist's death in 2005.
The Supreme Court's jurisprudence is often evaluated with respect to the service of a particular Chief Justice. Thus, for example, the Court between 1969 and 1986 is referred to as the "Burger Court" (for Chief Justice Warren E. Burger) and the Court between 1986 and 2005 is referred to as the "Rehnquist Court" (for Chief Justice Rehnquist).
Under the Judiciary Act of 1789, each Justice was required to "ride circuit," or to travel within the assigned circuit and consider cases alongside local judges. This practice, however, encountered opposition from many Justices, who complained about the difficulty of travel. Moreover, several individuals opposed it on the grounds that a Justice could not be expected to be impartial in an appeal if he had previously decided the same case while riding circuit. Circuit riding was abolished in 1891. Now, the duty of a Supreme Court Justice in this regard is generally limited to hearing emergency petitions in the relevant circuit and some other routine tasks like addressing certain requests for extensions of time. The Justice assigned to a given circuit is known within that circuit as "the Circuit Justice" and may, but in practice almost never does, sit as a judge of that circuit. A Circuit Justice takes precedence over the Chief Judge of the circuit when a Justice decides to sit.
The Chief Justice is usually assigned to the District of Columbia Circuit, the Federal Circuit and the Fourth Circuit (which surrounds the District of Columbia); each Associate Justice is assigned to one or two judicial circuits.
For the D.C. Circuit, John G. Roberts, Jr.
For the Fourth Circuit, John G. Roberts, Jr.
For the Eighth Circuit, Samuel A. Alito, Jr.
For the Federal Circuit, John G. Roberts, Jr.
The circuit assignments frequently, but do not always and need not, reflect the geographic regions where the assigned Justices served as judges or practitioners before joining the Supreme Court. Four of the current Justices are assigned to circuits on which they once sat as circuit judges: Chief Justice Roberts (D.C. Circuit), Justice Souter (First Circuit), Justice Stevens (Seventh Circuit), and Justice Kennedy (Ninth Circuit). Furthermore, Justices Thomas and Ginsburg are assigned to the circuits that include their home states (the Eleventh and Second Circuits, respectively).
David Souter September 17, 1939 67 New Hampshire G.H.W. Bush 90-9 October 9, 1990 Circuit Judge, Court of Appeals for the First Circuit (1990–1990); Associate Justice, New Hampshire Supreme Court (1983–1990); Associate Justice, New Hampshire Superior Court (1978–1983); Attorney General of New Hampshire (1976–1978); Deputy Attorney General of New Hampshire (1971–1976); Assistant Attorney General of New Hampshire (1968–1971); Private practice (1966–1968).
As of 2006, the average age of the U.S. Supreme Court justices is 66 years. See also Demographics of the Supreme Court of the United States.
Research suggests that justices are often strategic in their decisions to leave the bench with personal, institutional, and partisan factors playing a role. The fear of mental decline and death often precludes justices from stepping down. The desire to maximize the Court's strength and legitimacy through one retirement at a time, when the Court is in recess, and during non-presidential election years suggests a concern for institutional health. Finally, if at all possible, justices seek to depart under favorable presidents and senates to ensure that a like-minded successor will be appointed.
Currently, there is only one retired Justice of the Supreme Court, Sandra Day O'Connor, who announced her intent to retire in 2005 and was replaced by Justice Alito in 2006.
During Court sessions, the Justices sit according to seniority, with the Chief Justice in the center, and the Associate Justices on alternating sides, with the most senior Associate Justice on the Chief Justice's immediate right, and the most junior Associate Justice seated on the left farthest away from the Chief Justice. Therefore, the current court sits as follows from left to right when looking at the bench from the perspective of a lawyer arguing before the Court: Breyer, Thomas, Kennedy, Stevens (most senior Associate Justice), Roberts (Chief Justice), Scalia, Souter, Ginsburg and Alito (most junior Associate Justice).
Seven of the current justices of the court were appointed by Republican Presidents, while two were nominated by a Democrat. In legal circles, it is popularly accepted that Chief Justice Roberts and Justices Scalia, Thomas, and Alito compose the Court's conservative wing. Justices Stevens, Souter, Ginsburg and Breyer are generally thought of as the Court's liberal wing. Justice Kennedy is considered a moderate conservative, who is most likely to be the swing vote that determines the outcome of close cases.
The Supreme Court occupied various spaces in the United States Capitol until 1935, when it moved into its own purpose-built home at One First Street Northeast, Washington, DC. The four-story building was designed in a classical style sympathetic to the surrounding buildings of the Capitol complex and Library of Congress by architect Cass Gilbert, and is clad in marble quarried chiefly in Vermont. The building includes space for the Courtroom, Justices' chambers, an extensive law library, various meeting spaces, and auxiliary services such as workshop, stores, cafeteria and a gymnasium. The Supreme Court building is within the ambit of the Architect of the Capitol, but maintains its own police force, separate from the Capitol Police.
The Constitution specifies that the Supreme Court may exercise original jurisdiction in cases affecting ambassadors and other diplomats, and in cases in which a state is a party. In all other cases, however, the Supreme Court has only appellate jurisdiction. The Supreme Court considers cases based on its original jurisdiction very rarely; almost all cases are brought to the Supreme Court on appeal. In practice, the only original jurisdiction cases heard by the Court are disputes between two or more states.
The power of the Supreme Court to consider appeals from state courts, rather than just federal courts, was created by the Judiciary Act of 1789 and upheld early in the Court's history, by its rulings in Martin v. Hunter's Lessee (1816) and Cohens v. Virginia (1821). The Supreme Court is the only federal court that has jurisdiction over direct appeals from state court decisions, although there are a variety of devices that permit so-called "collateral review" of state cases.
The Supreme Court may only hear actual cases and controversies. It does not hear moot cases or issue advisory opinions. However, the Court may consider some cases, such as Roe v. Wade, that become moot during the judicial process, if it appears that the legal issue involved is likely to arise again but would not be reviewable by the Court under a strict mootness analysis. "Roe" had already had her baby when the case came to the Supreme Court, because judicial activity (trials, appeals and so on) takes much longer than human gestation. Because future abortion cases would face the same time constraints, the Court decided the case in spite of its mootness.
The Supreme Court is not required to hear every case presented to it. In cases that are heard by a three-judge United States district court (a practice that formerly was somewhat common but has been limited to very few cases by legislation in recent years), there is a right of appeal directly to the Supreme Court, although the Court may dispose of these appeals by summary order if it does not believe they are important enough for full briefing and argument. In most instances, however, the party must petition the Supreme Court for a writ of certiorari. By custom, certiorari is granted on the vote of four of the nine Justices. In most cases, the writ is denied; the Supreme Court normally only considers matters of national or constitutional importance. If the Court refuses to grant certiorari, it does not comment on the merits of the case; the decision of the lower court stands unchanged as if Supreme Court review had not been requested.
Supreme Court decisions are typically cited as in the following example: "Roe v. Wade, 410 U.S. 113 (1973)." The citation consists of the names of the opposing parties; the volume number; "U.S." (signifying United States Reports, the official reporter of Supreme Court decisions); the page number on which the decision begins; and the year in which the case was decided. The names of the opposing parties are listed in the format "Petitioner v. Respondent" or "Appellant v. Appellee." The Reporter of Decisions is responsible for publication of the Court's rulings. There are two other widely-used reporters: the Supreme Court Reporter and the Lawyer's Edition, corresponding to two privately-published collections of decisions. For more information on how these reports are cited, see case citation.
The Constitution does not explicitly grant the Supreme Court the power of Judicial review; nevertheless, the power of the Supreme Court to overturn laws and executive actions it deems unlawful or unconstitutional is a well-established precedent. Many of the Founding Fathers accepted the notion of judicial review; in Federalist No. 78, Alexander Hamilton writes: "A constitution is, in fact, and must be regarded by the judges, as a fundamental law. It therefore belongs to them to ascertain its meaning, as well as the meaning of any particular act proceeding from the legislative body. If there should happen to be an irreconcilable variance between the two, that which has the superior obligation and validity ought, of course, to be preferred; or, in other words, the Constitution ought to be preferred to the statute." The Supreme Court first established its power to declare laws unconstitutional in Marbury v. Madison (1803), consummating the system of checks and balances.
The Supreme Court cannot directly enforce its rulings; instead, it relies on respect for the Constitution and for the law for adherence to its judgments. One notable instance of nonacquiescence came in 1832, when the state of Georgia ignored the Supreme Court's decision in Worcester v. Georgia. President Andrew Jackson, who sided with the Georgia courts, is supposed to have remarked, "John Marshall has made his decision; now let him enforce it!"; however, this quotation is likely apocryphal. State militia in the South also resisted the desegregation of public schools after the 1954 judgment Brown v. Board of Education. More recently, many feared that President Richard Nixon would refuse to comply with the Court's order in United States v. Nixon (1974) to surrender the Watergate tapes. Nixon, however, ultimately complied with the Supreme Court's ruling.
The Constitution provides that the salary of a Justice may not be diminished during his or her continuance in office. This clause was intended to prevent Congress from punishing Justices for their decisions by reducing their emoluments. Together with the provision that Justices hold office for life, this clause helps guarantee judicial independence. However, as seen above, the President's practice of appointing justices with similar real, perceived or expected ideology can be seen to compromise judicial independence.
"I had never before argued a Supreme Court case on my own. Since arguments in that court are thirty minutes in length per side, and since most of the time consumed in argument is taken up with responses to questions of the Court, Dean and I devoted most of our preparation to three overlapping issues, ones that have consumed my attention in every later Supreme Court argument as well. The first was jurisprudential in nature. What rule of law were we urging the Court to adopt? How would it apply in any future case? What would be its impact on First Amendment legal doctrine?" Floyd Abrams, discussing Landmark Communications v. Virginia.
^ Todd S., Purdum. "Presidents, Picking Justices, Can Have Backfires", Courts in Transition: Nominees and History, New York Times, July 5, 2005, p. A4. Retrieved on 2006-04-24.
^ Quoted in the book by Floyd Abrams, Speaking Freely (2005), Page 65.
American Bar Association. (2002). "The ABA Standing Committee on Federal Judiciary: What It Is and How it Works."
Joan Biskupic and Elder Witt. (1997). Congressional Quarterly's Guide to the U.S. Supreme Court. Washington, D.C.: Congressional Quarterly Press.
Kermit Hall, et al. (1992). The Oxford Companion to the Supreme Court of the United States. New York: Oxford University Press.
Harvard Law Review Assn., The Bluebook: A Uniform System of Citation (17th Ed. 2000).
Peter Irons. (2000). A People's History of the Supreme Court. New York: Penguin.
Martin v. Texas, 200 U.S. 316, 26 S.Ct. 338, 50 L.Ed. 497 (1906).
William Rehnquist (1987). The Supreme Court. New York: Knopf.
The Rules of the Supreme Court of the United States (2005 ed.) (pdf).
Snowden v. Hughes, 321 U.S. 1, 64 S.Ct. 397, 88 L.Ed. 497 (1944).
Artemus Ward, Deciding to Leave: The Politics of Retirement from the United States Supreme Court, New York: SUNY Press, 2003.
Charles Warren. (1924). The Supreme Court in United States History. (3 volumes). Boston: Little, Brown and Co.
Bob Woodward, and Scot Armstrong. (1979). The Brethren: Inside the Supreme Court. New York: Simon & Schuster.
Garner, Bryan A. Black's Law Dictionary. Deluxe 8th ed. West, 2004. ISBN 0-314-15199-0.
Irons, Peter and Howard Zinn. A People's History of the Supreme Court. New York: Viking, 1999. ISBN 0-670-87006-4.
Rehnquist, William H. The Supreme Court. New York: Knopf, 2001. ISBN 0-375-40943-2.
Urofsky, Melvin and Paul Finkelman. A March of Liberty: A Constitutional History of the United States. 2 vols. New York: Oxford, 2001. ISBN 0-19-512637-8 & ISBN 0-19-512635-1.


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text:
Hospitals In Focus
Mike Wargo Discusses How Hospitals Are Preparing for Emergencies
Dr. Jonathan Perlin Discusses How Patients Benefit From the Use of Big Data
Bill Carpenter Discusses Advances, Challenges in Rural Health Care
From natural disasters to human tragedies, community hospitals have to be ready for anything and everything. Health care and hospitals especially have a role in every disaster that faces our country. In this episode, HCA Healthcare's Mike Wargo, VP of Enterprise Preparedness and Emergency Operations, sits with Chip in their brand new Emergency Operations Center in Nashville, TN. They discuss how hospitals are preparing for everything from major weather events like Hurricane Michael to man-made disasters like electrical grid failures. After our original conversation with Mike in August, two major storms hit the U.S., so we reached out to him again to talk about HCA Healthcare's response. Those stories of incredible cooperation are included in this episode.
Take a look at HCA Healthcare's Emergency Operations Center in action during Hurricane Florence: https://www.facebook.com/HCACare/videos/274748799807478/
For additional information on how HCA Healthcare responded to Hurricane Michael click here: https://hcatodayblog.com/2018/10/11/hurricane-michael-updates/
Chip Kahn (00:10):
Today's topic is emergency preparedness. We're coming to you from the new Emergency Operations Center at HCA headquarters in Nashville. Our guest is Mike Wargo, Vice President Enterprise Preparedness in Emergency Operations here at HCA. HCA is one of the nation's leading providers of healthcare services, and is made up of locally managed facilities that include 178 hospitals and 119 freestanding surgery centers located in 20 states and in the United Kingdom.
Mike Wargo is really a unique individual, not only as I said is he hold an important vice presidency position here at HCA, but he has a vast resume in the areas of counter terrorism as well as emergency preparedness and operations, and also has experience as a flight nurse.
Currently, he serves as co-chair of the United States Health and Public Health Sector Coordination Council of the National Critical Infrastructure Protection Program, which is sanctioned by the United States Department of Homeland Security and Health and Human Services. In this role, he serves as a trusted advisor to both federal secretary level leadership and private industry executives on readiness, response, and recovery initiatives impacting the U.S. healthcare national security system and healthcare system.
Now, Mike, as we prepared for this podcast, it became clear that because of the scale and size of HCA, your facilities have been in the eye of the storm literally and figuratively when it comes to disasters, both national and natural, and manmade, throughout the United States. Just last year, you had hospitals that were hit by hurricanes Harvey and Irma, and your team at Sunrise Medical Center in Las Vegas treated 100s of those affected by the tragic mass shooting at a concert there in Las Vegas.
But frankly for HCA, it's nothing new. There were also the recent Austin package bombings. Then going back, the Virginia Tech shooting, the Oklahoma City bombing, and even the anthrax attacks in Florida, which were actually identified at an HCA hospital. Of course, as a native of new Orleans, I am all too familiar with Hurricane Katrina. I think in terms of laying out our program today, I'd like to start there and ask you to talk about Katrina as not just an American tragedy, but in a sense as a watershed event for American preparedness and meeting disasters.
Mike Wargo (03:17):
Thanks for having me, first of all. Absolutely, the experience that not only HCA experienced during Katrina, but really the nation as a whole, healthcare globally as a whole, toward readiness was really appreciated. Or maybe the lack of preparedness at the time, or appreciation for what was needed, was really appreciated. We all know the devastation that it caused, the magnitude of the storm. But it really brought together the concept of having dedicated resources, really focusing on infrastructure and looking at infrastructure not just at utility failures, but looking at natural hazards like storms, and where do we put our generators, are they best served to be elevated or ground level.
With Katrina, certainly the experience was we need to move them higher for flood prone areas. Even the resources, what needs to come to bear when something of magnitude happens. Certainly for HCA, prior to my arrival, long before my arrival here when Katrina happened, it was a moment where they realized that it's important to preplan and have playbooks, to bring resources together for any type of incident, small scale, large scale, et cetera. So that we can continue to provide that patient care in our communities, not just during a disaster, but immediately following and managing the continuity of healthcare.
Chip Kahn (4:27):
Well, Katrina was many years ago. Since then, much prep has been done along the lines that you described. I guess in terms of these recent events, the playbook came out somewhat different with Harvey and Irma?
Mike Wargo (4:42):
Much different. Playbook is the key term because we literally have a library of playbooks for natural and manmade type disasters or potentials that we assess, hurricanes being one of them. That playbook, for example, starts 120 hours prior to the impact of a storm. It focuses on all the functional areas of our organization. It starts with, "How do we get ready once there's a notice?" 120 hours out, we start with staffing plans. We start to mobilize resources into an area.
This is way different from the Katrina days in a sense that we certainly are much better prepared because we've learned through experience. We pre-position resources into facilities, into communities, including things that most healthcare systems don't think of. Remediation teams, if there's storm damage to our structure, we have teams that are sheltering throughout the storm onsite to rebuild the facility, to make sure the plant operates, et cetera.
We also have on retainer a contract with a fleet of helicopters and planes to not only move patients, what we call de-risking, meaning moving those higher critical patients out of a risk area for a known event prior to the event. We also use those resources to shuttle equipment into areas.
For Harvey, for example, the contract that we had was with a company that also owns tourism helicopters. We found it more valuable to use the tourism helicopters to fly our nurses in from staging areas into hospitals that weren't accessible due to flooding, and get the staff that was in the area out so they can go assess their homes and get their lives back in order. For us, we had zero days of business closure because we were able to replenish our staff through these resources that we have.
It also includes playbooks for events like cyber. It wouldn't be in our favor that there was a cyber event on our wire. How do we go from the digital world to the analog world? That's a big challenge because one technical system, take an electronic health record, brings so many efficiencies. We can assess our patients and record it. Physicians could automate orders, laboratory results, diagnostics. Things that years ago would take dozens of people to accomplish in a very analog or manual process. Newer staff, younger staff, who have never experienced that, this presents a challenge.
The playbooks are now built to give them an illustration of here's a scenario. Here's the expected actions or considerations that we need to take in advance of, as I said, a natural or manmade type event.
Mike, and you begin to hit on this, can you catalog for us what the principles are that are really generalizable in these kind of situations that… Frankly, I'm not sure it's just healthcare organizations, but any critical community services have to go through when they think about how to be ready and how HCA gets ready?
Sure. There's a national framework. It really consists of four modules, very often considered mitigation preparedness response and recovery. Here at HCA, we have a slight iteration change where it's responsible leadership, which really talks about our leadership's commitment to preparedness in general. Having the resources in place, organizing an instant command structure. Then we have readiness response and recovery. For us, readiness includes preparedness, but it's also the immediate ability to respond.
Three tenets that we promote, not just in a response phase, but communication, coordination, collaboration. As you can imagine, nearly 200 hospitals, numerous physician offices, it's really important for us to maintain situational awareness. What's going on in the various local communities? What resources might be needed by our facilities or by the communities that we serve?
That's where the commination and the coordination comes into play. The collaboration really speaks to are we good community partners? Are we meeting with our healthcare coalitions, our neighboring hospitals that every day might be healthcare competition. In emergency operations, it's not competition, it's collaboration. There are the three tenets that we focus on.
Then most importantly, all our actions are really driven by the potential impacts. The potential impacts are the life safety impact, the physical or emotional impact on our patients and their family, our staff and their family, or the community. The priorities for our actions always start with life safety.
Followed by infrastructure. We look at hardening our facilities prior to a storm. We look at putting preparedness mechanisms in place to defend and prevent cyber intrusions. That's the infrastructure protection. Then the operations actually, delivering the care, maintaining healthcare operations within the community.
Lastly, is the mission. What are we doing to maintain the operational integrity of the company based on any type of impact or insult? We look at the greatest risk, and that's how we also prioritize our actions.
You know, when I was growing up, it's not so true today, but I don't want to show my age. You'd go around to different places and they would be these nuclear whatever signs-
Fallout shelters.
Fallout sheds, someplace in the basement. They were rusting cans and boxes of whatever. I guess for that period that defined preparedness, which was everybody put it in the basement and put up the signs on the sides of the buildings and that was it.
Fortunately, nothing ever happened. On the other hand, would that have worked even though you could have said there was preparedness? How do you, in an ongoing dynamic world, keep yourself ready to actually respond when preparedness can so easily become routinized?
We talk about really goes back to cold war civil defense. Part of us is we're living that again, the threat overseas to Hawaii, those duck and cover stories come back out. Civil defense has really matured from civil defense to emergency management. Now specific to healthcare, it's a maturing model or industry within healthcare, emergency operations. Part of what we do is focus on our core business, number one, being healthcare in the community.
When you look at any great impact to a community, somehow healthcare's always involved. Whether it's an industrial fire or an explosion in a community, there's always life safety and healthcare. There's traffic ways, railways, and those type of accidents, accidental or unintentional manmade events like a train derailment present different challenges.
Then you look inside and we are an organization where industry that's very much people driven, we care for people, we're managed by people. That brings its own threat, be it you're traveling and you don't have good hygiene, and you catch the flu. Now we're interacting with patients and patient family members. We want to prevent them from being impacted by the flu.
We really look at a broad spectrum of what can impact our core business to deliver care to the community. That's where we start to prioritize what has a direct patient impact, what has an interdependent or collateral impact on patient care. Then what's the likelihood of something to happen within a community?
There's various assessments that we do called hazard vulnerability analysis. We look at our top human risks, our top technological risks, chemical risks. From that risk assessment, we gauge what's the impact on direct patient care, financial integrity of the industry, not just the company, but the industry as a whole. Then we look at what counter measures do we have that if something impacts us, how can we respond to it, mitigate the impacts, manage the core business of patient care? Really the vulnerability's translated to where we don't have a good countermeasure or good ability to respond. That's where our greatest risk is.
That's where we focus quite a bit of planning toward readiness. Looking at the training and the education for our staff. Even simple briefings, making folks aware that a risk exists. Guiding them, what can they do as individuals and what can they do as healthcare providers? A big component of that is also focusing on the staff themselves to ensure that they have their own personal preparedness and readiness plans.
We talked a short while ago about Katrina versus Harvey and Irma last year. A major focus of not only our company but the responders in general was is your family prepared. We know many days in advance the storm was coming. We recommended to folks if your family can leave the area and seek shelter out of the impact area, it's advisable. Certainly, within our facilities, many family members came in and sought shelter there. We weren't even focused not only on the patients but now community members that needed to shelter in hospitals.
There's a broad spectrum of risk. It's really identifying where your inability to respond or have the greatest impact is without additional preparedness. That's where our focus goes.
Are there any differences in the way you think through man-made versus these large events as hurricanes or major weather events that sometimes you can see coming, but are community wide versus something that might be incredibly destructive but limited in the sense, but make great demands on the hospital like the event at Sunrise Medical Center, or the event in Las Vegas that obviously affected Sunrise Medical Center and the other hospitals there at Las Vegas at that shooting?
Absolutely. There's a difference in readiness related to manmade versus natural events. More importantly, I would categorize it as notice events versus no notice events. There's no notice events that are natural like tornadoes. They pop up. They go through a community and have widespread destruction, to a no notice event like the Route 91 or what is known to be One October Shooting in Las Vegas. The risk is there. It's a known unknown. We know things will happen like mass shootings. We know tornadoes are going to hit. When and where exactly, we don't know.
There are readiness plans that can go in place for tornadoes. Having a communication plan that when the warning goes out from the National Weather Service or your local, that we pull our patients away from the glass windows into hallways or we prepare the facilities the best we can in the event of a direct impact.
The no notice events like a mass shooting, it's difficult to prepare in the communities where it's going to happen but hospitals considered soft targets to domestic terrorism. Many hospitals do active shooter planning. Hospitals are very prone to violence because we care for victims of violence. That brings violence to healthcare facilities. Our hospitals, as well as the great majority of hospitals, put a lot of time into how can we prevent the violence on the every day.
In the event that violent act happened on our property or within our walls, how do we respond? Again, communication, coordination are key. Collaboration with our local law enforcement. Communicating to the staff that an incident's happening. Having gone through exercises and practice with them that if the overhead for an event like happens, how do you take care of yourself, number one, personal safety, and then your patient. Ensure that that we're protecting them and our visitors as much as we can, as the collaboration with our security force and the local enforcement really go after that direct threat.
The notice versus the no notice events guides our readiness a little bit differently. The notice events like a hurricane, we've got reports 72 to 120 hours from impact, we can start to position and have a different cadence of readiness activities and coordination. There is definitely a cadence difference. There's definitely an anxiety that's different when you know something is going to impact you versus you've got to get into gear and respond like at a shooting like Las Vegas.
Yeah, the Las Vegas was an amazing event to me. In Sunrise alone, there were 199 patients treated in under six hours, which is just staggering, and that was just one of the hospitals in Las Vegas that was treating 100s of patients.
Mike, I should note that you and I are not just sitting in another office building. We're actually sitting in the emergency center that's been developed by HCA. Can you give us some sense of what went into the thinking when you built this center and some of its characteristics that people might consider unique?
Absolutely. We talked about the scale of HCA. Part of the challenge as a company as large we are is, if you look at the board out there, our interns started a little checklist and says, "Days since last incident." It's hit two days at its max. It's at zero again today. Every day the company is faced with a different emergency in the various communities that we serve. This really serves to maintain situational awareness toward our corporation, be it responses to the community, be it infrastructure issues that we have that we have to support throughout the country, to just coordination of preplanned events goes on here.
You have a series of three conference rooms here that are tied together through pretty advanced technology. The suite itself is on segregated utilities, power, heating, ventilation, air conditioning, internet, phone service. It's got redundant communications for satellite communications. We're below ground for a reason. Nashville is at risk for tornadoes, so we're not above ground so that if the local community's impacted, this facility itself is secure. We don't have the risk of the natural threats like tornadoes and the flooding that traditionally has gone on here.
More importantly, it's a dedicated center that during a time of crisis, we don't have to take the resources to transition a conference room into a command center or a coordination center. The technology sits in here in a readiness state every day. We're well connected through social media, moderating platforms, incident management systems that we're logged into the communities in our facility. At any given time, you can look at these dashboards and have a pulse for what's happening from an emergency perspective across the company.
We really pride ourselves in the name preparedness and emergency operations because it's not just about emergency preparedness. The state where do your assessments and put things in a readiness state. It really is about functioning every day and ensuring effective situational awareness and communications every day. It's about bringing all the various business functional units together to have a state of mind that no matte what we're challenged with, we come together as a team to work through the operations itself, to ensure that each of our facilities we can maintain patient care and are ready every day.
Before we close out, Mike, I guess one thing I'd like to return to Harvey and Irma. One of the things that was unique about that, at least from my observation relatively unique, was that those storms hit over a short period of time, but vastly different areas of the country. Ironically, HCA was engaged with hospitals in both areas. It would stretch any organization, even if it was the government, and you had to face that. What are your observations in closing from that?
The hurricanes of 2017 were really unprecedented because it was back to back large scale storms with tremendous magnitude. Harvey, as lessons from Katrina taught us to prepare, respond and coordinate. What it surprised us with, not just us at HCA but the community, was the storm stalled. What we thought to be a hurricane which is certainly a rain storm with high winds became a major flooding event. The plans for major flooding are very different from a hurricane event.
That challenged resources in the sense that air operations were on hold for many days because the storm stalled for three days. Accessibility to healthcare services to get to our staff and into the community was challenged because roadways were flooded. Our company got creative. One of our security managers, Kevin Cleveland, suggested we should get those duck boats that they tour in. We actually did to shuttle supplies from roadways across some waterways that were flooded that weren't free flowing. We moved resources. Innovation is absolutely key.
The challenge was that it was so widespread across all of Texas, from a local to a state to a federal response. Then those same responders and those same critical resource re- suppliers for generators and pharmaceutical supplies, et cetera, were challenged to now move from Texas into Florida. There's time to move resources. There's time to take response assets and personnel. Now they're fatigued responding to Texas. We're moving resources into Florida. Not just HCA again, but as a nation as a whole. The same people were exhausted. The manpower became an issue for many. That's where the collaboration of what resources do we have, what resources do other companies and services have, and how can we support one another and the community came into play.
Challenges certainly in many cases were answered by innovation. In times of crisis, a lot of barriers come down, and a lot of bureaucracy comes down. People can think on their feet and get access to resources pretty quickly. We're really proud to see how our company and the community really rallied to support the needs in the community and to support one another with the various challenges that we were faced with.
One of the nice things about podcasts is flexibility. We originally recorded this podcast with Mike last August. However, since then, there have been two major storms, Florence on the Atlantic coast, and Michael on the Florida panhandle, that have affected HCA hospitals and patients.
They offer us an opportunity to ask an additional question to Mike, which is looking at the 2018 storms and noting as you pointed out talking about preparation for storms in general, that you've seen one storm, you've seen one storm. What was unique and what was the experience with Florence and Michael that you think would be most illustrative of how HCA has to have contingencies to prepare for different kinds of storms?
Thanks for having me back. That's an excellent question. I've got a lot to share, but I'll keep it pretty brief. The framework that we deploy for emergency operations hasn't changed. The constant in terms of readiness and response has been the point of success for the company and for the communities.
When we look a Hurricane Florence, we had plenty of notice, well over 120 hours that a hurricane, high tropical storm, was coming off the coast of Africa heading in our direction, to the point that we almost had too much time and notice that people… We engaged our readiness with our cadence as typical, and the storm was still out there, and it was still out there.
We knew at the point of Florence getting closer by 72 hours out that within the Myrtle Beach area, we would either sustain a direct strike on our facility that's right on the water in Myrtle Beach, or we would sustain a very nearby strike. We made a decision quite early in that process, and early in the decision process is about 72 hours from impact, that we were going to fully evacuate the Myrtle Beach, the Grand Strand Medical Center. Right around 200 patients give or take a few, were either early discharged appropriately or transported in the masses by ground to both HCA and non- HCA facilities outside the risk area.
Then for our critical patients that required critical care transport in ICUs, it presented a very unique challenge to us in the sense that typically we use helicopters or rotor wing air medical to move those sick patients. The proximity of Myrtle Beach to the majority of the receiving hospitals that were outside of any risk area where it was safe to de-risk our patients to, was not a close proximity. It challenged us in the sense that we had to use fixed wing or airplane medical transport for all of those sick patients.
Logistically, that was a new challenge for us that rotor wing could not be used in the sense that it was all fixed wing. We had the right partner that brought those aircraft in and were able to safely move those patients out of the area.
The other component to Florence was the magnitude and the broad scope of where it was going to hit. It was pretty well known from the southern portion of North Carolina to the norther portion of South Carolina, that strike zone was clearly identified within the path. There was tremendous collaboration amongst the healthcare facilities, the state, and our partners at HHS in terms of readiness.
We look at the response to Hurricane Michael, that we're highly engaged in. Hurricane Michael was very much like Harvey in the sense that it was going into the Yucatan Peninsula as a high tropical storm. Then made this right turn into the Gulf late into the season, such that the waters were warm, the evenings were beginning to cool off. Typically, what that means for us is storms intensify significantly overnight, and that held true.
Where it really paralleled Harvey was it was a tropical storm that we knew was on its way, but it turned into hurricane conditions much quicker than expected, but also much further into our readiness timeline. We didn't have the typical five to seven days of known significant storm coming at us. It was that low grade tropical storm that very quickly intensified to cat one, cat two, and some would argue that in some sense it could even truly have been a cat five in certain areas. It was the highest end of cat four in terms of wind impact on the facilities.
Where it hit in the Gulf Coast Panama City area, there were two primary hospitals very close to the water. Our Gulf Coast regional medical center in Panama City being one of them. Another community hospital just a few miles down the road. Both of them sustained significant structural damage. The other community hospital much more than us, primarily because of its proximity closer to the eye of the storm. Then our facility that sustained structural damage, mostly superficial structural damage.
Then broader impact on the overall healthcare system was truly related to the community impact of no power, no water, no sustainable utilities within the community. Both facilities, and the only two in Bay County, are out of service in terms of acute care. I'm not sure the status of the ER at the other facility. At this point, our ER facility, our Gulf Coast Medical Center, is operating as a freestanding emergency department, transferring any patient that would need admission outside that region.
It sounds like the two storms really were unique. One you had time to plan, and the other one was on top of you before you knew it. Is there anything that you could say about rain and water versus wind because it sounds like in the Michael situation, it was really the strength and power of the storm itself, not the water that made the big difference. Is there anything that you prepare for and learned from your Michael experience?
Your observation's spot on. You said it before, you've seen one hurricane or one storm, you've seen one hurricane or one storm. The Florence was similar to Harvey in the sense that it was almost that stall storm again. The wind impact was significant, but not catastrophic. Where the water impact as it went up the coast, the storm slowed and stalled and dumped significant amounts of water on northern South Carolina and then pretty much throughout North Carolina into the capital region.
That created a tremendous challenge because once the storm passes, it doesn't mean the risk and the threat is over. It actually gives us almost a false sense of security because what happens, particularly with the Florence event and that rain and stall like Harvey, was the northern waterways and tributaries surge and have flash flooding and sustained flooding. That water goes south and it goes toward the coast. We have to very strategically look at where our staff lives, where our tributaries of waters lie, what the flood plains and tables are. Not just during the event, but the weeks following the event because that water's coming back down.
We again look at Michael, that stall and that significant water event really impacted us for two almost three weeks where the threat of community-wide flooding and infrastructure outages existed from a mass flooding event or a major flooding event. This is something that can be predicted in the sense that there's population growth, there's community growth, with hard space from an infrastructure standpoint that we need to be much more aware of. We're dealing with the same crisis this past week in the city of Austin where all of healthcare was greatly impacted from the rain events that contaminated the water supply. A totally different scenario, but again lessons learned from these storms that contribute to more events.
Looking at Michael, Michael was almost like a widespread tornado that came through with such high magnitude of wind shear and impact on the community. If you had the opportunity to go down there or just watching the media reports, to see the impact from the wind on that community was absolutely devastating.
The challenges there initially are, one, it's not safe to transverse the community, the roadways, because there's power lines that are down. There's trees and debris everywhere. Pre-staging remediation resources within our facility was a key element to us rapidly getting back to the restoration of that facility. We did that with the anticipation of this looks like a high category storm, which translates to high wind impact. We did bring remediation teams that sheltered in our facilities. Literally the next morning, once the storm had passed, they were on site clearing debris, doing immediate repairs to the facility, and cleaning the space up itself so that we can restore healthcare operations as quick as we can.
Two different considerations to go into play. You go back into the Carolinas with Florence and that significant rain storm, some of the lessons that we brought from there and truly this is the mindset, and the genesis was from our emergency planners from across HCA. We bring some folks here to the corporate Emergency Operations Center.
During the storms and pre-storm, we put them in a conference room, and we give them as much information and intelligence on our facilities as we can provide to them. To me, they're a catastrophic impact assessment team. We give them worst case scenario while we're managing the readiness. They're in a separate room saying, "If we have a direct strike, what are the priorities we need to be concerned about? How do we manage the patients if there are any in-house? How do we respond so that if we have that hardened strike, we already have a team that has studied the facilities, that knows what the proprieties need to be, is in communication with the facility and onsite, and we can immediately respond and react."
The lessons learned that they provided to us from Florence and the flooding event was we need to re-look at our hurricane and our major storm playbooks, and have a flood push pack, which essentially would be flood mitigation, be it sandbags or some new technology that as the water hits it, it self-inflates and prevents flooding. Looking at areas that traditionally have flooded on property, and marking the ground so that we know our high risk areas prior to a flood, and we can just do different mitigation strategies to prevent water from going in the facilities.
That same team that I spoke of during the response to Michael was here in Nashville and throughout the pre-storm and into the storm, they did that catastrophic planning for us. We knew what our priorities would be. We knew how many patients remained onsite. We knew what resources it would take and where those patients would go immediately post storm if we had a significant impact. We had a pretty moderate impact to that facility, but had a significant community impact which forced us post storm to evacuate.
We immediately deployed that catastrophic planning team as an incident support team the very next day by plane down into the community so that they then went boots on the ground and they assisted that leadership team with a list of… We've rehearsed this. We feel the priorities are, we are going to present them to you. If you concur, let's take action and make this happen.
That was another best practice I really believe that came out of both of these storms that will inform the future readiness and response of HCA to future events.
You've described how you're going to treat these storms and move into the future on the facilities themselves and capacity. On the employee side, on the caregiver side, obviously they're impacted because they lie in the community. What kind of things did you do with the healthcare workers in both the Florence and the Michael situation? In terms of those who provide the care, do you have any lessons there going forward?
Absolutely. First of all, this is what makes me most proud to be a member of HCA is to see not only how we care for our patients, but how HCA stood up to care for every single one of our staff members and their family, not just pre-event but post. It's truly shown as a company what we've done with them in mind.
What we do pre-storm is continue to communicate to them. Every Enterprise and regional call we have for readiness always ends with prepare yourself, prepare your family. If you are part of A or B team that is committed to be onsite to ensure that quality care continues for our patients, we will assist in sheltering your families as needed, in some case, the pets as well. We have plans to manage that because we know continuity of direct care needs to go on, and we need to invest in our staff. That means we need to take care of them and help protect them as well.
We do offer those resources in that [inaudible 00:37:49] storm. For those that are not working on a high impact event, we encourage them ready your house, ready your property. If you can, throughout the event, relocate to an area outside the direct impact zone so that you're safe, you don't have the worry about your family, the structure of the property. We'll get through together post storm once we're engaged in [inaudible 00:38:11].
As the storm came through, we used our mass notification system that's pretty new to the company to push messages, in this case for Hurricane Michael, to 6,700 employees that live in that region, saying HCA emergency operations is engaged in preparing for the storm. You will receive additional messaging from us with resource availability or resources that are available to you post storm. We're also going to check on your status to ensure you're safe and you're okay. We did continue to use that mass massaging system for that throughout.
Post storm, we had an overlay from the National Oceanic Service. I think most people may be familiar with this that they did satellite images pre-storm and post-storm that showed the devastation and the impact. One of the systems that we used was our HR system to look at every employee address. Not who lives where, but just the physical address of our employees. We did a heat map that we overlaid on that impact map that NOAA provided. We were able to quickly assess where we needed to focus on employee residence in terms of what resources can we get to them, where can we set up shelters. Our Human Resources Department set up employee shelters for those that may have had a direct impact. It gave us an assessment of what percentage of our workforce have sustained a tremendous loss or a tremendous impact on their life.
That simple innovation really gave us the ability to understand how much of an impact on the workforce there would be. We continued those processes throughout until we had 100% accountability from every single one of those staff members that number one, they were safe. Then we began the process of what impact have you had? Can we help you get through the FEMA assistance application process, which is number one after we get life safety taken of.
Number two, we have an internal system called Hope Fund, where it's employees helping employees. So far as teams from across HCA deploy to that hospital and set up an employee commissary where those that had loss can come in and get a backpack. That backpack has all the basic essentials, toothbrush, deodorant, sweat pants, [inaudible 00:40:43] that if they have absolutely nothing after the storm, they have the basic essentials to life. Then the commissary had cleaning supplies and diapers for babies and formula, you name it, the company thought of it and provided that as a benefit to our staff to take care of them.
Well, that's really impressive, Mike. I know it's so important that the staff be ready to take care of patients. Knowing that HCA is going take care of them and their families in the process is just so important.
Mike, we've spent a lot of time focusing on what you have done as a company to make sure that the patients and the caregivers come first at the hospitals. Obviously, in terms of the larger community and the role that HCA hospitals play in the larger community, there's the governmental entities, the other first responders. In terms of these recent storms, what was the level of cooperation, how did you feel about the coordination?
Was it where we needed to be as a nation when we faced these tremendous weather challenges?
Chip, I've been in emergency operations for well over 20 years related to healthcare. I would say that this has been the most collaborative and effective response and coordination that I've experienced in the majority of my time. Not just by HCA to the other facility in Bay County, but more so the collaboration that we had with the State of Florida and their responsiveness, the collaboration that we received from the Office of the Assistant Secretary from Preparedness Response at HHS, the ASPR. We engaged with them very quickly at the state, at the coalition of regional level. Our federal partners, unlike prior years have taken an approach of a forward lean where they pre-deployed federal assets into the Jacksonville and Mobile, Alabama area. Looking at the high potential.
That communication with our state partners and coalition and the feds, each morning we stood up, what I defined as a unified leadership call. That call was the three HCA facilities in the direct impact zone, any local healthcare coordinators, the State of Florida, the ESFA or the Emergency Support Function Aid, which is health and medical of the state emergency operations center. Then the regional emergency coordinators from ASPR were on that call. It started every day with the State of Florida and the Hospital Association giving us essentially an overview. The state of wellness of healthcare in the community and impacts are pretty tremendous every morning. Our facilities on what's your direct impact, what needs do you have?
We very quickly realized that the community impact was tremendous. Both of the acute care hospitals had direct strikes. That we could not get through this alone, even with the resources that HCA as an enterprise has, we still required the resources and collaboration from the state to provide to the community. In turn, our federal partners stood up. We requested federal assistance to DMAT, disaster medical assistance teams, to respond to our emergency departments for the mission of decompression. What that means is we knew that we can operate an emergency department, but we didn't have the surgical services, the cardiac services, all that needed services or admission. With that, our emergency department quickly would be overwhelmed.
This has been the quickest federal response to have federal boots on the ground that I've experienced in my career where we had within less than 36 hours a fully established DMAT base of operation. A special thank you to Massachusetts One, who was the DMAT team at Gulf Coast Regional and Delta One from Mississippi that was at Fort Walton Beach, and our colleagues from Michigan One. Some shout outs here, but they absolutely deserve it because these are colleagues from all across the country that we collaborate with in a routine basis that come together as intermittent federal employees. They were there and without their assistance, we would have been crippled. We would have been overwhelmed.
They were able to take on a high portion of the ER volume that came in. They would stabilize. We'd also stabilize. Then we'd use the local resources, either the helicopters to fly the critical patients out to other receiving centers, or the FEMA EMS [inaudible 00:45:42] two days to transport them by ground. It wasn't unique to our facility. The other community hospital in Panama City was in the same circumstance, where we had to do this.
What I would say is collaboratively local, state, federal and us as a private service coming together, there was no interruption in healthcare services to that community. There continues not to be because of the collaboration. I think that's pretty important because there's a lot of commentary and rhetoric that goes on that talks about systems not effective and not working. I'd say in my experience and my observation, it was pretty tremendous how they've come together to work collaboratively for the community.
Thanks terrific, Mike, and really good to know that you can depend on the government and the other officials at all those levels and other institutions to all row in the same direction when we're dealing with some kind of challenges that we are.
With that, Mike, it really has been a great opportunity to talk with you and learn about how HCA faces these kinds of challenges. Particularly, as I mentioned, having the unique aspect of a podcast where we come back in and experience with you the most recent events before the podcast actually plays during our season. We had really a good discussion that should open a lot of eyes about being ready for as well as meeting head on these challenges that hospitals and communities face when there's a major event whether it's weather or manmade. With that, I just want to appreciate you taking time this afternoon.
Thanks for having me.
Thanks for listening to Hospitals in Focus. Please be sure to subscribe to us on Apple Podcast, Google Podcast, your favorite podcast platform, or by visiting us at our website, FAH.org. We hope you will share your reviews and tell a friend about us.
Thanks so much for listening.
Mike Wargo, HCA Healthcare
Mr. Michael Wargo is the Enterprise Vice President for Preparedness & Emergency Operations. Mike joined HCA Healthcare in 2016 and was tasked to lead the organization's disaster and emergency operations program across both the U.S. and metro London area of the U.K. In both 2017 and 2018, Mike and his team, along with the entire enterprise, were faced with a number of incidents that present significant challenges to HCA's ability to provide care. Mike brought to HCA more than 20 years of clinical experience in high quality patient-centered care and more than a decade in public safety leadership. He also currently serves as the Chairman of the Emergency Preparedness Committee for the Federation of American Hospitals and is a co-chair of the U.S. Health and Public Health Sector Coordination Council (HPH-SCC) of the National Critical Infrastructure Protection Program. In this role, he serves as a trusted advisor to both Federal Secretary-level leadership and private industry executives on readiness, response and recovery initiatives impacting the U.S. health care national security. Mike is a veteran health care leader with experience that includes leading the medical operations division of Northeast Regional Counter-Terrorism Task Force based in PA. He is the prior Administrator and Chief of Emergency Operations for Lehigh Valley Health Network and a former Flight Nurse and Administrator of LVHN-MedEvac. Federally, Mike still serves in the role of Supervisory Nurse Specialist for the HHS National Disaster Medical Services. His combined experience includes both domestic and international homeland security and medical response training & operations. Mike holds multiple post-graduate certifications in homeland security, disaster preparedness and medical transport. He is a graduate of St. Luke's School of Nursing with a Diploma of Nursing, Kutztown University of PA with a bachelor's degree in Nursing, and he received his Master of Business Administration from the American Military University.
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text:
Resumption of fistic excellence as local boxers gear up for Tri Nation affair
Feb 12, 2017 Sports 0
3 shortlisted for tournament in Azerbaijan
After ending last year on a high where they had clinched the lion's share of gold medals at the Caribbean Developmental Boxing Tournament in Bridgetown Barbados, Guyanese amateur pugilists are set to continue their
Seon Bristol (left) and Steve Ninvalle are collaborating for this amateur event. (File Photo)
dominance in the ring when they square off with their counterparts from Suriname, St Maarten and Trinidad and Tobago in one night of fistic fury next Sunday February 19.
The action is slated for the National Gymnasium, Mandela Avenue, and will feature fifteen local boxers matching skills with those of the above mentioned countries in what the organizers assure will test the mettle of the local punchers.
Two former boxers, Seon Bristol and Alford MacDonald, are the driving forces behind the card which has received the blessings of the Guyana Boxing Association (GBA). Mr. Bristol arrived in Guyana yesterday morning and immediately started putting the modalities in place for an unforgettable night of fistic fury; his organizing counterpart, Alford MacDonald is expected from his Miami base by Wednesday.
To date, Suriname has endorsed the participation of 5 boxers, while those administrators of the other two participating countries have requested a few more days to affirm their numbers.
Mr. Bristol admitted to the challenges of promoting cards of this nature owing to a paucity of adequate sponsorship. Nevertheless, he remains adamant that boxing must not be the casualty and as such, is willing to plod the extra mile in the realization of his goals. "I am prepared to look past those challenges to ensure that local pugilists remain active," Bristol said in answer to a question of the boxers' activity. He remained firm that inadequate funding should not be the decisive factor in the scheme of things.
Admission to the fights will be $1000 for the VIP section and $500 for general admission. Mr. Bristol further said that the organizers will place a high premium on punctuality and the first bell will be sounded at 20:00hrs sharp.
Meanwhile, President of the GBA, Steve Ninvalle, has lauded the efforts of the organizing crew and said that his entity is indeed delighted that those stalwarts could shrug aside the challenges to make the card a reality.
Mr. Ninvalle said that he is extremely delighted by those efforts and urged the boxers to train hard in order to produce the fiery contests fans have come to enjoy. The GBA boss said that this year will be a hectic one for local pugilists and already three boxers have been spotlighted and advised to commence training for a tournament in Azerbaijan slated for May. Those boxers are heavyweight Jason Baker, Desmond Amsterdam (middleweight) and lightweight Joel Williamson. Mr. Ninvalle said that the fund raising drive to facilitate these boxers' trip has already begun and he has recently dispatched the names to the President of the Guyana Olympic Association, K. A. Juman Yassin, for possible financial and other assistance.


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Suspect Sought in Eighth District Stabbing Incident
by Aaron E. Looney
Categories: Be on the Lookout
Topics: Assault/Battery, Eighth District
The NOPD is seeking to identify and locate a suspect in the investigation of an aggravated battery by cutting incident that occurred on September 11, 2022, in the 800 block of Burgundy Street.
NOPD Identifies Suspect Wanted for Attempted Murder in Shooting Investigation
Topics: Assault/Battery, Third District
The NOPD has obtained an arrest warrant for Michael Ranson (pictured, black male, DOB; 09-26-1999, 5'10", 176 pounds) in the investigation of a shooting that occurred on September 11, 2022, in the 5000 block of Lakeshore Drive.
UPDATE: NOPD Arrests Wanted Suspect in Fourth District Attempted Murder
Topics: Assault/Battery, Fourth District
UPDATE: Wanted suspect Christopher Allen was located and arrested today (September 7, 2022) in this investigation. He was booked accordingly into the Orleans Parish Justice Center.
Suspects Wanted by NOPD in Investigation of First District Shooting Incident
Topics: Assault/Battery, First District
The NOPD is seeking the public's assistance in identifying and locating two suspects wanted in the investigation of a shooting on August 23, 2022, in the 1100 block of North Rampart Street.
Suspect Identified by NOPD in Fourth District Domestic Aggravated Burglary
Topics: Assault/Battery, Burglary/Theft, Fourth District
The NOPD has obtained an arrest warrant for Lemar Harris (pictured, black male, DOB: 10-02-1993) in the investigation of a domestic aggravated burglary incident on September 3, 2022, in the 2000 block of Pace Boulevard.
Displaying results 26-30 (of 1181)


This may break your bubble, but if you can't take it with you when you die, it was never really yours.
As a human, you have stewardship over the material world while you are here, but when you try to "own" physical stuff, you waste your precious time defending that claim.
Your time cannot be saved for later and is at the center of all that matters.
Spend it wisely in stewardship of all that surrounds you.
I hope everyone is enjoying the awesome weather this summer. I just wanted to let you know I will be out of the office next Thursday and Friday, July 4th and July 5th. I will be available Monday, Tuesday and Wednesday next week to help you prepare for your holiday adventures. Please call Christina at 436-9355 to reserve your spot.
I so look forward to getting to work each morning. I revel in the opportunity to help people recover from serious health problems.
My thoughts this morning are again on equality. Can two individual human beings be equal? I like to split the human experience into four parts. Which of these parts can be brought to equal across a group of people?
These factors carry varying weight and can shift as time passes.
Notice the only part of this equation that is actually equal on both sides is time.
Time is where we are equal.
What we each do with our time as it passes creates separation or understanding between us. Then the beat goes on…. Each pulse we all loose time, gain experience, face challenges, and live on.
Cleveland Chiropractic College is publishing an informative E-Magazine for Chiropractors and our patients. Please enjoy this link and make sure you bring up anything you find interesting.
Cleveland Chiropractic College – May/Jun 2013, Vol. 6, No. 3.
A moment in humble gratitude for the opportunity of another day.
My thoughts go out to the suffering around the globe.
Massive earth quakes, blizzards and acts of war are challenging the hearts of man.
Fear not, you must not cover your love.
Tell someone you love them today, and mean it.
Any action steps conceived with fear in our hearts will only paralyze our progress to the benefit of the status quo.
Conceive your response to tragedy in gratitude and love and you will help all of us heal and improve.
The living puzzle we call our body.
As always, I am constantly trying to come up with the wording to help people understand the difference between what I do and what happens at a typical medical doctors office.
This morning the following analogy came to mind. I would love your input. Does this help explain things, or does it just make it more confusing?
Your body is made up of trillions of cells. These cells are arranged into tissues, organs and organ systems that work together to perform the various activities needed to keep the community (body) alive. Think of it as a complex moving puzzle.
When you go to a typical medical doctor with a problem s/he is going to perform a series of exams that may include blood work, xrays, sonograms, MRIs, and other tests. The purpose of these exams is to take the puzzle apart and look at the smaller pieces more closely to try and determine what exactly is causing your discomfort. Their entire system is based on this reductionist model of the body. Their preferred treatments are based on taking over for what ever piece of the puzzle isn't working right with external chemical or surgical interventions.
What i do is interview you to see where you've been, where you are now, and where you want to go with the remainder of your life. I perform a few orthopedic and neurological tests to get your body to show me what it is dealing with. Then I set about restoring things to a more natural configuration, allowing the innate intelligence of the body to regenerate itself into a more vigorous and happy formation moving forward.
Sometimes aggressive intervention is necessary. But I have found over the years, most of the time, my methods are much more likely to produce a happy outcome in both the short and long term with far fewer side effects and subsequent illness.


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Internazionali BNL d'Italia
Venus Williams cruises, holder Dinara Safina loses first match in Rome 2010
The 1999 Rome champion Venus Williams cruised to the third round of this year's tournament with a 6-2 6-2 victory over Patty Schnyder. The fourth-ranked Williams, who had a bye in the first round, was playing her first match since a decisive loss to Kim Clijsters in the Sony Ericsson Open final in the beginning of March. The reason for Williams' layoff was a knee problem, but the time out didn't prevent the American from extending her career record against Schynder to 10-0.
Defending champion Dinara Safina, seeded third, is still under the radar because of her back injury and the fact that her second-round match in Rome was only her third since January. The Russian world No.3 came back from 4-0 down to level to 4-4 in the first set against Romanian world No.43 Alexandra Dulgheru, before quickly losing the initiative and the set. Safina managed to win the topsy-turvy second set in the tiebreak, before crushing in the decider. Final score: 6-4 6-7(5) 6-1.
I would like to mention one more result: seed No.7 Jelena Jankovic defeated good friend Bethanie Mattek-Sands 6-3 3-6 6-1 in the second round. (photos: sr_cranks)
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Previous articleAna Ivanovic beats Elena Vesnina at the Internazionali BNL d'Italia round one
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Venus Williams presents EleVen dress for the 2021 Australian Open
Snake, zebra and tie-dye prints: EleVen by Venus Williams Spring/Summer 2021 collections
EleVen by Venus Williams in 2020: Sparkly details, floral prints, superheroes and K-Swiss partnership
jacob May 5, 2010 At 4:05 am
Venus looked hot!!!


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The GMS Program
Economic Corridors
Health and HRD
Transport and Trade Facilitation
GMS Summits
Ministerial Conference
Economic Corridors Forum
Summary of Proceedings
Greater Mekong Subregion-Phnom Penh Plan for Development Management Research Reports
This series features the scholarly works under the Phnom Penh Plan for Development Management, a region-wide capacity building program of the Asian Development Bank that supports knowledge products and services.
Factors Affecting Firm-Level Investment and Performance in Border Economic Zones and Implications for Developing Cross-Border Economic Zones between the People's Republic of China and its Neighboring GMS Countries
The establishment of cross-border economic zones in the border areas of the People's Republic of China and its neighboring countries in the Greater Mekong Subregion has recently emerged as a strategy for further promoting trade and investments in the subregion. Unlike a border economic zone (BEZ), which is confined within the national territory, a CBEZ is an economic zone traversing a transnational area and requiring a unified set of policies and incentives in such areas as finance, taxation, investment, trade, and customs regulation.
Read more about Factors Affecting Firm-Level Investment and Performance in Border Economic Zones and Implications for Developing Cross-Border Economic Zones between the People's Republic of China and its Neighboring GMS Countries
Improving Accessibility of Financial Services in the Border-Gate Areas to Facilitate Cross-Border Trade: The Case of Viet Nam and Implications for Greater Mekong Subregion Cooperation
Over the years, cross-border trade has expanded rapidly among countries in the Greater Mekong Subregion (GMS). Among the factors that contributed to this phenomenon is the application of a number of cross-border trade facilitation measures.
Read more about Improving Accessibility of Financial Services in the Border-Gate Areas to Facilitate Cross-Border Trade: The Case of Viet Nam and Implications for Greater Mekong Subregion Cooperation
Earnings and Quality of Female Labor in the Border Areas of Viet Nam and Implications for Greater Mekong Subregion Cooperation
Border-gate economic zones (BEZs) are symbols of the increased cross-border exchange and the development initiative of the border areas in the Greater Mekong Subregion (GMS). Over the past decade, BEZs have been able to attract a great number of women workers seeking for new job opportunities.
Read more about Earnings and Quality of Female Labor in the Border Areas of Viet Nam and Implications for Greater Mekong Subregion Cooperation
Cross-border Contract Farming Arrangement: Variations and Implications in the Lao People's Democratic Republic
This paper presents the variations and implications of contract farming arrangements in three case studies - cabbage, maize, and sugarcane - in the Lao People's Democratic Republic (Lao PDR).
Read more about Cross-border Contract Farming Arrangement: Variations and Implications in the Lao People's Democratic Republic
Last Updated: Friday, 13 April 2018
The Phnom Penh Plan for Development Management: A Retrospective
More on Health and HRD
Greater Mekong Subregion Secretariat
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