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Highlights

Hurricane Katrina demonstrated difficulties involved in evacuating communities and raised questions about how hospitals and nursing homes plan for evacuations and how the federal government assists. Due to broad-based congressional interest, GAO assessed the evacuation of hospital patients and nursing home residents. Under the Comptroller General's authority to conduct evaluations on his own initiative, GAO examined (1) the challenges hospital and nursing home administrators faced, (2) the extent to which limitations exist in the design of the National Disaster Medical System (NDMS) to assist with patient evacuations, and (3) the federal requirements for hospital and nursing home disaster and evacuation planning. GAO reviewed documents and interviewed federal officials, and interviewed hospital and nursing home administrators and state and local officials in areas affected by Hurricane Katrina in Mississippi and Hurricane Charley in Florida.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Homeland Security To address limitations in how the federal government provides assistance with the evacuation of health care facilities, the Secretary of Homeland Security should clearly delineate how the federal government will assist state and local governments with the movement of patients and residents out of hospitals and nursing homes to a mobilization center where NDMS transportation begins.
Closed - Implemented
The primary responsibility for the National Disaster Medical System, and correspondingly for this recommendation, was transferred to HHS in 2007. HHS has implemented this recommendation by completing the following four actions. (1) HHS and DHS collaborated with state and local departments of health in hurricane-prone regions to determine gaps between needs and available resources for hospital and nursing home evacuations and to determine local, state, or federal resources to fill the gaps. (2) Based on this analysis, HHS and DHS contracted for ground and air ambulances and para-transit services for Gulf and East Coast states. (3) HHS encouraged states to establish regional coalitions for mutual aid. (4) HHS has completed a hurricane "playbook" that improves the clarity of the role of federal assistance in evacuations. GAO reported on this implementation in April 2008 in GAO-08-544R.
Department of Homeland Security To address limitations in how the federal government provides assistance with the evacuation of health care facilities, the Secretary of Homeland Security should, in consultation with the other NDMS federal partners--the Secretaries of Defense, Health and Human Services, and Veterans Affairs--clearly delineate how to address the needs of nursing home residents during evacuations, including the arrangements necessary to relocate these residents.
Closed - Implemented
The primary responsibility for the National Disaster Medical System (NDMS), and correspondingly for this recommendation, was transferred to HHS in 2007. HHS has substantially implemented this recommendation. In GAO-08-544R (April 2008), we reported that HHS and DHS collaborated with state and local departments of health in hurricane-prone regions to determine gaps between needs and available resources for hospital and nursing home evacuations and to determine local, state, or federal resources to fill the gaps. Nursing homes were included in this analysis. Based on this analysis, HHS and DHS contracted for ground and air ambulances and para-transit services for Gulf and East Coast states. These vehicles could be used to evacuate nursing home residents. Although we noted in the April 2008 report that the federal role in the evacuation of nursing home residents was not specifically addressed in the hurricane "playbook" that described the role of federal assistance in evacuations, HHS has since modified the playbook to include consideration of nursing home needs during evacuations as an area that should be considered when planning the response to an incident. In addition, in the report we noted that HHS had not provided evidence that it had clarified the role of NDMS in evacuating nursing home residents, but HHS has since stated clearly that the NDMS memorandum of agreement provides for federal assistance in relocating these residents. In addition, the Catastrophic Incident and Mass Evacuation Incident Annexes to the National Response Framework now include information on meeting the needs of nursing home residents. Finally, HHS formed an Interagency Patient Movement Working Group to describe the process of moving a medical evacuee, including nursing home residents, from their point of origin to a destination at a safe facility. This group has drafted a Movement of Patient Evacuees document that covers nursing home residents. This document describes how state officials must determine patient movement requirements and request federal support, including what information the states must supply to the federal government and what support they can expect to receive. As of August 21, 2009, this document was still in draft form, and was being formally staffed for review and comment to federal departments and state authorities.

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