When the terrorist attacks occurred on September 11, panic was everywhere in lower Manhattan. Devastation, carnage, death, and an eerie silence engulfed the world as we knew it. I received minor injuries in the immediate aftermath of the attack, and was admitted to the hospital for observation and treatment. My immediate concern following my discharge from the hospital was not for the business of running a health plan, but for the safety and welfare of my coworkers. To my relief although several of the staff had been injured, none had been killed Many of the staff were stranded in Staten Island, New Jersey, and other outlying areas following evacuation efforts. Secure in the knowledge that the staff was safe, I then was able to turn my attention to the company.
Recognizing an Anniversary
The first anniversary of the September 11 terrorist attacks has just passed. In recognition of that anniversary, I would like to tell how one New York healthcare organization recovered from the devastation. The story is important for a number of reasons: It is one example of the spirit and determination shown as our nation has recovered from the attacks. Also, it is a cautionary tale for leaders of businesses--in particular, healthcare organizations. Your organization may never face a situation as extreme as the one described here, yet if the events of September 11 have shown us anything, they have shown us that everyday life can be changed forever in a moment. Although healthcare professionals are well acquainted with emergency preparedness, as a profession we should be ready for upheaval beyond our existing frame of reference.
Atlantis Health Plan was located in what was known as the 'Frozen Zone'--the area surrounding Ground Zero where the Twin Towers collapsed. Many buildings in the Frozen Zone, including the one that housed Atlantis, suffered major damage. This story tells how Atlantis, where I was executive director and CFO, worked to stay in business and provide necessary services in the days following September 11.
Communication was Key
It was clear that the New York State Department of Health and the New York State Insurance Department would expect some semblance of normal business activity from Atlantis during efforts to recover from the attack. Following the attack, the Department of Health requested a plan and estimated time frame for resuming full services. There was no doubt in my mind that a monumental task lay ahead.
An initial assessment of our physical and human resources showed that computer backup tapes for September 10, 2001, were available at our off-site storage facility. We were able to engage a medical utilization review and authorization system from an Alabama company to keep track of utilization; a waiver of precertification requirements was put into effect. No one was allowed access to lower Manhattan, where our office was located. The amount of damage to our office facilities and equipment was unknown. Staff would need a few days to get home from areas to which they had been evacuated.
Atlantis's CEO and I realized that communication with the organization's managers and staff was the key to resuming business rapidly. Our immediate priority was to telephone managers to inform them of steps being taken to resume business. Managers were directed to regularly communicate with their staff via telephone regarding the planned steps and their accomplishment.
On the afternoon of September 14, Atlantis's MIS director and I met to develop an interim plan for maintaining communication with our members and business associates. Our telephone and Internet service providers had advised that all switches located in and around the World Trade Center had been destroyed. It was not known when regular telephone service could be restored. Our web site was secure and still operational.
We determined that the company's telephone numbers would be redirected to a new 800 number that would record and archive incoming messages. Callers would not know that their call was being automatically redirected. A message would advise callers that the offices were closed temporarily due to the events of September 11 and that their call would be returned as quickly as possible. All callers would receive a message announcing the temporary waiver of precertification requirements.
The messages would be relayed to the appropriate staff to be returned and handled. A message would be posted on Atlantis's web site indicating that the office was temporarily closed, that the company's telephone numbers were operational, and that staff would respond to their calls. Our interim plan was approved by Atlantis's CEO and went into effect that night.
An emergency meeting was held for Atlantis managers on September 16 at a hotel in East Elmhurst, New York. The following actions were decided upon at the meeting:
* I was asked to contact the mayor's office and state and Federal authorities to try to obtain a pass to enter the Frozen Zone to inspect the Atlantis offices.
* All expenses personally incurred by the staff as a result of the disaster would be reimbursed.
* Payroll would continue for the staff. (It was processed through a New Jersey company)
* An e-mail message would be sent to all participating providers advising them of our interim plan for operation.
* The temporary waiver of precertification requirements would continue until Atlantis was able to resume full operations.
* Adjudication with worker's compensation carriers for health plan members injured in the attacks would occur later when the claims arrived.
Journey to the Frozen Zone
With assistance from the state Department of Health and Insurance Department, Atlantis's CEO and I were granted passes to enter the Frozen Zone to inspect Atlantis's office. We made the trip to the office on September 18. We were required to pass through multiple security checkpoints. A thick cloud of ash, smoke, and dust lingered in the air, making it necessary to wear a facemask. Debris lay everywhere, and all surfaces were coated with ash, dust, and soot. Fires were still burning at Ground Zero. Rescue workers appeared sad and fatigued, but seemed determined to continue urgently searching the buildings' ruins. The military presence was overwhelming. An eerie silence hung over the site.
The building in which the Atlantis offices were located had no electrical power, water, or telephone service. After climbing the 11 flights of stairs to the offices, we felt relieved to see that the office was structurally intact and had sustained only cracked and broken windows. The condition of the office, however, told a different story. A thick layer of dust, ash, and soot covered all the furniture, computers, and office equipment. Papers were strewn everywhere. I thought to myself that it would take weeks to clean and reorder the office.
The building manager told us that the building would be closed until power was restored. The City of New York was making arrangements to provide huge generators for each building that had been declared structurally sound. Atlantis's CEO and I agreed that our interim plan for responding to telephone calls would continue until access to the area was eased and the building was reopened.
Two days later, building management notified us that our employees could enter the building. The emergency generators were connected and had been tested. All staff were called and asked to report to the office the next morning. They were advised to bring their cell phones, face masks to protect against the poor air quality, and several forms of picture identification in addition to their employee and building ID cards. They were warned that they would face a gauntlet of security checkpoints and might be searched at some of them. Importantly, the staff was told not to turn anything electrical on, especially the computers, upon arriving at the office.
Back to Work
On September 21, the staff reported to work at the Atlantis office for the first time since September 11. Staff members arriving at the office greeted each other with hugs and tears of joy and relief. I met with our staff to inform them of our plans for interim operations. We continued to hold daily briefings for the full staff.
Because all cleaning services contacted were booked, our staff undertook the task of cleaning the office. An additional, imperative task was to restore internal MIS services as soon as possible. The MIS staff began the tedious process of taking apart each server and desktop computer, as well as ancillary computer equipment, so each piece of equipment could be cleaned, vacuumed, and tested. Several computers needed to be replaced, but within two days, the rest of the computers were again working. Backup data tapes were delivered and data was restored in the computers. Data from September 11 to the current date was entered into the system. Data backup was performed several times per clay because power blackouts and power surges were a daily occurrence.
Airflow was a daily problem. Staff had to choose between opening the windows and allowing contaminated air in or leaving them closed and suffering through the September heat. Fires were still burning at Ground Zero, and the smoke and fumes from them and the generators could not be escaped. As time went on, what we called the 'smell of souls' began to permeate the air. Ultimately, the windows were kept open, but staff were required to wear facemasks at all times to filter the air.
Normal water pressure was restored on September 20. Until then, staff flushed toilets using water from five gallon jugs that were placed in the facilities. Normal electrical service was restored on September 27, allowing us to turn on our air conditioning and air filtration systems. On September 28, telephone service was restored. Although deliveries and visitors still were restricted, at this point, Atlantis essentially had returned to full operations.
The Psychological Toll
Soon after the physical disruption of our work lives had subsided, the psychological impact of the horrors of September 11 began to surface in the staff. After first experiencing the attacks, the staff now had to walk daily past Ground Zero, viewing the morgue trucks removing victims' remains and smelling the acrid air. Bouts of depression, nightmares, and family pressures began to affect their work. Atlantis's executive team decided to offer professional counseling to the staff.
Staff members with young children experienced additional pressure. Their children began expressing real fears that their parent was working in an unsafe area and might not return home. The counselors and Atlantis's management decided to invite the children and spouses of employees to visit the office. Seeing the police, fire, and military presence along with a clean and operating office would help settle family members' fears. This visit was highly successful and seemed to alleviate some of the stress our staff was feeling.
Overcoming Adversity
Both the New York State Department of Health and Insurance Department have praised Atlantis for being able to serve our members so quickly following the tragedy. We were able to resume our business by following the disaster plan we had developed the previous year, communicating quickly and frequently with all parties involved, encouraging cooperation, and having faith in our ability to overcome adversity.
Those of us who experienced the horrors of the September 11 attacks thought the world was coming to an end. But we could not and cannot give up. Atlantis is proud to have contributed to bringing normal business operations back to lower Manhattan after the tragedy. Our feelings of responsibility to the members of our health plan were a large part of our motivation to resume our operations with as much speed as possible. With careful thought, planning, persistence, and cooperation, we were able to achieve our goal of continuing to serve our members.
ABOUT THE AUTHOR
Paul Cheng, Jr., FHFMA, is CFO, Lyndon Baines Johnson Health Complex, Brooklyn, New York, and a member of HFMA's Metropolitan New York Chapter.
Questions or comments regarding this article may be sent to Paul Cheng, Jr., at pchengjr@aol.com.
