The bridge leading from Fort Myers to Pine Island, Fla., is heavily damaged in the aftermath of Hurricane Ian on Oct. 1, 2022.
Gerald Herber/AP Photo

Hurricane Ian made landfall in Florida’s southwest coast at 3:05 p.m. with 150 mph winds. The devastation that followed was immense.

Fawcett Hospital suffered the most damage. The hurricane winds were so strong that it tore a hole in the 238-bed facility’s roof, allowing heavy rains to pour into stairwells and throughout its third and fourth roofs. The floors of the intensive care unit were covered in water, according to videos posted to social media.

About five hours after the storm made landfall, hospital officials called the state to help evacuate patients, according to records, but by that point, it was too dangerous. Rescuers had to wait for six hours before they could begin moving almost 200 patients from the hospital.

Other hospitals that remained open fared slightly better.

HCA Florida Englewood Hospital in Sarasota County suffered from water pressure issues and moved 48 patients one day after the storm made landfall. Two other hospitals, Gulf Coast and HealthPark medical centers, transferred a total of 295 patients while 91 patients were evacuated from Golisano Children’s Hospital.

The facilities, all in hard-hit Lee County, moved the patients two days after the hurricane struck the area — one of the facilities lost sufficient water pressure, and hospital leaders determined that any repairs to the county’s badly-damaged water lines would take too long for critically ill patients.

“Our structures fared well, and they’re in good shape, but our infrastructure — mainly our water and electricity — was challenged,” Lee Health President and CEO Larry Antonucci said on the day after the storm. “We cannot run a health care facility without running water.” Lee Health represents the Gulf Coast, Health Park and Golisano facilities.

‘Incredibly disruptive’

Florida Hospital Association President and CEO Mary Mayhew defended the hospitals’ decision to try to wait out the storm, saying moving patients poses risks and many facilities have hardened buildings to better withstand storms.

“It is incredibly disruptive to evacuate patients,” Mayhew said. “It takes a long time to do an evacuation, and then you get into that window of time where air and ground transport are no longer available.”

Debra Burbridge, a spokesperson for Nashville-based HCA Healthcare, which owns Fawcett hospital and Englewood hospital, said Ian’s predicted path over Florida had changed significantly in the days leading up to landfall, leaving the hospital with less than 24 hours to begin the complicated process of transferring patients without diminishing a continuous level of care. Like Fawcett, Englewood moved some of the most critical patients just before the storm made landfall, but the majority were moved a day later.

“Wind conditions ahead of the storm prevented the safe transfer of additional patients,” Burbridge wrote in a statement. “Patient transfers, which require the receiving hospital to provide the appropriate level of care, are carefully planned and coordinated.”

Burbridge also said Fawcett, Englewood and other HCA Florida hospitals all have long histories of staying open during hurricanes to continue to serve the community.

Federal health regulators tightened emergency preparedness guidelines for hospitals in the wake of Hurricane Katrina. The guidelines require hospitals to perform risk assessments of all threats, including natural disasters, develop an emergency communications plan and perform regular testing and training.

The guidelines are intertwined with state law, which requires that hospitals maintain what’s known as a Comprehensive Emergency Management Plan. The plan must be approved by a local emergency management official and reviewed by the Florida AHCA annually. Hospital staff must also carry out the emergency management plans once a year during a simulated disaster.

“You can’t just wake up today and evacuate,” George Washington University’s Barbera said. “How are you going to rapidly find the placements for patients, and the staffing?”

Guthrie estimated that 90 percent of hospitals facing a threat from a hurricane will evacuate patients to higher floors of the hospital rather than to another facility outside the area. But, he said, underground infrastructure such as water pipes can be damaged during hurricanes, leaving those facilities in dire need of help. Hurricane Ian, for example, severely damaged a water main in Lee County, leaving almost 800,000 people there without water.

“What happened with Fawcett, and with a couple of other hospitals, is they decided they were going to stay on the river, on the coast, in a high impact area, and vertically evacuate their patients,” Guthrie said. “When all of the infrastructure is on the ground.”