HURRICANE SEASON 2006

The Big One: Is S.C. ready?

Ineffective nursing home evacuation plans, coastal growth and lack of shelters are cause for alarm

By WAYNE WASHINGTON

wwashington@thestate.com

The Big One, the monster storm of Katrina proportions, would overwhelm South Carolina’s ability to respond, forcing residents to cope with some of the same challenges storm-battered New Orleans faced last year.

Less than a month before hurricane season starts, gaps remain in the state’s preparedness.

Coastal counties have roughly half the shelter spaces called for in the state’s emergency plan. With no pre-planned way to cope with a large number of long-term evacuees, the state would have to rely on charitable groups, churches and private citizens, just as the Katrina survivors did.

Nursing homes in coastal counties have relied on the same transportation providers for an evacuation, increasing fears facilities won’t be able to move residents as a big storm approaches.

Road construction has not kept up with the pace of coastal growth, adding to the amount of time it would take to evacuate.

The S.C. Emergency Management Division conducted a review of its needs after Katrina hit the Gulf Coast. It decided it needed just about everything — satellite telephones, supplies, more and better-paid staff.

The division, the agency responsible for overseeing disaster response, has seen a 20 percent turnover in personnel over the past four years and ranks last in the Southeast in per capita state funding.

That’s set to change, with budget-writers aiming to ratchet up state spending. Along with equipment, the division plans to set up a stockpile of disaster relief supplies.

Even with supplies and more, better-paid staff, state and local officials caution a Katrina-like storm cannot be contained with an overarching emergency plan.

How the state weathers a storm and how many lives are lost will depend largely on the preparedness of individuals and how closely they heed evacuation orders.

Rick Alatorre, disaster services director for the Palmetto Chapter of the American Red Cross, said people should do two things when an evacuation order is issued.

“Leave early. Go far,” he said.

A PLACE TO STAY

Lincoln High School in McClellanville was supposed be a refuge. But Hurricane Hugo, the monstrous 1989 storm that blasted ashore north of Charleston, made a mockery of that plan.

The storm swamped the school, forcing terrified evacuees onto table tops, then literally into the rafters as they clung there and prayed for the water to recede.

No one died at Lincoln, but since then the Red Cross has been more selective in deciding which facilities can serve as shelters. In most cases, the Red Cross will not certify a structure if it is vulnerable to storm surge or rainwater flooding, has roof spans longer than 40 feet, is higher than 60 feet, is unable to withstand high winds or stores hazardous materials.

The Red Cross’ standards means a certified building is a safe bet to survive the storm. But fewer buildings qualify.

“I understand their concern,” said Cathy Haynes, Charleston County’s emergency preparedness manager. “They don’t want a repeat of Lincoln. But that knocks our capacity down tremendously.”

For example, only two of the eight high schools in Charleston were certified in 2005 to serve as shelters.

When Hurricane David threatened Charleston in 1979, Wando High School in Mount Pleasant served as a shelter. But with Mount Pleasant deemed too vulnerable to flooding, not even the new Wando, opened in a different location three years ago, is available for use as a shelter.

Emergency management officials and the Red Cross are finalizing the 2006 list, but coastal residents will likely still rely on neighboring facilities. Horry and Georgetown counties lost shelters this year because officials believe they would be threatened by falling trees or flooding.

All told, coastal counties had only 52 percent of the number of shelter spaces required in the state’s 2005 emergency plan, leaving a gap of 37,479 spaces.

Excluding Beaufort County, which would evacuate all residents if a major storm approached, four of the state’s seven coastal counties had fewer shelter spaces than required.

Charleston had the biggest gap. Based on a percentage of residents who could experience high winds or flooding, the state plan calls for Charleston to have 30,624 shelter spaces. But the county has just more than a quarter of that, with 8,620 spaces. No shelter is located east of the Cooper River, meaning all of fast-growing Mount Pleasant would have to be evacuated.

The new, $632 million Ravenel Bridge over the Cooper won’t be much help. State transportation officials will shut it down once winds reach 40 miles per hour.

Mount Pleasant, like so many other towns in South Carolina, has both high-end development and old houses on dirt roads where poor residents have limited transportation options.

Reaching those residents, particularly those with special medical needs, will be a challenge for all coastal counties.

Some plan to encourage residents to call emergency operations centers to request help. Others plan to send local bus system vehicles and school buses to predetermined pickup points.

Smaller Colleton County expects to have a list of addresses for its special needs residents completed before hurricane season.

“They live out in rural areas,” said Suzanne Gant, Colleton County’s emergency preparedness director. “And we would need to go and get them.”

Winn cautioned even the best-laid plans can be blown away by a powerful storm.

“The public needs to understand that we’ve experienced the same storm they have,” he said. “My cars have been blown away. My roof’s been blown away. The streets are flooded.”

NURSING PLANS

The elderly made up a large share of those killed by Katrina. More than 30 died in a single New Orleans nursing home, highlighting the critical need for effective emergency planning.

In South Carolina, nursing homes must have an emergency evacuation plan, which is updated each year and reviewed by the Department of Health and Environmental Control. Nursing homes are required to have contracts with transportation providers to evacuate residents, a sheltering plan detailing where residents would be taken, and supplies of food, water and medicine.

But county emergency officials, Health and Environmental Control and nursing home operators agree Katrina exposed gaps in preparedness that remain.

The State newspaper examined emergency plans of the 31 nursing homes licensed in the seven coastal counties and confirmed what local emergency officials have long worried about: Nursing homes rely on a limited number of transportation providers who may not be able to honor their commitments if the state is hit by a powerful storm that affects a large area.

State regulators say they let nursing homes know when their providers are committed to other facilities. They don’t check to see whether those providers are equipped to handle commitments.

The Department of Health and Environmental Control has 18 staffers who monitor all of the state’s 194 nursing homes and is considering designating one employee to review emergency plans, spokesman Thom Berry said.

Records show coastal nursing homes are licensed for 3,124 beds. Most facilities have contracts with multiple transportation providers, usually a chartered bus company and another that would evacuate those residents who need to travel by ambulance.

But the same company names pop up frequently on nursing home files.

Sunway Charter and Tours of Myrtle Beach, for example, has agreed to help evacuate five of the six nursing homes in Horry County and another in Georgetown County, records show. Sea Island Stages of North Charleston has agreements with five nursing homes in Berkeley and Charleston counties. Records show Carolina MedCare of Florence has agreements with nursing homes in Georgetown, Berkeley, Charleston and Beaufort counties.

Nursing homes in South Carolina had few problems evacuating in storms such as Bertha in 1996, Floyd in 1999 and Charley in 2004. But those affected a limited part of the coast. A much larger storm could force the evacuation of dozens of facilities, not simply a handful.

“If something like a Katrina came up the whole seaboard, I think we’d have a problem,” said Randy Lee, president of the S.C. Health Care Association, a nursing home trade group.

J.B. “Sonny” Kinney, senior vice president for NHC, which operates a dozen nursing homes in South Carolina, said evacuation traffic and transportation are his main hurricane concerns.

“We’re as prepared as we can be,” Kinney said. “The main concern I have is the traffic. And when we call the transportation provider, will they come to us or will they go down the street?”

Efforts to reach Sunway Charter were unsuccessful. But some documentation providers gave to nursing homes and the Department of Health and Environmental Control offer no guarantee they will be able to perform.

In a letter to one Charleston nursing home, Sea Island Stages wrote it would be able to help evacuate residents “depending on the availability of buses and drivers at the time.”

Sunway has written it will be available to help “on a first come, first served basis.”

Some transportation providers are small firms located in small towns in South Carolina. Others, such as Carolina MedCare, have a large fleet of vehicles. Carolina MedCare’s Web site says it has 50 ambulances and 32 paratransport units. The company has agreements with 75 health care facilities in 20 counties.

Nursing home transportation agreements are required by state law. But Lewis Dugan, Georgetown County’s emergency management director, said he worries counties will have to step in if private transportation providers are not able to get to all of the facilities with which they have agreements.

“The county doesn’t have the manpower to provide transportation for nursing homes,” Dugan said. “I’m not faulting anybody for signing contracts. But if you can’t do it, tell people you can’t do it.”

Nursing homes are required to submit emergency plans on or before their license renewal date. If they have not done so by June 1, they have to provide regulators with an affidavit stating the plan is being updated.

The agency has fined nursing homes for noncompliance and can refuse to renew licenses for persistent problems, Berry said. Regulators levied more than $21,000 in fines over the past year. Berry could not say how much related to emergency plans.

“The onus is on the facilities,” he said. “It’s their responsibility to do all of these things for their clients.”

Dugan wants the agency to do more.

“As far as I’m concerned, they’re not tough enough,” he said.

The Department of Health and Environmental Control and nursing homes are planning to hold a summit next month to discuss preparedness.

Berry said the agency is working with the Motorcoach Association of S.C. and a nationwide ambulance service to set up a coordinated transportation plan. Details have not been finalized, but the plan could be in place next month.

Evacuating nursing homes would contact Health and Environmental Control, which would call on the transportation providers. Such a system would end the competition for private transportation that could leave some facilities without a way to evacuate its residents.

It also could limit another problem nursing home operators say they confront when they must evacuate: exorbitant costs.

Kinney said one transportation provider tried to charge his company $113,000 after it evacuated NHC’s Garden City facility when Hurricane Floyd threatened the coast five years ago.

NHC felt it was being gouged, Kinney said.

“We reported it to the attorney general,” he said, adding the firm agreed to accept about $25,000 for moving residents and staff from Garden City to Columbia.

Beyond transportation, nursing home operators face difficult choices.

“I think a false impression is given that everything is OK when you’ve evacuated,” Lee said. “In reality, that’s when our problems begin.”

Most nursing homes, he said, would prefer to “shelter in place” — ride out the storm in their own facility.

“Our people would say if you’ve got a facility that’s been wind-tested by engineers, they’d rather shelter in place unless it’s a Category 5,” Lee said. “In a Category 5, you better be packing and you better be leaving.”

Hugo initially struck South Carolina as a Category 4 and caused much of its damage as a Category 3. Katrina was a Category 3 storm at landfall.

Moving elderly and often frail patients is risky. Putting them on buses for long rides might seem like an easy call, Lee said, until considering how nursing home residents would tolerate the trip and cope with new surroundings.

“There is no such thing as a good sheltering plan for nursing facilities,” he said. “They end up on the floor at another facility. Sheltering in place is preferred.”

Berry said the agency would like nursing homes to evacuate when a voluntary order is given to avoid the traffic crush usually associated with mandatory orders. State regulations, however, do not mandate nursing homes evacuate during voluntary orders, and Kinney said his preference is to go later, not earlier.

“Do not make us evacuate first,” he said. “I say let us evacuate last. That way, the roads are clear.”

GROWING PAINS

The defining sounds of South Carolina’s coast are the hammering of nails and the droning of earthmovers.

Not even Hugo cooled the sizzling rate of coastal growth. From 1980 to 1990, Census Bureau figures show coastal counties grew 20.1 percent, nearly twice the statewide pace. In the next decade, while the state’s population swelled another 15.1 percent, coastal counties boomed a combined 22.5 percent.

Census Bureau estimates through July 1 show the state’s population has grown another 6.1 percent since 2000. Coastal counties grew 8.4 percent.

Growth has made evacuating the coast quickly more difficult. More people means more cars, increasing the amount of time it would take to evacuate and decreasing the amount of time emergency officials have to decide on an evacuation.

“You’re not going to quickly get anybody off the coast,” said William Winn, emergency management director in Beaufort County. “We’ll get them out, but it won’t be quick.”

It could take as long as 27 hours to get some people out of harm’s way, depending on factors such as the intensity and direction of the approaching storm, according to state estimates.

Low-lying Beaufort would have to evacuate entirely if a major storm approached. Winn said officials will work hard to keep residents informed and to encourage them to evacuate as quickly as possible. But it will be a tough task.

Road construction has not kept pace with other development in some parts of the Lowcountry.

“We do not have adequate infrastructure to move the Lowcountry population inland,” Winn said. “And that is the Achilles’ heel of our hurricane planning.”

Some new roads have been built in Horry County. A new project would establish an evacuation route extending from U.S. 17 in the southeastern part of the county to U.S. 501 near Conway. Public meetings on the project, an initial step in a lengthy process, start this month. Final approval and full funding have not been secured.

Residents and government officials have formed the Southern Evacuation LifeLine to push for the project. The S.C. Department of Transportation is conducting an environmental impact study.

Even with other new roads in Horry, traffic still snarls in spots there during rush hour.

Adam Parness, chairman of the Horry County Planning Commission, said he and his colleagues give careful consideration to the threat posed by hurricanes before deciding whether to approve new development.

“We take it very seriously,” he said. “Everything gets studied ad nauseam.”

But Parness added there’s only so much that can be done to limit growth.

“As long as people own property, they’re going to sell it for development,” he said. “As far as large-scale tracts, those go on without extra warning about hurricanes. People are well aware that hurricanes strike South Carolina on a regular basis.”

PAYING FOR CHANGE

Katrina was a spotlight that illuminated all that South Carolina has not done in the years since Hugo to protect itself from a big, powerful hurricane.

But the General Assembly appears poised to boost state readiness.

The Senate budget includes $6 million in new, one-time funding for hurricane preparedness projects:

• $3.2 million to install generator connectors in shelters along Interstate 95

• $2 million for a warehouse of relief supplies that could aid 50,000 storm survivors for three days.

• $570,000 for satellite telephones and other communication costs

• $203,000 to set up a regional disaster coordination program that would eventually have 12 staffers working with local officials if a hurricane struck

The House put together its budget before the Emergency Management Division completed its post-Katrina review. But leaders there say they’ll support the added money.

Senate Finance Chairman Hugh Leatherman, R-Florence, agreed his House counterparts will support more preparedness spending.

But even if lawmakers approve everything in the Senate’s budget, most upgrades won’t be made in time for this hurricane season. The money won’t be available until the beginning of the new fiscal year on July 1.

Winn, Beaufort County’s emergency management director, said state legislators and the public need to understand the threat posed by hurricanes and do more to prepare for them.

“People ask me, ‘Are you ready?’” Winn said. “I say, ‘Define ready.’ There are only so many things that we can do. Somewhere along the line, people have to take responsibility for their own safety.”

Reach senior writer Wayne Washington at (803) 771-8385.