What three O&P facilities are doing to rebuild, and what you can learn from them.
According to the National Weather Service (NWS) and the Insurance Information Institute (III), earthquakes, tornados, hurricanes, floods, droughts, and other natural disasters have done more than a half-trillion dollars in damage and caused more than 22,000 deaths in the United States since 1980. Hurricane Katrina, the costliest natural disaster in the United States to date, resulted in more than $145 billion in damages and 1,833 deaths.
The American Red Cross says that 40 percent of all small businesses will fail following a major disaster. If a business does not have a recovery plan in place when nature wreaks havoc, it is often too late for them, says Patricia Billinger, regional communications director for the American Red Cross, Mile High Chapter in Denver, Colorado.
"It is bigger than just you, and it can quickly consume you, so you need to be self-sufficient," she says.
In addition to having a plan for what to do in the immediate aftermath of a natural disaster, it is important to plan for longer-term needs as well. For example, Billinger advises businesses to have processes in place to ensure that employees continue to be paid while the business works to get back on its feet. "Businesses are essential to the ability of a community to recover; they provide employment and a tax base for a city."
Three O&P businesses know just how true Billinger's words are: Klemmt Orthopaedic Services (KOS), Johnson City, New York; Advanced Orthotics and Prosthetics (AOP), Joplin, Missouri; and the Hanger Prosthetics & Orthotics patient care facility in Jefferson, Louisiana.
Tropical Storm Lee
In 2006, the "100-year flood" struck Johnson City, New York. Though the community flooded, water did not reach the KOS facility. "We moved computers off the floor, and the staff went home early," says KOS owner Marc Klemmt, CPO. "That was about it."
KOS, which was established in 1965 by Klemmt's parents, Lucia and Fritz, did not have a disaster plan in place. It did, however, have flood insurance, which Klemmt says he "grumbled" about keeping.
In September 2011, when Tropical Storm Lee left its watermark on KOS, Klemmt became thankful he had kept the company's flood insurance in place. The first floor was submerged in ten feet of contaminated floodwaters, which made recovering anything impossible, Klemmt says. Clean-up efforts included establishing a product inventory list, compiling addresses, forwarding phone calls, communicating appointment changes and cancellations, recreating computers' systems, and restoring computer services—all while finding a new, temporary office space. When KOS moved in to a temporary building, it was then unable to do fabrication.
"You can never really be prepared enough for the complications created by this type of disaster," says Klemmt, who graduated from New York University (NYU) in 1983 and has worked at KOS since 1985.
If such a disaster ever happens again, KOS has learned several valuable lessons about what and what not to do. KOS now stores all of its information, from insurance information and contact lists to patient phone numbers, off site. All of this information had been stored onsite before Lee struck and was lost in the flood. "It caused a lot of delays," Klemmt says.
Due to the extreme devastation of the facility, KOS had to hire a cleaning restoration company. If Klemmt had it to do again, he says that he would take more time to select such a company. "I would be more alert in getting the right company to get some things salvaged that were thrown out," he says.
Klemmt cautions any O&P facility that has to recover from a natural disaster not to tell a restoration company what the facility's insurance level is. "They'll bill you trying to consume the maximum amount," he says. "Be careful what you sign." Perhaps most important, "Stay calm," Klemmt advises. "Decisions made in a panic are risky."
If there ever is a next time, KOS will also heed Billinger's advice regarding payroll. Several of Klemmt's employees went without pay for several weeks, and his technician had to draw unemployment for a short time because the company was not able to provide fabrication services in its temporary office space.
For all the lessons learned, KOS also did some things right following the storm: the company contacted a "trustworthy, reliable contractor," Marchuska Brothers Construction, Endicott, New York, a contractor KOS had used previously on a facility remodel in 2004. "They've been working without delays, even though the insurance company has only sent a small advance," Klemmt says.
Klemmt says he decided to keep the KOS facility in the same location because they own the building, and the facility is in a prime location in relation to physician offices and the hospital, as well as on the bus line for many of its patients.
Life at KOS is slowly returning to normal. Insurance money has started to trickle in, and the office officially reopened in early December.
One cannot live through such an experience, however, and not be changed. "Work days are endless," Klemmt says. "It's much harder to focus with so many different concerns all seeming to be happening at once. It is a balancing act to be owner, practitioner, husband, and father."
Despite the magnitude of the disaster, however, Klemmt remains optimistic that "things will return to normal in the near future."
On May 22, 2011, an EF-5 tornado roared through Joplin, Missouri, destroying AOP, owned by Frank Ikerd, CPO. Even though AOP had a disaster plan in place when the tornado hit, recovery and restoration were difficult given the magnitude of the devastation. (Editor's note: For more information, read "Joplin O&P Practice to Rebuild after Deadly Tornado.")
"Every facility should have a crisis plan and a disaster response/recovery plan," says Ikerd, a 15-year Joplin resident. "No one ever thinks a disaster is going to affect them. I would suggest that everyone have plans in place for different scenarios and different levels of disaster. Some of those resources you have in mind may not be there when you need them."
Immediately after the tornado struck, Ikerd says he attempted to contact all of his employees to check on their safety. Once he was assured that all of his employees were safe, he transferred the office phones to his cell phone number so he could receive and respond to incoming patient calls. He also let the local hospital know that they were still available to assist with patients who needed O&P care. Supplies were shipped to Ikerd's home, which was spared during the storm, until the company was able to secure temporary office space.
"Given the scope of the disaster, we were able to execute our crisis plan as well as could be expected," he says. "We were able to provide hospital care to patients just a few days after the tornado."
When planning your facility's crisis plan, Ikerd says to be prepared for the worst-case scenario, and not to plan on other resources in the community being available for your response efforts. "They may be in the same situation you are," Ikerd says, adding that he plans to eliminate paper patient files from the new office, switch to electronic medical records (EMR), and store everything off site on a back-up server.
"We were able to save our computer files," he says. "But we lost so many [paper] files with notes and measurement sheets. Those aren't replaceable."
Ikerd further advises O&P business owners to keep an accurate inventory of everything in the facility. "It's easy to lose track of the tools and components you have accumulated over time," he says.
He recommends that companies be aware of the level of coverage in their insurance policies. "Make sure you have enough coverage to replace everything in your facility," he says.
Like Klemmt, Ikerd is rebuilding his facility in the same location as the old one. Plans for the new building are being reviewed by the Joplin City Council. "I hope that rebuilding in our same location within the disaster zone will be a sign of resiliency and inspire others to do the same in reshaping our community," Ikerd says.
Though chances are slim his O&P facility would be hit a second time, he is rebuilding with insulated concrete forms (ICF) to withstand such a possibility, he says.
Going through the disaster has put into perspective what is important in life, Ikerd says. "Everyone in our community has a new appreciation for our community and each other," he says. "It has brought everyone together to help one another. Everyone was affected by the tornado in some way."
Josh Millet, CPO, currently works at Parr Prosthetics Lab, Slidell, Louisiana, an O&P practice located on the north shore of Lake Pontchartrain, about 25 miles east of the Crescent City. When Hurricane Katrina hit the Gulf Coast during Labor Day weekend in 2005, however, he worked at the Hanger Prosthetics & Orthotics patient care facility in Jefferson, Louisiana. At the time, his patient-coverage area included New Orleans, Jefferson, the West Bank, Metairie, and Kenner—well-populated areas encompassing roughly 60 square miles.
Like AOP, Hanger had a crisis plan in place at the time of the storm, Millet says. The Jefferson practice was next to Jefferson Water Works, within sight of the Mississippi River. Before the storm hit, the O&P facility had compiled a list of employee phone numbers and emergency contact information and had moved all computers and electronics from the floor to higher locations.
Within 24 hours following the storm, the practice manager attempted to contact all employees, but cell phone service was intermittent. Several of the employees lived in areas that had been devastated, Millet recalls. "When you work closely with someone for a period of time, you become family. Here in the South, we take care of our own."
The most difficult thing about Katrina's devastation, Millet says, was losing all the patient records. "It helped me realize the benefits of theâ€¦drive to implement paperless records," he says. "It also showed me that a practice that took decades to build could be wiped out overnight."
The biggest lessons learned from Katrina were to heed the advice of officials who warned area residents to evacuate. "News reports were advising us to leave, but we saw patients throughout the week," Millet says. "It was business as usual up until the end. We should have encouraged everyone to have a family plan of their own. We should have taken a more active role in encouraging employees to leave if it was advised. In the end, practices and buildings can be rebuilt."
Following Katrina, Hanger secured temporary employment for Millet and its other employees who had been affected by the storm until its practice could reopen. Hanger also continued to pay its displaced employees, he says. "They even offered financial assistance if we had property damage and a need," says Millet, who managed Hanger's Jefferson practice for three years following the storm.
While the Jefferson patient care facility sustained little damage, the Tulane, Louisiana, office was submerged in seven feet of water. Hanger management decided it was best not to rebuild at that location, as all the machinery and merchandise were a complete loss. A company was hired to destroy patient records, which had become soaked and covered with mold. "They were actually hazardous," Millet remembers.
The population served by the Tulane office was scattered. "We had no idea who was coming back or when," he says. "We decided to see those patients from that area at the Jefferson location."
Millet says the two facilities affected by the storm didn't receive much aid from the state, save for packed lunches from the National Guard. But it didn't seem to matter, Millet says. "We were a strong company and were blessed to have the resources to make it on our own." The Jefferson facility reopened about a month later, while most of the area businesses remained shut down for months following the storm.
By the time Millet left Hanger, things had nearly gotten back to normal. Patients began to trickle back in about six months later. "We had rebuilt many of the connections with referral sources that we had prior to the storm," he says.
Before Katrina made landfall, eight people were employed between the Jefferson and Tulane Hanger locations. Today, none of those employees work in the area. A clinician, a technician, and a secretary lost everything because of Katrina, and Hanger offered them transfers. One clinician moved to a Hanger facility in Atlanta. Another clinician and a technician moved to the Northshore, north of Lake Pontchartrain, to work for another company. The secretary stayed on at the Jefferson location for several years but has since left the company. The original manager was transferred to Alabama before becoming a regional manager in Tennessee. Millet also moved to the Northshore and built a new home well above sea level.
The storm changed many people's lives personally and professionally, Millet says.
"I saw how quickly things that you worked hard for could be taken away," he says. "We lost relationships with patients and referral sources. Many people left and never came back."
"When companies... find themselves face to face with a disaster, more often than not the necessary forces can be quickly marshaled to deal with the matter at hand," writes Norman Phelps in the article "Setting Up a Crisis Recovery Plan" (Journal of Business Strategy, 1986). "However, when the dust begins to settle, the aftershocks are often more devastating and costly... than the original crisis. That is why crisis recovery planning should be a part of any strategic planning process."
Betta Ferrendelli can be reached at