While on a Hurricane Katrina relief trip, I heard the heartbreaking story of a woman who lost her husband in another hurricane, years earlier. Unlike tragic stories surrounding Katrina, her story did not involve torrents of water and flying debris. The cause of her husband’s death was one we have all experienced: a power outage. The blackout’s impact on this man was greater than usual as he required a ventilator to breathe. Without electricity for a significant period of time, he could not survive. So while many people reach for a flashlight when the lights flicker, the consequences can be deadly for individuals who rely on life-sustaining electricity-powered medical devices.
The question for public health officials is how to ensure the safety of vulnerable individuals in these circumstances?
All levels of government allocate resources for large-scale emergencies, yet officials may be less than adequately prepared for power outages, which are more likely to occur. For many people, accessing electricity in a power outage may be as easy as driving to the nearest hospital. But for those with mobility-limiting health conditions and limited resources, that solution may not be available. If severe weather caused the outage, venturing outside to find a power source may be impossible. The bottom line is that individuals reliant upon medical devices ought to be a priority for government officials when power outages occur. Law and policy change may be necessary to achieve this goal.
Currently, the federal government’s contribution to this issue is through community education. The Food and Drug Administration published Guidance on Home Use Devices, recommending that individuals dependent on a medical device establish a plan for responding to a power outage and maintain medical information, a list of emergency contacts, extra oxygen tanks, battery backups and contact information for transportation services. Some states impose obligations on medical device providers to assist patients or their caregivers in understanding how to respond to an emergency. Maryland home health agencies are required to educate the patient and caregiver, by providing “the telephone number of persons who can deliver critical care on an emergency basis,” and documenting the patient’s level of comprehension “about the use of ventilator, . . . power sources, emergency backup systems, [and] emergency resuscitation . . . .”
Education and preparation are important but they are far from a complete solution. Battery backups can fail or will simply not provide electricity for long enough to get the vulnerable individual to a source of electricity. Moreover, medically vulnerable individuals may not be in the best position to prepare for such events and their family members may already be overwhelmed with care responsibilities.
In many jurisdictions, power companies bear certain responsibilities to individuals on life-sustaining medical devices. For example, electricity providers in Massachusetts must communicate with registered Life Support Customers “before, during and after an Emergency Event” and must provide “information to public safety officials regarding the status of electric service to Life Support Customers' homes.” State laws vary on how an individual is placed on the list of customers with medical-based electricity needs. Many require doctor’s certification and annual renewal. Power companies urge customers to register as medical device users so that the customer can receive estimates of the “power restoration timeline” and “obtain special outage planning information.”
But the legal responsibility of power companies is limited because they are not obligated to provide direct service to those customers in emergencies. Providers explain that “it is not possible to provide restoration priority to individual customers when there are extensive power outages” and that providers will “focus on restoring power to homes and businesses, starting with the circuits with the largest numbers of customers.”
What this hodgepodge of laws demonstrates is that law can play a significant role in ensuring the well-being of individuals on life-sustaining medical devices but that it currently falls short. Public health professionals must continue to educate individuals about appropriate preparation. Additionally, medical device providers ought to be required to enhance those efforts by assisting device users to register with the local electric providers and public safety officials. Laws must mandate that electricity providers maintain accurate lists and communicate effectively with customers and public safety officials in periods of power outage. Policymakers ought to eliminate unnecessary hurdles to getting on and staying on the list of special needs customers. Local public safety officials must engage collaboratively in order to respond before an emergency becomes a sad story. Because so many entities must contribute for a program to work, policymakers ought to consider designating a lead agency to ensure all obligations are met.
With proper planning and collaboration, tragedies such as the story I heard in Louisiana may become a thing of the past.
This blog was prepared by Gregory Sunshine, student attorney in the Public Health Law Clinic at the University of Maryland Carey School of Law, supervised by Kathleen Hoke Dachille, director of the Network for Public Health Law – Eastern Region.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.