The aftermath of the California Wildfires will impact physicians and healthcare organizations as they strive to deliver safe patient care. In addition, administrators and providers will be concerned about having complete medical records, and ensuring that access to records is handled appropriately and protects patient confidentiality. NORCAL offers the following resources and strategies as part of a risk management approach to encountering fire-related issues. These are presented as general guidance – depending on the circumstances, your current resources and capabilities may not be able to accomplish activities as you would during normal daily operations. The main objective is to provide safe, appropriate, and legal care to your patients. Policyholders should not hesitate to contact NORCAL’s Risk Management Department at: 855.882.3412 with a specific issue or concern.
Keep up with information from the command centers at the state, county, and municipal levels. The California Statewide Wildfire Recovery Resources site provides robust resources across multiple topic areas for those affected and the California Department of Forestry and Fire Protection (CalFire) posts current information about the fires in impacted counties.
The California Hospital Association (CHA) Hospital Preparedness Program (HPP) contains a variety of practical emergency preparedness information, tools, and resources. Although these are intended for hospitals, other healthcare organizations can adapt these tools. (Accessed: 11/9/18)
Typical patient care concerns following a disaster include follow-up, hand-offs/transfers, and medication management.
As you are able, review schedules to determine which patients have acute issues and upcoming or missed appointments. Attempt to contact patients, prioritizing by urgency. Document the communication and resulting action/status. If your office is unable to see patients, document where you instructed patients to go (e.g., shelter, clinic, urgent care, emergency department), or if other arrangements were made (e.g., home health visit).
If your facility had to evacuate patients, or needs to do so, tracking those patients is a key risk management measure. Documentation to accompany patients should ideally include elements such as:
Source: Minnesota Department of Public Health. Emergency Sheltering, Relocation, and Evacuation for Healthcare Facilities [Word Document]. (Accessed: 11/9/18)
The California Hospital Association (CHA) Hospital Preparedness Program (HPP) includes a “Hospital Repopulation After Evacuation: Guidelines and Checklist.” (Accessed: 11/9/18)
Patients may need replacement prescriptions for medications that they have not finished, or they may be due for refills. You may also encounter patients who have been displaced and are seeking care in your community. The prescription management process should be handled carefully and in compliance with law and regulation.
Pharmacies can be a resource in a state of emergency. Requirements for furnishing prescription drugs and providing emergency refills without prescriber authorization in a declared emergency area are specified in California Business and Professions Code §§4062; 4064. When California wildfires triggered a state of emergency in 2015, pharmacies were able to prescribe to patients without physician authorization.
For additional information, visit the California State Board of Pharmacy at: www.pharmacy.ca.gov or call (916) 574-7900.
Check with your patients’ insurance companies to see if they are able to facilitate patients obtaining replacement medications in the event that your systems for prescribing are not functioning. Some health plans are doing this; see the following links:
Many healthcare facilities and physician offices will be trying to recover and restore damaged paper and electronic records in the weeks and months following the wildfires. Before investigating potential damage to medical records:
Records may not only sustain fire damage, but water damage from fire-fighting efforts. Please see NORCAL’s recommendations and resources regarding water-damaged records (paper and electronic), which was provided following the hurricane disasters of 2017.
If you cannot salvage medical records or otherwise reconstruct them via electronic data recovery, you should recreate them to the best of your ability. Approach the various other entities that are storing your patients’ PHI in their own databases and record-keeping systems. For example, pharmacies, consultants, prior treating physicians, third-party insurers, transcription services, and hospitals most likely have PHI they can provide. The following strategies can facilitate the reconstruction process:
The American Health Information Management Association (AHIMA) also offers guidance on this process. See: What to do if a Record is Lost, Destroyed or Stolen. In: AHIMA's Long-Term Care Health Information Practice and Documentation Guidelines: Practice Guidelines for LTC Health Information and Record Systems. (Accessed: 11/9/18)
Document the PHI record/data damage recovery efforts, including:
If affected PHI is requested, include documentation of PHI damage and recovery efforts with your response to the PHI request.
See the following resources regarding medical information privacy following a disaster:
While the HIPAA Privacy Rule is not suspended during a public health or other emergency, if the Secretary of HHS declares a public health emergency in California, then HHS may exercise its authority to waive sanctions and penalties for certain HIPAA violations. Check with the U.S. Department of Health & Human Services.
The information provided on this website is intended as risk management advice. It does not constitute a legal opinion, nor is it a substitute for legal advice. Legal inquiries about topics covered on this website should be directed to an attorney.
Reference herein to any specific product, process, service, or entity does not necessarily constitute or imply the endorsement, recommendation, or favoring by the NORCAL Group of companies.