In California’s East Bay, clinicians worked in the dark. In a rural town, staff had to choose: power their records or protect their vaccines?

When the lights go out, all bets are off.

At best, power outages mean a compromise of care, especially when patients are poor, disabled, or geographically isolated. At worst, they’re dangerous, forcing care providers to close their doors and leaving patients dependent on medical devices with no reliable way to keep them running.

Many low-income Americans – who, to complicate matters, often live with chronic health conditions and have limited access to transportation or healthy food sources – rely on the nation’s health centers and clinics for primary care, prescription medications, behavioral health services, and dentistry. As power outages roil California, healthcare organizations are feeling the heat.

As of Wednesday evening, the California Primary Care Association counted 70 health centers, with over 250 locations, either affected or threatened by the power outages, said Bao Xiong, the organization’s assistant director of health center operations.

When the power goes out

Health centers frequently run on the narrowest of budgets. Many strain their resources to act as a front line of defense during disasters, offering needed medications, food, water, and shelter; and even providing in-home healthcare to stranded or ill patients.

But these organizations rely on electricity for everything from protecting temperature-sensitive medications to tracking patients’ records. Many can’t afford a backup generator. When they have one, it’s generally can’t power everything.

“We could either choose to run our servers or our electronic medical records or our refrigerators,” said Christopher Kelsch, the executive director of Winter’s Healthcare, which serves an overwhelmingly poor population in rural Northern California.

The staff at Winters chose to power their medical records system, lighting the clinic with whatever they could find at the hardware store and transporting their expensive, temperature-sensitive vaccines for safekeeping to a nearby health facility unaffected by the outage. “We wanted to be open in case something happened to folks during the winds or the power outage,” Kelsch said.

Not everyone had the luxury of choosing. “We do have a small generator, put in to protect vaccines and a few infrastructure pieces, but it’s not enough to operate,” said Jill Damian, CEO of the Mendocino Community Health Clinic (MCHC).

While MCHC was able to keep one location open in Ukiah, Damian was concerned about the clinic’s primarily rural population, many of whom, she said, can’t afford the gas to travel to it. “For us, it’s really [about] not being able to open to take care of patients,” she said. “It’s hard for me to send a licensed provider home when they’re ready to work and there are patients to be seen.”

And it wasn’t just clinical care that worried Damian. “We’re really concerned about patients with durable medical equipment,” such as dialysis machines and oxygen concentrators,” she said. “I don’t think we’re really going to know [the situation] until we get to the other side of it.

At LifeLong Medical Care in the East Bay, staff quickly moved vaccines and other temperature-sensitive medications to a nearby hospital for storage as their Oakland clinics lost power.

Open in the dark

But LifeLong serves a disadvantaged population, with high rates of diabetes and other chronic conditions, in what medication program counselor Elaine Rossiter described as a “food desert.”

Closing operations wasn’t an option.

So a clinician kept each location open in the darkness. Staff members worked remotely to get prescriptions to vulnerable patients. “Service would be limited and there’s no light…[but] our patients rely on us to be open when we are needed,” said Kate Lewis, LifeLong’s director of operations.

Primary care providers are used to moving mountains. That doesn’t mean they don’t feel the strain.

One healthcare executive, whose Los Angeles clinic faced the possibility of an outage, described the nightmarish process required to move hundreds of perishable vaccines to a safe location, should the power go out.

“Not doing so means the loss of many thousands of dollars in vaccines we purchased for the working poor” or received from the government and nonprofits, the executive explained.

But for poverty-level patients reliant on medical devices, such as CPAP machines and nebulizers, “few have home generators or battery backup that can last even eight hours,” the executive said.

An ongoing scare

Californians are used to the threat of fire. That’s not necessarily a good thing.

At Winters Healthcare, where the community has been threatened by fires repeatedly over the past several years, Kelsch made sure mental health providers were available to patients unsettled by the darkness.

“We’re at this conundrum right now. Everyone’s angry at PG&E and I understand,” he said. But in a community where fires are a regular hazard, he also understood the reason for caution.

“Is this causing more stress or damage than that? I’m not one to say,” Kelsch said. “Our job is to be there for the patient.”