In the middle of the night, Kate Lewis has repeatedly had to ask clinic staff to move valuable vaccines from one clinic location to another.

The reason? The lights go out, and the expensive medications will be unusable if they’re not kept under carefully monitored refrigeration.

Lewis is the deputy chief of clinical operations at LifeLong Medical Care, a health center with locations primarily in California’s East Bay. “We have power outages every year here, and each time it happens, it’s a challenge,” she said. “Sometimes, it’s only an hour or less, but we certainly have had a few lately that were twelve-plus hours.”

Lindsay Farrell, the president and CEO of Open Door Family Medical Center in the Hudson Valley area of New York, described losing medications earlier this year when Hurricane Ida barreled through, knocking out power at one of her health center’s locations.

“It could have been much worse,” she said of the event. “Yes, we were flooded, and yes, we lost our vaccines, but so many of the people we take care of, they lost everything.”

For health centers across the United States, power outages bring serious challenges, whether it’s the loss of medication, lack of access to electronic medical records, a shutdown of some clinic procedures, or absent staff members – at precisely the moment when patients need increased care.

An emerging link

For researchers, the link between power outages and health outcomes is just beginning to be understood.

“The data’s not that great and it’s not that comprehensive, so my sense is that we’re severely undercounting the effects of power outages,” said Joan Casey, a professor of environmental health sciences at Columbia University’s Mailman School of Public Health.

What is known tends to center on the impacts to individuals rather than on interruptions to health systems, Casey said. In the wake of single large outages, clinicians report people showing up in unexpected numbers, most frequently with carbon monoxide poisoning related to generator use, cardiovascular issues, and uncharged medical equipment that’s dependent on power.

However, Casey explained, the link between health and access to reliable power is of increasing interest: “I would say this is an emerging area. One, our electric grid is aging, so we’re having more power outages, and two is climate change, so we’re having more storms.”

For health centers treating patients on the ground, however, the link is clear.

“The mission of the [federally qualified health center] is to be open all the time and to see everybody,” said Tom Knox, director of emergency management at the Florida-based health center PanCare. “In order to do that, we have to have electricity to be open, or use one of our mobile units,” which have their own sources of power and which the health center deploys during emergencies, such as during Hurricane Michael.

Backup power

When Hurricane Michael knocked out power at a PanCare clinic location in 2018, a backup generator should have kept the most indispensable clinic functions, like medication storage, up and running.

But large trees had fallen on the generator, damaging it too badly for it to function.

Some health centers have backup sources of power; others don’t. It’s not precisely clear how widespread backup power is among safety net providers, although a recent analysis run by Direct Relief, the California Primary Care Association, and MacroEyes found that fewer than 40% of California’s safety net health care sites had some form of backup power.

Generators aren’t always a viable solution. Farrell described an intricate, multilayered process of getting permits, finding funding, and other roadblocks. “It was one issue after another,” she said.

And having source of backup power doesn’t mean that everything functions as usual.

Dr. Charles Fenzi, the CEO of Neighborhood Health Centers in Santa Barbara, California, explained that while his health center is in the process of developing solar power systems at two of its locations, it’s also reliant on backup generators. “We periodically lose power living in Santa Barbara,” he explained. The generators will power some computers and refrigerators so that electronic medical records are accessible and medications are safe, but the ultimate goal is to have solar backup for everything.

“We live in a place where that’s absolutely possible, because most of the time we have sunlight,” he said.

Some of LifeLong’s locations do have backup generators, but the health center has also installed solar power at one location and is looking into doing so at another.

But LifeLong also has a series of protocols it employs whenever the power goes out, so that clinic locations can stay open. They use paper charts and prescription pads, keep a charged laptop and battery-operated lamps, and employ an electronic medical record system that can be accessed through a remote server.

“We can provide services as long as we have light and as long as there’s paper,” Lewis said.

The power of electricity

A power outage often means that health centers can’t carry out procedures, run a dental clinic, or conduct some exams. That may be the case even though need is always high, and will likely be exacerbated after an emergency, when patients have injuries, lose their chronic medications, or have mental health needs related to what they’ve just undergone.

Knox described having to reschedule dental appointments, flu shots, and medical appointments requiring equipment.

Having power isn’t just about powering medications or electronic medical records, Knox said. It’s also about encouraging staff – also dealing with flooding, damage, or whatever the aftermath of an emergency has brought – to come in and help with the increased medical need.

“There’s always a surge after a big event,” he said. “Do you want to meet the surge with 40% of your staff or 65% of your staff?”

Providing a place for staff members to take a shower, do laundry, eat a meal, and put the kids in front of the TV is one of the most effective things PanCare can do to make sure patients receive needed care after a hurricane, Knox said. In part for that reason, the health center’s goal is to outfit each of its 15 locations with a large backup generator.

“That’s how important electricity is,” he said.

Keeping doors open

Recognizing the indispensable link between reliable power and access to health care, Direct Relief recently announced the launch of its “Power for Health” initiative. The organization is committing an initial $5 million to ensure that the U.S. health care safety net has access to resilient power.

The commitment follows $10 million that the organization has already invested in solar and battery power systems for health centers and other nonprofit health care providers.

As disasters such as wildfires and hurricanes grow more severe, the threat of power outages will only grow, Casey said: “I can say as we continue to see more climate-related events, we will continue to see more power outages, especially if we don’t invest in our grid.”

Casey explained that solar power, in particular, presents a significant opportunity to both “reduce our carbon emissions and also improve our resiliency to disaster.”

For health centers doing everything in their power to stay open, even during an emergency, a reliable, resilient power source is a valuable piece of the puzzle.

Lewis explained that need doesn’t stop during an emergency, which means that LifeLong, like other health centers, continues to see patients as long as it’s safe to do so.

Closing the doors is “always absolute last-case scenario,” she said. “Our community relies on us so much for their health care needs, and we always do whatever we can to prevent having to close up. We will keep going through the normal schedule.”