Information visualizations by Lydia Zuraw
LOUISVILLE, Tenn. — When a giant storm hits, Peninsula Hospital could possibly be underwater.
At this decades-old psychiatric hospital on the sting of the Tennessee River, an intense storm may submerge the constructing in 11 toes of water, chopping off all roads across the facility, in line with a classy laptop simulation of flood threat.
“My first feeling is doom,” Aurora mentioned as she watched the simulation of the river rising across the hospital. “These are probably some of the most vulnerable people.”
Covenant Well being, which runs Peninsula Hospital, mentioned in a press release it has a “proactive and thorough approach to emergency planning” however declined to offer particulars or reply questions.
Aurora, a former Peninsula Hospital affected person, appears upon the Tennessee psychiatric hospital the place she was dedicated as a youngster. KFF Well being Information agreed to not publish her full identify as a result of she shared personal medical historical past.
A lot of this threat to hospitals will not be captured by flood maps issued by the Federal Emergency Administration Company, which have served because the nation’s de facto software for flood estimation for half a century, regardless of being incomplete and typically many years old-fashioned. As FEMA’s maps have develop into divorced from the fact of a altering local weather, personal firms like Fathom have stuffed the hole with simulations of future floods. However lots of their predictions are behind a paywall, leaving the general public principally reliant on free, considerably restricted authorities maps.
“This is highly concerning,” mentioned Caleb Dresser, who research local weather change and is each an emergency room physician and a Harvard College assistant professor. “If you don’t have the information to know you’re at risk, then how can you triage that problem?”
The deadliest hospital flooding in trendy American historical past occurred 20 years in the past throughout Hurricane Katrina, when the our bodies of 45 individuals have been recovered from New Orleans’ Memorial Medical Middle, together with some sufferers whom investigators suspected have been euthanized. Extra flooding deaths have been narrowly prevented one yr in the past when helicopters rescued dozens of individuals as Hurricane Helene engulfed Unicoi County Hospital in Erwin, Tennessee.
Rebecca Harrison, a paramedic, referred to as her kids from the Unicoi roof to say goodbye.
Rebecca Harrison, a paramedic, was rescued from the rooftop of Unicoi County Hospital in Erwin, Tennessee, throughout extreme flooding brought on by Hurricane Helene in September 2024. “I was never so happy to see helicopters,” she says.
The investigation — among the many first to research nationwide hospital flood threat in an period of warming local weather and worsening storms — comes because the administration of President Donald Trump has slashed federal businesses that forecast and reply to excessive climate and in addition dismantled FEMA applications designed to guard hospitals and different vital buildings from floods.
When requested to remark, FEMA mentioned flooding is a standard, expensive, and “under appreciated” catastrophe however made no assertion particular to hospitals. Spokesperson Daniel Llargués defended the administration’s adjustments to FEMA by reissuing an August assertion that dismissed criticism as coming from “bureaucrats who presided over decades of inefficiency.”
Alice Hill, an Obama administration local weather threat skilled, mentioned the Trump administration’s dismissal of local weather change and worsening floods would waste billions of {dollars} and endanger lives.
In 2015, Hill led the creation of the Federal Flood Danger Administration Normal, which required that hospitals and different important constructions be elevated or incorporate additional flood protections to qualify for federal funding.
FEMA stopped imposing the usual in March.
“People will die as a result of some of the choices being made today,” Hill mentioned. “We will be less prepared than we are now. And we already were, in my estimation, poorly prepared.”
‘Flood Risk Is Everywhere’
Hospitals have been decided to have a big threat if Fathom’s 100-year flood knowledge predicted {that a} foot or extra of water may attain a substantial portion of their buildings, excluding parking garages, or minimize off street entry to the hospital. A 100-year flood is an intense climate occasion that has roughly a 1% probability of occurring in any given yr however can occur extra usually.
Extra Than 170 US Hospitals Face Vital Flood Danger
Supply: KFF Well being Information evaluation of 100-year flood threat knowledge from Fathom; hospital areas from the U.S. Division of Homeland Safety.
The investigation discovered heightened flood dangers at massive trauma facilities, small rural hospitals, kids’s hospitals, and long-term care services that serve older and disabled sufferers. Not less than 21 are essential entry hospitals, with the next-closest hospital 25 miles away, on common.
Flooding threatens dozens of hospitals in coastal areas, together with in Florida, Louisiana, Texas, and New York. Farther inland, flooding of rivers or creeks may envelop different hospitals, significantly in Appalachia and the Midwest. Even within the sun-soaked cities and arid expanses of the American West, storms have the potential to encompass some hospitals with a number of toes of pooling water, in line with Fathom’s knowledge.
These findings are probably an undercount of hospitals in danger as a result of the investigation neglected pockets of potential flooding at some hospitals. It excluded services like stand-alone ERs, outpatient clinics, and nursing houses.
“The reality is that flood risk is everywhere. It is the most pervasive of perils,” mentioned Oliver Wing, the chief scientific officer at Fathom, who reviewed the findings. “Just because you’ve never experienced an extreme doesn’t mean you never will.”
Dresser, the ER physician, mentioned even a small quantity of flooding can shut down an unprepared hospital, usually by interrupting its energy provide, which is required for life-sustaining tools like ventilators and coronary heart displays. He mentioned probably the most weak hospitals would probably be in rural areas.
“A lot of rural hospitals are now closing their pediatric units, closing their psychiatry units,” Dresser mentioned. “In a financially stressed situation, it can be hard to prioritize long-term threats, even if they are, for some institutions, potentially existential.”
City hospitals can face harmful flooding, too. Fathom’s knowledge predicts 5 to fifteen toes of water round neighboring hospitals — Kadlec Regional Medical Middle and Lourdes Behavioral Well being — that straddle a tiny creek in Richland, Washington.
By Fathom’s estimate, a 100-year flood may trigger the close by Columbia River to spill over a levee that protects Richland, then loosely comply with the creek to the hospitals. Among the deepest flooding is estimated round Lourdes, which was constructed on land the U.S. Military Corps of Engineers put aside in 1961 as a “ponding and drainage easement.”
On the time, this land was purported to be able to storing sufficient water to fill a minimum of 40 Olympic-size swimming swimming pools, in line with army paperwork obtained by means of the Freedom of Info Act. A psychological well being facility has occupied this spot for the reason that Seventies.
The most important hospital in Charleston, West Virginia, CAMC Memorial, is positioned close to the Kanawha River, which runs the size of the town. Fathom, a flood modeling firm, predicts that excessive climate may trigger the river to overspill its banks and convey as a lot as 5 toes of flooding to the hospital’s ER.
Each Kadlec and Lourdes mentioned in statements that they’ve catastrophe plans however didn’t reply questions on flooding. Tina Baumgardner, a Lourdes spokesperson, mentioned authorities flood maps present the hospital will not be in a 100-year flood plain.
Typically the distinction is stark. For instance, at Ochsner Choctaw Basic in Alabama — the one hospital for 30 miles in any course — FEMA maps counsel a 100-year flood would overflow a close-by creek however spare the hospital. Fathom’s knowledge predicts the identical occasion would flood a lot of the hospital with 1 to 2 toes of water, together with the ER and the helicopter pad.
Ochsner Well being didn’t reply questions on flooding preparations at Choctaw Basic.
The Limits of FEMA Flood Mapping
An evaluation of Ochsner Choctaw Basic, a essential entry hospital in Butler, Alabama, reveals how there is usually a consequential distinction between trendy flood simulations and the Federal Emergency Administration Company’s flood maps, which have develop into a de facto software for flood estimates in a lot of the nation.
Sources: FEMA’s Nationwide Flood Hazard Layer dataset; KFF Well being Information evaluation of 100-year flood threat knowledge from Fathom.
FEMA flood maps have been launched within the ’60s as a part of the Nationwide Flood Insurance coverage Program to find out the place insurance coverage is required and constructing codes ought to embrace flood-proofing. Based on a FEMA assertion, the maps present solely a “snapshot in time” and aren’t meant to foretell the place flooding will or gained’t occur.
FEMA spokesperson Geoff Harbaugh mentioned the company intends to modernize its maps by means of the Way forward for Flood Danger Information initiative, which can allow the company to “better project flood risk” and provides Individuals “the information they need to protect their lives and property.”
This system was launched by the primary Trump administration in 2019 however has since obtained sparse public updates. Harbaugh declined to offer an in depth replace or timeline for this system.
Chad Berginnis, government director of the Affiliation of State Floodplain Managers, mentioned it’s unknown whether or not FEMA continues to be attempting to improve its maps beneath Trump, because the company has minimize off communications with exterior flooding consultants.
“There has been not a single bit of loosening of what I’m calling the FEMA cone of silence,” Berginnis mentioned. “I’ve never seen anything like it.”
Floods are anticipated to worsen as a warming local weather fuels stronger storms, drenching areas which are already flood-prone and bringing a brand new degree of flooding to areas as soon as thought of decrease threat.
The Nationwide Oceanic and Atmospheric Administration has mentioned that 2024 was the warmest yr on report — greater than 2 levels Fahrenheit increased than the Twentieth-century common. Scientists throughout the globe have estimated that every diploma of world warming correlates to a 4% improve within the depth of maximum rainfall.
“Warmer air can hold more moisture, so this leads us to experience heavier downpours,” mentioned Kelly Van Baalen, a sea degree rise skilled on the nonprofit Local weather Central. “A 100-year flood today could be a 10-year flood tomorrow.”
Intensifying storms increase considerations about Peninsula Hospital, which has operated for many years mere toes from the Tennessee River however has no recognized historical past of flooding.
Peninsula Hospital, a psychiatric hospital southwest of Knoxville on the sting of the Tennessee River, could possibly be surrounded by 11 toes of water in an intense storm, in line with flood simulations by Fathom. Covenant Well being, which owns Peninsula, mentioned it has deliberate for emergencies however declined to debate the potential for flooding on the hospital.
Peninsula spokesperson Josh Cox mentioned the river is overseen by the Tennessee Valley Authority, which makes use of dams to handle water ranges and generate electrical energy. Estimates offered by the TVA counsel the dams may hold Peninsula dry even in a 500-year flood.
Fathom, nevertheless, mentioned its flood simulation accounts for the dams and harassed that a big sufficient storm may drop extra rain than even the TVA may management. These predictions are echoed by one other flood modeling agency, First Avenue, which additionally says an intense storm may trigger greater than 10 toes of flooding within the space round Peninsula.
“It’s a hospital right on the banks of a major American river,” mentioned Wing, the Fathom scientist. “It just isn’t conceivable that such a location is risk-free.”
Jack Goodwin, 75, a retired TVA worker who has lived subsequent to Peninsula for 3 many years, mentioned he was assured the dams may defend the world. However after reviewing Fathom’s predictions, Goodwin started to analysis flood insurance coverage.
“Water can rise quickly and suddenly, and the destruction is tremendous,” he mentioned. “Just because we’ve never seen it here doesn’t mean we won’t see it.”
‘All the Elements of a Real Disaster’
One yr in the past, as Hurricane Helene carved a lethal path throughout Southern Appalachia, Angel Mitchell was visiting her ailing mom at Unicoi County Hospital within the tiny city of Erwin, Tennessee.
Swollen by Helene, the close by Nolichucky River spilled over its banks and across the hospital, which was inbuilt a flood plain. Workers tried to bar the doorways, Mitchell mentioned, however the water obtained in, trapping her and others inside. The lights went out. Individuals fled to the roof, the place the roar of dashing water almost drowned out the strategy of rescue helicopters, Mitchell mentioned.
In the end, 70 individuals from the hospital, together with Mitchell and her mom, have been airlifted to security on Sept. 27, 2024. The hospital stays closed, and the corporate that owns it, Ballad Well being, has mentioned its reopening is unsure.
Angel Mitchell and her mom have been rescued from catastrophic flooding at Unicoi County Hospital in Erwin, Tennessee, throughout Hurricane Helene in September 2024. “Seeing any of those patients get out of that water, it was a miracle,” Mitchell says. “God was with us.”
For instance, within the Cumberland Mountains of southwestern Virginia, a 100-year flood is projected to trigger Slate Creek to engulf Buchanan Basic Hospital in additional than 5 toes of water.
Close to the Nice Lakes in Erie, Pennsylvania, LECOM Medical Middle and Behavioral Well being Pavilion may develop into flooded by a small drainage creek that’s lower than 50 toes from the entrance door of the ER.
Neither Buchanan nor LECOM responded to questions on flooding or preparations.
And in West Virginia’s capital of Charleston, the place about 50,000 individuals reside on the junction of two rivers in a large and flat valley, a single storm may doubtlessly flood 5 of the town’s six hospitals directly, together with colleges, church buildings, hearth departments, and different services.
“I hate to say it,” mentioned Behrang Bidadian, a flood plain supervisor on the West Virginia GIS Technical Middle, “but it has all the elements of a real disaster.”
On the largest hospital in Charleston, CAMC Memorial Hospital, Fathom predicts that the Kanawha River may deliver as a lot as 5 toes of flooding to the ER. Throughout city, the Elk River may encompass CAMC Girls and Youngsters’s Hospital, chopping off all exits.
And within the heart of the town, the place the overflowing rivers are predicted to merge, Thomas Orthopedic Hospital could possibly be besieged by greater than 10 toes of water on three sides.
WVU Medication, which owns Thomas Orthopedic Hospital, didn’t reply to requests for remark.
CAMC spokesperson Dale Witte mentioned the hospital system is conscious of its flood threat and has ready by elevating electrical infrastructure and buying flood-proofing tools, like a deployable floodwall. CAMC additionally often revises and drills its catastrophe plans, Witte mentioned, though he added that hospitals there have by no means been examined by an actual flood.
Shanen Wright, 48, a lifelong Charleston resident who lives close to CAMC Memorial, mentioned many within the metropolis have little fear about flooding within the face of extra quick issues, just like the opioid epidemic and the decline of producing and mining.
Tugboats and coal barges sail previous his neighborhood as in the event that they have been vehicles on his road.
“It’s not to say it’s not a possibility,” he mentioned. “I’m sure the people in Asheville and the people in Texas, where the floods took so many lives, they probably didn’t see it coming either.”
Shanen Wright has lived in Charleston, West Virginia, almost 5 many years and says he has by no means seen the Kanawha River rise above its banks. Positioned on the junction of two rivers in a large and flat valley, Charleston is liable to a single storm doubtlessly flooding the town’s 5 largest hospitals directly, in line with flood knowledge from the corporate Fathom.
‘The Water Is Coming’
Regardless of extensive scientific consensus that local weather change fuels extra harmful climate, the Trump administration has taken the place that considerations about international warming are overblown. In a speech to the United Nations in September, Trump referred to as local weather change “the greatest con job ever perpetrated on the world.”
The Trump administration has made deep workers and funding cuts to FEMA, NOAA, and the Nationwide Climate Service. At FEMA, the cuts prompted 191 present and former workers to publish a letter in August warning that the company is being dismantled from inside.
Daniel Swain, a College of California local weather scientist, mentioned the administration’s rejection of local weather change has left the nation much less ready for excessive climate, now and sooner or later.
“It’s akin to enforcing malpractice scientifically,” Swain mentioned. “Imagine making a medical decision where you are not allowed to look at 20% of the patient’s vital signs or test results.”
Beneath Trump, FEMA has additionally taken actions critics say will depart the nation extra weak to flooding, particularly:
FEMA disbanded the Technical Mapping Advisory Council, which had repeatedly pushed the company to modernize its flood maps to estimate future threat and account for the impacts of local weather change.
FEMA canceled its Constructing Resilient Infrastructure and Communities program, which offered grants to assist communities and very important buildings, together with hospitals, defend themselves from floods and different pure disasters.
And after stopping enforcement early this yr, FEMA intends to rescind the Federal Flood Danger Administration Normal, which was designed to harden buildings in opposition to future floods and save tax {dollars} in the long term.
Berginnis, of the Affiliation of State Floodplain Managers, mentioned the administration’s unwillingness to organize for local weather change and worsening storms would lead to a harmful and expensive cycle of flooding, rebuilding, and flooding once more.
“The president is saying we are closed for business when it comes to hazard mitigation,” Berginnis mentioned. “It bugs me to no end that we have to have reminders — like people dying — to show us why it’s important to make these investments.”
Few hospitals perceive this risk greater than the previous Coney Island Hospital in New York Metropolis, which has suffered catastrophic flooding earlier than and has ready for it to come back once more.
Superstorm Sandy in 2012 compelled the hospital to evacuate lots of of sufferers. When the water receded, fish and a sea turtle have been discovered within the constructing.
Eleven years later, the ability reopened as Ruth Bader Ginsburg Hospital, remodeled by a FEMA-funded $923 million reconstruction mission that added a 4-foot floodwall and elevated affected person care areas and utility infrastructure above the primary flooring.
It’s now probably one of the vital flood-proofed hospitals within the nation.
However, up to now, no storm has examined the ability.
Svetlana Lipyanskaya, CEO of NYC Well being+Hospitals/South Brooklyn Well being, which incorporates the rebuilt hospital, mentioned the query of flooding is “not an if but a when.”
“I hope it doesn’t happen in my lifetime,” she mentioned, “but frankly, I’d be surprised. The water is coming.”
Methodology
After Hurricane Helene made landfall a yr in the past, a raging river flooded a rural hospital in jap Tennessee. Sufferers and workers have been rescued from the rooftop. Floods have hit hospitals from New York to Nebraska to Texas in recent times. We needed to find out what number of different U.S. hospitals face related peril. In the end, we discovered greater than 170 hospitals in danger.
For this evaluation, we used knowledge from Fathom, a United Kingdom-based firm that focuses on flood-risk modeling throughout the globe. To evaluate the US’ vulnerability, Fathom makes use of subtle laptop simulations and detailed terrain knowledge protecting the nation. It accounts for environmental elements equivalent to local weather change, soil circumstances, and lots of rivers and creeks not mapped by different sources. Fathom’s modeling has been peer-reviewed and utilized by insurance coverage firms, the World Financial institution, the Nature Conservancy, and authorities businesses in Florida, Texas, and elsewhere. The Iowa Flood Middle has validated Fathom’s U.S. knowledge.
By an information use settlement, Fathom shared its U.S. mapping knowledge that predicts areas with a minimum of a 1% probability of flooding in any given yr. Fathom’s knowledge estimates the results of three essential varieties of flooding: coastal, fluvial (from overflowing rivers, lakes, or streams), and pluvial (rainfall that the bottom can’t take up). The info additionally accounts for dams, reservoirs, and different constructions that defend in opposition to floods.
To establish at-risk hospitals, we used a publicly accessible Division of Homeland Safety database containing the GPS coordinates of greater than 7,000 short-term acute, essential entry, rehab, and psychiatric hospitals — mainly any hospital with inpatient companies. (DHS beneath the Trump administration has discontinued public entry to the database, so knowledge for hospitals and different infrastructure is now not broadly accessible.)
Utilizing GPS coordinates because the centerpoint, we created a circle with a 150-yard radius round every hospital, which normally captured the constructing plus close by grounds and entry roads. We then mapped Fathom’s flood-risk knowledge to see the place it overlapped with these circles. We began by in search of hospitals the place a minimum of 20% of the circle’s space had a predicted flood depth of a minimum of 1 foot. That gave us an preliminary checklist of greater than 320 hospitals throughout the U.S.
From there, we visually inspected these hospitals utilizing mapping software program and Google Maps, each satellite tv for pc and road view. We trimmed our checklist to solely the hospitals the place a substantial portion of the constructing or all entry roads have been predicted to have a minimum of a foot of flooding.
If two hospitals have been mapped to the identical constructing — for example, a small rehab facility inside a big hospital — we counted just one hospital. We additionally excluded hospitals just lately transformed to nursing houses or for different makes use of.
We ended up with a listing of 171 hospitals throughout the U.S. That’s more than likely an undercount. Some hospitals may nonetheless face vital impression from flooding that isn’t deep sufficient or widespread sufficient to suit our methodology. Our evaluation additionally doesn’t account for the way flooding farther from a hospital may have an effect on workers or sufferers. And it doesn’t assess what steps hospitals could have already taken to organize for extreme climate occasions.
We additionally ran a spatial evaluation evaluating Fathom’s knowledge with flood hazard maps from the Federal Emergency Administration Company, which in lots of circumstances are incomplete or haven’t been up to date in years. We discovered that a couple of third of hospitals recognized as flood dangers by Fathom’s knowledge didn’t overlap in any respect with FEMA’s 100- or 500-year hazard areas.
Fathom offered steering and suggestions as we developed our evaluation
