IceStorm 98 Study

Mr. McFarlane’s and his staff of four are responsible for placing and supporting appropriate patients of Kingston Psychiatric Hospital into supervised, residential accommodation in the community.

Malcolm McFarlane recalled that there was heavy ice elsewhere but Highway 401 was “not bad” as he drove to Kingston Psychiatric Hospital (KPH) from his home west of Odessa at 6:15 a.m., Thursday January 8/98. But when he saw the drooping powerlines over Sydenham Road and the detours for storm debris on Portsmouth Avenue he knew that the storm that had passed overnight was a major event. This was additionally confirmed by the reports of upset staff who witnessed the explosion of an electrical transformer on King Street, on the hospital grounds.

Mr. McFarlane indicated that at no time did the KPH site lose electricity or heat. Sometime on Thursday morning, KPH’s auxiliary electrical power system was activated and remained on for the duration of the emergency declared by the Mayor of Kingston, to reduce the strain on the city’s electrical system. Mr. McFarlane noted that a unique feature of the KPH site is that it has a completely independent back-up system including electrical generation, heat, water, waste and sewage disposal. With irony, he added, “actually the Christmas tree lights stayed on”.

Mr. McFarlane said that he did not appreciate the scale of the storm until between 9:00 and 10:00 a.m. when he started receiving telephone calls from several of the homes where his office had placed former inpatients of KPH. They were calling to inform him that the homes were lacking electricity and heat and they wanted ideas as to how they might adequately care for their residents. By 11:00 a.m., he and the staff who had been able to make it in to work had canvassed other locations where patients were placed: retirement homes, boarding homes, “homes for special care” and licenced homes. He concluded that alternative accommodation would be required.

Mr. McFarlane attempted to speak with the KPH Administrator, Wayne Barnett but storm damage had prevented him from getting to the hospital. Mr. Barnett’s assistant, Susan Mills referred Mr. McFarlane to Chief of Psychiatry, Dr. Pierre Leichner. Mr. McFarlane wanted to explore his idea that “decommissioned” hospital space could be re-opened to provide shelter for former patients. At noon, after a quick tour of mothballed areas by Mr. McFarlane, Mr. Grant Kimmett, Head of Maintenance and two others, it was determined that the areas could be used. By then, the Ministry of Health in Toronto had instructed KPH to assist the community in emergency relief, however possible.

Mr. McFarlane said that there followed a remarkable effort by all levels of staff to get the unused areas ready. Switchboard operators, clerical staff, maintenance people, painters, social workers, physiotherapists and occupational therapists all pitched in to move furnishings and clean everything. At 1:00 p.m. Mr. McFarlane said that he phoned the homes to inform them that their residents could be accommodated in the hospital from 4:00 p.m. Early in the afternoon as well, Kingston Friendship Homes, the largest operator of homes for adults with psychiatric disabilities in the Kingston area, phoned requesting shelter for some of their residents. KPH was now being asked to accommodate a very large number of people who had some previous contact with KPH. There were also a few “frail, elderly” residents from retirement homes, most of whom were integrated into the psychogeriatric population of the hospital.

For the first night, Thursday, January 8th, there was a shortage of staff available at KPH. Mr. McFarlane and one of the social workers on his staff agreed to remain overnight and assist the ward staff. About fifty people, most of whom had some previous hospitalization at KPH were sheltered that night. In addition to the KPH staff present, a condition of accepting the residents of the homes was that some staff from the homes would be assigned to assist in the shelter.

Mr. McFarlane said that the kitchen staff of KPH was remarkable. Although short-staffed, they were able to increase the production of hot meals to meet the greatly increased number of people staying at the hospital and they continued to do so as the number of shelter “guests” increased. “The kitchen staff lady told me, jokingly on Thursday night, that ‘by the time this is over we’ll be serving 300 extra meals’. And after it was over she was dead-on. It was exactly the number of meals that she was serving.”

Mr. McFarlane remained on duty throughout the first weekend. He recalls that on Sunday he was worried that the guests’ spirits were flagging. Without recreation staff, he felt that he needed to do something for some diversion. To meet this need VCRs were set up in the shelter areas and videos were brought in. Games and other items were found and brought to the shelters.

The staffing from Thursday, January 8th through Sunday, January 11th involved “pretty much the same people”. Other staff members were unable to come in to work, as they were busy making sure that their personal and family needs were being tended to. It was not until Monday, January 12th that additional staff reported for work and were assigned to relieve those who had, by then, been on duty for up to 96 hours.

According to Mr. McFarlane, the key to the success of the shelter operation was the informal networking and cooperation amongst a staff who knew each other and who were willing to pitch-in where needed. They recognized that the ice storm crisis was not a situation where normal rules always applied. They set aside rules and protocol. They performed tasks outside of their normal job descriptions, in order to meet the emergency. Everyone did what he or she could according to what needed to be done. Nobody said “It’s not my job!”

As noted earlier, KPH had been instructed by the Ministry of Health to do what it could to meet the emergency needs resulting from the ice storm. Mr. McFarlane added that Brockville Psychiatric Hospital had also been given the same and that the instructions were initiated by the Ministry. He then noted that both hospitals had the infrastructure, equipment and expertise to deal with this emergency.

There were enough supplies to get things going. By the time additional supplies were needed they were available from the regular suppliers. And although the hospital normally operates on a very tight budget, the Ministry assured KPH that it should spend what was required to deal with the emergency. Mr. McFarlane said that this was very important as it relieved some of the pressure that has been on the hospital.

For the record: the KPH Administrator is Wayne Barnett, the Chief of Psychiatry is Pierre Leichner, the Head of Maintenance is Grant Kimmett, the Head of Purchasing and Operations is Keith Campeau.

The hospital usually operates on an open door basis. With the exception of those patients who are restricted for legal reasons people can come and go pretty well as they please. The KPH administration decided that because in this emergency it was important to know if people were safe, the shelters at KPH would keep a registry and required that the shelter guests check in and out of the premises.

Authority for the operation of the shelters rested with the nursing coordinators. Daily administrative meetings were held were numbers and status was reported on and any special needs or circumstances where discussed and decisions made. Counts were taken at 1:00 a.m. each day. Mr. McFarlane did not attend these meetings but did send required information to them. These meetings took on greater significance when the Penrose shelter opened involving the Red Cross and Salvation Army.

Mr. McFarlane and the social workers in his unit oversaw the shelter for those people from the homes where they had referred patients and Kingston Friendship Homes. Former KPH patients who lived in the community but who were being followed by the KPH Rehabilitation Unit were sheltered in the Rehabilitation Ward. People with special medical needs stayed in the Medical Ward. Seniors from a large retirement home stayed in the re-opened Beechgrove building. Guests from externally staffed housing providers were accompanied by some of their own staff.

Mr. McFarlane noted that the extended contact with the Kingston Friendship Homes staff was “an excellent exercise to break down some misunderstanding regarding who we were, what our goals were.” He thought that some “territory and turf” issues were clarified and that some of the Kingston Friendship Homes staff received an appreciation of what it was like to work with people who are severely disabled.

Decisions were made mainly by talking things over. But leadership evolved from existing roles of leadership and delegation. Mr. McFarlane became the leader for the Ward 12 shelter and he delegated the leadership for the Beechgrove shelter to one of his staff who continued to report to him. Relationships as a team already existed and when something was needed, they already knew who to go to. Mr. McFarlane felt that senior administrators expressed their confidence in him and let him operate the shelter as he saw fit. Some questions of legalities did arise. For example, initially nursing had some concern about the higher than regulated ratio of residents to staff. But once it was recognized that they were operating a shelter and not a hospital for those who were seeking only shelter, the nursing concerns were satisfied.

After the first weekend those who had been on duty since Thursday except for a few hours of sleep on site, were sent home by Mr. McFarlane’s supervisor, Glenn Outhwaite.
But before leaving Mr. McFarlane drew-up a schedule for on-going staffing and back-up help needed for operation of the shelters. This was reviewed on the second Thursday (January 15) when it was known that the shelters would need to continue. Other support from the homes and Kingston Friendship Homes was increased so only one of his staff would be needed per shift. This allowed his staff to make it home daily. However, it was judged that some additional nursing support was needed. This was agreed to and scheduled.

Over the two-week period, Mr. McFarlane reported that he worked 98 hours over his regular shifts. His staff worked almost as many. “In the 70’s” he said. In retrospect, Mr. McFarlane recalled feeling angry when after the first four days of organizing, developing and running the shelters, he was told to go home and get some rest. He recognised that he was tired. He also recognised that he was feeling a sense of ownership and custody for the shelter and resentment that anyone else might think that they could operate it as well.

The hospital’s emergency plan was not used… “mainly because it was a different kind of disaster. It was not a bomb. It was not something that, BANG, happens and everybody responds. It caught everybody in their own personal lives.” Mr. McFarlane explained. He added that had the plan been insisted on, it would not have been a good thing as it would have forced people in to work who did not want to be there and who had serious personal things to deal with. Also, not everyone works well in crisis situations. It was important that those who were there were the ones who wanted to be there, were emotionally and professionally appropriate to be there and who already had some connection with the people being sheltered. The emergency plan may have been applied with success by the support services including laundry and food services but as it happened, the people who were in place wanted to be there and had the knowledge needed to meet the emergency.

Mr. McFarlane reported that some of the administrators commented to him that one of the things that helped them deal better with the ice storm emergency was the 6 week OPSEU strike two years ago. It gave the administrators a better idea of all of the things that had to happen in order to operate the hospital. (Mr. McFarlane noted that he was one of the strikers.)

Mr. McFarlane recalled a couple of incidents which he felt illustrated how the particular skills and understanding of KPH staff helped to address difficult situations. The first involved a “dysfunctional family” with a baby who were creating pandemonium at the Hotel Dieu shelter. Not only did the Hotel Dieu wish to transfer the family to KPH, they needed to have KPH provide the transportation. Mr. McFarlane arranged for transportation help, went to the Hotel Dieu shelter, got the family to KPH and found volunteer support, in the form of his two school teacher daughters, to help care for the family. The second incident involved a resident of Kingston Friendship Homes who lived by himself in one of their apartments. This man was refusing to leave his apartment even though he was freezing. Mr. McFarlane determined that the survival of the resident required that someone had to make the decision to force this man to a shelter because he was not able to make the decision for himself. The resident had to either come along with him and the Kingston Friendship Homes staff or the police needed to be called to assist in preserving the safety of the resident. The resident came to the shelter without the police being called.

What worked well? Mr. McFarlane replied that human beings rose to the occasion. Many unsolicited letters of thanks have been received from individuals. Bridges were built between people. The shared experience broke down professional and class barriers between people who now relate more cordially to each other as they pass in the halls of the hospital. Mr. McFarlane thought that there was nothing he would do differently were it to happen again.

By way of emergency training, there are regular courses available to staff on how to manage difficult situations and difficult individuals. Mr. McFarlane did not mention training for more generalized emergency response.

Mr. McFarlane recalled that the emergency measures organizations, both provincial and federal, provided beds and blankets which were much needed.

Regarding interaction with the media Mr. McFarlane recalled that the media was present for the visit by Prime Minister Chretien and also covered the successful operation of the KPH shelters.
Stress during the ice storm was mostly exhaustion according to Mr. McFarlane. Initially he felt some stress getting approvals for the things that he wanted to do. Once things were approved the only other stress was walking across the grounds on the first night with trees crashing down. Generally, “It was an upbeat kind of atmosphere. People kept each other’s spirits up.” This even applied to a group of guests who had to wait for hours on a bus in Seeleys Bay while shelter was being confirmed for them at KPH.

After the ice storm there was internal debriefing at KPH as well as the availability of the Employee Assistance Program. In addition, Mr. McFarlane and others attended a workshop in Kemptville that discussed handling disasters and assisting employees’ post-disaster affects.

What changes may come out of the experience? Mr. McFarlane said that the aftermath involved having to accept that bureaucracy was reasserting itself. Attending to questions like “Do we get paid for the Thursday if we were unable to get in to work?” became more important than saying thanks to a whole lot of people who pitched-in. Returning to normal is complicated. “We (KPH) have lived with insecurity for something like seven or eight years… downsizing, re-sizing, whatever you want to call it… new governance” and now more “down to the wire”. “So it’s returned back to that indefiniteness again. Do we exist? Do we not?… Who is our boss? Who isn’t? So it’s back into that. It’s not a normal… We do not live a normal… focussing on patients only… For a while the focus was on helping people, period! All the rest of it was gone. Now you’re back to all this complexity of life which is our reality.”