Podcast: ABC Pediatric Clinic, Houston, TX

Susanne Madden:

This is Susanne Madden from Verden ViewPoint Magazine. Today I’m speaking with two pediatricians, Doctors’ Silen and Sogol Pahlavan of ABC Pediatric Clinic in Houston, Texas. Our theme this issue is disaster planning and recovery and these two sisters managed to go through Hurricane Harvey with flying colors.

I’m so glad to have you guys on the pod cast today. Thank you so much for joining us and for being willing to share your story.

Sogol Pahlavan:

Thank you for having us.

Susanne Madden:

It looks like you really were severely challenged there, in Houston, when Hurricane Harvey decided to whip through. You closed your offices on Friday, August 25th, at 2:00 PM. At what point did you have this sense that the following days were going to be critical and you were dealing with this crisis.

Sogol Pahlavan:

On Friday, as we were watching the news … We didn’t even know if we were going to close that day until later on, around noon or one o’clock, then things got serious. So we decided to close at two o’clock, and by midnight on Friday the street had flooded. People were taking different routes and then on the following day, which was Saturday, is when the rain got worse. On Saturday actually, we still were hesitant about closing for the entire week. We didn’t know the severity and we didn’t know how devastating the flood was going to be. It was actually not until midnight, Saturday at midnight and early on Sunday, is when things became really serious.

Silen Pahlavan:

We woke up on Sunday morning with the streets flooded. The news continuously talking about flooding, street closures. And then luckily we have access to cameras remotely from home. So I was able to log into the cameras, and we were just constantly watching the parking lot, the streets around the clinic. So that wasn’t until Sunday. Sunday in the morning at 9:00 AM we saw the front of the street, that was flooded. And then by night time, by about 8:00, 9:00 PM, half the parking lot was full. That was on Sunday. And then we started to panic at that point because we didn’t have … We weren’t that prepared mentally and physically and financially for what was happening.

Sogol Pahlavan:

And our biggest worry was our generator. And so she’ll talk a little bit about that. But we were fine with losing the revenue from the clinic but we were not fine with losing thousands of dollars worth of vaccine. So I think our vaccine fridge was our priority at this point.

Susanne Madden:

My goodness! Of course, there’s just so much revenue tied up in those vaccines and you just can’t rely on insurance to help cover for that. You want to have put your planning in place. So did you have any disaster preparedness plans in place at all generally? Had you ever experienced any other disasters before? What was that like? Did you have any prior preparation for this or was this completely out of the blue and you had to start from scratch?

Sogol Pahlavan:

No. I would say, personally, as having any experience, no. But we have a good community of physicians through one of the AAP groups – SOAPM – we rely on their experience. This new clinic that we’re in, we built out in 2013 and we spent over $30,000 on a very robust generator. It’s a commercial generator. Our old space that we had sub-leased had a smaller generator. And there’s a lot of power outage in our area, so the older generator was run on power. So the new one that we received, it’s run on natural gas. I would say that’s one thing that we did, as far as preparing ahead of time. And it wasn’t specifically for Harvey, it was just because  we had taken some experiences from other physicians and prepared for it.

But what had happened, there’s a lot a power outages in this area, so I think three or four months passed; there was some sort of power outage and we relied on the generator to keep the vaccine safe. But what had happened is, prior to that, we had a gas leak scare at the clinic. And when they came out to investigate – the city came out to investigate the gas leak – they actually turned off the natural gas that had gone to the generator without notifying us. So a couple of months after that when we had this power loss, we came back and we realized, why didn’t our $30,000 generator work? Well, it’s because the people from the city turned off the gas! So that was a personal experience that we went through.

So we were hyper focused on our generator. We had everything in place when we locked up on Tuesday and I think coincidentally we had the maintenance people from the generator come in two weeks prior to the hurricane just to do a maintenance check. But that was completely coincidental. We didn’t predict a hurricane coming.

Silen Pahlavan:

And we do maintenance checks twice year, but it was just the right time that they had come so recently to check everything out.

Sogol Pahlavan:

And I would say, the other portion of the office that you really need to think about in these situations are your electronic health records. And with us, we still have an on-site physical server. We do backups every night and our office practice administrator actually physically carried the back-up disc with him everywhere. So two things that happened is that our EHR reached out to us about 24 hours [into the situation]. I would say, probably, it was Friday or even Thursday night, they reached out to us and they said, “Let’s get you uploaded on our cloud.” So they uploaded all our data on our cloud. So we had that safety zone. And we really appreciated the fact that they reached out to us because once you’re in the middle of preparing for all those things, if you don’t have a very good checklist things get missed.

And then the other thing we did is we backed up our servers. We usually would [do that] on a back-up disc and we carried that in a backpack with us the entire time. Literally, if my house would have flooded, I would have probably picked up the backpack versus the kids!

Susanne Madden:

Your patients can rest assured that no matter what, their medical records are safe with you then! There were a couple of really great points there that you pointed out there. One, obviously, is luck. That the maintenance had been done on the generator and that you had actually identified that the generator wasn’t working due to another power outage that had happened. Now it’s one thing when there’s a power outage and then your generator kicks in using that natural gas. It’s another thing when there’s a flood. So I have to ask, did the generator perform? Did the generator actually work

Sogol Pahlavan:

So what happened was, the Sunday, we had full access to remote videos until Monday 3:00 PM. We were still monitoring. We were looking at the videos. Great, everything’s good. We have power. 3:00 PM on Monday, it all went down ’cause the power went out, the cameras went out, and we were literally sitting in the dark from Monday 3:00 PM to Wednesday 8:00 AM. So a good 48 hours. And our nurses, the staff that lives around here, weren’t able to come to the clinic because the streets were flooded. But luckily we have a neighbor that’s right behind the clinic, and we were able to reach him and he would come out, literally every hour and check on the clinic. So he would give us a update on the status of how far the water is, close to the clinic, and then the generator. Do you hear the generator running every hour? We would call him, “How’s it going? Do you still hear it?” And thank God, it was working. It kicked in and it started to last until we opened up. So get to know your neighbors.

Susanne Madden:

So, good neighbors! Couple of take-aways here. Definitely, you want to build good relationships with your neighbors. You never know when you might need them in a disaster for sure. But it sounds like, obviously then, your vaccine survived just fine. And I really like this idea that your EMR vendor actually reached out to you. Being very proactive, very supportive, really offering that partnership. For the record, who is your EMR vendor?

Sogol Pahlavan:

We use Office Practicum.

Susanne Madden:

Terrific! So Office Practicum were able to help with that preparedness; make sure that you were okay; get you backed up. Even though you have an on-site server, you have a physical record of your records. Just in case anything would happen to those they were able to upload all of your records into their cloud as well. I do think that’s terrific, to have partners in a disaster is so very fundamentally important too. A piece of this around this whole disaster thing is, your staff couldn’t get in, you guys were kept away from it. How did you all communicate? How did you communicate with your staff and with your patients throughout this whole disaster situation?

Sogol Pahlavan:

So as far as our staff, we’re a mid-sized clinic. So our mission here is, “ABC Pediatric Clinic – Treating You Like Family.” And we have each and every single one of our staff’s cell numbers, emails on our personal cellphone. We divided up the clinic. I took the physician, Dr. Silen took the nurses, and then our front-desk supervisor took the MAs – the front-desk employees. And we were in constant communication with them via text and phone. If one couldn’t be reached, then one staff member reached out to the other staff member, which is something … The silver lining in all this is that our clinic is much more solid and much more collaborative. And there was a sense of compassion and empathy and collaboration that came through this disaster. If I were to go back and say, “Would you ever do it again?” I would say the only thing that really came out through this is that we are now a stronger team for what we have gone through.

Susanne Madden:

What a wonderful silver lining. That is absolutely right just to galvanize the team; everybody comes together. And then obviously you had an opportunity to show how much you care about your employees too.

Silen Pahlavan:

And as far as keeping the patients updated, we have a strong presence on social media. So we have a Facebook page for our clinic. We have Instagram for the clinic. So constantly we were updating our Facebook page regarding the status of the clinic; when we were going to be open; numbers patients could call for assistance; FEMA numbers. And we also posted our on-call nurse contact number. The patients already are familiar with the nurse help-line. Every patient that walks in gets a magnet with our on-call nurse helpline number on it. So they have that but we just, again, put it on the Facebook so they knew that that nurse line was available. And luckily they’re out of Dallas, so they had no problems taking the calls.

Susanne Madden:

Of course, if they had been located in Houston and going through the same thing then that absolutely would’ve put you in some situation there where you probably would have been fielding patient calls on your cellphones or some such thing. I think that’s remarkable too. Just the use of social media to really be able to connect with people and that people really know to go there. To be able to say, “In a disaster, if I can’t get to the office or reach these people in another way, I know there’s going to be communication coming out through Facebook.” So it’s almost as if social media has really become part and parcel of disaster [management] for the future. Including their feature to report yourself safe and do those sorts of things. I think that that’s very powerful.

So in terms of resources that you could fall back on and rely on, obviously social media was one of them and a really big component of it. Your nurse line that you already had in place. So that was sort of continuity of something that patients would already be familiar with. What other resources were you able to fall back on, if any? Was FEMA around? Were there local services? Did the AAP help in some way? What did that look like for you guys? Who were you able to turn to for a little bit of extra help?

Sogol Pahlavan:

So FEMA was definitely around, but as you can imagine, they were overwhelmed. So with any natural disaster, having the support to be able to … And this was a historical flood. So if it was just a regular flood then I think the manpower from FEMA would have been able to handle. But it was beyond that and I don’t think that the federal government or the State had any insight into the severity of this natural disaster. I think overall if you looked back FEMA did a good enough job, as much as they could, with the resources that they had. Did they reach out every single family? No. Did they reach out to every family in a timely manner? No. But I don’t think, in a situation like this, they could have. It’s not practical. In reality, they could not have reached out to every single family.

We opened up the office Wednesday afternoon. Most offices around our area, if you drove down Wednesday morning when we came to our clinic, if you drove down Wallisville [Road], which is like a two-mile street, I would say, I think we were the only medical clinic that was open. 50% of the dental clinics, there’s about four or five on the span of that road, were all flooded. And half of those still have not opened. We really wanted to do something to really give back, but within our own capabilities, to give back to the community.

We did two things. There were four staff members that were affected by Harvey; our staff members specifically. One of them totally lost her apartment and she had a two-month-old infant at home. Another one had significant damage to her trailer home. One was displaced for an entire week, and you can just imagine the salary that she lost for that week. And then the other lost her car. So what we did for our staff members, we … Again, via social media, we created a GoFundMe page for them. The amount of support and love and compassion that we received from people that we don’t even know. It was friends of a friend, or physicians that other physicians in other states was … Incredible.

Silen Pahlavan:

And it was immediate. It was like right away, “I want to help you. What can I do? Here it is.”

Sogol Pahlavan:

So we raised $13,000 through our GoFundMe page and we divided that money according to employees’ needs. So the one that lost her home got a significant amount out of that fund. And then the one that was displaced basically got the funds that would cover her salary for that week. And besides that, we also reached out to our community through Facebook. We’re in a underserved Hispanic community. So we personally reached out to the upper class communities in the more affluent areas of Houston to be able to give donations and clothing to our patients and also the two employees that had lost clothing in the flood.

Silen Pahlavan:

Four days after the hurricane hit we were able to start collecting the items. It was clothes, it was backpacks, it was books and diapers and toiletries; anything that we could get. After four days our entire kitchen was full of items that were donated. And what we did for the next three weeks, as the patients were coming through, we would give them a survey, a questionnaire, and they would mark their needs. Do you need diapers? Do you need toiletries? Do you need clothes? What size do you need? And they would fill out the questionnaire and we would come to the back. We had one nurse that was in charge. She would come in the back and kinda shop for these items for them from our donation center. And they really appreciated that.

Susanne Madden:

So you really turned what was a disaster for everybody into you guys really becoming the resource for your community and for your staff. That is an incredibly powerful story. We will be providing links on the website and in this story to your Facebook page so that people get some of these videos and read some of the responses from the community. But I have to say, in terms of hearing a disaster story, the sort of recovery where you become the resource for your community themself, is really, truly remarkable. I have to give it to you. You took something that could have been potentially devastating and really turned it into such a positive way to foster closeness in the community and reach people in need and be able to deliver those services. You sorta became your own FEMA for your patients. To heck with FEMA! ABC Pediatric Clinic is the place to go to in a disaster!

Sogol Pahlavan:

We were incredibly blessed that we had minimal damage. We had just, prior to the storm, built out the back of our clinic, which is an additional 2000 square feet literally four weeks before the storm. And the only damage we had was minimal water damage that seeped in through foundation. But in my, and Dr. Silen’s office, which is way in the back of the building … And we rarely use the office. It’s not a functional part of our workflow that affects the patients. So we felt like with that we really need to do something to really give back.

Susanne Madden:

And you accomplished it. Well done.

In terms of any quick tips, if you had a top two or three pointers that you wanted to give to other pediatric practices that may experience something in the future – because it certainly seems like that’s where we’re headed for, more and more with these historic storms – are there any two or three quick-hit points that you would want to identify for other pediatric practices?

Silen Pahlavan:

So I would say anything is possible. We never thought we would have this historical natural disaster in Houston. We’ve had other storms before. So preparation is really key. The reason that we got out some of it was by luck, but looking back, if we didn’t have that luck, we would’ve had a lot more damage. One of the things that we didn’t mention is to definitely get business interruption insurance. I did not know that existed prior to this storm. Some of the insurances have a deductible of 72 [hours]. It was 48 to 72 hours of business prior to reimbursing. Because we opened up within those 72 hours we didn’t meet any of their criteria to have any money reimbursed.

But look into that and really look at the details like with any other insurance. And read the fine print to see what it does cover. And then, definitely, insurance for your vaccines. So cover yourself with insurance and then cover your insurance, your building generator. So covering your vaccines somehow, even physically. A lot of the smaller offices in Houston had taken their vaccines to hospitals, bigger entities. And then your EHR. I would say those are the top three things. Those are the big dollars in business that really need to be covered.

And then engaging with your patients and engaging with your employees, which, it shouldn’t take a disaster for you to be able to do that. That should be a culture in your business. And reaching out, because we were really surprised by the significant effect that social media had and using that medium to communicate with our patients. And it worked.

Susanne Madden:

Terrific. Thank you both so very much for sharing your story with us today. It really is truly a remarkable tale. And I just love that there’re so many positive things that have come out of this for you, including galvanizing your staff, really building better relations and really becoming this resource for the community. Well done. And again, thank you so much for your time today in sharing your story with us. We very much appreciate it.

Sogol Pahlavan:

Thank you so much. Thank you for having us. Have a wonderful day.