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4007 Estate Diamond Ruby, Christiansted, St. Croix, USVI 00821 Good morning, Honorable Senator Marise James, Chairperson of the Disaster Recovery, 1 Infrastructure & Planning, Senators of the 36th Legislature of the U.S. Virgin Islands present, and 2 all listening and viewing. I am Darlene Baptiste, Chief Executive Officer for the Governor Juan 3 F. Luis Hospital and Medical Center (JFL) and Schneider Regional Medical Center (SRMC). I 4 am joined today by: 5 • Adeline Williams Connor - Chief Operating Officer 6 • Darice Plaskett - Chief Nursing Officer 7 They are here to support this presentation and assist with any questions. 8 Thank you for the opportunity to present an overview of JFL’s disaster preparedness and 9 hurricane season readiness, including our infrastructure resilience, continuity of operations, surge 10 management, interagency coordination, recovery initiatives, and responsibilities under the 11 Territorial Emergency Operations Plan. 12 Hurricane preparedness is a critical responsibility for JFL. As the only acute care hospital on St. 13 Croix, our community relies on us to remain operational during the most challenging 14 circumstances. 15 JFL continues to operate from a temporary healthcare facility established after Hurricane Maria. 16 While this facility enables us to provide essential services to St. Croix residents, it was not 17 designed as a permanent hospital. 18 It is important to acknowledge a key reality that shapes all aspects of our emergency 19 preparedness planning. 20 Our hurricane preparedness strategy relies on proactive clinical decision-making, resource 21 conservation, and collaboration with local, federal, and national partners. Every operational 22 decision before a storm is guided by one question: 23 Will this action improve our ability to care for our community during and after the storm? 24 25 Emergency Support Function Responsibilities 26 Under the Territorial Emergency Operations Plan, JFL serves as a critical healthcare partner 27 supporting Emergency Support Function 8 – Public Health and Medical Services. 28 Our responsibilities include maintaining hospital operations, providing emergency medical care, 29 supporting medical surge management, coordinating patient transfers, sharing situational 30 awareness with emergency management partners, and supporting the Territory's broader public 31 health response. 32 Healthcare Infrastructure Resilience 33 JFL-North, our temporary facility, remains fully operational and continues to provide essential 34 healthcare services. However, operating within a temporary structure requires continuous 35 vigilance and contingency planning. 36 Based on the facility's design specifications, JFL-North was intended to withstand wind speeds 37 up to 175 miles per hour, equivalent to a Category 5 hurricane. While this provides a planning 38 benchmark, JFL-North has not yet been tested by a storm comparable to Hurricane Maria. As a 39 result, our preparedness efforts follow a cautious, risk-informed approach that emphasizes 40 planning for various potential scenarios. 41 Hurricane Readiness Framework 42 Our preparedness strategy includes ongoing assessment of our physical infrastructure and the 43 resources necessary to sustain patient care. Throughout the year, and more frequently as storms 44 approach, our Facilities team routinely tests and evaluates critical utility systems, including 45 emergency generators, fuel reserves, electrical systems, bulk oxygen storage, medical gas 46 distribution, and potable water. These assessments help ensure the hospital can safely maintain 47 essential healthcare services as long as conditions allow. 48 Ahead of hurricane season, clinical and support departments assess their inventories of 49 medications, supplies, food, and other essentials. This enables stockpiling and helps identify 50 potential limitations for improved resource planning. 51 If a storm threat emerges, JFL follows a phased activation process to deliberately and 52 coordinately escalate operations as conditions evolve. 53 Phase I – Enhanced Monitoring (Approximately Seven Days Before Potential Impact) 54 When a system may threaten the Territory, we enhance monitoring and increase assessments of 55 infrastructure, utilities, staffing, and supplies. Department leaders review preparedness checklists 56 and identify resource needs based on the current conditions and expected disruptions. 57 At the same time, clinical leadership and medical staff monitor patient census and assess 58 hospitalized patients to identify those suitable for discharge, transfer, or alternative care if 59 conditions worsen. Early evaluations enable timely, clinically appropriate decisions regarding 60 decompression while maintaining continuity of care. 61 Phase II – Operational Readiness (Approximately Three Days Before Potential Impact) 62 As projected storm impact increases, preparedness activities intensify. Clinical leadership 63 finalizes decompression plans and coordinates discharges and transfers. Staffing assignments are 64 confirmed, emergency utility systems are verified, and specialized service lines, such as 65 outpatient dialysis, implement emergency treatment protocols. 66 Phase III – Emergency Operations 67 When JFL’s Incident Command System is activated, the Emergency Operations Plan is fully 68 implemented. Priorities shift to sheltering in place, conserving resources, maintaining essential 69 services, and preparing for post-storm response and recovery. Operational conditions are 70 continuously assessed throughout the event. 71 Continuity of Operations 72 JFL’s Continuity of Operations Plan aims to maintain essential healthcare services during 73 emergencies and restore any disrupted services as quickly as possible. Our planning ensures 74 critical clinical and administrative functions remain operational, despite the limitations of our 75 temporary facility. 76 Our strategy during a category 1 or 2 storm is to safely shelter patients in place. This minimizes 77 unnecessary movement and allows continued delivery of essential services. If forecasts predict a 78 category 3 storm or higher and the structure may not withstand storm conditions, contingency 79 plans provide for relocating patient care operations. 80 The Virgin Islands Cardiac Center is the primary Alternate Care Site due to its clinical 81 infrastructure, medical gas capabilities, utility support, and proximity to hospital operations. This 82 enables continued essential services if relocation is necessary. An additional contingency site has 83 been evaluated with territorial partners but would only be used under extraordinary 84 circumstances due to limited infrastructure. 85 The continuity of healthcare services depends on both our facilities and the careful management 86 of the JFL's limited resources, before, during, and after storms. Key departments collaborate to 87 assess inventories and implement conservation strategies to sustain critical services when 88 resupply may be delayed. Resources are continuously monitored, prioritized, and allocated to 89 patients with the greatest clinical need. 90 Maintaining continuity also requires sustaining critical clinical and business functions. 91 Established downtime procedures guide operations during interruptions to electronic medical 92 records or other information systems. These include manual clinical documentation, medication 93 records, laboratory reporting, and patient tracking, ensuring essential services continue safely 94 until systems are restored. 95 Clear, reliable communication is essential throughout every phase of an emergency. Internally, 96 JFL utilizes its emergency notification system, leadership briefings, and Incident Command 97 communications to provide timely updates on operations, staffing, and safety. Externally, our 98 Public Information Officer coordinates with territorial partners to share updates on hospital 99 operations, available services, and critical health information, keeping patients, families, and the 100 community informed. 101 These continuity measures enable JFL to sustain essential healthcare services, adapt to changing 102 operational conditions, and continue providing high-quality care. 103 Clinical Preparedness and Patient Decompression 104 Given our facility’s limitations, proactive patient decompression is a key component of our 105 preparedness strategy. 106 Unlike larger healthcare systems that may expand bed capacity during disasters, our goal is to 107 preserve the existing resources, so they remain available when our community needs them most 108 after the storm. 109 As storm threats become imminent, physicians and clinical leadership assess each hospitalized 110 patient. Those who can be safely discharged are released when appropriate. Patients needing 111 specialized or intensive care, such as ventilator support or advanced critical care, are evaluated 112 for transfer to off-island partner facilities when clinically appropriate and transportation is 113 available. 114 This strategy serves two important purposes. 115 First, it ensures continuity of care for patients whose needs may exceed local capabilities during 116 a prolonged emergency. Second, it preserves beds, staffing, and supply resources for patients 117 needing care after the storm. 118 We also recognize the unique challenges in our healthcare system. Patient transfers may be 119 complicated by insurance, financial, or other socioeconomic factors. Nevertheless, our staff and 120 case management teams work diligently with patients, families, insurers, and referral facilities to 121 facilitate transfers. 122 Outpatient Dialysis Preparedness 123 Continuity of dialysis services is a top clinical priority, especially since our outpatient dialysis 124 unit also operates from temporary trailers. 125 In emergencies, we make every effort to ensure all dialysis patients receive treatment before an 126 emergency, hurricane, or curfew. 127 Each patient receives an individualized dialysis diet plan to help extend the time between 128 treatments by minimizing fluid and waste buildup. 129 Before hurricane season and as needed, the emergency diet plan is reviewed with each patient, 130 and a copy is provided for reference. 131 Depending on medical condition and adherence to the emergency diet plan, some patients may 132 safely go without dialysis for three days or more. 133 After an emergency or hurricane, dialysis staff contact each patient to assess their condition and 134 provide post-emergency treatment instructions. 135 We are also in discussion with an external dialysis provider to establish an alternate site, similar 136 to our arrangement with Schneider Regional Medical Center, in the event of a prolonged 137 disruption. 138 Emergency Medical Surge Management 139 Because our temporary facility cannot expand inpatient capacity, our surge strategy focuses on 140 protecting existing capacity through coordinated healthcare delivery across the Territory. 141 Working closely with the Department of Health, community health centers, dialysis providers, 142 and other partners to ensure patients with low-acuity or non-emergent conditions receive care in 143 the most appropriate setting. This coordinated approach preserves emergency department 144 resources and inpatient beds for critically ill and injured patients. 145 During disaster operations, we continually reassess patient census, staffing, utilities, supplies, 146 and operational capability to ensure available resources are directed to those patients requiring 147 the highest level of care. 148 Interagency Coordination 149 We actively participate in weekly Emergency Management meetings that include all government 150 stakeholders. We have begun discussions with VITEMA and HHS on resource needs, triggers 151 for pre-emergency declarations, related activities, and timelines for potential deployment of 152 federal resources before and after storms. 153 We work closely with VITEMA, the Virgin Islands Department of Health, the Virgin Islands 154 Fire and Emergency Medical Services, the Virgin Islands Police Department, our federal 155 partners, air medical transportation providers, and regional healthcare facilities. Together, we 156 coordinate and manage patient movement, emergency communications, resource requests, and 157 recovery operations. 158 We are grateful for the support of these agencies. Their assistance is vital to helping JFL 159 maintain the resources needed to provide safe, compassionate care to our community. 160 161 162 Current Challenges 163 Like healthcare organizations across the nation, we continue to face challenges, including 164 operating in a temporary facility, infrastructure limitations, workforce shortages, supply chain 165 disruptions, and more frequent and severe weather events. 166 These realities have shaped our preparedness strategy. 167 They require us to plan earlier, coordinate more closely with our partners, conserve resources 168 more deliberately, and make thoughtful clinical decisions that prioritize patient safety above all 169 else. 170 Conclusion 171 Madam Chair and Committee members, Governor Juan F. Luis Hospital & Medical Center 172 approaches hurricane preparedness with a clear understanding of both our capabilities and 173 limitations. 174 Although our current facility was not intended as a permanent hospital, we have developed a 175 preparedness program focused on early planning, patient decompression, continuity of 176 operations, and collaboration. 177 Our commitment is clear: to ensure that when the people of St. Croix need us most, we will be 178 prepared to provide safe, quality healthcare to the greatest extent possible. 179 We appreciate the Legislature’s continued support as we work to strengthen the Territory's 180 healthcare infrastructure and improve our future resilience. 181 Thank you for the opportunity to appear today. I am pleased to answer any questions the 182 Committee may have. 183