Hurricane Milton Disrupts Infrastructure, Could Trigger More Hospital Evacuations In Florida

Hurricane Milton hit Florida’s West Cost hard Wednesday night as a Category 3 storm, bringing torrents of rain and tornadoes that caused millions to lose power and triggered widespread destruction to roads and water and sewage services.

While the region’s hospitals were largely ready for storm due to legacy hurricane preparations, health systems are still grappling with critical infrastructure outages, and are making “hour-by-hour” calculations on whether to evacuate more patients, according to Mary Mayhew, CEO and president of the Florida Hospital Association

Over 350 healthcare facilities, including 16 hospitals and seven emergency departments, had already evacuated patients prior to Milton making landfall, according to the state’s Agency for Health Care Administration.

Mayhew said her main priority now is determining hospitals’ capacity for receiving patients should evacuations be necessary. Should more evacuations be ordered, they would be due to disruptions to utilities that are critical to patient care, she said.

“The bottom line is that all of the efforts that hospitals have made over many years to harden their facilities, to address flood mitigation have absolutely paid off yesterday,” Mayhew said. “What we are contending with, though, is the disruption in public infrastructure. In the [St. Petersburg] area, we have hospitals now that are without public water and sewer and electricity.”

Hospitals have been preparing for Milton’s arrival since at least Monday, when Florida Gov. Ron DeSantis declared a state of emergency for 51 counties.

Government officials and the FHA were concerned about Milton’s size — weather projections said the storm could make landfall as a Category 5 storm — and its timing. 

Florida hospitals are still cleaning up physical debris from Hurricane Helene, which hit the Big Bend region two weeks ago. They are also navigating supply chain shortages from damage to a key IV solution plant run by Baxter in North Carolina. 

One of the big challenges for hospitals was “the amount of cleanup and debris that was still underway that that we knew would compound the flooding, the clogged drains, the debris obstructing the roads” from Helene as Milton approached, according to Mayhew. 

HCA Healthcare, which was also heavily impacted by Helene in Western North Carolina, is expected to take the biggest financial hit from Milton, according to an analyst note from Jefferies, though insurance is expected to cover most of the total cost. The system has 27% of its total beds in Florida with significant exposure in the Tampa and Orlando region.

HCA Healthcare is among the systems that transferred 400 patients via air and ground to other hospitals ahead of the storm, according to a spokesperson. The system closed five hospitals in St. Petersburg, Tampa, Largo, Port Charlotte and Englewood in anticipation of Milton.

Other systems, including BayCare and Orlando Health have paused elective procedures during the storm, according to press releases.

Health systems in Florida have spent years optimizing facilities for hurricanes, Mayhew said. Some moved electrical infrastructure to higher floors, away from flood prone areas. Others built wells on campuses to shore up water supplies, and Tampa General erected an aqua fence to withstand a 15-foot storm surge. 

Because of that preparation, the physical hospital buildings in the region have little damage from Milton and Helene, she said.

Still, the initial fallout from the storm illustrates that hospitals’ emergency preparedness can only go so far when they rely heavily on public infrastructure, according to Mayhew.

Similar to the aftermath of Hurricane Helene or Hurricane Ian in 2022, Florida hospitals are waiting to see how quickly public services can rebound from the disaster.

“Now, hospitals absolutely have generators, so they have their backup power. They will have other means of potable water, but ultimately, one of the biggest challenges is to have the water for both cooling and for fire suppression, so that that is the urgent focus right now,” Mayhew said. “Everyone is working with local officials.”