The Joplin Tornado: Recovery One Year Later

You may have forgotten the date, but we all remember the event. May 22, 2011, started out as a not too unusual Sunday afternoon in Joplin, Mo; families playing in the park, high school graduation underway at the football stadium, bustling emergency departments at the local hospitals, and an emergency orthopedic case in progress at St. John’s Regional Medical Center (Mercy Joplin). There were storms brewing in southeast Kansas and severe weather watches, but that is par for the course for late spring in “Tornado Alley.”

Then at 5:17 p.m. on May 22 the National Weather Service issued a tornado warning for the Joplin area. A mere 24 minutes later the unthinkable happened. Mercy Joplin sustained a direct and devastating hit by an EF 5 Tornado that cut a mile wide path of devastation across the densely populated south central part of Joplin.

The death and destruction caused by the deadliest single tornado in Missouri’s history was indescribable. The rest of the country watched in horror as the news channels broadcast nonstop coverage of mass casualties, the search for the missing and dead, and the destruction of homes, business and lives. In the end, there were 161 fatalities, over 1,000 injured, 8,000 homes and businesses damaged or destroyed, and over $2 billion in damage. Included in this mayhem was the story of Mercy Joplin and how 183 patients and untold number of visitors were heroically evacuated in 90 minutes via dark stairwells, amid spewing water pipes and with gas fumes filling the building. As tragic as the devastation was, it was miraculous that only five hospital patients and one visitor lost their lives. See Figure 1.

The resiliency and determination of the Joplin community and the recovery efforts in the first days, weeks and months are now legendary. No less remarkable has been the commitment by Mercy Health (the parent company of Mercy Joplin) to support its co-workers, physicians and the community during this disaster. Immediately after the disaster, Mercy Health publicly announced that they were committed to rebuilding the hospital. More than that, they would continue paying normal wages to coworkers and maintain physician compensation at pre-tornado levels. One can only imagine how devastating it would have been for the community and the individuals if they had lost not only their loved ones, friends and their homes, but also their jobs.

Work began immediately on reestablishment of physician and hospital services by Mercy Joplin. From makeshift clinic space in tents in Memorial Hall and an inflatable MASH hospital to the groundbreaking for the permanent replacement hospital, these commitments on the part of Mercy, its coworkers and physicians have provided not only much needed health care services and facilities, but also a significant boost for the morale of this devastated community. What follows is a brief chronicle of the phases of recovery of Mercy Joplin – now widely termed “Mercy Rising.”

The debris had barely settled early in the week following May 22, but Mercy leadership had already identified a way to get hospital services re-established. The Taney County, Mo., ambulance district had purchased a mobile medical unit or “field hospital” with a Missouri Homeland Security grant. By the morning of May 29, 2011, less than one full week after the tornado hit, with assistance from the Missouri Department of Health and Senior Services (DHSS) and the Missouri Disaster Medical Team, an inflatable 60-bed hospital had been transported from the Branson, Mo., area and set up just east of the destroyed Mercy-Joplin hospital. This field hospital included an emergency department, multiple surgical suites and diagnostic imaging. The facility treated an average of 130 patients daily during the first two weeks after the tornado. It remained operational providing emergency services and basic outpatient and inpatient hospital services until early October.

Many physician offices were also hard hit and several were completely destroyed, including the medical office building on the Mercy campus. Repair work started immediately on those offices that were not a total loss. Most of the Mercy primary care physicians were back in their offices within two weeks. Specialists worked out of Memorial Hall for the first couple of weeks until other facilities could be found and modified for clinic operations. Work also started quickly on a temporary replacement medical office building on the Mercy campus. Within six weeks, a 45,000 square foot modular clinic park had been erected in the hospital parking lot and most of the remaining displaced physicians were again seeing patients in a hard sided office.

On the hospital side, two simultaneous activities were underway. McCune-Brooks, a critical access hospital in Carthage, Mo., had been built with the capacity to expand beyond its 25 critical access beds. With a waiver from the agencies of jurisdiction, Mercy and McCune-Brooks were allowed to effectively double the hospital capacity to approximately 50 inpatient beds. Physicians and co-workers from Mercy Joplin were deployed to McCune-Brooks to increase the capacity of the emergency department, surgical department and the inpatient floors.

At the same time, work was underway to construct a temporary, hard sided hospital in Joplin with both a greater capacity and a more stable platform as the winter months were approaching. S. Johnson Portables of Michigan was chosen to expedite this project. By mid-August, the emergency department of the component facility was ready for use. In early October, the 34,000 square-foot component hospital was fully operational including 24 med-surgical beds, a 10-bed ICU, 15 emergency department beds, two operating suites and a cardiac cath lab. At this point, the inflatable field hospital had served its purpose and was disassembled.

While a major improvement over the inflatable mobile medical unit, even this 50-bed component hospital would not be adequate to meet the demands of the Mercy physicians or the Joplin community. However, the permanent replacement hospital would not be ready until early 2015. The solution: build an even larger and even more stable temporary hospital to serve until the permanent hospital could be completed. For this project, Walden Structures of Mentone, Ca., was chosen. In a cooperative effort between Walden, Mercy, and the Missouri DHSS, work began on a modular hospital. These modules were constructed of the same steel and concrete used for on-site building construction. In order to assure the structures would meet the strict Missouri hospital licensing requirements, a few modules were actually finished out as a prototype and inspected by the Missouri DHSS while still in California. Once preliminary approval was obtained, two hundred and twenty-four 60 × 14 foot modules were preassembled in California and transported by truck and rail to Joplin. See Figure 2.

At the same time, construction crews in Joplin were preparing the site and the foundation for the Walden modules. As the modules arrived, they were assembled, plumbed, wired, and received exterior and interior finishes transforming them into a hospital that is indistinguishable from one built traditionally on site. The new facility encompasses more than 150,000 square feet including two story inpatient wings capable of accommodating over 100 patients. According to John Farnen, Mercy’s executive director of planning, design and construction, “The resulting structure is 30 percent stronger than the requirements for the old hospital and the glass is rated to withstand winds of 200 mph.” The coordination between Mercy and Walden Structures allowed the design, construction, and assembly to be completed in a mere eight months. The Walden modular Mercy Hospital Joplin opened on April 15, less than one year after that fateful day in May 2011.

The modular hospital includes 60 patient rooms that could accommodate 100 inpatients including 18 ICU beds, the reopening of OB services in an OB suite with 10 LDRP rooms, 22 emergency department beds and four operating suites. In addition, there are a cafeteria, gift shop, pharmacy, and chapel. The patient rooms now include all the amenities expected in any hospital including remote monitoring and communications capabilities as well as private bathrooms. Even the most optimistic physicians were amazed at the progress that has been made in less than a year. According to Dr. Sean Smith emergency department physician and president of Mercy Clinic’s Joplin division, “We are light years ahead of where I thought we could or would be by now.”

The excitement shows in the Joplin Mercy co-workers and physicians. Co-workers who had been driving to Carthage or even Springfield are now able to return to work close to home. Physician recruiting to Joplin has, if anything, accelerated since the tornado. Physicians who had been recruited before the tornado to start work in Joplin in the summer of 2011 all came – in spite of only having a “field hospital” in which to work. Several of the independent physicians in the community were faced with the decision of whether to rebuild their destroyed clinics or join one of the local health systems. Many chose to join Mercy, in part due to the commitment Mercy showed to its coworkers and physicians during the recovery.

So, what is still to come for Mercy Joplin? Construction has already begun on Mercy’s new 100-acre campus just south of I-44 south of Joplin. The opportunity to start from scratch and build a completely new hospital for the future of Joplin is one on which Mercy intends to capitalize. With an approximately 870,000 square foot facility planned, the campus will include a 211-bed hospital with capacity to add an additional 48 beds as well as an integrated medical office building, breast center, cancer center, imaging center, and both behavioral health and hospice facilities. The new permanent facilities are expected to be ready for use by early 2015. See Figure 3.

In the end, an EF-5 tornado did not determine the fate of Joplin or Mercy Joplin. Rather, the resiliency and determination of the Joplin community and the commitment of the co-workers, physicians, and administration of Mercy Joplin to rise from the devastation of that fateful day are shaping the future of this community. With the promise of a hospital and clinic facility designed for the future and a steadily increasing number of physicians being recruited to the area, it is truly encouraging and inspiring to see “Mercy Rising” in Joplin.