Numerous proposals directly and indirectly related to health operations during disasters will be before House and Senate committees in the weeks to come. Legislators from both parties have been filing the bills in the face of recommendations from a special House panel on Hurricane Ike that held public hearings around the affected region.
"I think we have become aware of the fact that when disaster strikes, we're all operating from the same playbook," said Republican Sen. Jane Nelson of Flower Mound, sponsor of some of the legislation.
Many of these bills are procedural, requiring state agencies, hospitals and individuals to better establish exactly what steps they should take during a disaster. Most have a clause that would allow the laws, if enacted with a two-thirds majority of the Legislature, to take effect immediately.
Hurricane season begins June 1.
Some bills attempt to address what hospitals and first responders said was an unexpected strain from the sheer number of nursing home and other health-facility patients who streamed into Texas hospitals before the Sept. 13 storm and in the weeks the coast went without power.
Inland from the storm, San Antonio became a hub in the days leading up to landfall for patients moving from major hospitals in the Houston-Galveston area. But what caught them off guard was the number of homebound patients who evacuated and the severity of their needs, said Eric Epley, executive director of the Southwest Texas Regional Advisory Council, which received special needs evacuees.
"The home health system in America now has people who, five or 10 years ago, would have been in a nursing home," Epley said, adding that 68,000 homebound people are registered with the state for special services only a portion of those who need help in disasters.
"Knowing how many and knowing the level of care that's going to be required is the biggest hurdle," he said.
Meanwhile in Harris County, many of the nursing homes and live-in facilities that kept residents through the storm didn't have generators, so they had to send patients to nearby hospitals that had power, either through generators or because they had underground power lines that weren't blown down in the 110-mph winds. Those hospitals including Houston's two Level One trauma centers were already packed with extra beds after Ike devastated the trauma center at the University of Texas Medical Branch at Galveston.
Because UTMB's trauma center is closed and the hospital's capacity has been cut by more than half, patients who relied on the island are still taxing inland hospitals. Trauma centers at Houston's Ben Taub General Hospital and Memorial Hermann Hospital are diverting cases elsewhere.
"We're already in a situation where we've got limited capacity. Any other event that puts stress on that system whether it be a hurricane or a refinery explosion I think is a concern," said John Hawkins, a lobbyist with the Texas Hospital Association, which represents about 500 hospitals in Texas.
Houston Democratic Rep. Sylvester Turner has sponsored three proposals aimed at helping coastal health-care facilities better weather storms so they don't send their patients to already strained institutions.
"There was a tremendous amount of stress placed then on everyone else to meet those needs (of evacuated patients), and we are trying to respond to that as quickly as possible, because in five or six months we're going to be back in to the hurricane season," he said.
Turner wants to require nursing homes and similar facilities to have back-up generators and emergency plans in place. He also filed a bill that would require community and home-care services to help get patients registered with the state and prepared for evacuations.
Lawmakers and lobbyists say deciding who needs to evacuate when and where they should go is a big piece of the puzzle for people with medical needs.
"It's not like you and me leaving in a car decide to go to Dallas for the weekend. If you have someone who is in a hospital, they're in a hospital for a reason and you don't want to unnecessarily move someone 50, 75 or maybe even several hundred miles away," Epley said.
Hawkins said hospitals are trying to balance their concerns after Hurricane Rita in 2005, when too many evacuated who didn't need to, with those from Hurricane Ike, when those who stayed put in their hometowns added hefty strain to the system along the coast.
One of Nelson's proposals would require the Texas Department of State Health Services to inform the public how and whether they should evacuate based on where they live and what kind of medical problems they have.
Other bills address problems that Texas would face if evacuees had to leave the state. After Hurrican Katrina in 2005, Texas saved $3 million to $4 million in re-immunization costs because Louisiana allows other states to view residents' immunization records, which were needed for children to enroll in Texas schools. Texas cannot share records with other states, but a bill proposed by Austin Democratic Rep. Donna Howard would fix that problem.
While policy legislation continues to move through, funding, staffing and the future of UTMB remain questions for still strained facilities and hospital systems along the coast.
"We are very hopeful that the Legislature is going to address the lessons after the last storm, but you know, there's always the next one and Mother Nature always has something new and different for us," said Carolyn Belk, a lobbyist for The Methodist Hospital System.