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E N D U R I N G

The story of Mercy in Joplin

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© 2012 Mercy. All rights reserved.

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Table of ContentsPreface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Inside the disaster: Mercy remembers . . . . . . . . . . . . . . . 7

A race for records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Together: Mission possible . . . . . . . . . . . . . . . . . . . . . . . . .32

A closer look | Lessons learned . . . . . . . . . . . . . . . . . . . . . .43

About this series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

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P A T H O F T O R N A D O

Sunday, May 22, 2011, at 5:41 p.m.

A direct hit

A twister strengthens into an EF5 just as it tears into St. John’s Regional Medical Center. At the hospital, 117 co-workers

rescue 183 patients. Five patients and one visitor die.

The storm kills 161 people and destroys 8,000 structures, including 7,000 homes.

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The deadliest U.S. tornado in modern times descended on Joplin, Mo., in May 2011. Winds churning at 200 mph leveled nearly every home, school and business in a path six

miles long and nearly a mile wide.

Amid the destruction stood the ruins of St. John’s Regional Medical Center, a part of Mercy since 2009 and whose nine stories of shattered windows and crumpled metal became an iconic image of the broken city. For 90 minutes, Mercy co-workers and volunteers evacuated 183 patients from their rooms, carrying them down dark, debris-strewn stairs to safety.

The people of Joplin have fought to recover and rebuild their Midwestern homeland. In their progress emerge tales of inspiration and hope. The Mercy hospital is one, a story that reaches across medicine, faith and community.

Despite gas leaks and a hissing mist, Mercy co-workers ran toward their stricken hospital and not away. Nurses, doctors and others terrorized by the winds shook off their own trauma to address the pain and suffering of others. The ministry’s investment in sophisticated electronics helped speed simple healing, ensuring continuous care for St. John’s patients and the newly injured. The health ministry’s pledge to rebuild in Joplin extended its healing deep into the community.

Like the rest of Joplin, Mercy has borne losses that will haunt it for a generation. But its people have shown a spiritual strength, mental resolve and generous response that would be familiar to the founding Sisters of Mercy.

This is the story of Mercy enduring a disaster and helping a community shape its future.

Preface

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Inside the disaster:Mercy remembers

Dr. Tim O’Keefe remembers seeing blue skies when he reported for duty at the emergency department at St. John’s hospital. It was early afternoon on that fateful Sunday. To

be sure, there had been storm warnings that weekend, but O’Keefe had no reason to expect his world would come unhinged that afternoon.

Even after the sky turned black, the wind whistled through the hallways, debris began to fly through the corridors, the power failed, and a falling light fixture hit his shoulder, causing him finally to duck beneath a desk, O’Keefe says he felt a measure of calm.

“I was in this big hospital,” he recalls. “What could possibly happen?”

Not too long after, one of O’Keefe’s co-workers, Sharell Questelle, a nurse with 15 years of service at St. John’s, arrived at the hospital burdened with dread. She had seen what O’Keefe could not. A tornado cut a swath through the heart of Joplin, three quarters of a mile wide and six miles long. After riding out the storm at her home just north of Joplin, Questelle jumped in her Ford F150 pickup. It was driven by her son Dakotah, 25, and they were joined by his girlfriend, Felicia.

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As they sped to the hospital, they began to lose their bearings. The massive twister had utterly changed the landscape. “There were no landmarks,” Questelle says. Then they caught sight of the hospital. Dakotah rammed the family’s pickup over fallen utility poles, through piles of brick, drywall, roofing and the personal effects of thousands of devastated families to get his mom where she needed to go.

Questelle jumped out of the truck and clambered over wreckage that included an emergency helicopter only to find a twisted wad of fence standing between her and the entrance. A man reached for her, told her to give him her hand, hoisted her over, and she ran for the emergency entrance. “And I just remember thinking,” Questelle says. “Prepare yourself. Prepare yourself. Everyone is dead.”

Though Questelle and O’Keefe had entirely different perspectives on the storm, they held one thing in common with each other and hundreds of other Mercy caregivers that day. They gave fresh meaning to what Sister Cabrini Koelsch, the hospital’s director of mission, says is the heritage of what Mercy is and what Mercy is about. In a word that is “charism” — from a Greek word meaning the graces given to individuals to act for the good of others.

Sr. Cabrini proudly recalls one scene as described by a patient evacuated from the hospital. He told her that as he left the building, he saw masses of people, apparently nurses and doctors, running toward the hospital instead of away. “If Mercy’s taking care of people under a tree,” the patient told her, “that's where I’m going.”

That, Sister Cabrini says, is the spirit of Mercy.

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Condition Gray

Can it be said that blessings and good fortune were found in a whirlwind that destroyed a pillar in Joplin’s community like St. John’s, that crushed thousands of homes and businesses, and that took 161 lives?

It can. Good fortune came in the timing. The tornado arrived out of the west on a Sunday afternoon, a time when many Joplinites including Mercy caregivers were in their homes and not in stores that proved particularly vulnerable.

Thousands who were out could be found at Missouri Southern State University north of town where commencement had concluded for 455 Joplin High School seniors. Many had not yet returned home or had sufficient warning to stay put at the college. Others drove into the path the storm would take, including Joan Hatfield, a speech pathologist whose son Robert was among those wearing a mortarboard that day. In little more than a couple of hours, Hatfield would feel blessed to find herself in Mercy’s care.

Torrential rains continued to soak St. John’s in the hours after the tornado.

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Dr. Dusty Smith was performing the hospital’s only surgery on a patient’s infected hip. Carey Miller was among three nurses in obstetrics, where there were four moms and as many babies. Two were getting ready to go home.

Early in the afternoon, a nursing supervisor at the hospital had sounded an alert on the intercom system. “Prepare Condition Gray.” Every hospital worker knew what that meant. They needed to be ready to move patients away from windows and into hallways.

At 5:30 p.m., as tornado sirens were blaring across Joplin, word came to “execute Condition Gray.” Dr. O'Keefe did not hear that warning. The Emergency Department has its own intercom system, he would later explain.

Those Mercy caregivers who did hear “execute Condition Gray” reacted immediately and followed the training they had been

29 ICU patients

183 admitted patients +25 emergency patients

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and their babiesin obstetrics

Including at least:

1 physician performing hip

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25 emergency patients

The people in harm’s way

Emergency Department

According to records of who was clocked in at the time; others may have been in the building as well.

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through repeatedly over the years. Patients were wheeled out of their rooms and into hallways, co-workers making sure to keep their IVs and/or ventilators running. ICU Nurse Tammy Fritchey provided an extra measure of protection by putting pillows atop her patients.

But they had just minutes before the wind began howling, a roar, many say sounding not like the proverbial freight train but more like a jet engine. And, as on an airliner, eardrums began to pop. “The air pressure was moving my chest, controlling my breathing,” says O’Keefe. He could hear stuff tearing apart.

At the eighth-floor Birthing Center, Carrie Miller remembered doors blowing open and one of the other nurses, Diane Lankford, hanging on to Room 16’s door as the storm outside began sucking her into the room. Miller grabbed Lankford but the two couldn’t pull the door shut. Then they tried pushing a bed with a patient and baby in it out of the way. Miller also wrapped the baby in her jacket just before the wind pushed the bed up against the nurses, pinning them against a wall. The two nurses could barely reach and hold hands, Miller says, starting to sob at the memory. “I started yelling at her to pray for Jesus to wrap his arms around us.”

On the third floor, visitor John Seay was tending to his mother, Gladys Seay of Welch, Okla., who long ago had trained as a nurse at St. John’s. Seay had held onto her bed as the wind sucked them down a corridor. He then left her for a few minutes to check on other relatives who had suffered injuries. When Seay returned, he couldn’t find a pulse. Mrs. Seay was wearing a “do not resuscitate” bracelet. Seay then did what he believes his mother would have wanted him to do: help other people.

Mrs. Seay was among five patients and a visitor who died at the hospital that day.

Obstetrics

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‘The closest of friends’

On the first floor in the hospital cafeteria, Matt Hutchison was with about 15 other food service workers also responding to Condition Gray. Hutchison figured they were in a reasonably safe place as the cafeteria sat partly below ground level. But when the storm hit, Matt, 6 feet 6 inches and 280 pounds, had to brace

himself inside a doorway. Not long after, he encountered Kourtney Grisham and her year-old daughter Emily from Greenfield, Mo. Kourtney’s husband, Adam, had come to the hospital from his home 50 miles to the northeast feeling ill with what was later diagnosed as a hernia.

In an account that she wrote for the Joplin Independent, Kourtney told how she began to run down the hallway with Emily tucked tightly to her chest and no destination in mind. That’s when a hand reached out to her from a small doorway leading to the back of the cafeteria. The hand belonged to Hutchison, who by then had taken cover inside the doorway with six other people. “I screamed out a prayer, a plea to God to save us, and began begging for it to be over,” Kourtney wrote. She says Hutchison held on “to both of us as if we had known each other and were the closest of friends.”

As the wind died down, Hutchison helped Kourtney, Emily and the others find co-workers who would lead them out to safety. Then he did what so many co-workers did that day. He stayed inside to help others.

If Hutchison had paused to take stock for just a moment, he might have come up with many reasons to flee. He smelled natural gas from a ruptured line and jet fuel from the shattered helicopter. A white plume enveloped the hospital, which many at the time believed came from fire but was a release from broken oxygen tanks. Water poured from the ceiling. Exposed wires hung in the hallway.

And then there was another threat that would not have occurred to Hutchison but was much on the mind of Dr. O’Keefe. He was

Cafeteria

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concerned that the destruction might have caused the hospital’s magnetic resonance imaging machine to become unstable. A damaged MRI might leak nitrogen that could filter down the hall and snuff the oxygen in a vestibule where patients and co-workers gathered. Dozens could die in an instant.

Power was out for good and flashlights with batteries would only last so long. “We were going to be in a cave with no light,” O’Keefe recalls. Everyone had to get out.

He also knew they would need supplies, including bandages and gauze for those wounded by flying glass and impaled with building materials. The ICU nurses were concerned about oxygen tanks and Ambu bags — hand-held devices used to ventilate patients when a mechanical ventilator can’t be used.

Hallways helped protect patients from shattered windows but not winds that swept through the building.

Emergency Dept.

MRI

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Emergency Department

Chapel Main entranceCancer Center

entrance

Cafeteria

Patient rooms

ICUThe path of destruction

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Of course, the elevators were out and patients had to come down the steps with the strongest rescuers carrying them on backboards, mattresses and even broken doors. Other co-workers walked alongside the patients carrying IV poles or working the Ambu bags to keep patients alive.

Dakotah, nurse Sharell Questelle’s 300-pound, 6-foot-4-inch son, hoisted crash carts weighing more than 100 pounds each into the back of their truck to be hauled wherever they would be needed.

O’Keefe and a group of other doctors and nurses wanted to re-establish an emergency department in a post-operative recovery room, but decided that wouldn’t work. They then elected to get their patients outside and across McClelland Boulevard to a parking lot where they could perform a semblance of triage. Some were then taken to Freeman Hospital West — and to Memorial

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Hall, a building more often used for concerts, and McAuley Catholic High School, both near downtown Joplin. At the same time, many of St. John’s inpatients were moved indoors to the Brady building, a rehab center just to the south of the hospital.

Once outside, O’Keefe could see many more people coming toward the hospital. Some needed care. Many were bleeding, in shock with impalement wounds, stumbling toward the hospital pleading for help without realizing the storm had crippled the facility. Questelle, the nurse who by that time had made it outdoors, encountered a woman who said, “I think I need to sit down.” She had a portion of a two-by-four sticking through her head. Questelle found a truck to transport the woman to Freeman. She later learned the woman survived.

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Pickup trucks to the rescue

More people arrived to help. Many were St. John’s supervisors, doctors and nurses. Some had ridden out the storms in their bathrooms and closets, then emerged to find the roofs ripped off their homes. (Joplin’s HR department later counted 224 co-workers — roughly 10 percent of the staff — whose homes were damaged in the tornado. Half of those were left uninhabitable.)

Some Mercy co-workers had family members they couldn’t yet account for. Still, they came to St. John’s.

Trauma Director Dr. Bob Dodson, who was among those coming to the hospital from their homes, remembers a fireman at one of the entrances trying to stop people from going in because of a gas leak. “All these people kept going right by him,” Dodson says, adding that everybody came to do what was needed. They weren’t going to be stopped by concern about themselves.

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D O W N T O W N

The aftermathIn addition to the hospital, many other Mercy structures were in the path of the tornado. In the hours after the storm, many patients were treated at Memorial Hall, a high school and Freeman Hospital.

MERCY FACILITIESDestroyedMajor damageModerate damageMinimal damageNo damage

Regional Eyecare Plaza

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The tornado flattened neighborhoods surrounding St. John’s, which is at the far left.

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Also arriving were everyday Joplinites in their pickups and four-wheel drives. This was at once heartening and vital. O’Keefe says he didn’t put one patient into an ambulance that night. Everyone went into the back of a pickup, some into a bus sent by the school district.

Emily Huddleston, then 13, was one of those who found herself in a pickup coming and going. She was riding home with her brother and parents after attending the Joplin High School commencement for her brother, Joe, when the tornado struck. It blew their Chevy Suburban two blocks down the street, miraculously leaving all but Emily uninjured. Flying debris left a long gash along Emily’s left thigh. After taking shelter in a dental clinic for an hour, she was loaded into a passing pickup that took her several blocks to the parking lot across from the hospital. When she arrived, Emily says, she could tell “St. John’s was gone.”

But she recounts with a mixture of amazement and appreciation that there were caregivers on hand ready to help. They found a gurney for Emily and an IV drip. Then they loaded her into another pickup for a ride to Freeman. Emily says, “I remember thinking it was only going to get better from there.”

‘Don’t leave me’

For others, it was getting worse. Emergency Department nurse Questelle was dealing with “the swarm of walking wounded.” But not all were walking. Questelle, nurse Marsha O’Connor and Manager of Nursing Sandy Woods later provided aid and comfort to a man crushed under a minivan in the parking lot. He needed an IV, oxygen and reassurance while first responders worked to free him. “He kept saying, ‘Don’t leave me. Don’t leave me.’ And we reassured him that we wouldn’t,” Questelle says.

Several days later O’Connor would attend his funeral on behalf of her co-workers.

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Around 2 a.m., Questelle and her son arrived at Memorial Hall with their truck full of supplies. The facility was built in the 1920s to honor war veterans and had hosted everything from basketball tournaments to concerts to circuses. Never had it seen anything quite like this: Dozens of St. John’s administrators, maintenance workers and caregivers scrambling in the evening and through the night to set up a triage center/emergency room with beds, crash carts and all the wiring necessary to support ventilators and monitors. The stage was established as the supply area. Respiratory products could be found in one section; orthopedic supplies in another.

Questelle marveled at how much had been done when she arrived. It had been just seven or eight hours since the tornado struck. “It was just mind boggling that it was so organized,” she says.

Mercy’s centralized depot in Springfield delivered tractor trailers full of clinical supplies to Memorial Hall.

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Over at McAuley high school, Joan Hatfield was just as impressed — not as a professional, but as a patient. On her way home from the commencement at Missouri Southern with her friend Bonnie Weston, Hatfield had taken cover in a Domino’s Pizza at 17th and Rangeline. “The entire building collapsed on top of us,” Hatfield recalls. “Bonnie and I clasped our hands together under the debris and said the Lord’s Prayer.”

Within an hour, men in lime green vests appeared to get them out and took them to McAuley for an assessment of their injuries. She marvels at the organized process in place to make sure everyone who walked through that door got attention. “They did such an incredible job learning what your injuries were.” They took down who her family doctor was and they had a contact person for follow-up.

The caregiving did not end there for Hatfield. She would avail herself of a mental health counseling service that Mercy established for Joplin educators dealing with the aftermath of the storm. “I went,” Hatfield says, “because it was Mercy based.”

• • •

Talk to Mercy co-workers about the 24 hours after the storm and many will say they began to lose track of time. Their touchpoints and markers were patients not the hours. But nurse Questelle does remember finally getting to her home at 6:30 a.m. Monday morning. By that time, she had been up 28 straight hours. She remembers sleeping for 90 minutes, then returning for duty at Memorial Hall.

She says she didn’t have to be there, that many people were there to help, but she couldn’t stay home. “There was still too much to do.”

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Most technology disaster plans focus on the loss of electricity, telecom or hardware — not on a natural disaster that ravages all three.

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A race for records

With no warning, the computer network that connected St. John’s to the rest of Mercy went dark. That rang alarms in a windowless room near Washington, Mo.,

where Mercy techs monitor the ministry’s sophisticated data links. They were perhaps the first Mercy people outside Joplin to know something was amiss at St. John’s.

The techs began troubleshooting the problem, which was unusual for its size. A group of computers might go down somewhere on the four-state Mercy network once or twice a month. Never a whole hospital. The co-workers rang up Will Showalter, Mercy’s chief information officer, and other leaders were called to a teleconference about 15 minutes after the tornado had left St. John’s.

Still, nobody knew the cause until Showalter and others switched on their TVs. “I could see we had a much bigger problem than anyone had realized,” he recalls. Within minutes, the group decided to start printing out medical files for St. John’s patients. The records were done about two hours later, and transported to Joplin a few hours after that.

Mercy’s operations center monitors ministry facilities, from heating and cooling to its medical records system.

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A half-billion-dollar investment in technology had paid off for Mercy, better than anyone could have expected — and sooner.

Just months earlier, Mercy had opened a new data center in Washington, a small town along the Missouri River more than 200 miles from Joplin. That blockhouse of a building holds the tech monitoring center and is the heart of a $550 million commitment Mercy has made to electronic health records. Mercy stores its medical records in only one form — the ones and zeroes of modern data systems.

The theory was that computers can help doctors and nurses better care for their patients. Improved care will mean fewer

sick patients, which by the way, could help slow the rise in health care costs. It’s a theory that’s gaining fans,

including the federal government, which established significant new grants in 2009 to encourage electronic medical records.

It was five or six years earlier that Mercy had committed itself to this revolution in health care.

‘It was toast’

After the tornado hit, a tech supervisor made her way to the computer room in a building next to

St. John’s to see what might be salvaged, using her mobile phone as a flashlight through the trashed halls. She was met with a distressing scene. “Wires were hanging down and water was dripping from the floors above,” says Summer Myers. Racks of computers were blown through walls. It looked beyond salvaging. “It was toast.”

Myers dug out a working flashlight and made her way to the hospital itself, where she was told co-workers needed help evacuating patients. She helped guide the many rescuers shuttling patients down the steps. “Life became more important at that point,” she says. “Do what you can to save lives.”

At about the same time in St. Louis, Showalter had made it to his office and watched as the TV cameras swept across the

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shattered neighborhoods of Joplin. They would pause to show the blown-out windows and peeled roofs of St. John’s. Showalter remembers thinking the hospital was a “crisis embedded in a disaster.” The images suggested firefighters racing there might face a grim task: “If they have to do a body count, how many bodies would they be looking for?”

Because of the electronic records, the answer came quickly — the hospital had 183 registered patients. And he soon learned most were being successfully evacuated. The ministry’s computer network also told top managers how many hourly co-workers had clocked into the hospital, and soon how many salaried co-workers were scheduled for duty.

The life-and-death questions continued, though. “How do we ensure a continuity of care?” Showalter wondered. How would Mercy get the right information about patients to their new doctors?

The tornado blew out the computer room including new Dell equipment still in boxes.

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The system was ready for that, too. The technology team could get the electronic records transferred to wherever the patients had landed. They could be zipped electronically to anywhere in seconds. But there was a more reliable medium: good ol’ printouts. “Paper is still the lowest-common denominator when sharing data,” says Jeff Bell, also a Mercy tech leader.

The technology team looked first to print the records at one of Mercy’s largest hospitals, roughly an hour’s drive from Joplin in Springfield, Mo. But the storm that had pummeled Joplin was heading east toward Springfield. Not wanting to rely on paper records making it through the gale, the team also looked west, behind the storm, to a Mercy hospital in Fort Scott, Kan.

The medical records, each a couple of pages to a handful, finished printing at both locations a couple of hours later. Couriers ran them to hospitals that were receiving Mercy patients.

Fort Knox of data

A day after the tornado plowed through Joplin, Bell stood amid the wreckage outside the now-empty St. John’s hospital. He had a few minutes to scan the scene and was stunned at the ruined building and the devastation that stretched in all directions, as well as the stories trickling in of lost lives and injuries.

A tech guy, he noticed PC screens littering the grounds around the hospital. Many were monitors recently installed by Mercy — modern flat panels that were light and wide, probably lifted like sails in the ferocious winds. Looking at them, though, he actually found relief because he knew they were empty vessels for precious cargo that had already shipped to Washington.

“This is why we built it,” he thought to himself.

“It” is one of the most advanced electronic data systems in a U.S. health organization. Mercy was a rarity, particularly among small health groups — and overall one of perhaps 5 percent of U.S. health organizations at the time — to commit to electronic records. The switchover would cost about $450 million over the next seven or eight years, part of a decade-long upgrade to data systems.

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3 Couriers rush the printouts to Joplin.

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The Mercy Data Center in Washington is built to withstand a tornado, with second walls and roofs protecting the computers themselves.

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Mercy’s top leaders were continuing an emphasis on innovation that began under the founding Sisters of Mercy. Sister Mary Roch Rocklage, the ministry’s first CEO, remembers long discussions about technology in the 1980s. “Those were the most boring meetings for me,” she says with a chuckle. But she endured them out of faith that computers were central to the future of good care.

Today’s advanced network links Mercy’s hospitals and clinics across four states. Patients can stop into another of the ministry’s clinics across town or in a different state and know caregivers will have access to their Mercy records.

To ensure it works, about $100 million went to building a central resource that would safeguard the ministry’s data files, and establish procedures for storing and accessing them. Besides protecting the medical records from disaster, the center would make them available to any doctor, anywhere within Mercy at any

Mercy has room for yet more banks of computers within the data center overseen by Jeff Bell and others.

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time. "Once you’ve committed to electronic records, you can’t afford to have a system that goes down,” Bell says.

The data center sits in an industrial park outside Washington. Some 42,000 square feet are divided between two floors. The computers holding the data occupy a quarter of the total space. Most of the rest is used to bring electricity to the computers, and draw away the heat they create — sort of a body designed to keep alive the brain buried deep within.

All the mechanicals nurturing the brain are in pairs. Electricity comes to the building from two different directions. Two communication companies supply Internet connections. A pair of giant generators provides backup power. Two large tanks hold fuel for the generators. The first floor has essentially two halves that mirror each other, and either can support the data center on its own.

Showalter likes to call it the “Fort Knox of data.” But even the center has a backup. In a nondescript building in a St. Louis suburb, where Bell and Showalter have offices, are more computers that mirror the data in Washington.

Valuable data

While printouts helped with the care of St. John’s evacuated patients, Showalter’s group ran a steady race in Joplin to keep up with others needing Mercy care. Communications were tough in the first days, with text messaging the most reliable. Mercy also deployed two-way radios. The techs scrambled to bring more robust communications to Memorial Hall in downtown Joplin, where many St. John’s patients had been moved and where Mercy doctors and nurses treated others injured in the tornado. Within 48 hours, satellite dishes linked caregivers to Mercy’s network, including electronic records.

“Supporting patient care was the first objective,” says Mike McCreary, a Mercy tech coordinator who traveled to Joplin from St. Louis the night after the tornado.

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While setting up phones and computers at Memorial Hall, Showalter’s team also turned to the wrecked data center at St. John’s. Three co-workers wearing hard hats, gloves and surgical masks ventured into the ruins to fetch hard drives and tapes that held important information. Yes, the invaluable data — concerning patients and their care — had made it to Washington. But other data hadn’t yet made the transition to the new Mercy system, and held its own sort of important information, including financial records.

A lot of it was historic information that technicians were able to reconstruct, partly with the help of the previous company that had been responsible for St. John’s, McCreary says.

With those tapes and hard drives salvaged, the team then had a command center to help set up at the local Holiday Inn, where Mercy co-workers could get help and their paychecks. Next was the tent hospital across the street from St. John’s, where more wires connected work stations to Mercy’s network and electronic records. In less than a week, techs built full phone and

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computer systems at multiple locations. Its satellite dishes made Mercy perhaps the first organization in the city with fully restored communications.

Mercy’s response and electronic system have drawn national attention, including from officials overseeing the health industry. “The availability of an electronic record may have actually saved lives,” U.S. Health and Human Services Secretary Kathleen Sebelius told an Associated Press reporter when she traveled to Joplin after the tornado.

That’s because paper files weren’t available. Those that still existed remained trapped and often ruined inside the wrecked hospital. A few did get out, but to no good, such as the X-rays found in Springfield, some 70 miles from St. John’s — carried there by the winds. The electronic system wasn’t perfect, but its value surprised just about everyone, including its architects. “Even I’ve wondered at times if this wasn’t overkill,” Bell says, motioning toward the data center. He doesn’t wonder anymore.

Mercy leaders coordinated the ministry’s response from a convention hall, which is where co-workers also came for assistance.

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Together: Mission possible

Joplin faced difficult questions after the tornado wreaked its terrible destruction. Homeowners and businesses weighed rebuilding. Parents wondered about a district whose high school

had been destroyed. Workers worried they wouldn’t have jobs.

Looming over it all was St. John’s, rendered a concrete ghost tower whose shadow darkened the mountains of debris. Mercy was the city’s second-largest employer and by far the largest to take a direct hit. Its fate would help shape the lives of thousands of people, their families and their futures. Community leaders wondered if Joplin’s torn fabric might be beyond repair.

The entire region breathed a sigh of relief a few days later when Lynn Britton, Mercy chief executive officer, announced the Joplin hospital would be rebuilt and all its co-workers would keep their jobs.

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“It calmed people’s nerves,” says Alden Buerge, chairman of First State Bank in Joplin. It also had immediate economic impact, beginning with the decision to continue paying employees, he adds. “People can pay their rent, they can buy cars, buy lawnmowers.”

The announcement helped spur a positive outlook throughout Joplin, one noticed by federal emergency workers, volunteers and other first-time visitors, says Rob O’Brian, president of the area Chamber of Commerce. An upbeat attitude was hardly a given. “That positive attitude could have turned very quickly had Mercy said, ‘We’re done and we’re leaving town,’” he adds.

As word spread that Mercy intended to stay, school officials also projected confidence. Schools would start on time in the fall and no district paychecks would be missed. When schools did open in the fall, enrollment was down only about 5 percent, a sign Joplin would avoid the enormous population losses that had crippled other hard-hit communities. Mercy’s decision was key to many families staying, Superintendent C.J. Huff says. “They have hope if they know there’s going to be an end.”

Mercy provided a starting point for the recovery, says City Manager R. Mark Rohr: “Mercy gave us something to work with as we rebuilt the city.”

‘Mission-driven’

It would be a $1 billion undertaking. Mercy would first build temporary structures called St. John’s Mercy, and permanent structures under a new name, Mercy Hospital Joplin. The commitment to Joplin was all the more remarkable given Mercy’s place in the local health care market.

A city served primarily by two hospitals, Joplin was challenging for St. John’s in the years before Mercy entered the scene in late 2009. Mercy, which operated dozens of other hospitals in the four-state region, took responsibility of St. John’s with the idea of making it the leading health institution in the area. The plan

Britton

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included new management led by Pulsipher, previously a hospital administrator in Oregon. Eighteen months later the tornado struck, the hospital was in ruins and local leaders found themselves wondering about Mercy’s long-term commitment.

Looking at the devastation, even St. John’s co-workers had to wonder. “My wife said, ‘You’re a hospital administrator — if the hospital’s gone, what are you?’” Pulsipher recalls.

Britton’s announcement two days later provided the answer. Mercy’s leaders insist they didn’t hesitate in their decision to rebuild. Still, the raw numbers surrounding the decision made it unclear how the ministry would do it. “We didn’t have a clue,” says Mike McCurry, Mercy’s chief operating officer.

It turned out that the hospital’s insurance was better than McCurry and others had anticipated. While final figures were still in flux, Mercy estimates that it could recoup more than $700 million.

Schools opened on time in temporary facilities, including East Middle School in a building at an industrial park.

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But that won’t be enough to cover Mercy’s broader ambitions, which included building interim hospitals, along with full paychecks for all employees. The price tag stretched to nearly $1 billion.

Mercy’s decision appeared to fly in the face of its fiscal interest. Even Missouri Governor Jay Nixon expressed concern when he flew in to meet with Mercy executives the day after Britton’s announcement. “I’m deeply worried about you,” Britton recalls Nixon telling him, even as the governor expressed his gratitude. “You’ve not made the best business decisions over the past few days, and you have a board to answer to.”

Nixon feared Mercy’s board of directors wouldn’t like what Britton had done and that he would soon be an ex-CEO, but Britton knew better. The bigger risk was telling the board that Mercy should take the money and run. “Then they would have fired me,” Britton says.

Governor Jay Nixon (left) and Joplin schools Superintendent C.J. Huff announce state aid to help reopen Joplin’s schools.

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Mercy’s heritage outweighed the financial challenges of rebuilding in Joplin, agrees Ron Ashworth, chair of the Mercy board. “It never seemed too monumental,” he says. “We are mission-driven.”

The health ministry hopes to generate donations and other aid to help cover its loss. Either way, Mercy is big and healthy enough to absorb a significant loss, McCurry says. “Mercy will be alright.”

Bringing back Main Street

If city leaders were relieved that Mercy would rebuild its hospital, they were exhilarated by its choice of location: just south of the intersection of I-44 and Main Street. Mercy leaders worked through the summer to identify the future footprint of the new building, consulting with the community at nearly every turn. The Mercy board approved the new site in August and the ministry broke ground in January 2012.

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Although the I-44 exit where Mercy is building is called “Business 44,” there’s not much business — or anything else — there, due in large part to the rolling topography. Downtown Joplin is about three miles north and the city’s development historically had proceeded east, west and north of the core. The city sees the new hospital as an anchor that can spur growth in a corridor stretching to a reinvigorated downtown.

The city has a new opportunity to develop its southern edge, says Joplin Mayor Mike Woolston, while Mercy met a specific request to keep the new hospital within the city. Adds Rohr, the city manager: “We couldn’t have asked for anything more.”

Others go further. “It may be the single biggest boon to expansion for the city of Joplin since Interstate 44 went in,”

Pulsipher

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says Danny Thomas, a local TV executive who sits on Mercy’s regional board.

The Main Street exit off the highway was underdeveloped, says the chamber’s O’Brian. Now passers-by will see a state-of-the-art development at Joplin’s Main Street. “It creates a focal point that helps us make a statement about who we are.”

The new location won’t just be good for Joplin, but good for Mercy, says Dick Weber, a local businessman who chairs Mercy’s regional board.

The location just off the interstate will offer easy access for patients coming from Arkansas, Oklahoma and Kansas — as well as Joplin. Mercy’s new hospital is also near the planned extension of I-49 from the state of Louisiana to Kansas City. “Joplin is right at the crossroads,” Weber says.

Mercy’s new hospital will bring activity to a previously under-developed corner of Joplin.

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Back in business: Customers flock to local stores as they reopen.

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Pulsipher says the visibility will be a boost to Mercy’s business. “People won’t have to wonder: ‘How do I get to the hospital?’” He notes that Mercy also wanted the new building far enough removed from its newly acquired hospital in Carthage, Mo., which is about 10 miles northeast of Joplin.

A brighter future

All this adds up to a difficult but inescapable truth, says Pulsipher: While the tornado produced destruction and death, it also produced an opportunity for Joplin, and for Mercy. St. John’s was in many ways outdated and past its prime, and Joplin will benefit from a new hospital.

The sentiments have many echoes in Joplin. “Our future could be significantly brighter and significantly different than it would have been had we not had the storm,” says Mayor Woolston.

The city assembled a panel of leaders to receive input about how to redevelop Joplin — they were deluged with 1,500 ideas. They’ve interviewed planners and are looking at ways to bring new ideas, along with financing from the public sector. “It’s a huge opportunity,” Woolston says.

It’s not just big ideas or big buildings that suggest a brighter future for Joplin, but also the smaller stories of recovery. Of the 7,000 homes damaged or destroyed, more than half have received building permits for repair or reconstruction.

Small business owners like David Starrett wasted little time in rebuilding. Starrett’s Joplin pharmacy was wiped out, but he relocated and was filling prescriptions less than a week after the tornado. Like others, he credits Mercy with helping to inspire the recovery. “If Mercy hadn't come back to Joplin, I don't know what the town would have done,” he says.

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A year later, more than 80 percent of the businesses that were damaged are up and operating, representing more than 90 percent of the city’s employment base.

“We’re doing remarkably well,” Woolston says.

Much of it started with the announcement early on that Mercy was staying. “Mercy was the major one,” the chamber’s O’Brian says. For the people of Joplin, Mercy’s rebuilding means money and jobs, but as City Councilman Gary Shaw says, it means something more important as well: “It’s reason for hope.”

Businesses rebuild with confidence Joplin can thrive.

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One year later:Lessons learned

A CLOSER LOOK

Even as Mercy and Joplin work to rebuild their future, they’re keeping a sharp eye on lessons to be learned from the past.

Mercy leaders are looking critically at hospital disaster plans that, while far-reaching, didn’t envision the scope of the destruction that actually befell them. No manual can anticipate every disaster, nor perhaps any the scale of the Joplin tornado. But universal lessons can be drawn from Mercy’s experience:

• Spread the health care. It’s important to have health facilities that are dispersed around the community. Not just for patient convenience, but for protection from natural disaster.

A video crew documents damage.

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• Strengthen corridors. New hospitals should include reinforced “safe areas” on every floor. Versions can be retrofitted to old buildings, as well.

• Drill, baby, drill. No emergency exercise can anticipate a disaster the scale of Joplin’s tornado, but they help under any circumstance. Disaster drills teach thinking skills that can be applied to all situations.

• Include everyone. Disaster drills too often emphasize co-workers in the trenches. Everyone needs to participate, especially doctors and top leaders. When disaster hits, they’ll be in charge.

• Protect backup power and supplies. A super-reinforced, bunker-like area should secure emergency power equipment and medical supplies.

• Plan for losing all utilities. Prepare for an intensive care unit without power, for hallways that are midnight black, for wired and wireless phones that don’t work.

• Think ahead for patients. Keep shoes with patients as they’re moved to hallways or safe areas; they may need to walk over glass-strewn floors. Every room should have an emergency kit with essential supplies such as flashlights, bandages and tourniquets.

• Back up all records off site. Modern networks make it easier to copy data to another location. If the backup is made to tapes, they must be regularly and frequently moved to another site.

• Designate off-site meeting points. Your building may be gone, along with the typical meeting places for emergencies.

• Send disaster plans home. Co-workers at home need to know where to go.

• Unify the paging system. One announcement must reach everyone in the building, and maybe adjoining buildings.

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An investigator studies the hospital wreckage.

Engineers try to find their way in the darkened hallways of the ruined St. John’s.

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Perhaps the most important lesson was one taught by the Sisters who founded and guide the ministry: Be Mercy.

That means a response that can be likened to triage, says Mike McCurry, a Mercy leader. “What are we going to do for our patients? What are we going to do for our co-workers? What are we going to do for the community?

“If we can find our way to the right answers to those things, then we’ll be Mercy. And if we’re being Mercy, being true to that, we’ll be OK.”

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About this seriesAs the nation remembers the storm that ravaged Joplin in

May 2011, Mercy has published a series of books on the events that changed the lives of so many in the community, and how the health ministry has responded.

The books include this one, “Enduring,” in which Mercy captures stories of courage in the aftermath of the storm and looks ahead to Joplin's future. “Rebuilding” describes how Mercy has replaced the hospital destroyed in the tornado. “Caring” explores how Mercy is supporting its co-workers while they try to help Joplin.

The works weave a story of past, present and future — and Mercy’s promise to value all three.

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