Docs resilient after Wilma, but what about your billing service?

One pediatrician in Palm Beach County was lucky enough to get his power back one week after Wilma. But the building where his billing service was located had no power for two weeks, and managers locked out the tenants. The result: The pediatrician was forced to see patients amid chaos and uncertainty with no support and sporadic communication from his vendor.

Another doctor, a nephrologist in Dade County, didn’t have power but wanted to see patients as soon as possible after the hurricane. His billing service was in contact with him immediately after the storm, and they hand delivered to his office a hard copy of his appointments and superbills for every patient. The doctor saw as many patients as possible and his back office maintained control – even without power.

It’s this new generation of more sophisticated companies that will make it easier for medical offices to bounce back quickly after the inevitable next storm.

Keeping big promises

Hurricane Wilma was a reality-check for companies that provide medical offices with Internet-based practice management software (also known as application service providers, or ASP-model software). Billing and collection services and other firms that serve physicians were also put to the test. These companies all make big promises to protect your practice data, to provide reliable software, to protect your billing, and to support your office during and immediately following a storm like Wilma.

By most indications, the promises were kept and the planning paid off for those ASP-model companies who were prepared. Their client practices in the hardest-hit areas of South Florida had access to data from office and from home, and there was reliable customer support immediately after Wilma passed. Internet reliability and security also scored well. Practices outside the tri-county area saw patients the same day Wilma hit, Monday the 24th, without a single flicker in service.

Still, for practices that use billing services or Internet-based software, some important early lessons emerged from the days that followed Hurricane Wilma:

Seven Lessons

Lesson 1: Beware owner/operators! Your vendor must have a clear management hierarchy

For any vendor your practice deals with, but especially a billing service, there should be clear responsibilities to the clients and defined lines of communication at all times – it’s even more crucial following a natural disaster. Be wary of vendors where the owner is also your main point of contact within the company, or worse, when that person also is doing most of the work for your practice. After the next storm, chances are this owner/operator will not be focused on your practice’s needs.

Lesson 2: Your billing service must have a real, rehearsed Business Continuity Plan.

Power outages were widespread after Wilma. Was your vendor prepared, or was their office closed for two weeks? What happens if power returns to your medical office, but your vendor’s place of business is without power? What plans are in place for the billing company to continue serving you even if their workplace was damaged?

Lesson 3: Your vendor must have the resources to support you when conditions are worst – that is, in the immediate hours and days after the next storm.

Don’t forget the chaos that followed Wilma, when everyone was trying to re-open businesses under less than perfect conditions (i.e., power or phone is out, employees impacted, traffic nightmares). What can your billing service or software supplier do to help you? What kind of team is in place, is their staff motivated and responsible?

Lesson 4: Your appointment schedule and superbills are “mission critical”.

Even under the worst conditions, you may still be able to see some patients and thus generate revenue – but you must have your appointment schedule, and you need superbills for each patient. How can your vendor help you with these? Without them, your office can’t run effectively, so make sure your vendor is there to support you.

Lesson 5: Generators are easy to set up and cheap to run, so consider buying one.

A small generator (5 KW) and 10 gallons of gas per day is enough to power a 1-2 doctor office (computer, a few lights, a small fridge, a couple of fans). If you can, buy one now and be prepared.

Lesson 6: Internet-based software comes in handy when doctors or employees must do some work from home.

The Internet, for the most part, passed its first big natural disaster test in South Florida. From most reports, the Internet came back with the electricity, although a couple of local DSL dark spots remained. A strong ASP-model billing service will be prepared for any possible scenario. Make sure your vendor can help your office see patients and continue effective, error-free claims submission.

Lesson 7: Protect your practice data.

Most practices are familiar with the ritual of the nightly back-up, but where are the tapes kept? Although I heard few reports of damage to computer servers located in medical offices that contained patient data, Hurricane Wilma should remind you that office buildings are designed to be comfortable for patients, not to protect computer equipment and data. A properly set-up ASP-model vendor will have your practice data stored on servers in a secure, professionally managed facility.




A requirement in the delivery of equitable access to healthcare services is the need to address and consider language diversity. It is important to ensure the same standard of care to Limited English Proficiency (LEP) speaking patients as to those who are English speaking. With the use of interpretation services in healthcare systems these language barriers are obstacles overcome.

A growing number of administrators are responding to the healthcare needs of diverse populations. In turn, restructure and use of language services become integral in these organizations.

Healthcare providers and patients who speak different languages obtain understanding through interpretation. This becomes necessary for appropriate treatment and accurate diagnosis. In addition, information pertinent for illness management should be understood by the patient. It is their right to negotiate their priorities and expectations of care. In some instances where information is not communicated in the patient’s language and an interpreter is not utilized, a patient’s inability to manage their illness as a result can be found to be non-compliant. Therefore, if a health provider and patient relationship fails in lieu of an ineffective communication of illness management or consent, the patient could incur further health implications, which in turn may cause the healthcare system or insurer to sustain added costs.

Not everyone is able to act as an interpreter in a healthcare environment. Omissions, summarizations, additions, and lack of knowledge in technical healthcare terminology, among other variables, have been committed by untrained interpreters including family members and healthcare staff when communicating between the patient and healthcare provider. Confidentiality issues concerning the patient’s medical history and ethical concerns arise when a family member or non-healthcare experienced interpreter is utilized. The burden and expectation that the patient and family will provide their own interpretation adds to the economic difficulty of the non-English speaking families.

Legal consequences of inadequate interpretation, which are associated with incompetent care, must be of interest to healthcare administrations and insurers. It is each organization’s duty to have by policy in each patient’s medical records an informed (meaning fully understood) consent. If the language barriers are not breached with successful communication the hospital or insurer could be liable for an invalid consent to treatment.

In California the state Department of Managed Health Care is drafting regulations for Senate Bill 853, sponsored by Senator Martha Escutia, D-Montebello. The bill passed in 2003 and will require health insurers to provide interpreters by next year. Therefore the proposed rules state that health plans must have language assistance in effect by July 1, 2007 and written communication must be provided in Spanish and other languages by October 1, 2007.

With the assistance of trained medical interpreters, patients who speak a different language than their healthcare providers are able to ensure quality correspondence. The legal liability and ethical concerns surrounding patients in clinical situations or illness management require accurate language services. Whether it is Sign Language, Turkish, Italian, or any other language, organization and implementation of language services is needed to facilitate language diversity in healthcare systems.




Do you make your own paper clips? No, because you can’t make them efficiently or at a cost less than you can buy them. This same principal holds true for other areas of your business, including payroll processing. Payroll is a critical business function, but not one that brings value to shareholders or improves service to customers. You have the best understanding of your core business and should focus on its growth and success, and not having to worry about payroll tax due dates and compliance. Outsourcing payroll processing can free up a substantial amount of human and capital resources – resources that could be better used for developing and implementing value-adding strategic initiatives.

Many business owners underestimate the cost of processing payroll internally. They fail to account for all of the man-hours spent by anyone in the organization that touches the payroll from the point of data collection and entry to the balancing and filing of the quarterly payroll tax returns. This is on top of the obvious costs of maintaining payroll software and purchasing annual tax updates. The largest cost of them all is the cost of mistakes. The IRS has reported that forty percent of small businesses that perform their own payroll duties are fined for inaccurate returns, and the average fine is $845. There is also employee dissatisfaction that can result from inefficient payroll and benefits processing, which can certainly effect employee retention, thus becoming a competitive disadvantage.

Outsourcing payroll also gives the small business owner options that are not otherwise available. Payroll companies now have a wide range of outsourcing options not available to the in-house processor, including workers’ compensation “Pay As You Go” and employee self service. There are also numerous reporting abilities not typically found with internal payroll software programs. In many businesses, timely, accurate and specific payroll reports are key to labor cost control by alerting managers of problem areas.

When selecting a payroll provider there are a few keys in finding the right one. Look for a company that has payroll as its central function. Ask the provider about services they provide to other companies that are in a similar industry to yours. Get a clear picture of the price by asking for an approximate annual cost rather than being distracted by introductory offers. Most importantly, look for a company that can provide you with personal customer service. Larger payroll companies are not always the best.

Payroll is a vital function of any business. Outsourcing to experts is not only cost efficient, it’s a wise and sensible move for businesses of any size. Once payroll functions have been outsourced to a reputable company, you can sit back and concentrate on your real business.




Jay Miranda
Chief Executive Officer
Coral Gables Hospital

As chief executive officer of Coral Gables Hospital, Jay Miranda is responsible for continuing the institution’s commitment to medical excellence and maintaining its high physician and patient satisfaction ratings. Miranda’s dedication to his job is evident in the care he has taken to make his hospital not only an advanced medical facility, but also a warm and welcoming haven for patients, employees and members of the surrounding community.

Miranda, a Cuban immigrant, has strong ties to the community he serves. These connections manifest themselves as a commitment to becoming a true boutique-style “community hospital” that offers superior medical technology. Last year, he paved the way for a complete renovation of the radiology department, including the addition of a new 16-slice CT scanner and ultrasound machine. Expansions of the ICU are underway to increase capacity by one-third and to add a 16-bed “step-down” unit within the next two years.

In addition to improving the hospital’s physical structure and medical services, Miranda’s leadership also has ensured some of the highest physician and employee satisfaction ratings in the healthcare industry. A recent survey of 89 percent of the hospital’s physicians demonstrated that 91 percent were completely satisfied. To verify the results, Miranda personally visited nearly all of his physicians to elicit their comments and suggestions. Many other Coral Gables Hospital employees also exhibit high job satisfaction. Miranda recently held a “Golden Occasion Luncheon” to honor three nurses who had been in the field for more than 50 years and at the hospital for more than 25 years, demonstrating the commitment of Coral Gables Hospital’s employees to the hospital and the community.

Although Miranda’s employees are one of his top priorities, he also focuses his efforts on educating and serving the surrounding community. Coral Gables Hospital provides free periodic health lectures and health-screening opportunities throughout the year. Through the Tenet Healthcare Foundation, Miranda and Coral Gables Hospital offer continued support to the American Heart Association and the American Cancer Society, as well as other local community initiatives that promote diversity and assist at-risk youth.

Employees, physicians and patients can all vouch that Jay Miranda has significantly improved his hospital’s capabilities and atmosphere. A Cuban-American leading a hospital in a highly Cuban populated community, Miranda’s efforts to build a boutique hospital within Coral Gables make the city’s namesake hospital a uniquely warm and inviting medical institution to all Coral Gables residents and Miranda a healthcare CEO worthy of distinction.


Eduardo J. Bustillo
Director of Risk Management
Hialeah Hospital

Born in Chicago, where his father was attending medical school, Eduardo Bustillo moved with his parents back to their native Colombia as a young boy. The youngest of six siblings, Bustillo quickly learned the importance of helping others, a value that ultimately inspired his return to the United States at age 19 to pursue a career in healthcare.

Currently, as director of risk management for Hialeah Hospital, Bustillo carries the important responsibility of patient and employee safety squarely upon his shoulders. His duties include advising hospital staff of real and potential liability situations, developing and recommending new policies for patient safety and ensuring patient needs are met and hospital policies are followed. The alacrity with which Bustillo has approached both these challenges and his education has cemented his status as an up-and-comer in heath services administration.

Bustillo’s rapid professional advancement is an indication of his future potential in the healthcare field. In less than ten years, he has risen from a position as an occupational nurse to the director of risk management at a 378-bed hospital. In April, members of the Hialeah Hospital administration awarded Bustillo with the A-Team Award for his commitment, hard work and dedication to the hospital. In June, Bustillo was honored as a certified professional in healthcare risk management by the American Hospital Association certification center. This national designation distinguishes elite individuals who satisfy work and education requirements, adhere to Professional Standards of Conduct and pass a qualifying examination.

One of the most crucial elements to Bustillo’s success has been his dedication to self-improvement and education. He has earned no fewer than five degrees in his field, including a practical nurse degree from Dekalb Technical College and a Bachelor of Science degree in biomedical sciences from Barry University, where he received a Minority Biomedical Research Support Grant and National Science Foundation Award. He has also earned an associate’s degree in nursing from Broward Community College, a Bachelor of Science degree in nursing from Florida International University, master’s degrees in both business administration and health services administration and is working on a doctorate of health science from Nova Southeastern University. He also holds numerous certifications as a registered nurse, licensed healthcare risk manager and medical-legal consultant. Bustillo’s continued commitment to sharpening his skills and improving his knowledge reveals his dedication to the patients and employees under his care at Hialeah Hospital. Bustillo currently resides in Weston.


Alex E. Contreras-Soto
Chief Operating Officer
Palmetto General Hospital

As the person directly responsible for the day-to-day operations of fifteen separate departments at Palmetto General Hospital, Chief Operating Officer Alex Contreras-Soto is one of the busiest people in healthcare. Fortunately, Contreras-Soto has more than twenty-five years of combined experience as a nursing assistant, public accountant, chief financial officer and chief operating officer that allows him not only to succeed as a hospital executive, but also to positively impact the surrounding community.

Contreras-Soto’s background has played a strong role in his healthcare career, from his personal choices to his professional advancement. Originally from Chile, he came to the United States in 1978 to attend college. After earning a Bachelor of Science degree in accounting from Florida International University and being promoted through several financial positions as a CPA, Contreras-Soto decided to follow in the footsteps of his mother, a nurse, by pursuing a career in healthcare administration. He became chief financial officer of Coral Gables Hospital in 1997 and of Palmetto General Hospital in 1999, helping the hospital achieve “Most Improved Health Information Management Operations” by Tenet at its Financial Leadership Conference. In July 2002, Contreras-Soto was promoted to chief operating officer of Palmetto General Hospital, and he since has been recognized twice by Tenet for outstanding performance in this position. Always continuing to better himself, in 2004, he earned a Master’s in Healthcare Administration from the University of Miami.

While Contreras-Soto’s professional responsibilities are considerable, he consistently makes time to support his family and community. Due in part to his efforts, Palmetto General Hospital was recognized in July 2006 with a “Merit Award” from the cities of Hialeah and Hialeah Gardens for noteworthy assistance to the community. Contreras-Soto also volunteers with his local church providing advice to young married couples and helping organize youth groups.

Contreras-Soto lives in Miramar with his wife of 25 years, Fabiola, and their two children, Nicholas and Melissa. Nicholas is a high school student. Inspired by her father and grandmother, Melissa has decided to pursue a career in healthcare and is enrolled at FIU, where she is studying to become a certified registered nurse anesthetist.


Antonio F. Mazzorana
Chief Operating Officer
Hialeah Hospital

Antonio Mazzorana has more than twenty-five years of experience in the healthcare field, and he uses every bit of that knowledge each day as chief operating officer of Hialeah Hospital. His dedication to his hospital’s patients, and to the other members of the primarily Hispanic community he serves, has made him one of South Florida’s rising stars in the field of healthcare administration.

A native Cuban, Mazzorana emigrated with his parents when he was just three years old. The family moved to Hialeah, the city Mazzorana considers his hometown. After earning his medical degree in 1987 from Universidad Central del Este Escuela de Medicina in the Dominican Republic, he returned to South Florida to pursue his medical career. Ultimately, Mazzorana determined that his desire to help others was better served by a career in healthcare administration, where he could impact the quality of care for hundreds of people each day. He has actively pursued this career change and earned an MBA from the University of Miami in 2004.

As Mazzorana has risen through the healthcare administration ranks, he has continued to keep close ties with his native community of Hialeah. When in January 2002 he was offered a chance to return to Hialeah as assistant administrator of Hialeah Hospital, he saw it as an opportunity to give back to the community to which he owed so much. Now, as COO, Mazzorana spends nearly all his time improving the hospital and serving its patients. His current projects include a 12,000-square-foot, $11 million expansion of the operating rooms, scheduled for completion in late 2007, and the recent addition of a $3 million, 64-slice CT scanner to replace the four-slice scanner the hospital has used since 1995. Both projects will improve the speed and accuracy with which patients are treated.

Even though Mazzorana’s duties as COO consume most of his day, he still finds time for community outreach. Shortly after Hialeah Mayor Julio Robaina was elected in 2005, Mazzorana’s government contacts in Tallahassee informed him of a large state donation of toys that currently had no planned recipient. Mazzorana quickly worked to secure delivery of the toys to Hialeah, where new Mayor Robaina distributed them to underprivileged and ill children for the holidays. A very private person, Mazzorana declined to take any public credit for the windfall. Mazzorana currently resides in the Miami area, where he enjoys spending time with his family.


Dr. Victor Pazos
Mount Sinai Medical Center

Dr. Victor Pazos is a dedicated physician who demonstrates an outstanding commitment to the patients he serves. He specializes in interventional cardiology at Mount Sinai Medical Center.

Born in Cuba, Dr. Pazos studied medicine at Universidad de la Habana, where he graduated Summa Cum Laude, before continuing his education in the United States. “My background and experience practicing medicine in Cuba allows me to understand the needs of the Latin culture in South Florida,” Dr. Pazos explained.

He completed his internship and residency at New York’s Mount Sinai School of Medicine and ultimately pursued his cardiology training at Mount Sinai Medical Center in Miami Beach. “I enjoy the teamwork among the surgical physicians and the support staff I work with,” Dr. Pazos said. “Here, I can also consult with colleagues who have expertise in a variety of specialized fields.”

At an academic institution like Mount Sinai, Dr. Pazos is also able to pass on his knowledge to up-and-coming physicians in the medical center’s Cardiology Fellowship program. “I enjoy teaching,” Dr. Pazos said. “It’s not only important for the students, it’s rewarding to me on a personal level to continue to learn and be challenged.”


Jessetta Harris
Environmental Director
Mount Sinai Medical Center

After 17 years in healthcare, Jessetta Harris of Mount Sinai Medical Center says there are two keys to being an effective manager: trust and accountability. As the Environmental Director at the 955 bed hospital, she provides strategic planning, operational leadership and direct management of the housekeeping, transportation and linen services for the medical center. She must ensure that all operations are compliant with federal, state, and local regulations. In addition, she continuously monitors and evaluates the efficiency and effectiveness of service delivery methods and procedures to identify opportunities for improvement and directs the implementation of changes.

As the operation is so large, Harris has worked to build a strong team of professionals that she trusts and empowers to perform at their highest levels. She also believes in holding each team member accountable for his or her accomplishments and failures and coaching those around her to learn and grow from their mistakes.

“Working in a community like South Florida, it can be challenging to manage a very diverse group of employees.” Harris said. “But if you hire people who are committed to helping others, as a team you overcome these challenges.”


Dr. Rosebud Lightbourn Foster, Ed.D., MSN
Nova Southeastern University’s Health Professions Division

Dr. Rosebud Lightbourn Foster, Ed.D. and Master of Science in Nursing Education currently serves as Professor and Special Assistant to the Chancellor of Nova Southeastern University’s (NSU’s) Health Professions Division. Since 1973, Dr. Foster has demonstrated considerable service in the Florida State University System, serving as a Dean and Professor of the School of Health and Social Services, Associate Vice President for Academic Affairs and Vice Provost. She played an instrumental role in planning, organizing and operating Florida International University’s North Miami Campus in the 1980’s.

Dr. Foster recently completed ten years on the Executive Committee to the Public Health Trust of Miami-Dade County, which operates the Jackson Health System/public countywide health system. Currently, she is serving a four-year term to the Governor’s Gold Seal Panel on Excellence in Long-Term Care, which is administered by the Agency for Health Care Administration (AHCA). In addition, Dr. Foster was appointed and reappointed as Chair of the Department of Health (DOH) Advisory Council tasked with reducing racial and ethnic disparities in Florida. She also previously held gubernatorial appointments to the Governor’s Council on Diabetes and to the Florida Advisory Council to the Department of Elder Affairs (DOEA).

In research, Dr. Foster completed the National Study of AHECs and Managed Care, funded by Health Services and Resources Administration (HRSA), U.S. Public Health Service, and served on HRSA’s Center on Managed Care Task Force on Managed Care. Currently, Dr. Foster functions as the chairperson of the Advisory Committee of the federally funded Florida Border Health Education and Training Centers Program, which links academic and community-based partnerships with Florida’s five medical schools to serve minority populations throughout the state.

Among her most prominent awards, Dr. Foster has been recognized as a Greater Miami-Dade, Florida Chamber of Commerce Health Industry; Health Care Heroes. She has also received the AXA Advisors Lifetime Achievement Award, 2001; the President’s Award of the Florida Statewide Area Health Education Centers; and the Miami-Dade County Days in Legislature, 2004, “Sherman Winn ‘We Care’ Award. She has also been honored with the Dade Women’s Historical Coalition, Women of Impact Award.

Dr. Foster served as a Florida Delegate to the White House Conference on Aging in 1995. Previously, she chaired the Surgeon General Hispanic Latino Regional Workshop: Southern Regional Conference on Hispanic Health Care Access to Health Care in Miami. Presently, Dr. Foster continues to provide leadership in the development of organizations and systems, and maintains an important role at the forefront of Health Policy, Planning and Management on local, state and national levels.

She has provided unwavering leadership at the state and federal levels in identifying barriers, particularly those in highly impacted communities throughout the state, to improve access to health care services and increased awareness of the major health disparities through strengthened outreach and education. Her focus has been on five key areas: cardiovascular diseases, cancer, diabetes, maternal and infant mortality and HIV/AIDS.

The “Closing the Gap: Racial and Ethnic Health Disparities Advisory Committee,” of which she is a member, is charged to examine areas where public awareness, public education, research and coordination regarding racial and ethnic health outcome disparities are lacking; consider access and transportation issues which contribute to health status disparities; make recommendations for closing the gaps in health outcomes and increasing public awareness and understanding of health disparities that exist among racial and ethnic populations.


Rev. John M. Nganga
VITAS Innovative Hospice Care® of Broward County

“Just Chaplain John”

Life changed for Rev. John M. Nganga when, in 1989, he was asked to visit an AIDS patient.

John Nganga (say NAH-na) was a newly ordained minister in the Anglican Church of Kenya at the time. He knew nothing about AIDS except that it was a mysterious disease. He knew nothing about the people who’d requested he visit their niece.

“I was very scared,” he admits. He went dutifully, remembering Isaiah 6:8: “Then I heard the voice of the Lord saying, ‘Whom shall I send? And who will go for us?’ And I said, ‘Here am I. Send me!’”

That visit sparked what has become Marafiki Global AIDS Ministry, Inc., still going and growing today. So is Chaplain John.

In 1991 he left Kenya for St. Louis, Missouri, and a master’s degree in theology. In 1995 he wrote his doctoral thesis on the need for chaplains to respond to AIDS patients without judgment. By the time he returned to Kenya in 1998, there were 25 million people living with AIDS in Sub-Saharan Africa, leaving a generation of children living on the streets.

“It was devastating,” he recalls. “I needed to do something to ease the suffering of the children.” When he returned to the United States, he began a sponsorship program, asking Americans to donate $25 per month to help 200 orphans in Kenya. He organized his first American mission to Kenya in 1999.

Since then, hard work and generosity have built an orphanage on five acres of land that also holds a primary school, a technical school and a clinic. Some of those orphans are now attending universities, taking pre-med classes, working as nurses. “We are reaping the benefits of those early donations!” Chaplain John beams.

He made frequent visits to Kenya, but he continued to live and work in the United States. Several years ago he discovered VITAS Innovative Hospice Care® during an internet search. “What I loved about VITAS were its values,” Chaplain John recalls. “‘We take care of each other!’ That is very powerful to me! What a company!”

So in 2005 Chaplain John moved his wife and two young sons from Ohio to Broward County, Florida, so he could work as a VITAS chaplain. “I have faith that God brought us here for a reason,” he says.

“Chaplain John is different,” says his supervisor, VITAS Nursing Home Team Manager Esther Gabriel. “He has his eyes open on everyone: the patient, the patient’s family, even the patient’s roommate. And his team.

“He’ll show up with a gift, or take someone out to lunch—whatever is needed, Chaplain John seems to know what to do. Yet he’s humble, down-to-earth. He doesn’t give glory to himself. I asked him if his business card should read Chaplain John M. Nganga, D.Min. He said, ‘No, just Chaplain John.’”

“With AIDS and with VITAS, I strive for patience, honesty and transparency,” Chaplain John explains. “At VITAS I see my role as supporting my team—but they also take care of me.”

In fact, Chaplain John finds support wherever he goes. The congregation of St. Benedict’s Episcopal Church in Plantation, where Chaplain John is assistant minister, has raised $15,000 to build a girls’ dormitory in Kenya. When a running injury turned him from marathons to golf courses, he discovered more than exercise; he found a new venue for raising money and awareness. His next American mission to Kenya is set for June—with a VITAS nurse among those on board. And he has written a book, out this year, titled “A Call from God.”

“In this life, we all have to go the extra mile,” Chaplain John believes. And then he adds another of those VITAS Values: “I am proud to make a difference.”




On Thursday, January 25th 2007, St. Lucie Medical Center (SLMC) received a call at 9:50 a.m. that there was a potential Hazardous Material exposure at St. Anastasia School and was notified by Emergency Medical Services personnel that it would be getting students from the school who had been exposed to an unknown substance. Based on this information and not knowing exactly how many students it was going to receive, SLMC administrators decided at 10:05 to call a Code Orange (Haz Mat). A few minutes later EMS called with additional information stating that up to 40 people had been exposed and asked the hospital how many patients it could handle. After careful assessment, SLMC notified EMS that it could safely take up to 15 patients. By the end of the day, SLMC treated a total of 12 students and 1 faculty member.

Approximately six members of the hospital haz-mat team immediately reported to the decontamination shower area to help arriving patients. Upon arrival, those patients who had been exposed to the potentially harmful substance were taken to the decontamination room attached to the ER. The hospital haz-mat team explained to the patients how the decontaminating process worked and answered any questions that they had. The remaining ER staff set up the ER fast-track area as the treatment area and all students who had been exposed were treated in this area. The outpatient lobby was used as the receiving area for family and media.

Once SLMC received word that no additional students/faculty needed medical attention, the decision was made at noon that same day to call an all clear.