For four decades, David Taylor has relied on a ventilator to breathe, the whoosh, whoosh of the machine part of the background metronome of daily life. Then, on the night of Feb. 14, an Arctic blast began to overwhelm the Texas power grid. The next morning, the electricity flickered out in the Fort Worth home that the 65-year-old shares with his mother.
David's ventilator switched over at some point to a backup battery and kept running. A family member brought over a generator and spent several hours trying, unsuccessfully, to get it working in the sub-freezing air. By nightfall, the one-story house had gone around 12 hours without power, other than an hour or so when the lights briefly turned on, recalled David's 89-year-old mother, Dorothy Taylor. The temperature inside had dropped to the low 50s. David, who has muscular dystrophy, remained in bed beneath a pile of blankets. Dorothy kept one eye on the clock, unsure how much longer her son's backup battery would hold out. "I couldn't wait 'til the last minute," she says. "He would die within minutes."
Across Texas, other families were facing similar dilemmas. The ambulance provider MedStar, which serves the greater Fort Worth area, fielded more than 50 calls — including Dorothy's — from Feb. 15 to Feb. 17 involving patients with life-sustaining medical devices and no power. A San Antonio emergency room doctor, Ralph Riviello, tells Undark that around 18 to 24 people showed up at his hospital during the crisis, desperate to recharge medical equipment. Near Houston, a 75-year-old man froze to death in his truck; his family believes he ventured out to get a spare oxygen tank from the vehicle after losing electricity at his home.
These are not just one-off tragedies. Some experts warn that complex home-based medical care is on a collision course with climate change, as severe weather events become more frequent nationwide.
While it's difficult to attribute a single weather event like the Texas Arctic blast to climate change, these crises have become more frequent in recent years as the planet warms, highlighting the need to protect such vulnerable individuals, says Sue Anne Bell, an assistant professor at the University of Michigan who studies the health effects of disasters. "Thinking that you've had your once-in-a-100-year storm — that's not a reality anymore," she says.
At the same time that climate change has fueled a rise in severe events, the power grid is aging. By the 2000s, there were 10 times more major power outages reported each year compared with the 1980s and early 1990s, according to an analysis of data from 1984 to 2012 by the nonprofit news organization Climate Central. They were mostly driven by severe weather, though changes in data collection likely contributed as well.
"We have climate change coming, which is going to throw at us more of these curve balls, more of these unexpected events that can impact the infrastructure," says Joan Casey, an environmental epidemiologist at Columbia University who has studied the health impact of power outages.
Casey is among a cadre of researchers, environmentalists and physicians who are trying to draw attention to the growing threat of power outages for people with medical devices. They propose more research and data collection to better identify how many Americans face this risk, as well as to document the medical complications and deaths that result. Along with highlighting the need to update and weatherize the existing power grid, they suggest a range of public health strategies, including routine text alerts warning vulnerable individuals that power might be disrupted. And, in place of generators — which can be difficult and dangerous to use — they call for the adoption of battery storage that automatically kicks in when the lights go out.
But for now, individuals like David and Dorothy Taylor are left fretting in the dark.
That cold February night, Dorothy was unsure how much life remained in the ventilator's backup battery. But she was not taking any chances. At around 9 p.m., she called the paramedics.
More devices, more need for reliable power
Over the past several decades, Americans have increasingly benefited from in-home technology, which can extend lifespans and enable more people to stay in their own homes. But the expanding array of such devices — including home oxygen machines, medication nebulizers, home dialysis, infusion pumps, and electric wheelchairs — all depend on a reliable power supply.
Federal officials collect and map where the 2.6 million people on Medicare with these medical devices live, providing the information as a tool for public health and emergency preparedness efforts through its emPOWER Program. It's unknown how many non-Medicare recipients also rely on this equipment, but data indicate that overall usage is increasing, Casey says. She was involved with a study published earlier this year in the journal Epidemiology which found that rentals of oxygen equipment had nearly tripled from 2008 to 2018, based on data from more than 243,000 Kaiser Permanente patients.
In Texas, the February outages were so widespread that the solution was not as simple as going to a nearby home to plug in, says Riviello, who chairs the department of emergency medicine at the Long School of Medicine at UT Health San Antonio. "There are a lot more people living at home with medical assistive devices that are being maintained because of these devices," he says. "And I don't know that they always think of the 'What if' situations.'"
Some research has documented the danger of power outages for this population. One study of the 2003 power blackout in the northeastern United States found that 23 of 255 patients coming into a New York City hospital during a 24-hour period reported a medical device failure.
Shao Lin, a University at Albany physician-researcher who studies the health effects of extreme weather events, more recently assessed whether power outages affected hospitalizations among patients with chronic obstructive pulmonary disease (COPD), who may require oxygen machines and other devices to help them breathe. Lin and her colleagues compared hospitalizations in New York state when the power was out with normal days. They estimated that, on days without power, 23% of hospital admissions for COPD patients could be linked to the loss of electricity.
When patients require oxygen, they don't have the luxury of time, she says: "They have to go the ED [emergency department] or otherwise they die, right? The people die."
In Texas, a blast of Arctic air, paired with chronic failures to weatherize the power grid, led to outages that rolled on for days. Slightly more than two-thirds of Texans lost power at some point from Feb. 14 to 20 — outages that averaged a total of 42 hours, according to a University of Houston survey conducted online with 1,500 residents.
Once the power is out, and medical devices are failing, the next stop is often a nearby hospital.
There are a lot more people living at home with medical assistive devices that are being maintained because of these devices. And I don't know that they always think of the 'What if' situations.'
The need for oxygen drove most of the 50-plus calls that MedStar responded to in the greater Fort Worth area, according to brief dispatch notes the ambulance service shared with Undark. "No power, trouble breathing, no O2," reads one note, using an abbreviation for oxygen. "No power out of oxygen can barely breathe," records another. There were a few other power-related calls: "Asthma attack, no inhaler and no power to use nebulizer."
After Dorothy called MedStar, she says, "they came immediately." The ambulance couldn't make it up the steep snowy driveway, instead parking at the bottom and carrying David down, says Tim Gattis, one of the paramedics that day. "There's like six of us hanging onto the cot," he says, "as we're sliding down the hill trying to get back to the ambulance with him."
On a March afternoon, Dorothy and David gathered around the kitchen table to revisit that scary, frigid February night. David, who has difficulty speaking but can mouth some words that his mother understands, sat in a wheelchair at one end. Dorothy described staying with her son in the hospital overnight, trying to doze on a straight-backed chair with no arms. "I don't leave him," she says.
For each person who needs potentially life-saving help, there are ripple effects of strain on the health system and the broader community, Bell says.
"It's that individual, it's his family, maybe his neighbors, maybe a person's primary care provider," she says. "It's the emergency department physician."
More needed than backup batteries
Some physicians and other clinicians advise people with medical devices to have an emergency plan if the power fails. But that's easier said than done, says Casey. "Poorer people might not have somewhere else to go, might not have the money to purchase a generator, to have a backup power supply," she says.
"So I also see this as an environmental justice issue, moving forward," she adds.
Clinicians may also suggest that these patients sign up for a registry, a list that municipalities or utilities compile of customers who use electricity for medical devices. In principle, registries allow officials to prioritize outreach and response to such individuals in the event of a power outage. They are also intended to prevent utilities from shutting off power if a person falls behind on paying their electric bill.
Still, these registries have been subject to renewed scrutiny as more people are impacted by power outages, says Marriele Mango, a project director at Clean Energy Group, a nonprofit advocacy organization in Vermont.
"A fraction of the people who qualify for these registries are registering," she says, citing various reasons, including language barriers and confusion about eligibility. Moreover, even if someone is listed on a registry, they may not receive advance notice of an outage, she says, citing media coverage showing that Pacific Gas & Electric (PG&E) failed to notify some device users in 2019 when it shut off power to a large swathe of California as a wildfire prevention measure.
Casey, Mango and other experts have proposed new research and programs that might help address the issue. One strategy, Casey says, would be to use location data from the emPOWER system and other mapping efforts to develop a text alert system to warn people when their power might go out. Another possible strategy, according to Casey, is for hospitals to set up a charging area on-site to allow patients with life-sustaining devices to get power without filling up the emergency room.
Poorer people might not have somewhere else to go, might not have the money to purchase a generator, to have a backup power supply. So I also see this as an environmental justice issue, moving forward.
In 2020, leading into the wildfire season, PG&E launched a program to get free backup portable batteries to lower-income residents who depend on medical equipment. But these portable batteries can only last so long; David's was projected to provide power for just eight hours.
Mango and Casey are co-authors on a recent paper, published in the journal Futures, which looks at a longer-term approach — the installation of battery storage either in someone's home or at a community gathering area. The technology, which stores power on-site in case the electrical grid goes down, provides a more reliable power supply than portable batteries. It's designed to kick in automatically in the event of an outage, operating independently from the grid. When the battery storage system is paired with solar panels, as long as solar is available, Mango says, it can potentially keep recharging the battery.
These battery storage units are still quite costly, although prices are declining, Mango says. A product review of one of the existing devices, the Tesla Powerwall, shows costs of $9,600 to $15,600, including installation. Some programs may help bring the cost down for residents with medical devices, such as incentives offered by the California Public Utilities Commission.
Battery storage is a cleaner option than diesel generators, and it doesn't pose the risk of inadvertent carbon monoxide poisoning that generators do, Mango says. Generators can also be difficult to operate or refuel, particularly for older or frail individuals. And, during power crises, people scrambling to buy and operate these generators can run into life-threatening trouble. "They've never had to do it before," Mango says.
One funding mechanism would be for Medicare to classify in-home battery storage as durable medical equipment. Then a physician could simply prescribe the battery along with the device itself, Mango says. "It would be a huge step in the right direction to be able to get that in the hands of folks."
What's happening now is 'clearly not working'
Casey is dubious that providing and paying for battery storage on an individual basis is feasible, though, given the price tag and the risk that lower-income and other populations would fall through the cracks. "It's a Band-Aid sort of situation rather than solving the problem," she says. Establishing central charging stations backed up by battery storage in communities would reach broader groups, she saysid, and could offer other medical support amid a weather-related power crisis.
But who, Casey asks, should be responsible for these stations? For instance, should a large health system like Kaiser Permanente establish charging stations to help patients in their communities?
"That's starting to go way outside the hospital walls," she says. "It's hard for me to say that they should. But we need to figure out who's responsible here. Because right now no one is, and that's clearly not working."
Dorothy Taylor says that her home, where she's lived for nearly 50 years, is listed on her utility's registry, a step that required physician paperwork to document her son's medical condition. But that did not keep the electricity humming as large sections of the state went dark.
Since the February storm, Taylor has considered installing a generator. But it would be expensive, she said, and outages are rare, at least historically. "That's happened one time in the 47 years we've been living on this hill," she says. "So what do you do?"
Charlotte Huff is a Texas-based journalist who writes about the intersection of medicine, money, and ethics. Her work has appeared in Kaiser Health News, Slate, STAT, and Texas Monthly, among other publications.
This story originally appeared in Undark, a nonprofit, editorially independent digital magazine exploring the intersection of science and society.
Copyright 2021 Undark Magazine.