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When Tragedy Strikes: How to Prepare for and Recover from a Natural Disaster by Krista Houstoun, Associate Editor, Dentaltown Magazine

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On the night of May 22, 2011, Margie and Dr. Mike Fitterling rested in their fully intact beds in their fully intact home - just about the only thing that felt intact when just five miles down the road their 36-year dental practice sat buried in rubble. Dr. Stephen Menke wasn't as fortunate; along with his dental practice being totaled, his car was done for and his home was damaged to the point of being unlivable. The culprit? Hours earlier, the deadliest tornado in 60 years ripped through Joplin, Missouri, demolishing a third of the town, killing 161 people, and forever leaving emotional, physical and mental scars on all who survived.

In the 13.8 miles of ruin, approximately 8,000 homes, 500 businesses, 18,000 cars, one of the town's hospitals, and numerous schools and churches were destroyed as a result of the massive F5 tornado. Destruction that vast in a town so small (its population just exceeds 50,000) granted no immunities in its reach. The question was not, "Were you affected?" The question was, "How were you affected?" And everyone had a story to tell.

Responding to Chaos

The National Federation of Independent Business poll found that man-made disasters affect 10 percent of small businesses, whereas natural disasters have impacted more than 30 percent of all small businesses in the nation.1 Whether man-made or natural, an unexpected disaster is a real threat to small businesses and can cause such severe loss that it changes the lives of those affected in an instant. Compelling statistics or not, people never think it could happen to them. This is reflected in the fact that 74 percent of small businesses do not have a disaster recovery plan, and 84 percent do not have proper natural disaster insurance.2

When the Fitterlings arrived at the demolished area near their dental practice, their worst fears were confirmed: Joplin was a literal disaster zone. Nothing was familiar; everything was destroyed. People were crying, screaming for help, and they had to crawl over power lines and heaps of debris to even reach what used to be their practice. Mentally, no amount of preparation could have armed them.

In an e-mail to family and friends around midnight after the tornado hit, Mrs. Fitterling, an employee at the practice, explained the depth of their shock: "We drove as far as we could and walked a couple of miles in the dark to the office. It is totally gone! Just a heap of bricks, equipment and sticks of wood. We don't know where to even begin. We have eight employees depending on us, and it will be months before Mike can see patients. We are numb."

This numbness was universal, and many small business owners were paralyzed for some time, emotionally and, and in some cases, physically. "At the shock of the event, I think I was numb," Dr. Menke corroborated. "[How to rebuild] the office was uncertain. I did not know how to set up for a new practice - if I could keep my employees paid in the down time, temporary equipment and building."

Following shock came an enveloping sense of self-pity for Dr. Fitterling. "I was feeling sorry for myself. The next morning I just sat in the corner with a pillow." However, moving forward in a timely manner, despite the shock and the self-pity that consumed him, was perhaps the Fitterlings' best move. Still deep in shock, they made phone calls to realtors, insurance agents and the like the very next day after the tornado. "There were so many details that it really was overwhelming [to get back on our feet]," Mrs. Fitterling said. "But by taking it a step at a time and by having good people on our side, we were able to get it accomplished."

The Fitterlings were victims of a tragedy yet they didn't adopt a victim mindset. This resilience allowed them to be the first of the destroyed dental practices in Joplin to be up and running again in a temporary dental trailer (which their insurance paid for at a whopping $4,800 per week). They saw their first patient on June 20th - just a few days shy of the tornado's onemonth anniversary.

Dr. Doug Carlsen's Natural Disaster Financial Preparation List
  1. Have an emergency fund of six month’s personal living expenses, at least $50,000, in money market funds.
  2. Take pictures! As you would at home, take photos of anything worth more than several hundred dollars in your office. Yes, that includes your implant inventory and all your handpieces. Take a picture of your disposables and your professional supplies. Don’t forget the refrigerator.
  3. Keep computer backups, both practice and personal, off site.
  4. Go over your Building and Business Personal Property Insurance once a year with your front-desk person and insurance agent. Your front-desk person might remember new items that you missed and the insurance agent can prompt for new coverage available.
  5. Build a safe room for your important papers, medicine safe, server and people. As we learned from Hurricane Sandy, huge fires in the West this summer, and more tornadoes in Birmingham and Oklahoma City, no area of the United States is safe!
  6. If a disaster does strike, be the first to reopen your office - the early bird got the worm in Joplin.
Surviving Vs. Thriving

When disaster strikes your business, wallow as you might, there is nothing you can do to undo it. That simply is not an option. The options for small business disaster recovery are strict: adapt or expire. Preparation counts, yes, but how well you respond becomes the chief factor in how well you recover.

Of the 23 destroyed dental practices in Joplin, every dental practice chose to adapt and eventually reopened - with the exception of the couple of dentists who opted to use the disaster as a catalyst for retirement. However, this successful recovery percentage is not the norm. The U.S. Department of Labor estimates more than 40 percent of businesses never reopen following a major disaster. Of those that do, at least 25 percent will close within two years.3

It's in the recovery where the Fitterlings truly shined, and it had everything to do with their attitude. From the beginning they saw the light in the dark, rather than being consumed by it. "We never ever thought we'd be doing trailer dentistry at 62 years old," Mrs. Fitterling said. "It's something you aren't prepared for. But when you get in that situation, you have a choice. You can continue to sit in the rocking chair and hug your pillow and think, 'I don't know what I'm going to do!' Or, you get busy and focus on what needs to be done."

And for the Fitterlings, getting busy certainly paid off. Having the first practice to bounce back, they saw an enormous stream of new patients in their temporary office, which consisted of two treatment chairs rather than their usual five. "We did very well while we were in the temporary trailer," Mrs. Fitterling said. "I mean we were inundated with new patients. And it's amazing how we were able to keep production up... we just did what we had to do."

Simply put: They weren't just surviving, the Fitterlings were thriving.

The difference between merely adapting and flourishing post-disaster, it seems, is courage - specifically, having the ability to take risks in the face of uncertainty and fear, and view challenges as opportunities to grow.

The Fitterlings chose an entirely new location and decided to go big, doubling the size of their previous practice. Most of the town's rebuilds were much more conservative. Why did they decide to take such a big risk? Because, they said, what better time to make their life-long dreams come true?

In particular, Dr. Fitterling always wanted to mentor someone, but the facility they had pre-tornado would not have allowed him, space-wise, to ever realize that dream. However, within their devastating loss, they saw a clear invitation for expansion.

"We kind of swallowed hard and said, ‘Let's go for it. Let's go big!' It was scary but we were also confident that we were making the right choices. We doubled the size of the office. Since then, we have hired a recent dental graduate, who will be, over the course of the next six or seven years, purchasing the practice, from us," Mrs. Fitterling said. They also added a parttime dentist and five additional team members, all which has paved the way for substantial practice growth.

That isn't to say that Dr. Fitterling wasn't afraid, it's just that he transcended the fear. "I was scared the entire time to be honest with you," he said, "but what got me through it was faith that things would work out. Maybe faith is a lot of hard work. We did a lot of that. So maybe it's faith, maybe it's hard work - maybe it's a combination of both."

Whatever it is, take note, because now they are "living the dream that we never thought was going to be possible." Thriving.

Financial Lessons Learned

The economic damage per year from natural disasters in the United States comes in around $17,577,645.4 The insurance loss of the Joplin tornado was estimated to be between $1 and $3 billion5 - for a town whose budget is 20 million, and in the throes of the then-sweltering recession, that number is stifling. Add to the fact that the town's two largest employers - St. John's Hospital and Walmart - were wrecked by the tornado, and the economic scenario of this disaster becomes beyond debilitating.

On an economic level, the tornado spared no immunities - even with those who better responded to the disaster than others. While the Fitterlings excelled in recovery, they couldn't make it clearer that a failure to update their insurance policy after a 2010 office remodel is what cost them in the end. The Disaster Survival Resources website similarly insists that the most important step in pre-planning is taking an inventory of your belongings.

"We had several loans [from the remodel] that we ended up having to use insurance money to pay off," Mrs. Fitterling said. "Therefore, not all of the insurance money went to the future office. It went to take care of the things we had lost. Unfortunately, that meant we had to get more loans for the future office.We learned how important it is, as you remodel, as you purchase equipment, to make sure you contact your insurance agent and update your insurance policy. We remodeled and it didn't even cross our minds that it was something important - but it is huge."

The Fitterling's fellow Joplin dentist Dr. Menke echoes their advice: "Audit your policies; it is much more expensive than you think to replace everything in your office. Once you go through and inventory - not just dental, but office, maintenance and consumables - there can be very significant expenses. Make sure replacement values are correct and do an audit of replacement costs for everything… down to the last paperclip."

Dentaltown Magazine's financial guru Doug Carlsen confirms that "you, your front desk person, and your business liability and property agent should go over your coverage once a year or after any remodel." He advises to check for changes or additions such as:
  • Imaging equipment: X-ray units, sensors, panorex
  • Dental operatory equipment: delivery units, chairs, overhead lights, computers, iPads, computer screens
  • High-tech items: lasers, cone beam, CAD/CAM, Isolite, DIAGNOdent
  • Small equipment: handpieces, cavitrons
  • Equipment room: compressor, vacuum
  • Sterilization room: sterilizers and cassettes
  • Office supplies: have as much detail available as possible. Most often doctors have more than $25K. Some have more than $100,000.
  • Office: furniture, fax, phones, copier, management software, all office computers (make sure model numbers are written down)
  • Misc.: TVs, educational patient software
Both the Fitterlings and Dr. Menke feel financially prepared for a disaster now; but they hope their dental colleagues will heed their advice and not learn like they did - the hard way. The key financial implications couldn't be any clearer: Don't wait to seriously consider your insurance policy until after disaster strikes. Do it now. Being proactive doesn't only save, it pays.

Data Back Up Emergency Plan
by Jim Higgins, founder and CEO of Solutionreach

With the myriad tribulations dental practices will encounter postdisaster, data back up should not be one of them – not now, when cloud-based solutions are easily accessible. However, dental practices do need an emergency plan for contacting their patients in addition to recovering sensitive information.

In the wake of Hurricane Sandy, patients of Dr. Michael Masella’s New Jersey dental practice could have faced that frustrating scenario. Fortunately, access to Dr. Masella’s schedule and patient information remained available through the cloud-based Solutionreach platform that his office was using. Though he couldn’t contact patients himself due to the lack of power, Dr. Masella’s representative at Solutionreach immediately sent out customized messages in his name, rescheduling appointments and conveying his support.

When most dental offices were unable to reach their patients, Dr. Masella maintained communication while his office was forced to shut down. His patient relationships were enhanced, and the financial impact of the storm was mitigated by his ability to get them back through the door as soon as possible. Electronic correspondence even allowed him to see patients who couldn't communicate with their regular dentist in the weeks after the superstorm. Dr. Masella’s communication platform didn’t charge for extra services, so he didn’t have to worry about increased costs for mass messaging or utilizing emergency support.

With the right tools, you can keep your patients covered and your practice safe – even in the face of disaster.


It Can Happen to You

According to the International Disaster Database, the number of reported natural disasters has been steadily rising for decades.6 Add in the chances of man-made disasters, and the odds of coming face-to-face with some kind of disaster in your practice's lifetime becomes far from improbable. But facts lay static on the page; they might entertain the mind but rarely do they trigger people to take precautions. That's what stories are for.

Nearly everyone is deluded into thinking it could never happen to them. That common human error of perceived invincibility, and the accompanying failure to prepare and hesitation to respond, is perhaps the biggest risk to your dental practice in regard to disasters. "You never think you are going to lose everything. We never thought that we would lose everything," Dr. Fitterling said. But take it from him, it can happen. When it does, the question is: Will you survive, or will you thrive?

References
  1. http://www.411sbfacts.com/sbpoll-about.php?POLLID=0023
  2. http://readwrite.com/2013/02/22/the-severe-impact-natural-disasters-can-have-on-small-businesses-infographic#awesm=~oizbuNJ0SC9qUp
  3. http://c.ymcdn.com/sites/www.iamcp-us.org/resource/resmgr/microsoft/microsoft-disaster-preparedn.pdf
  4. http://www.preventionweb.net/english/countries/statistics/?cid=185
  5. http://www.eqecat.com/catwatch/devastating-2011-tornado-season-continues-joplin-tornado-couldcost- 1-3-billion-2011-05-25/
  6. http://www.emdat.be/natural-disasters-trends
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