Since January 2019 over 60% of all major incidents reported in a large chain of national hospitals were related to power outages. MPS business consultant Tony Behrman sketches the legal implications to practitioners of outages.
Behrman writes:
Since January 2019 over 60% of all major incidents reported in a large chain of national hospitals were related to power outages. Since January 2019, there have been over 900 incidents reported or 225 power outages per month.
At the recent MPS roadshows in South Africa, entitled “Experience Matters”, power outages and the doctor’s duty surrounding operating with tenuous power was raised. I have elected to investigate the legal position for South African doctors and offer the following advice.
The law and power outages:
The Occupational Health and Safety Act 85 of 1993 and regulations, forms the basis of risk assessments regarding, for amongst others, power outages. The 16.1 and 16.2 appointee (the CEO and his designated appointee) with their risk staff have the final decision as to whether a hospital is safe to proceed with surgical cases, provided that the risk can be mitigated.
It goes on to state that the employer has to provide a work environment which is safe, including routine maintenance to eliminate, mitigate, and reduce the risk of danger to external healthcare providers, employees and patients.
The South African National Standards Electrical guidelines 10142 (SANS), is the only permissible guideline to follow and contains a section on minimum power requirements for a medical facility. It refers to a power supply from a “safe source”, which shall be energised in the case of a failure of the usually supplied sources of power.
Minimum response times for replacement power:
There are 3 response times specified in the SANS 10142 regulations:
Uninterrupted Power Supply (UPS) – the response time for an alternate power source in the event of a power failure needs to be faster that 0.5 sec. for all medical equipment in ICUs, theatres and recovery areas where there are high risk patients. This requirement can only be met using an Uninterrupted Power Supply (UPS).Unfortunately most UPSs only function for a limited time before they need re-energising, and as a result, hospitals are required to invest in UPS battery back-up equipment which must deliver power for a regulated 20 minutes as per SANS 10142. This power source is only a temporary bridge that ensures enough time for an alternate source of power from a generator, to supply the hospital.
Critical Generator Supply. A response within 30 secs is required of the critical emergency generators that supply critical elements in the hospital for the continuation of critical services like emergency lights, wards, medical gas compressors, pharmacy fridges, certain lifts, UPS support etc… These generators must be able to function for at least 24 hours OR for a minimum of 3 hours to complete surgery and evacuate the building, and the day theatres, if required.
This will affect the type of cases surgeons will be able to perform in that facility, as there is no legal requirement for an alternative power source over the requirement for a critical emergency generator. It is important that practitioners working in such a facility are aware of the generator back up system in place, to understand the risk exposure in the event of a power failure or load shedding event.
Due to the 30 second start up time of critical generators to accept the load, UPSs are deployed to supply the equipment within 0.5 second equipment and carry it through the 30 second power break until the critical generator takes over.
Based on this supply of power, a surgeon may need to cancel further operations after completion of the current case until the full risk is mitigated. For this reason, many large hospitals have dual redundancies on generators, for example 2 or more separate generators supplying power to the hospital if required, the essential and the non-essential generators, inclusive of a UPS bridge.
Surgeons are encouraged to find out whether there are additional mobile generators prior to commencing surgery when power outages are threatened.
Base load generator supply:
These will supply a response in longer than 30 seconds. They are for non-essential supplies, and are only needed when a hospital provides a replacement ongoing base load supply as back up.
When such a generator is present, the surgeon may carry on with activities as if the normal power supply is present and until this fails, resulting in only the critical load generator being functional. At this point the surgeon should finish his/ her case as described above, and not consider starting any cold cases
The decision to install and utilise these baseload generators is a commercial one, based on the cost of total downtime to a hospital versus the return on investment of keeping the hospital up and running. With these facilities, doctors are safe to do cold cases as long as all systems remain functional.
How long to these base generators last?
These generators depend on the regular supply of generator fuel as well as a significant bulk- storage capacity. The bulk storage might be constrained due to space and fire regulations.
Base load generators can go for days or weeks as long as there is sufficient fuel. They are however not a legal requirement but are on the basis of commercial expediency.
It should also be remembered that in a national outage, if a state of emergency is declared, the state might need to commandeer all of the fuel supplies nationally.
Final Word:
Surgical teams who are working in a facility where power outages are likely to occur should have a contingency plan in place. They should confer with the general manager of the facility and carefully consider their advice and explanation of the risks of losing back up power. Should they advise not to proceed with further cold cases, this advice should be taken extremely seriously. A doctor who ignores this advice could put a patient’s safety at risk and this could also form the basis of a clinical negligence claim, an inquest and even a possible ensuing criminal charge.
Dr Tony Behrman
Medical Business consultant to the MPS