Management of Medical Surge During a Disaster: The Project MESH Medical-Legal Collaboration

In this presentation we describe MESH, the Managed Emergency Surge for Healthcare Project, an innovative collaboration among the Marion County Health Department, Indianapolis-area hospitals and a cadre of lawyers representing all sectors of the hospital and public health community, funded with a grant from the Department of Health and Human Services. Disasters threaten the ability of hospitals to remain operational, even after disaster conditions have abated. For hospitals that remain undamaged and able to operate, legal challenges, especially related to reimbursement, have the single largest impact on a hospital's ability to survive. These challenges are rarely addressed in conventional all-hazards disaster preparedness initiatives. As a result, hospitals are frequently forced to choose between regulatory compliance (and reimbursement) and doing the “right thing” during a disaster event. As part of an overall strategy to manage a surge of patients during a disaster, MESH has established a legal working group composed of (1) the Director and General Counsel of the Marion County Health Department, (2) in-house counsel and medical directors from hospitals in the Indianapolis-metro area and, (3) MESH staff and outside counsel retained for the purpose of providing legal support services to the group. Early in the process MESH conducted an innovative legal table-top exercise, exploring in detail the myriad legal barriers impacting hospitals during and after a disaster. The MESH collaboration is an active project. We hope that through our presentation we can promote discussion and thinking among a variety of public health and legal professionals around this important topic.