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A PG&E truck.

The widespread PG&E power shutdowns are depriving California's rural and indigent residents of critical care from community health clinics that they have come to count on not only for primary care but also for many types of emergency care, leaders in the industry told The Bee.

"The health center in Winters ... had some available power, but they had to make the choice between keeping the lights on, keeping the electronic medical records running or keeping the vaccine refrigerator running," said Thomas Tighe, chief executive officer of Direct Relief, a nonprofit that supports clinics in medically under-served regions of the United States and world. "They decided to keep the electronic medical records operational and hand off the vaccines to a hospital that did have backup power."

Tighe said Pacific Gas and Electric Co.'s power shutoff earlier this month revealed a dangerous vulnerability in the state's healthcare system. A survey of 70 rural and community health centers showed that only 44 percent had a backup power source, and like the Winters health clinic, those power sources can provide only a limited amount of electricity.

Consequently, each clinic has to make a choice.

Christopher Kelsch is the executive director at Winters Healthcare, the clinic that Tighe referenced. His team offers medical, dental, pharmaceutical and behavioral health services out of two brownstones in downtown Winters.

During this month's prior blackout, Kelsch and his team decided to keep the electronic health records and phones up and running. They kept the medical clinic open with a skeleton staff for drop-ins and appointments, he said, but they closed the dental clinic and canceled appointments despite a three-month backlog.

Winters Healthcare has been building a new home at 172 E. Grant St., Kelsch said, and as part of the plans, they left a space for a backup power source that could supply electricity to the building.

Now, he said, he and his staff decided after the early October PG&E power shutoff that they were going to focus for the next year on raising enough money to make sure they have a backup power source on site. For now, Winters Healthcare is buying a second small generator, Kelsch said, but he urged the state to consider ways to help organizations like his with financing a large-scale power source.

"Next year, we can't be in this predicament. We can't be running on (small) generators," Kelsch said. "We've got to be open and consistent. If we do that, no one in the community misses a beat in terms of their health, in terms of getting access to health care and in terms of the impact on staff."

Founders of Grass Valley's BoxPower, a company that offers solar-powered microgrids that can store and supply power directly to structures, said they've been hearing from a number of pharmaceutical and healthcare organizations looking for backup power sources.

"The most common issue that we have heard, beyond of course not being able to provide care, is that these medical clinics have many vaccines, medications, blood transfusions, etc., that require constant refrigeration, and in the event of a power outage, they can lose hundreds of thousands or millions of dollars worth of medical supplies due to a shutdown of refrigeration," said Angelo Campus, BoxPower's CEO. "Beyond the immediate shutdown where they can't provide care, it can actually set them back massively financially."

Campus said he hasn't been able to take a day off since the first power shutoff, and his company is trying to hire people as fast as they can. He's getting inquiries from many types of small businesses, he said, but also calls from elderly residents who feel too vulnerable to be without power and others who have essential medical equipment which requires power..

"I believe our daily inquiry rate jumped about 10 times for the first couple of days after the first power shutoffs," Campus said. "Right now, it's at about three to four times what our average was before that."

People sometimes forget that power is a prerequisite for health delivery in this country, Tighe said. For instance, he said, 68 of the 70 clinics that responded to the Direct Relief survey reported that they had medications on site that required refrigeration. Insulin, vaccines and other medication must be kept within a certain temperature range, Tighe said, and if they fall out of that range, they have to be thrown out.

"Everything presumes the existence of power," Tighe said. "The move to electronic health records ... is important for a number of reasons, but the first word is electronic. I think the loss of access to patient records, when the electricity goes down, is severely compromising."

The Direct Relief survey reported clinics had a variety of backup power sources -- solar; solar-diesel; and generators that ran on propane, diesel or natural gas -- but all had disadvantages. Some backup generators provide power for 12 hours. One clinic had solar power but said PG&E wouldn't allow it to store the power in batteries, so it sent that power to the grid and relied on a limited-capacity diesel generator. Some could store solar power in batteries, but only for a limited amount of time.

If generators run on diesel, clinics also have to ensure they can get a supply of the fuel during times when there can be a four-hour wait in lines at the few gas stations that can still operate during an outage. Kelsch said he feels somewhat fortunate to have been in Winters because, even if gas stations in his area didn't work, he could get to stations in Sacramento County powered by Sacramento Municipal Utility District.

Patients at his clinic do not have that same kind of mobility when it comes to getting healthcare, he said.

"They're a stationary population. They're not a traveling population," Kelsch said. "They're folks and families who have been here, but at the same time, they have limited transportation. They don't have the option to go somewhere else where there is power."

The toughest part of this power outage, Kelsch said, was not knowing whether it would last for 48 hours or five days.

Kelsch said it presented a hardship for staff and patients. The clinic runs on a lean budget, he said, and could not pay staff for the days they weren't working. These are people who live on $15 to $19 an hour salaries.

The clinic's leadership also was reluctant to cancel five days worth of dental appointments, knowing that it would be a challenge to fit them into an already packed schedule, Kelsch said.

Yolo County so far isn't included in Wednesday's shutdown, but Kelsch said he's concerned for clinics and patients in other more rural areas.

"Most of the rural clinics I'm familiar with and that I used to work with in Northern California and down in the Central Valley and on the east side, were remote," he said. "Some were frontier. If you're shutting them down, there is no other place to go. There was one place to go. You don't have hospitals in every town. You have a clinic. That's what you have. People don't have the option to travel."

Even in Winters, Kelsch said, Winters Healthcare is the only place open for extended hours. There's a small medical practice there, he said, but they also have to close during a power outage.

Tighe said he and his team at Direct Relief got concerned about the far-reaching implications of power outages after watching the death toll skyrocket after Hurricane Maria left Puerto Rico's community health clinics without power for weeks. His team installed a backup power system with triple redundancy at their facility to protect precious medication supplies that they send all over the world during emergencies.

But in Puerto Rico, where solar panels are everywhere supplying energy to the grid, few could supply power directly to the health clinics that desperately needed it, Tighe said, and even if clinics had diesel generators, they couldn't get the fuel needed because roadways were washed out or blocked. The generators also needed maintenance and replacement parts to remain operational, he said.

His team had no desire to get into the business of advancing solar battery storage and system design in Puerto Rico, he said, but they ended up doing so because they realized their stores of cold-storage medicines wouldn't last long enough to help people in a country that lacked power. Consequently, they have been fundraising and helping to get equipment shipped and installed at Puerto Rico's community health clinics.

Although what happened in Puerto Rico was extreme and dramatic, Tighe said he sees California's power outages as having similar impacts on the state's clinics and their patients: the loss of drug stocks, the loss of information in health records, the potential loss of a telephone lifeline, difficulty in transportation and lack of access to information because of radio or television being unavailable.

Ultimately, he said, all that puts the lives of already vulnerable people at risk.

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