Customer Service

Critical power: Supporting customers with medical needs

Sometimes having electricity is a matter of life or death. There are customers who cannot live without medical equipment that is powered by electricity, and others who depend on electricity to keep medications cold, fend off heat-related conditions, or for other critical reasons.

As public power utilities keep the lights on for their communities, they go the extra mile to ensure that customers who depend on electricity aren’t stranded in a major outage or if they require assistance to pay their bill. From coordinating with public safety officials, to communicating with customers about backup options, and formalizing safeguards in disconnect policies public power shows that compassion comes first.

Understanding the scope

A study in the Journal of Public Health and Managed Practice found that for every 100,000 people living in private residences, about 218 depend on electricity for a life supporting medical need. Utility and emergency response teams can also reference the Department of Health and Human Services’ emPower Map to find out how many Medicare beneficiaries who rely on electricity-dependent medical equipment live in their area.

As public power utilities have a strong track record in reliability, it is rare that customers would need to be concerned about sustained outages. The challenge often comes down to how to manage restoration following a storm or other major event.

Wayne Scarbrough, assistant general manager at Athens Utilities in Tennessee, said that the utility’s medical necessity protocols are most helpful to have in place during the winter, when the area experiences ice storms that might have a big impact on the electric system.

Outside of major events, Scarbrough said the utility has a good track record of getting all customers restored within 30 minutes. In the event of a major outage, the utility reaches out to customers with a life-sustaining need for electricity to make sure they are aware of the situation.  

“We aren’t saying ‘We will have you back on first,’ but the call could say, ‘We might not have you back on within the next 48 hours… so please take steps,’” said Scarbrough. Athens Utilities encourages customers with special needs to have a backup plan and asks them to think through how they might move to an emergency location.

The ADA National Network advises people who use devices such as ventilators, oxygen, or power wheelchairs to have a plan for alternative sources of power. For example, they can ask if nearby fire departments or hospitals can support their needs in an emergency. 

Allowing for compassion

Tim McCollough knows the stress of seeking to get electricity restored for a life-sustaining purpose. In May 2019, McCollough was visiting his father, who required oxygen as part of home hospice care, when a meter technician from the utility came by to shut off the electric service due to non-payment. Fortunately, McCollough had a backup battery-powered oxygen concentrator on hand, which he turned on before connecting with the utility about getting service restored.

The issue stemmed from an error on the billing address, and it took many calls and steps to resolve the error and get the power back on.

The experience stuck with McCollough, who serves as a deputy director at Fort Collins Utilities in Colorado. “The first thing that was most sobering to me was understanding how this same thing could have happened in my own utility,” said McCollough in a blog post for the American Public Power Association.

HHS has a list of state disconnection policies as a resource available to beneficiaries of the Low-Income Home Energy Assistance Program (LIHEAP), which details the policies and criteria set by state utility commissions about when utilities cannot disconnect customers. However, public power utilities are often outside the purview of utility commissions, and usually have to set their own policies.

In a follow-up interview, McCollough said that almost immediately after returning to work following the incident with his father, he gathered the utility staff and shared his story. Most importantly, he emphasized to staff that they are empowered to make decisions when policies and procedures “don’t fit.”

He said the message was well-received by staff, and that many told him stories of dealing with situations where following a set policy or procedure “doesn’t feel right.”

“Maintaining a financially sustainable utility is critically important, but we must not forget compassion,” McCollough noted in his blog. “Those of us in utility leadership must empower our employees to resolve these situations in the moment. Without that empowerment, we are stuck with our established procedures. Procedures do not have compassion; our people have compassion.”

“We’ll fix the billing issues later. You can’t fix the customer relationship later – that has to be done in the moment,” emphasized McCollough.

McCollough recommends that utility operations staff and management regularly review incidents, customer complaints, and other feedback to determine if there are any policies and procedures that aren’t working or that need to be adjusted.

“We have to keep a close eye on the customer service side of our business so that we can adapt to changes, but also have to understand the impact of when we do make policy changes,” he said. “Sometimes there are unintended implications, and if you don’t have a high frequency of looking at your issues, you may not be able to recognize that you might have fixed one thing but created a problem in another place.”

To gather additional customer feedback, Fort Collins Utilities asks employees from all levels to share their experiences. “Because we’re public power, we live in our communities. We can think of ourselves not just as ones who provide the service, but we are our own customers as well,” noted McCollough. He advised that utility leaders should make an intentional effort to seek feedback from customers across different socioeconomic classes and hard-to-reach groups to see if any policies have a disproportionate impact.

Relating back to the experience with his father, he said, “The only way I could make a payment was by credit card and over the phone those are two things that some people don’t have. And if you don’t have the means to drive across town… it would have been impossible.”

A personal touch

Amy Burris, customer service manager at Richmond Power and Light in Indiana, noted that the public power utility keeps a list of customers who depend on electricity for life support purposes. Customers fill out a form that a doctor must sign that lets the utility know that the customer has a medical need for electricity. The form includes some basic details, such as the healthcare provider’s number and the type of device needing power.

Burris explained that customers on Richmond’s life support list are specially flagged, so if one appears on the utility’s disconnect list because of nonpayment, then an extended process ensues. On top of the usual notices the utility sends, life support customers receive a certified letter that informs customers they have another 10 days to pay. After that point, if the bill still has not been resolved, then a utility employee reaches out, often in person, to see if the customer can call the utility to discuss options to receive assistance on the bill or if there are other ways the utility might be able to support that customer.

“We try to make sure that we have actually talked to the customer,” noted Burris. “We spend quite a bit of manpower in trying to notify them so we don’t have to shut them off.”

Burris said that by sending someone in person, the utility can often find out more information, such as if the property is now vacant, or if the customer’s phone number has changed. She stressed that the utility documents all efforts to notify customers. 

“You want to be sure [the customer is] aware, but you also want to cover the utility,” added Burris.

Burris said the utility is careful to note on its form that being part of the list does not release a customer from the obligation to pay the bill. She noted that some common misperceptions among customers include that the utility can restore the customer’s individual home in the event of an outage, or that they do not need to worry about having emergency backup plans or generators.

To counter these misperceptions, Burris said that the utility provides customers with a letter explaining battery backup options, and the actions the utility takes when customers are added to the life support list (such as tagging the customer’s meter and nearby distribution poles).

“We always make sure that they understand they’ll need battery backup or be prepared in an emergency,” said Burris.

Athens Utilities also makes sure to have that personal contact with people on its medical list each year. The utility keeps hard copies of letters from healthcare providers in its dispatch center, and once a year, the dispatcher calls all customers on the list to check if the need is still active. If the customers affirm the need, then the utility keeps them on the list customers do not have to send another letter to qualify again. 

Both Scarbrough and Burris noted that a challenge to having such a list is that customers will often question what does and doesn’t qualify as “life sustaining” needs. Both utilities leave that to the healthcare professionals to decide.

“We have a level playing field when it comes to how we treat customers whether they have critical life support services or they’re just trying to cook for their families. I consider what we do on the electric side as a critical public safety and public health function in general,” said McCollough. “Our priority is to get everyone’s power back on.”

A public safety matter

“If someone is in a critical life safety issue because of a power outage, we ask that they call 911,” explained McCollough. “We can’t provide the medical care necessary ... We’re in the business of keeping the lights on, and that’s where we need to stay in our core business.”

Burris provides an updated list of the life support customers to local emergency response teams on a monthly basis.

For Silicon Valley Power in California, customers with a medical need for electricity are asked to connect to the community’s emergency services in the event of an outage. Kathleen Hughes, senior division manager of customer engagement at SVP, said that the public power utility offers “background support,” but that the fire department registers individuals with critical equipment, and handles response to their electrical needs as part of a public safety emergency response.

The utility revisited how to support customers with medical needs over the summer, as the region began to discuss the implications of the public safety power shutoffs to reduce wildfire risk. SVP’s service territory was not directly affected by the shutoffs. However, given its interconnection with nearby systems that were impacted, SVP had a plan in place in case it had to curtail use through rolling blackouts. Hughes said such curtailment might have affected about half of the approximately 90 customers who have critical equipment in their homes.

To prepare, SVP developed marketing materials on outage preparedness and handouts that detailed which facilities would be open for backup in the event of a shutoff. SVP distributed these materials at senior centers, libraries, and other facilities; sent information via email, and conducted other public outreach to spread the word.

The preparation also involved a county-wide effort, which Hughes noted brought about greater interdepartmental coordination around outages.

“No one really ever had to think about the electricity system, how all our buildings were connected, how our generators are connected ... until planning for the public safety power shutoffs began,” said Hughes. “It really opened up the doors to discussion.”

Previously, out of concerns for privacy of personal health information, the utility did not have information on customers with critical equipment. Now, the fire department scrubs the list of any sensitive data and then sends it to SVP.

 “It’s not an official change in policy, but heightened awareness,” said Hughes.

She explained that increased coordination helps the utility understand what public safety is already doing and how it can help that effort. Looking ahead, SVP is exploring how it can support customers with critical-care needs, such as through rebates or other programs to provide backup equipment. 

In Athens, crews doing repair work or building lines are also made aware of who is on the emergency medical services list via a “very prominent” notation that appears on every page of a customer’s account information. Crews can search or reference by circuit to see if any emergency medical accounts are affected by work. Details are limited, however, to protect customers’ privacy.