Chapter 12: Center Administrative Director: The Emergency Center (2002 – 2010)

Chapter 12: Center Administrative Director: The Emergency Center (2002 – 2010)



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In this chapter, Mr. Brewer talks about his role as Center Administrative Director for the Emergency Center between 2002 – 2010. He talks about the areas of improvement needed, most stemming from the enormous growth in patient volumes during the late nineties and into the early 2000s, and the fact that the majority of patients would come into the MD Anderson system through the Emergency Center.

Mr. Brewer first discusses the challenge of bringing the image of the Emergency Center into alignment with the overall image of the institution as a center for multidisciplinary cancer care. Next he talks about what was involved in getting the Emergency Center designated as a Level 3 emergency center, including controversy over this decision.

He also covers the unique demands on the medical staff, who needed expertise in emergency medicine as tied to oncology. He discusses partnerships he established between MD Anderson’s Emergency Center and Level 2 and 3 centers in the Texas Medical Center. Mr. Brewer then discusses his approach to recruiting for the Emergency Center’s specialized work environment. He also discusses his involvement in the design for the new Emergency Center, which opened in 2007 and received an architectural award (2008?). He lists the wide array of services that were built into the design. He discusses the electronic patient tracking system he implemented. He notes that work on the Emergency Center was a career high point.



Publication Date



Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Overview; Professional Practice; The Professional at Work; Leadership; On Leadership; MD Anderson Culture; Working Environment; Definitions, Explanations, Translations; Survivors, Survivorship; Patients, Treatment, Survivors; The MD Anderson Brand, Reputation

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.


History of Science, Technology, and Medicine | Oncology | Oral History


T.A. Rosolowski, Ph.D. Now, tell me about your movement into the next role, and you actually was overlapping because in 2002, you moved into the center administrative director role for the emergency center. So tell me about making that transition. Why? Why did you choose to do that?

Cecil C. Brewer, RN, BSN, MS In the mid-’90s when I took over the directorship for the Ambulatory Treatment Center, which consisted of the—we call it the ATC. ATC had a bed unit, 25 beds; a chair unit that’s 25 chairs, and stretchers. We developed a transfusion unit. In 1999, there was another 25 beds. We had a satellite facility called Green Park One on South Main that was like 20 beds and that was—and guess what? There was exponential growth in patient volume at MD Anderson going on at this time from the mid-’90s up to the early 2000s, just exponential growth, and we were bursting from our seams, so we needed a lot of process improvements throughout the org. It was all process improvement, process improvement. How do you control volume? Then, on top of that, we—in my—under my direction, I had the emergency center. At that time, it was approximately, let’s say, another 20, 25 beds, so... And it’s growing 40% a year, too big.

Why was there a change? Exponential growth. I’ve grown the early days of MD Anderson’s ma and pa shop if you will. The Ambulatory Treatment Center now was a, a major revenue center for the institution. I think when I left there, we were generating some quarter—$200 or $300 million year in overall revenue for the institution. That means that the throughput, the throughput of the dollars, the med—the drugs, the chemotherapies, the blood products, the volume added on to that, and you can get your—and then you can see the amount of dollars that are being generated, so... And then now you’ve got emergency center, which is coming unglued with too many patients, overcrowding, also a huge revenue center for the institution, lots of focus because this is your front door to the hospital is the emergency center. That’s your front door.

T.A. Rosolowski, Ph.D. Right. A lot of people are not aware of that.

Cecil C. Brewer, RN, BSN, MS So now, you have to deal with your front door issues, your image, safety, liability.

T.A. Rosolowski, Ph.D. Well, and there was that on one side and then on the other side, there’s also this strange position that the emergency centers had at the time at MD Anderson, which is that of—there were a lot of questions about whether there should even be emergency doctors there. I mean, who were actually the medical staff? So it had an interesting identify.

Cecil C. Brewer, RN, BSN, MS We transitioned that. When I first came up to the Ambulatory Treatment Center, it was called Station 19. It was in the mid—late-1990s, met with the medical director at that time, Dr. Ed Rubenstein. We moved to change the image because there had been a bad image created before the stations prior to me getting there. So how do we change the image? We need to put on a new face for the institution for people, so they could look at us different. So with the new change going on with the multidisciplinary care centers, it was an ample opportunity to change the name of the stations to something different. We called it the Ambulatory Treatment Centers A, B and C and then we lobbied institution. We documented why we should be called not an urgent care center but a true emergency center. So we documented all the reasons why we felt we can live up to the status of emergency center. And by looking at the definition as put forth by the joint commission, by Medicare, and we looked at the criteria, and we met the criteria for level III emergency center because we were a specialty emergency center, and we weren’t, what you call, a typical general emergency center level I, level II trauma. We did not do trauma, we didn’t do obstetric and gyneco—obstetrics, we didn’t do obstetrics, and we didn’t do burns, and those are your level I, level II general hospital setting.

We were a specialty hospital, and we were the first oncology institution to create and be named and called an emergency center of all the comprehensive cancer centers. So we became the place where other oncology hospitals wanted to come to us for consultation on how to create this environment. Our physicians were not at the time emergency-trained physicians. They were internal medicine-trained physicians with an expertise in oncology. There’s a very special expertise that you have when you have oncology, which is a specialty that the general hospitals don’t have, but they have the internal medicine. But we have the internal medicine and the oncology too, and that’s what’s so special about our emergency center is that—are those two components. We do not have an emergent—we have a tremendous number emergency. So it’s just a matter of telling your story, yes, we have emergency, we have codes, and then we have medical cardiac arrests going two at a time. I mean, these are things that the oncology community doesn’t see because we’re not in that emergency domain out there. But once we documented how the—what we were doing, the liabilities that we were facing and all of the criticality of what we were doing, the number of patients that we were transferring to critical care and having to transfer to the other hospitals, all the EMTALA laws that we have to abide by because of the fact that you’re putting yourself out there that you treat emergency, but you’re not calling yourself an emergency, but patients will show up on your doorstep expecting the emergency. So as to legitimize that, you create this, not only the name emergency center but the—all the instruments and things that it takes to operate an emergency center—more staffing, more training, and more applicability of the laws, the EMTALA laws and how you follow those things. Because there’s a tremendous amount of liability in transferring and receiving transfers and patients who show up on your doorstep requiring treatment and how do you manage all of those. So that’s a true emergency center.

T.A. Rosolowski, Ph.D. Why did you transition from the one to the other?

Cecil C. Brewer, RN, BSN, MS I was recruited.

T.A. Rosolowski, Ph.D. Oh, you were recruited. And why were you the person they wanted to recruit?

Cecil C. Brewer, RN, BSN, MS They felt that I was the problem—I think why I was recruited is: that I had developed a reputation of being able to bring people together to solve problems; that I was levelheaded, I was not emotional; that I was pretty smart. And that I had some unique leadership skills that the medical director thought I could help him accomplish his goals in that unit.

T.A. Rosolowski, Ph.D. When you look back at that period because you were in that role for eight years, what were the high points of what you—maybe the high-point challenges that you had to address and what you felt you achieved?

Cecil C. Brewer, RN, BSN, MS I think some of the high-point challenges of running the Ambulatory Treatment Center—

T.A. Rosolowski, Ph.D. No, I meant in the emergency, in emergency case.

Cecil C. Brewer, RN, BSN, MS Oh, in the emergency center? [00:45:02

T.A. Rosolowski, Ph.D. Yeah.

Cecil C. Brewer, RN, BSN, MS Oh, my goodness. In the emergency center, the challenge is number one, was moving the needles from an urgent care designation and stigma, if you will, to an emergency center where you got a high level of expectations and... What are the high—so some of the things, first of all is your—first, you have to—the challenges were we must adhere to the stated legalities of an emergency center. EMTALA laws, we have to abide by them.

T.A. Rosolowski, Ph.D. And what is that EMTALA?

Cecil C. Brewer, RN, BSN, MS It’s emergency transfer—medical transfer labor law—act. It stems from the fact some years ago when patients were—show up in labor, and they were not treated because for whatever reason, and the law was created, and it was called—to react to that situation—EMTALA, emergency medical transfer. If you can’t care for the patient, you have the obligation to transfer that patient to a higher level of care.

T.A. Rosolowski, Ph.D. Got you, got you. I’ve never heard that acronym before.

Cecil C. Brewer, RN, BSN, MS So that—

T.A. Rosolowski, Ph.D. Was there a controversy within the institution or from leadership making that redesignation from urgent to emergency?

Cecil C. Brewer, RN, BSN, MS Yes, there was controversy from the institution in moving the designation from Station 19 urgent care to emergency center because it opens up, as you call, Pandora’s Box that the community will start coming to MD Anderson for care. How do patients and how do people in a community know that MD Anderson—if you have a gunshot wound or you’re in an automobile accident or if you—a stab wound or if you have a patient in labor or you have burns, you don’t show up at MD Anderson for that, okay? That’s not what we do. So we don’t want to open up our... We don’t want to open up this problem in the community by calling ourselves an emergency center. If you noticed the way we created that and the way I created this over time and still exists today at MD Anderson Emergency Center on the first floor of the Alkek building, we worked—I worked very hard and tirelessly to make sure that we didn’t expose the institution. Anytime you post the sign on the wall of your hospital, let’s say the emergency room, emergency care, you have now opened—you have now opened that to the public. And if I arrive there in the emergency, you have a duty to stabilize me and transfer me. I don’t think you’re going to see a sign on MD Anderson’s anywhere on the outside that’s going to say emergency.

T.A. Rosolowski, Ph.D. Right. Okay. Got you. Because that’s always one part of the hospital, emergency center.

Cecil C. Brewer, RN, BSN, MS No, it’s not on the ex—you don’t see it on the external.

T.A. Rosolowski, Ph.D. No, no, no. I was going to say—

Cecil C. Brewer, RN, BSN, MS


T.A. Rosolowski, Ph.D.

—but that’s sort of with the general hospital. Yeah.

Cecil C. Brewer, RN, BSN, MS That’s the EMTALA issue. That’s the EMTALA law.

T.A. Rosolowski, Ph.D. Got you, got you.

Cecil C. Brewer, RN, BSN, MS And so what you will see out there, it will say ambulance entrance, but internally, there’s internal teaching, internal operation that we have an emergency center for our cancer patients. And everybody knows that’s for cancer patients. So we don’t exert that type of issue externally for the public that we treat all types of emergency. Now, if someone shows up with any of those type of emergencies that I just described, obstetrics or burns or stab wounds and that—we have to help all of those. We have the obligation to do the best that we can, and we are protected by various Good Samaritan laws to stabilize, all of it. You know we have to do [that?] and say we do a general triage on that patient, exam cursory as much as your expertise and then transfer that person to an appropriate higher level of care. Burn, we probably send to Ben Taub. If it’s a heart issue, we have a relationship with different hospitals, Methodist, St. Luke’s, Harris County Hospital District, Hermann Hospital. And I worked, and one of my challenges was establishing relationships with those hospitals. How did I do that? I called up my peers, and I would go meet with my peers in those different hospitals and talk to them about what we do at MD Anderson because they had a misconception of what we did at that you’re not a general hospital, how do you have an emergency room? We had to educate the public, the hospitals about what we do. We had to educate the EMS system, Harris County Emergency management system, Dr. [Paul?] Persse and the Houston Fire Department. We had to educate them on what we were doing at MD Anderson and then he would educate the firemen and the EMS, and so forth, and so on. And over time, that’s become just a natural process now. So it was a huge job, huge. This is all from grassroots up, all these, all of these developments.

T.A. Rosolowski, Ph.D. What did you like about the job?

Cecil C. Brewer, RN, BSN, MS Challenges, never a dull moment, people, my staff, my physicians.

T.A. Rosolowski, Ph.D. I mean you get all excited when you talk about it. You obviously love the work. (laughs)

Cecil C. Brewer, RN, BSN, MS Yeah, It’s very stressful, very stressful because there was high demand from the institu—from the administration of the institution. Like I said, we were the face of the institution, we were the front door of the institution. That is a tremendous amount of pressure, and everything didn’t always go right.

T.A. Rosolowski, Ph.D. What kind of things would go wrong?

Cecil C. Brewer, RN, BSN, MS Oh, my goodness. What type of things can go wrong in the emergency center? It’s what can go wrong in any emergency room. You have complaints, you have overcrowding, you have challenges with the competence of staff not only nurses but maybe it could be medical staff or some of the other technicians. You know things happen. You have...

T.A. Rosolowski, Ph.D. Was there good support at the time, or I should ask it differently. Recruiting seems like it would be a key issue, I mean getting the right people in that place and so what was your strategy around that or the team of people who were managing the emergency center?

Cecil C. Brewer, RN, BSN, MS What were the recruiting strategies around the emergency center? It was twofold. One, you had your nursing department recruits, then you have your medical recruits. And my relationship with the medical director was very collaborative. After Dr. Ed Rubenstein departed in the late—or in mid-’90s, Carmelita Escalante who’s still here as the chair of the Internal Medicine Department was the director the Ambulatory Treatment Center and the emergency center. Our challenge was how do we recruit nurses? If you recruit just the oncology nurse with oncology experience, then she doesn’t have emergency experience. If you recruit external emergency nurses who have all of the expertise as far as high-level trauma and that high level of stress job and then they’re not going to get it at MD Anderson. They’re not going to get the gunshot wound, those—the motor acci—or car accident victims and stab wounds and all of that and the babies and all, they’re not going to get that, so you’re going to be bored working here.

So how do you do that? Well, how do you recruit? You recruit nurses with good basic skills, and you have a training program for the component that they don’t have, the oncology. Or you could get a nurse, recruit a nurse with emergency background who is—who has the understanding that they’re not going to have this level of participation that they had in the trauma center. The trauma nurses really don’t work well in the MD Anderson Emergency Center. Those trauma nurses and those trauma doctors have a whole different mindset. That whole domain of care is like a war zone. But if you find a nurse from a regular community hospital, a 100-bed hospital, 200-bed hospital, they’re not—depending on the level of the emergency they come from—you have trauma centers, you have level I centers, level II centers, level III centers, etc. Right now, in Houston, I think we only have, what, two level I trauma centers, Harris County, Ben Taub and Memorial Hermann’s and then you have one in Galveston, John Sealy, and so... Then, everybody else falls into—you’ve got different categories as identified by—in your Medicare laws and joint commission etc. because each one provides a different level of care, and that’s how they are evaluated. That’s how they are surveyed, and that’s the level. But the challenge is tremendous. It was a challenge then, and is still a challenge—

T.A. Rosolowski, Ph.D. A challenge now.

Cecil C. Brewer, RN, BSN, MS —today on not only recruiting appropriate and competent and good nurses and doctors but keeping them, retaining them, and avoiding burnout. You know burnout is also another issue.

T.A. Rosolowski, Ph.D. Oh, yeah, yeah. What is something you did during that time at the emergency center that you’re particularly proud of?

Cecil C. Brewer, RN, BSN, MS I’m particularly proud of a lot of things that I did in the emergency center, [not only?] getting it renamed from an urgent care center to an emergency center but also managing overcrowding effectively in the heyday of the late ’90s and the early 2000s. And developing a solid core of very competent and driven nurses and a very collaborative workforce with the physicians and with all of my partners throughout the institution. Every department in the institution is a part of the emergency center. We touch every, every element of the institution from research to technology to fiscal plan and all of these, diagnostic imaging, laboratory medicine, speech therapist, your nutritionist, you name it. That funnel all comes to the emergency center. So the partnership would be one, creating all these multiple partnerships and relationship not only internally but externally. The hallmark of all that work would be the culmination of convincing the institution that the emergency center of that era was not capable of sustaining itself in an effective way for safe patient care in the current location that it was in at the time and with the number of beds. We only had 20—I think it was 27 beds, but some of those beds were double-room beds, they weren’t private rooms, and we had some deficiencies in a way... The emergency center opened back in 1995, something like that, and it was designed at the time based on the needs of the time. Typically when you’re building something like that, you start building two years out, so you talk about the mindset of 1993 and so you’ve already outgrown things by the time you move in.

T.A. Rosolowski, Ph.D. And certainly by the time 1997 moves around and as John Mendelsohn was doing his growth thing, oh, my gosh.

Cecil C. Brewer, RN, BSN, MS And it was just tremendous. We would have 50 patients in 25 beds, you know. And so accomplishments there were that [manage the?] overcrowding, tremendous collaboration and partnerships, competent, very dedicated nurses, short staff, but we took care of the patients. Short staffing was a tremendous problem, not enough nurses, too many patients. You try to be Houdini in how to take care of patients. Creating a trust level with staff knowing that the director was not too good to not come and get his hands dirty with them. I created these different approaches. I have what we call—I forget what we called it. If all the nurses and all the doctors were so tired and so overworked, we have 40 patients and a cold situation going on, and you only had enough staff for 25 patients, and nobody could get lunch, I empowered anyone, any nurse to say—no one is able to go down to the lunchroom and say—“Pizza, this is a pizza night.” Or let’s say if it’s pizza, I’ve created a partnership with the Pizza Inn on the corner over there by the Texas Children’s Hospital, they can call them up or Pizza Hut, and I will come pay them the next day. And so everybody eats, everybody eats, no, not just the nurses, pizza is for everybody who interacts with the emergency center, the patient escort, the UT guard, the person who serves the dinners for the patients, the advocate. The food was for the team, and it’s enough, and we’ll... They knew that don’t worry about the money, we’ll take of the money. Look how much money you-all are making for the institution over here. Look at the thousands and millions of dollars that are coming through these doors over here. We’re going to get you $200 of pizza. And I empowered them to do that. And then we would celebrate a lot, parties, and when we check out, when you head downtown, you better enjoy because when you’re working, you’re working, there’s no breaks.

T.A. Rosolowski, Ph.D. Well, and it creates community, it creates the team, it helps reinforce it, so you’ve got people that are dedicated.

Cecil C. Brewer, RN, BSN, MS You asked me about what was one of the major highlights, high points. Probably the opportunity to build this vision of the ultimate emergency center for oncology patients, and that was the current emergency center. We worked for over—for several years and making site visits and design issues and talking with the staff. All the staff had input in the design. And so we designed an emergency center that supposedly at the time based on some projections that we put together that would meet the caseloads of the future if the throughput of the institution would allow. So we went from 25 beds to 43 beds in the current emergency center. We built in some—a couple of trauma beds for those patients who were having a high level of criticality when they come into the hospital, come into the emergency center either—whether it be a cold situation or just critically ill. We put in various specialty for those. We had rooms [specially designed?] just for pediatric patients that was designed by the pediatric department. It’s a department within a department. We set up a special room. We didn’t have OB-GYN, but we set up a special gynecological room for all the special needs of the woman—of the female patient who come to the hospital—coming to the emergency center. We put in negative airflow rooms to meet the demands of current times for all the various Ebola types, RSV, and all those respiratory type of issues that were happening right in the contemporary healthcare environment. We made sure we had ample bathroom facilities for our patients. We also made that since our patients—we had overcrowding and patient have to spend long lengths of time in the emergency center, sometimes up to almost 24 hours before they can get an inpatient bed. We arranged to have a new nutrition center built into the emergency center, so the Dietary Department could serve our patients effectively. With the demand for medications and all of the issues related to compounding the medications, all the pharmaceutical regulations, we built a satellite pharmacy in the emergency center.

T.A. Rosolowski, Ph.D. Hmm, so it’s almost like its own little world.

Cecil C. Brewer, RN, BSN, MS It is. Also, with the number of x-rays that had to be performed for the patient in the emergency center, we built in a diagnostic imaging room in the emergency center and set aside a space for future expansion for a CAT scanner, which is in place now. We also understood that we’re not always as successful with our patients as we possibly could’ve been. Patients do die. We had to admit, patients do die in the emergency center, and we set—and we created a bereavement room for those patients and those families to—if they so desire, the body could be placed in a certain area where the family could go through their grief process if that’s what they desired along with chaplaincy.

T.A. Rosolowski, Ph.D. When did the new center open?

Cecil C. Brewer, RN, BSN, MS Two thousand and seven.

T.A. Rosolowski, Ph.D. Hmm, wow, that’s amazing.

Cecil C. Brewer, RN, BSN, MS And so we tried to think of all the things that we didn’t have in the prior emergency center. That all private rooms has lots of little features. [And I include?] the emergency center received the number one award from the architectural society for emergency center design in 2000—I think it was 2008 when that award was given out.

T.A. Rosolowski, Ph.D. That’s very cool.

Cecil C. Brewer, RN, BSN, MS I think that was like the ultimate highlight. Now, we’ve taken from here or from this urgent care, overcrowded, lack of appropriate facilities to a spacious unit with, what we call, more than necessary supports coming here for respiratory therapy, cardiopulmonary, and just... Now, those are just a few of the items that were added to the emer—at the same time, the hospital became more businesslike, so we had to create a business center. You got an emergency center, so you call yourself emergency, and then now, you create some other issues around billing.

T.A. Rosolowski, Ph.D. Right, of course, of course.

Cecil C. Brewer, RN, BSN, MS So then, we had to create a business center to control the coding and the billing aspects that go on inside of the emergency center from not only the technical side but for the nurses to charge everything for their services of—not for nursing services but for the emergency system services but also for the medical staff, they’re charging for their medical care. So we had to create a business center for that.

T.A. Rosolowski, Ph.D. I noticed also—and I am aware of our time. I want to make sure we get through everything today. I noticed that as part of what you did for the emergency center, there was also the implementation of an electronic patient tracking—

Cecil C. Brewer, RN, BSN, MS Oh, the ETCS.

T.A. Rosolowski, Ph.D. —yeah, system. So that was all part of that grand vision.

Cecil C. Brewer, RN, BSN, MS Right. In the early 2000s, a tremendous amount of effort was going in how do we manage the number of patients that are coming to the emergency. Initially, everything was on paper, and we had a grease board where you write the patient—like you see on TV. They write the name of the patient on a board and say this is John Doe, room 5, diagnosis is x, y, and z. And with the applicable EMTALA laws, we had these privacy issues, so you couldn’t list the patient’s diagnosis with their name and, etc. But also just this whole thing about tracking the patients and then also had meaningful data to make decisions based on all of this traffic that you’re having. And I noticed that the diagnostic imaging set at the hosp—diagnostic imaging at MD Anderson had come up with an innovative way of keeping up with their patient through tracking. But also, I knew there were other tracking system that you could buy from vendors outside institution, but it cost a tremendous amount of money, but they were integrated systems throughout the hospital, and MD Anderson at the time was not ready for electronic medical records. So I worked with the diagnostic imaging information system department and their system analyst and software developers, and we came up with a strategy that worked for the emergency center. We studied the data that we wanted to collect and to display and the appropriate report that we want it to have generated and addressed some of the privacy issues (inaudible), and we named it the EC Emergency Center Tracking System, and it’s still in place today over there. And it’s the homegrown tracking system. It was way before what they call Epic now. We were able to generate all types of data that the institution wanted, volume of patient, types of patient, urgency, the level of care of the patient, the acuity of the patient, you name it, the number of providers that took care of the patient, you name it. And that was a tremendous innovation.

T.A. Rosolowski, Ph.D. Very cool. So tell me why you left that job? So in 2010, you transitioned.

Cecil C. Brewer, RN, BSN, MS Well, what happened is that I had done the—I think I transitioned because there comes a time in your career where it’s time to move on. I’ve done the ultimate, developed the emergency center tracking system, managed overcrowding, managed short staffing, built out a brand-new, state-of-the-art emergency center. Times have been different; stress levels were tremendously high.

T.A. Rosolowski, Ph.D. Yeah. Now, how did you hold up through all this? I mean were you feeling burned out? Were you…?

Cecil C. Brewer, RN, BSN, MS I don’t think I was— I wasn’t—excuse me. Was I feeling burned out? I don’t think I was feeling burnt out. The stress was tremendous. You put a tremendous number of hours and worked—12 hours a day was average. You began to feel am I getting the support that I need to manage what I’m held accountable for? I didn’t think so.

T.A. Rosolowski, Ph.D. Oh, really?

Cecil C. Brewer, RN, BSN, MS No. Because the—

T.A. Rosolowski, Ph.D. What were you lacking? What support were you lacking at the time?

Cecil C. Brewer, RN, BSN, MS The support I was lacking, probably more—if you give me appropriate staffing, I can accomplish anything, staffing. One of the things the institution was short on and that was—the institution had what they call a nursing flow pool. And the flow pool is a pool of nurses that are not assigned to a particular unit or clinic, and if there’s a number of call outs of a shortage of nurses on a particular unit, you called the pool, and the pool dispatches nurses either temporarily or for a set period of time to assist that area to—until they are able to get back to normal. That was for all the inpatient units. All the 24-hour-a-day units participated in that pool except the emergency center.

T.A. Rosolowski, Ph.D. Oh, gosh.

Cecil C. Brewer, RN, BSN, MS And that was very disheartening.

T.A. Rosolowski, Ph.D. Hmm. Why wasn’t it available to the emergency center?

Cecil C. Brewer, RN, BSN, MS Because we were not an inpatient unit. The pool was created for inpatient staffing not for outpatient. Because the emergency center was looked at as a hybrid. We’re outpatient, but we’re not outpatient. Why? Because we operate 24 hours a day, seven days a week, rain, sleet, or snow do this. We also were the front for the disasters—I forgot to tell you about that—for the emergency center. We were the disaster—we were the first responders. The emergency center, when I had—we were the first responders for internal disasters. We practiced internal disaster drills, and we participate in the NDMS system for Harris County, and that was one of my responsibilities was maintaining that.

T.A. Rosolowski, Ph.D. Why do you think the institution was not providing the s

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Chapter 12: Center Administrative Director: The Emergency Center (2002 – 2010)