Utility Shutoffs Can Be Deadly During Extreme Weather Events

Anna Mae* faced an impossible choice: either pay her electric bill or pay for her medication. An elderly woman with chronic obstructive pulmonary disease (COPD) and asthma, she came to me because she couldn’t afford to refill her inhaler. Miami was in the grip of a miserable heat wave, and Anna Mae had been running her air conditioning unit night and day. Now the electric bill was due, and she was in my office looking for help.

For many clinicians, Anna Mae’s story is sadly familiar. Many people with fixed or low incomes are still feeling the impacts of post-pandemic inflation and cannot afford to cover their expenses, including energy costs. As temperatures rise, this budget gap is becoming a matter of life and death. Losing electricity during an extreme weather event, including extreme heat, exacerbates the threat to life. We need to consider a more overarching solution to protect patients.

Extreme heat is the deadliest effect of climate change, killing more Americans than hurricanes, floods, and tornadoes combined. Worldwide, heat is responsible for nearly a half million fatalities each year. In addition to causing heat exhaustion and heatstroke, extreme heat can worsen health risks from cardiovascular, mental health, respiratory, and diabetes-related conditions.

And it’s getting worse. The summer of 2024 was the hottest in recorded history, in what is likely to be the hottest year yet. This July saw eight of the 10 hottest days on record; the other two were in 2023.

Here in Miami, heat season now runs from May 1 through October 31. The city sees 51 more days where temperatures top 90 degrees than it did 50 years ago. I fear for my patients, like Anna Mae, who simply cannot afford the air conditioning they need to stay alive in a hotter world.

But there is hope. Earlier this year, a bill passed in Virginia (with bipartisan support) that prevents utility companies from shutting off electricity when temperatures are at or above 92°F and at or below 32°F — protecting community members during the hottest and coldest days of the year. In the event of a particularly cold winter or intense storm, the same logic applies. For example, losing power during a cold snap places families at risk of hypothermia. To prevent that, many turn to gas stoves or electric space heaters for emergency heat — but those devices can emit dangerous air pollution or spark a house fire. Continued access to the heat provided by utility companies is essential.

Here in South Florida, a community group called Catalyst Miami is working with partners across the state to promote a similar measure that would protect residents during extreme weather events. Arizona also prohibits shutoffs during the hottest months.

These measures are urgently needed because existing protections aren’t working. The federal Low Income Home Energy Assistance Program provides assistance with energy costs; however, its funding is limited and often runs out in the early part of heat season.

Patients who are very ill, or who depend on medical equipment (like ventilators), can ask their doctor to complete a Serious Medical Condition Certification Form to prevent utility shutoffs, but here too, protection is inadequate. A nationwide doctor shortage means that even eligible patients would struggle to see a doctor within the limited window before an extreme weather event hits.

Moreover, a medical condition is deemed “serious” only if the patient is not stable. That wouldn’t have helped Anna Mae, who was stable while using her inhaler but risked becoming destabilized — and possibly hospitalized — if she lost access to her medicine. Given the enormous personal, social, and financial costs of hospitalization, it’s clearly good preventative medicine to make sure that no one has their utilities cut off during a heat wave or other disaster.

As clinicians, we can try to protect our patients by identifying those in need, using tools like the CDC’s CHILL’D OUT vulnerability questionnaire. We can help patients develop their own heat action plans, and deploy existing protections at the state and federal level on their behalf.

We can also launch or get involved with existing local outreach efforts. My organization, Florida Clinicians for Climate Action, works with our county’s heat task force to inform, prepare, and protect residents from heat-related illness. To that end, we educate healthcare practitioners and reach out to vulnerable populations. As a result of this team effort, Miami-Dade County had a relatively low rate of heat-related emergency department visits in 2023 — despite being in the hottest part of the state.

And finally, we can advocate for comprehensive solutions, like measures to prevent utility shutoffs during climate emergencies. Healthcare workers remain among the most trusted professionals in the U.S. today. We can earn and leverage that trust by keeping patients like Anna Mae safe in a dangerously hot world.

*Patient’s name has been changed.

Cheryl L. Holder, MD, is an internist and retired associate professor and associate dean of Florida International University’s Herbert Wertheim College of Medicine. Holder co-founded Florida Clinicians for Climate Action in 2018 and now serves as its executive director. She is co-chair of the Miami-Dade Heat Health Task Force and member of the National Academy of Medicine’s Climate Collaborative.

The views of the author do not necessarily reflect those of the Medical Society Consortium on Climate and Health or its members.

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