The pool of water didn't look too deep, so Steven and Christy Parker drove through, heading to a medical appointment they couldn't miss. But then, water started to rush in.
Passing cars sent a wave into the Parkers' vehicle as heavy rains raked downtown Charleston Friday. In the passenger seat, Christy Parker felt the grip of a panic attack. So, just steps away from the hospital, the couple called 911. They waded out into the knee-high water, which smelled of sewage. Then, they watched from a sidewalk near Storm Eye Institute as their silver Hyundai filled up.
This spot on the Medical University of South Carolina campus is known to flood, as it did Friday when a pounding afternoon rainstorm snarled traffic and drowned vehicles like the Parkers'.
As climate change brings ever-more frequent floods to the low-set Medical Mile, some wonder whether the region's premier medical institutions should be there at all. The rainfalls and hurricane surges that swamp the district are, already, a drain: persistent flooding has sapped an estimated $45 million from the institutions in the past five years, they estimate.
Climate change's urgency hadn't made its way into board room conversations in Charleston by the time the Medical University of South Carolina committed to a 20-year expansion plan in the early 2000s. The hospital system banked on flooding issues being fixed over time by the city of Charleston. But since then, the flooding has continued. During a tropical storm in 2017, personnel criss-crossed the campus in boats. MUSC even bought a military surplus high-water vehicle to make sure staff can move between hospitals.
Billions in investments made over more than 200 years have sealed the three hospitals' futures between Rutledge Avenue and Lockwood Drive, a low-lying basin on the western edge of the Charleston Peninsula.
MUSC and Roper St. Francis have together funneled at least $870 million into major projects on the campus since 2000, according to newspaper archives.
Some of that spending has been financed with debt that will mature in a time when Charleston's flooding problems will get more severe and frequent, scientists predict.
Flooding is already a slog for the hospital workers who walk, like Traci Davis, a technician at the Storm Eye Institute, which sits on one of the quickest-to-flood parts of MUSC's campus. Davis is constantly attuned to the weather, and keeps a change of clothes at her office in case she has to wade through floodwaters in shorts and flip flops.
Meanwhile, patients from all over the state continue to come to the medical campus for some of the most complex medical care available in South Carolina.
Centuries of building
Charleston's Medical District was built on some of the most vulnerable land in the city. It’s a fact that becomes clear standing atop Roper Hospital’s helipad. In extreme cases, when waters rise high enough, helicopters may be the only way for new patients to come to the hospital.
From that vantage, the broad opening of the Charleston Harbor sprawls into the horizon; only a retaining lake and low boulevard stand between open water and the front steps of the medical district.
But the concentration of complex care in this location is the result of centuries worth of decision-making and inertia.
Medicine has had a home in downtown Charleston since 1736, when the then-province of South Carolina funded a “work house and hospital.” In 1824, the Medical College of South Carolina became the first medical school in the Deep South.
Students have always needed a place to practice, and so the school has been tied to the nearby hospitals. Work on Roper Hospital completed in 1852, right next door to the medical college.
The Ralph H. Johnson Veterans Affairs Medical Center opened in 1966, later named for a Charleston-born Marine who threw himself on a grenade to save his comrades in Vietnam. It became the last of the three institutions to join the 80-acre campus.
The decades that followed have been a story of one construction project after another. In the mid-2000s, development began at a record clip, and in recent years, hospitals have moved to build new facilities inland and away from rising waters. Still, investments into the peninsula continue.
Today, the medical district is the only place South Carolinians can receive a new heart or lung in-state. It is also home to one of the South's top-rated hospitals for veterans, a brand-new children's hospital, four emergency rooms and a heart and vascular center.
But the ground under these towering institutions is problematic. It’s one of many areas on the peninsula that was artificially filled as the city tried, over the centuries, to claim land that was once part of the Ashley River.
When MUSC built its Ashley River Tower on Courtenay Drive, workers had to sink pilings low enough that they would reach the Charleston marl. The stiff, watertight layer of clay is the closest thing the city has to bedrock.
Engineers took core samples to estimate how deep the pilings would have to go. But, in a few cases, former MUSC Health president Dr. Ray Greenberg said, the estimations were off. Steel supports more than 100 feet long disappeared entirely underground.
Preparing for storms
One wrong turn, and Darci Kenagy’s minivan was floating.
Loaded with Kenagy, her husband and six children, the Toyota Sienna had made the two-hour trip from the family’s rural Midlands home to medical appointments in Charleston many times.
On one of those trips, the Kenagys tried to push their van through flooded Line Street after an SUV in front of them made a crossing through murky waters.
What happened next left them in a dangerous situation that’s unfolded time and time again for travelers to Charleston’s medical district.
For the Kenagys, three of the six children they had by that 2012 trip to Charleston were born with cataracts. Eventually, all of their children were being seen by specialists at Storm Eye. No ophthalmologist in the Midlands had the same expertise in pediatric cataracts as the doctors here, Darci Kenagy said.
The family was well-versed in Charleston's flood-prone streets, but they still ended up floating on Line Street. Water reached up to their headlights, air burbled out of the back exhaust pipe, and the Sienna started drifting toward a line of parallel-parked cars.
In a lucky turn, two passersby pushed the van to high ground. The Kenagys then spent hours waiting for a tow in a soul food restaurant; they were picked up by family, instead, and never made the appointment.
“It was a huge impression on my children,” Kenagy said. “They would draw pictures of the van in water for months afterward.”
Flash flooding like the Kenagys encountered strikes suddenly, and can put downtown Charleston at a standstill for hours.
But the city's hospitals also have to deal with the threat of hurricanes, which push a wall of ocean water onto land wherever they strike.
Five tropical cyclones have affected Charleston in the past five years, an onslaught that has helped to reinforce the dangers posed by the rising seas and stronger rains driven by climate change. The city hasn't had a true test of its defenses since the last major hurricane hit — Category 4 Hurricane Hugo in 1989.
After Hugo pushed water into Roper Hospital’s energy plant, the hospital spent millions to protect its infrastructure. In the basement facility, boilers thrum and chillers rattle. The hospital stores 45,000 gallons of fuel here.
“This is the heartbeat of the building,” Mike Gunter, engineering coordinator at Roper St. Francis, said. “Everything comes from here.”
Gunter has been keeping watch over it for three decades. He started the job just two months before Hugo. Then, he said, engineers had to shut off the generator that fed the intensive care unit. All night long, Gunter sat in the stairwell and ran portable generators with extension cords to the ICU.
When the floods receded, flounder, crabs and mud covered the concrete floor. The storm revealed how susceptible the hospital’s critical infrastructure is to rising water.
In 2001, the hospital started work to lift its generators to the third level.
The work has continued. One 15,000-gallon drum is now anchored to Roper’s concrete floor, so it won’t float away. Another is in a room entirely sealed, except a hatch at the top.
Roper is also installing a new generator, a step that will help ensure air conditioning keeps running if the normal power supply cuts out. All-told, the health system has spent about $9 million on flood mitigation, with the aid of grants from the Federal Emergency Management Agency.
The VA Medical Center, on a relatively high piece of ground above Bee Street, has never taken water onto its first floor. Still, managers there have taken their own precautions. They're moving generators up to the second floor, and plan to move all clinical services off the first floor.
Even when hospital leaders started discussing the future of the downtown Medical District years ago, flooding was a known problem.
Medical University Hospital and MUSC's College of Pharmacy were swamped in Hugo. Hollings Cancer Center flooded during Tropical Storm Irma in 2017. But, for the most part, flooding impacts mobility in and around the area, an issue for decades when a hard rain falls. On Friday afternoon, it took 20 minutes to drive two blocks down Bee Street, a drive that connects all three hospitals. A BMW stalled on Jonathan Lucas Street, within sight of Roper Hospital's emergency entrance.
The problems are so persistent that two or three times a year, ambulances with Charleston County EMS can’t reach the downtown hospitals and are diverted elsewhere in the region, a county spokesman said.
The area, Charleston’s stormwater chief Matt Fountain said, is “like a big bowl, and the water just doesn’t get out.”
The problem is compounded by climate change. A warmer atmosphere can produce more rain, and higher tides driven by sea level rise make it harder for that water to drain. The city logged a record-smashing 89 tidal events in 2019 alone, though not every one was enough to cause serious flooding.
Fran Clasby, who worked in physical therapy before retiring last November, was one of many workers who kept extra clothes on hand in case he had to cycle to work through standing water.
"It’s actually less scary than driving through it, because I know my bike's not going to stall," he said.
But workers moving back and forth have to contend with drivers, whether or not they’re in a car. Kim VanHorn, a nurse at Roper Hospital, was walking to her house on Fishburne Street in May when a truck surging down the street to avoid deeper waters almost sideswiped her.
"When I'm in my scrubs and I almost get hit by a truck going through floodwater, during a time that the whole nation is going through a (pandemic) together, it feels pretty crummy," she said.
Even Arlene Watrobski, a nurse and 20-year resident of Charleston experienced in driving around flooding, is challenged by the watery maze.
During recent rains in late May, Watrobski found the normal route didn’t work on the way home from Roper Hospital — she had to call her son-in-law for help, and a trip that usually took 10 minutes expanded to 40.
In the same late May event, Davis, the technician at Storm Eye, said she heard from patients for the first time that they couldn’t find a way onto the Charleston Peninsula. A family from Florence, two hours away, didn’t even bother to wait for the water to go down, she said; when police turned them away, they simply went back home.
VanHorn said Charleston needs to create a suggested driving route for medical workers and their patients.
"We’ve got people coming into Charleston using apps like the Waze app to try and get there. The city fails to do what I deem kind of the easiest thing to do," make a map of high ground, she said.
Doing that is the goal of Charleston Police Department Capt. Dustin Thompson, who took over traffic control earlier this year. He hopes to have a map for the public by the end of 2020.
Police are already starting to leave barricades at intersections that go under quickly, and encouraging the people who live nearby to deploy them when flooding starts.
Thompson has asked for detour signs that could be placed around the city to send unfamiliar drivers to high ground.
In recent years, Charleston’s hospitals have poured money into higher ground in the tri-county area. MUSC re-purposed a J.C. Penney at the Citadel Mall to give patients an accessible way to see their doctors. Roper St. Francis opened its fourth hospital in fast-growing Berkeley County. The VA broke ground on an outpatient center in North Charleston, citing flooding issues as a top motivation.
No institution has invested more into its downtown roots than MUSC. The state-backed health system estimates its economic impact on the Charleston area at $3.8 billion.
Thousands of people each day driving across the Ashley River see the sunlight glinting off the rounded glass faces of MUSC’s two newest buildings, a modern facade set against a backdrop of steeples.
Together, the two buildings are a $664 million investment, one MUSC committed to years ago.
Greenberg, president of MUSC Health from 2000 to 2013, said leaders started considering the hospital's future on the peninsula in the early 2000s. The health system needed a plan to replace its main hospital, which was so old that it was becoming hard to fit modern equipment inside, Greenberg said. They also wanted to expand specialties like cardiac and children's care.
Leaders debated moving away from flooding and traffic, potentially to North Charleston.
Ultimately, moving and splitting the campus apart was considered “too divisive” for faculty leaders, he said. And back then, while flooding was common, leaders didn’t account for climate change making the problems more severe.
There was a hope that projects planned by the City of Charleston would help alleviate the longtime problem. Then-Mayor Joe Riley, a friend of Greenberg's, was also key in swaying the hospital to stay, Greenberg said.
Riley was a tireless advocate for Charleston’s peninsula, championing projects there like the S.C. Aquarium and reinvesting tax revenues in the historic core of the city throughout his decades-long tenure.
But just before MUSC was considering its own commitment to the area, a different school had recently decided to abandon its downtown campus: Johnson & Wales University, which trained hospitality workers, announced in 2002 it would leave the Charleston peninsula for Charlotte.
For MUSC, Riley said in a June interview with The Post and Courier, "the dispersal of parts of those institutions takes something away, tangible and intangible, from a great university."
Looking back, the former mayor said he believed hospitals made the right choice by staying.
MUSC's leaders committed to a 20-year roadmap that sealed the health system’s future on the peninsula. Ashley River Tower opened in 2008; the Shawn Jenkins Children’s Hospital opened earlier this year.
The health system built both above the floodplain. It installed flood doors and pumps.
In May, MUSC reported it owes $530.6 million for the two projects, which it doesn’t expect to pay off for decades.
By 2045, the Charleston peninsula is expected to experience tidal flooding as frequently as every other day, according to a national assessment of climate change impacts conducted in 2018.
In the coming years, a third hospital will be joining the view as MUSC acts on the final phase of its plan to replace Medical University Hospital somewhere west of Courtenay Drive.
“To leave the peninsula now would take a level of investment that would require increases in state and federal funding that are not realistic or likely to fully address the need to move an entire campus,” MUSC said in a statement.
The campus of about 100 buildings, including its hospitals and six colleges, would cost “well over $3.5 billion” to replace, according to the health system. Roughly 17,000 people work for the hospital system, and about 3,700 students pursue a degree there each year.
MUSC’s decisions also affect the VA Medical Center, because the two institutions are closely intertwined. Some specialists and researchers work for both health care providers, said Rick Mahon, the local VA's chief of strategic planning and analysis, said. Students rotate across campuses.
Attracting the best talent will decide a hospital’s success. But by law, the VA can’t be a pay leader. So, with high salaries off the table, the proximity to an academic medical center is a key selling point.
The VA needs to move in tandem with MUSC, Mahon said.
“Both of us are committed to being on the peninsula,” he said.
Resolved not to move, Charleston’s hospitals are asking for money to help them stay, and stay dry.
Several projects are on the table, and they go beyond lifting generators or moving patients to higher floors.
At the top of the list is a shaft in the heart of the MUSC campus that would connect to massive drainage tunnels the city of Charleston has already carved to the north.
City officials and hospital officials were hoping, earlier this year, that the state might help cover the $10 million cost of the linkage in this year’s budget by directing the amount to MUSC.
Time is of the essence, they argued. They want to dig the connection before the main tunnels under the Septima P. Clark Parkway, a key thoroughfare known as the Crosstown, open in 2022.
“If construction can start in the fall, it will be just in time to link up with the main project,” Frazier said.
The item was nowhere to be found in the state spending plan that passed the House in mid-March, just before the pandemic halted the session and made that budget proposal moot. When legislators returned to pass a new budget in September, it wasn't included either. So the city is now pursuing federal funds.
Now, Frazier said, the city may add a watertight door to its tunnels, so a new connection can be hooked up after they’re full of stormwater. But that would add a new cost to the original tunnel project, already tens of millions over budget.
There are other projects that could also help: pumps in various locations could speed drainage to the Ashley River, and a greenway that could one day include underground cisterns to hold rainwater.
In the future, multiple buildings across the district could also be connected by skybridges.
MUSC is on the hunt for the cash needed to start work on those improvements. The coronavirus pandemic could open up new opportunities to apply for special funding, said Lisa Montgomery, executive vice president for finance and operations at MUSC.
But, of the five projects the Charleston Medical District association wanted to pursue in 2020, construction hasn't begun on one.