Exterior damage from a tornado at the Behavioral Health Center in Sioux Falls

Photo from the City of Sioux Falls

In the aftermath of a severe and destructive storm, young physicians in the school of medicine's psychiatric residency responded to an urgent need to provide care for displaced patients.

A thunderstorm system emanating from the central part of South Dakota reached Sioux Falls earlier in the evening of Sept. 10, but the fiercest aspects of this weather erupted closer to midnight. Rainfall came in dense downpours. Lightning sizzled and thunder boomed. Straight-line winds ranging from 80 to 100 MPH accompanied the storm as it lashed and battered Sioux Falls. Even more destructive were the three confirmed EF-2 tornadoes that briefly touched down within the city.

This particular cluster of storm cells was what meteorologists call “a deep convection,” meaning they extended high into the atmosphere. In this case, they rose up to about 50,000 feet. Lunging suddenly downward through the lowest levels of the storm system came powerful, swirling funnels that zapped buildings and trees before dissipating or quickly withdrawing upward into the dark, swirling sky. These weren’t the type of long-track twisters that churned across the land. Their lifespans were shorter, occupying only a momentary burst of time required to jab at the earth.

Jennifer Keating, M.D.
Dr. Jennifer Keating

Dr. Jennifer Keating, a second-year resident in the USD Sanford School of Medicine psychiatry program, had gone home earlier in the day after finishing her shift working with younger patients at Avera’s Behavioral Health Center, a brick and glass building connected to the Avera Heart Hospital in southern Sioux Falls. “I was on-call that evening,” she remembered. When her phone rang about midnight she learned the building she’d left only hours earlier had just been struck by a tornado. More than 100 mental health patients from the facility’s three adult units, its adolescent unit and the children’s unit (where Keating worked) had been hurriedly moved from residential rooms in the upper floors and ground level of the facility to storm shelters in the minutes before the funnel struck.

Keating returned to the facility and quickly discovered that storm damage was severe. A large section of the building had been torn open, and wind and rain had swept inside. She reached the scene after sending a mass text to the other 26 residents and three fellows, requesting their assistance in this unusual crisis and tracking responses to her request.

“When I arrived, I discovered that staff had moved patients from immediate danger, but conditions remained challenging,” explained Keating. “Several areas of the building had incurred water and wind damage, including areas where patients had been moved. At that point we didn’t know if the building was safe.”

Keating and other residents and staff began assessing the situation, examining charts and medication needs for patients, and trying to maintain calm and order. “There was lots to do,” recalled Keating, “including keeping everyone protected from the weather.”

Courtnee Heduk, M.D.
Dr. Courtnee Heyduk

Dr. Courtnee Heyduk, a second-year resident, was sleeping at her home in Sioux Falls when the text message from Keating awakened her. “I immediately got up and drove to Behavioral Health,” she said.

One of the first residents to arrive, Heyduk noticed that Avera CEO Bob Sutton and Thomas Ottenn, Avera’s vice president of Behavioral Health, were already there. She was shocked to discover the building where she worked was in complete disarray. “Inside,” she noted, “broken glass and water were everywhere.”

Heyduk found the patients and staff she worked with; they were hunkered down in a hallway. “I’d worked in Unit B, and I knew the conditions of the patients in that unit,” she explained, adding that Unit A was where adult patients experiencing the most acute conditions were housed. “Units B and C,” added Heyduk, “has mostly patients with depression and anxiety, though there are other conditions there.” Two other units, one for children and the other for adolescents, complete the facility. “We set up the younger patients in a separate area,” reported Heyduk.

Keating and Heyduk were surprised and relieved that them patients were orderly and calm, despite the disturbances and distractions. “You wouldn’t have known they were patients in a psychiatric setting,” said Heyduk. “Even the younger patients were well-behaved. There was no inappropriate behavior.”

At 3 a.m., Heyduk discharged a patient who was scheduled to be discharged later that day. “We sped up the process because it was appropriate and necessary to do that.” She also called the Avera pharmacy to warn that medication schedules would be complicated by the storm.

Interior damage to the Behavioral Health Center
It is expected that repairs to the interior and exterior of the Behavioral Health Center will be completed by the summer of 2020.

Other residents made coffee and distributed food and beverages to staff and patients. The supportive teamwork shown by all during such a demanding time was impressive.

Thomas Otten applauded the work of the residents. “The residents were intimately involved in our response,” said Otten. “They helped triage patients, and they helped our staff keep order and manage calmness. Our staff and the residents did an incredible job that night.”

Dr. Tim Soundy heads the medical school’s Department of Psychiatry, and his office in Avera’s Behavioral Health complex was destroyed by the tornado. “Our residents stepped up and did a terrific job,” said Soundy. “The event turned out to be a good bonding experience for the residents.”

Dr. Shawn Van Gerpen is a child and adolescent psychiatrist who oversees the psychiatry residency program for the medical school. As his charges dealt with different patients on the morning of Sept. 11, he began fielding questions about the future of the residency. “We initially worried we might lose our residency because of the damage to the facility,” Heyduk acknowledged. But Van Gerpen assured the residents their program would continue without any interruptions. Later that morning he convened a meeting among the residents to formally express that position. Simultaneously, plans were made to move some of the patients to other Avera facilities, and some would be moved to the Human Services Center in Yankton, South Dakota, 80 miles distant.

On the afternoon of Sept. 11, Behavioral Health staff and several residents, including Heyduk, traveled to Yankton to set up a new patient care facility. Avera contributed the necessary supplies to transform part of a state-owned building that had been vacant for about two years into functioning units for psychiatric patients. Later that same evening – and this is testimony to the relentless work and dedication of staff and residents – the first patients arrived in Yankton. “Almost unbelievably,” exclaimed Heyduk, “we set up a hospital in less than 24 hours.”

Heyduk was one of the residents who then volunteered to commute to Yankton from Sioux Falls to provide care for the displaced patients while repairs were pursued at Behavioral Health.

Exterior damage from a tornado to the Behavioral Health Center in Sioux Falls
Eleven people suffered injuries because of the tornado strike. One person had a broken leg, and there were minor concussions and small cuts and lacerations were also reported and treated. Damage to the facility was estimated at $10 million.

“I commuted daily to Yankton for about six weeks,” she said. Thirty adult patients from Sioux Falls had been transferred to the new, temporary facility, including 15 from Unit A and 15 from Unit C. Those patients remain in Yankton, and it is expected that they will be at the temporary facility for up to nine months. A 20-person adolescent unit was also moved to Yankton.

Lessons were learned from the storm, explained Van Gerpen. “The Sept. 10 event got us thinking about the type of training we must undertake to prepare our residents for disaster response. Our job is to prepare physicians, and that must be a part of that,” said Van Gerpen. “Keating initiated the response of our residents that night. We didn’t have a protocol in place. The residents came to help on their own. It was voluntary. I learned a lot about our residents. They were impressive and did a terrific job. They showed great character in how they responded.”

Memories of the storm and its impact remain vivid for both Keating and Heyduk. “It was certainly an experience that was out of the norm,” declared Keating. “But the residents provided excellent patient care, and we came together seamlessly to do the work that we have been called to do.”

“In some ways I’m still decompressing,” admitted Heyduk during an interview nearly two months after the tornado ravaged Avera’s behavior health hospital. “I benefited from the experience, though. I’m glad I was a part of responding to the disaster. Patient care didn’t suffer, and I learned some things about myself, about others and about health care that I would not have ordinarily learned.”


Although this article highlights the involvement of two psychiatry residents, a total of eight residents as well as staff and attending physicians contributed to patient care at Avera Behavioral Health in the hours following the Sept. 10 storm. This group of responders was able to manage the situation, and other psychiatry residents were told to remain in their homes because the situation was under control and because travel conditions in the city of Sioux Falls were problematic, even dangerous, due to debris on the streets and downed power lines.