Hospital officials: Oregon’s health care system is near a breaking point

According to Oregon health officials, COVID-19 hospitalizations in the state have increased nearly tenfold since early July. Hospital officials say that the system is near a breaking point: Elective surgeries have been postponed, some patients have been housed in hallways, and leaders in Tillamook County asked the state for a refrigerated morgue truck on Friday because they’d run out of places to store the bodies of people who’ve died.

“I would describe the situation as dire,” said Becky Hultberg, chair of the Oregon Association of Hospitals and Health Systems. There are currently nearly twice as many hospitalized patients in the state as there were at the worst stage of the pandemic last year.

In mid-August, Gov. Kate Brown dispatched National Guard troops to help hospitals in non-clinical positions. In addition, the state recently finalized a contract with a medical staffing company that will send up to 500 nurses and other health care staffers to Central and Southern Oregon.

“These staffing agencies are really going to help,” Hultberg said. But, she added, “We’re going to have to make some hard decisions about how to allocate those staff and where they go.”

Earlier this month, Brown mandated that all health care workers be fully vaccinated by whichever date came second: Oct. 18 or six weeks after full FDA approval of a COVID-19 vaccine. Officials from one of the larger hospital groups in the state, PeaceHealth, have said that if workers aren’t vaccinated by Tuesday, or don’t have a qualified exemption, they will be placed on unpaid administrative leave.

Hultberg said it’s possible that the state’s health worker vaccine mandate could lead to even more shortages in the workforce.

“Potentially we could lose some health care workers,” she said, “But, on the other hand, the risk of an unvaccinated workforce is so significant right now that we, as an association, had to make a hard choice in saying we do support these mandates because it’s the right thing to do for our community.”

This transcript was created by a computer and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB, I’m Dave Miller. We start this week with the situation in Oregon’s hospitals. According to health officials, COVID-19 hospitalizations in the state have increased nearly tenfold since early July. Hospital officials say that the system is near a breaking point. Elective surgeries have been postponed. Some patients have been housed in hallways. Leaders in Tillamook County asked the state for a refrigerated morgue truck on Friday because they had run out of places to store the bodies of people who have died. For more on what’s happening, we’re joined by Becky Hultberg. She is the CEO of the Oregon Association of Hospitals and Health Systems. Becky Hultberg, welcome to Think Out Loud.

Becky Hultberg: Thanks, and thanks so much for having me today.

Miller: Thanks for joining us. How would you describe the overall situation in Oregon hospitals right now?

Hultberg: I would describe the situation as dire. We are tracking several metrics that help us to understand the trajectory of this phase of the pandemic. One of the most important of course is hospitalizations. And as of this morning, we had 1164 COVID-positive patients in hospital beds.

That contrasts with the peak in November of 2020 of just under 600. So we’re about double the number of hospitalized patients that we had at the worst stage of the pandemic to date. When we look ahead at the forecast, we’re projected to peak in about a week in terms of hospitalizations. We expect that number to be over 1200, could be as high as 1400. It’s a lot of very sick people in our hospitals.

We’re kind of waiting to see if case counts flatten out. Once case counts flatten out, I think then we’ll see hospitalizations begin to flatten out and decline, but we’re not there yet. And so really, this is a day-to-day management exercise of trying to make sure that we have the right resources to the right hospitals so they can provide the best care to every patient that comes in their doors.

Miller: Can you give a sense for what you asked the governor to do, what you needed from the governor as the representative of the hospitals in the state, about three weeks ago?

Hultberg: Yeah, about three weeks ago, when it became apparent that this surge was not abating and in fact, would be the scenario that we feared in 2020, we approached the governor with a list of suggestions, more a list of requests to help our hospitals manage patients. And let me be really clear, this is not helping hospitals. This is helping Oregon patients in those hospitals. This is ultimately about patient care, about ensuring that patients in our hospitals get the best care so that they hopefully can survive their illness and be discharged. So really, this was about what do we need in order to help patients?

We needed three buckets of things. The first was regulatory flexibility. Loosening up restrictions to help give us the flexibility to get resources where they needed to go and to get professional staff licensed quickly.

The second was quite candidly just resources. It’s fairly easy to create space in a hospital. It’s really hard to create staff. And as we all know, staffing has been a challenge in so many industries. Healthcare is no exception, and it’s probably more severe in health care right now. So we’re kind of at the worst part of the pandemic in terms of our staffing levels. So one of our requests was around help to augment our staff.

And then the third is not as much a request, but just more of an ongoing process with OHA and the Governor’s office, and that is just close coordination. When a system as complicated as the health care system is in crisis like we are today, it requires coordination between hospitals and state government. It requires coordination with long-term care. It requires coordination with physicians. So we really needed to come together as a health care system to help manage this as a whole.

Miller: So let’s take some of these one by one. Looking at the people to come into hospitals to help out. There are a couple different versions of this that have happened, including 1500 or so National Guard troops being deployed to hospitals. What difference has that made?

Hultberg: The deployment of National Guard troops has made a significant difference for some of our hospitals, both large and small. We have National Guard troops in big hospitals, we have National Guard troops in critical access hospitals, serving really important functions. Our staffing shortage is not just in clinical personnel. Nurses, respiratory therapists, physicians. It’s also just people to do day-to-day jobs, like emergency department intake, or dietary staff, or environmental services. And so the National Guard staff that have been deployed are primarily doing those latter functions. They’re serving as runners in emergency departments. They are helping with intake. They are helping with the dietary functions. So they’ve been a really significant source of help for many hospitals across the state.

Miller: The state has also finalized a contract with a medical staffing company that’s going to send up to 500 healthcare providers. So not guardsmen who can be quickly trained up, but these are actually going to be healthcare providers, especially to central and southern Oregon. When is that going to happen? And can you give us a sense for the kinds of jobs that will be coming in?

Hultberg: We understand some of the staff are either on the ground now or will be this week. This help is imminent, and it’s absolutely critical because, as I said earlier, the National Guard staff are really providing a certain type of support, but it’s not in clinical positions. So these staffing agencies are providing trained staff that can help augment our clinical workforce. They’re providing nurses, they’re providing respiratory therapists, they’re providing nursing assistants. Those are really key positions right now. As we’ve seen in the media and really in many of the first-hand accounts of what life is like in the ICU, our healthcare workforce is strained. It is critical to be able to give some of those folks relief and to augment our workforce at a time when there is so much demand being put on it. So these staffing agencies are really gonna help.

I think the challenge is going to be the coordination effort of how do we deploy them to the most critical location? And then what are the triggers for us to move them? They’re not going to be enough. And so we’re going to have to make some hard decisions about how to allocate those staff and where they go. And we’re working on that right now.

Miller: Related to this is a request to the governor’s office that she changed staffing ratio requirements. Can you give us a sense for what the pre-emergency staffing ratios had to be, and how much flexibility you have now?

Hultberg: So there are two different staffing ratio issues. One is staffing ratios for hospitals. And while we didn’t really need the governor to take executive action to change that, we did need some assurance from our regulatory bodies, the Oregon Health Authority, that they kind of understood that during this period staffing ratios might flex. We’ve talked to some hospitals that are having staffing ratios of as many as 10 patients to one nurse, that is way above what is typically the accepted ratio. So on the hospital side it was really more around enforcement of the nurse staffing law. We didn’t need a particular action from her.

On the nursing home side, we did. And the reason for that is she had to take some action to change nursing home staffing ratios. And the reason that’s important is that today, we have over 400 patients in hospital beds who are medically cleared to be discharged, but there’s no safe place for them to go. And so one of the challenges of this pandemic has been how do we free up capacity in the post-acute care system so that we can get patients out of the hospital and thus make another bed available for a patient who needs it? So that temporary flexibility on nurse staffing was a result of that was a result of needing to try to create some temporary capacity so that the system as a whole can function and ensure that hospital patients can get a bed when they need one.

Miller: I want to turn to another issue here. Last year, the state eliminated a triage system it had developed that gave hospitals guidance for which patients could receive critical care during crises, like earthquakes or pandemics, and which ones might not because it just wasn’t enough care to go around. But so far, nothing has replaced those statewide-specific decision-making guidelines. So where does that leave us?

Hultberg: Back in, I think it was September of 2020 when the state had identified that the current guidelines were not appropriate and were in fact discriminatory and essentially publicly disavowed those guidelines, we pressed the state to come together with stakeholders quickly to create a new set of guidelines. Again, that was almost a year ago, and nothing has happened. And so a global pandemic is not the time to be without crisis care guidance. And unfortunately, that’s the position that we’re in.

Miller: I want to turn to vaccination rates among healthcare workers. They’re going to be fully required soon. The governor recently got rid of the opt-out for people who said they would submit to weekly testing. Officials from one of the larger hospital groups in the state, PeaceHealth, have said that if their workers don’t get COVID-19 fully vaccinated or give a qualified exemption by tomorrow, they’re going to be placed on unpaid administrative leave. According to KEZI in Eugene, that could mean more than 800 employees, just in this one health system that would be out of the active workforce. Other people have talked about a mass exodus of healthcare workers, because of the fact that many of these people simply will choose to not get vaccinated. What are hospitals doing right now to prepare for that possibility?

Hultberg: This is a really tough issue, as you know. I think one thing that we can look at is the past experience of hospitals that have employed vaccine mandates. And typically, they have not seen a significant number of employees exit. Now, the first mandates were early this summer and things may have changed. And of course, cultures are different, states are different, situations are different. So I’m not predicting that that’s what will happen here. But I think that we are in a situation where potentially we could lose some healthcare workers. But on the other hand, the risk of an unvaccinated workforce is so significant right now, that we as an association had to make a hard choice in saying we do support these mandates because it’s the right thing to do for our community.

So we’re working with our smaller hospitals which are the ones that are probably at the most risk about how can we support them? How can we help them to encourage their employees to get vaccinated? And in the event that a significant percentage of their employees choose not to, how can we support them? What can we do in order to help them to get through that? Those conversations are active, they are ongoing. There is no one tactic right now that’s going to help. But this was a really tough issue. And I think for the reason that you mentioned, we really have a collision of what’s in the public good and what’s the right thing to do from a public health perspective, and then this idea of individual rights and what people choose or choose not to do.

So as an association, we supported the mandate, we’re going to continue to do that. We’re also very sensitive to the issues around employment and people exiting the workforce, and we’re gonna do everything we can to support our hospitals.

Miller: What do you want to see from the public right now?

Hultberg: We’re all fatigued by the pandemic, by the last 18 months. I think people were so ready in July. It felt like five minutes where things were normal. We’re ready to be back to normal. But this is not over. This has become a marathon, and we still need to do our part to keep our neighbors and our friends and our families safe. And so just doing the smart things. Avoid really big gatherings, wear a mask, get vaccinated. We’re going to get through this. And hopefully the end, or at least the beginning of the end, comes sooner rather than later. For now, we need to do the things that we know will make a difference in altering the trajectory of the pandemic. And if we all do them together, we’ll get there.

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