Who gets to live? COVID pushing Kansas City area hospitals beyond limits, leaders say
With COVID-19 cases surging, hospitals in Kansas City and across the region are pushed beyond their limits like never before in the pandemic, which could lead to life-or-death decisions for all patients, even those who don’t have the virus, hospital leaders warned Wednesday.
They described gridlocked emergency rooms, a lack of hospital beds, staffing shortages as record numbers of employees are calling in sick with COVID, and patients dying in emergency rooms while waiting to be transferred to hospitals with available beds.
On Wednesday, for example, 740 staff members at The University of Kansas Health System were out sick out of more than 13,500.
The 18 chief medical officers (CMOs) and other leaders who spoke at the briefing see no immediate end in sight as hospitals brace for the additional stress of seasonal illnesses like influenza and winter-related injuries.
“We have had some conversations amongst the CMOs … how bad can it get? It can get bad enough that we may have to institute what’s referred to as crisis standards of care,” said Dr. Kim Megow, chief medical officer for HCA Midwest
“It is basically what the military does during wartime, which is deciding who gets care and who does not. Who gets a chance at living and who is left to die. And that is really dire, but I think it’s important to say that.
“That is how bad it could get if we are completely overwhelmed — and we’re at that point already — and we suddenly have an onslaught of additional patients. There have to be tough decisions made, and no one on this call wants to be faced with making those decisions.”
That is a fear of Dr. Steve Stites, chief medical officer for the KU system, which sponsored the briefing. “Crisis standards of care. Triage. Those are the things we do and then we have to let some people die in order that others may have a chance to live.”
Stites and his colleagues described what he called “hands-down the toughest surge the medical community has had to face since the pandemic began in 2020.”
“People like to think that, well, hospitalizations aren’t bad because omicron isn’t so bad,” said Stites. “You have to think again. There’s still a lot of delta out there. It may be 50-50, it’s hard to know. We know that omicron is coming on fast, but when it comes to hospitalizations, still driven by a lot of delta.
“We are now at a record high number of hospitalizations. And that’s a problem for us because a lot of our staff have COVID-19 as well.”
Hospital leaders asked the public to help bring those numbers down by masking up, staying home when sick and avoiding large indoor crowds.
Here’s what some of them were dealing with as of Wednesday morning:
▪ 48 active COVID cases at AdventHealth Shawnee Mission, compared to 12 in November. Of those, 70% are unvaccinated.
▪ 30 COVID patients at Children’s Mercy, a new high for the hospital. “We peaked around 22. We’ve never been above 30. We’ve never been above 25 until yesterday, so we are increasing at a rapid pace. A week ago we were at 15, so we’ve doubled in the last week,” said Dr. Jennifer Watts, chief emergency management medical officer.
▪ 98 COVID patients at University Health hospitals, an all-time high representing about 25% of the system’s licensed bed capacity.
Postponing surgeries
Some hospitals are delaying surgeries because of staffing shortages.
Stites said the KU system has postponed 128 this week — surgeries such as hip replacements, gastrointestinal procedures and breast reconstruction — “and had to close 20% of our ambulatory practice in order to divert people back to inpatient so we can continue to take care of the high number of COVID patients, and then everyone else,” he said.
“These are … not truly elective cases. They are cases that have to have inpatient stays, and that’s one of the few levers we have left to pull.”
HCA is also postponing procedures “because we are not only facing the highest number of COVID patients we have ever seen, but that is in the face of some of the most extreme staffing shortages we’ve ever seen as well,” said Megow.
“We’ve had at least 190 call-outs today. That number changes hourly, so that’s a moving target and difficult to report.”
Long ER waits
Anyone who has been in a local emergency room lately has seen that they are full and wait times are long, a situation that affects everyone, not just people sick with COVID.
HCA emergency rooms are at 100% capacity. The current average wait time in AdventHealth’s ER is three hours, said chief medical officer Dr. Lisa Hayes.
On Wednesday, there were eight patients in the ER at University Health, formerly Truman Medical Center, waiting for a bed; 21 at AdventHealth.
West of Kansas City at Salina Regional Health Center, 15 emergency room patients — eight with COVID — were “waiting for a bed upstairs” on Wednesday, said chief medical officer Dr. Robert Freelove.
Hayes said “it’s just devastating” when her hospital can’t accept dozens of patients from smaller hospitals because her facility is full, too. “That breaks my heart that those doctors have to watch those patients suffer,” she said.
Yes, people are still dying
People continue to die every day of COVID. At University Health, 18 patients died of COVID in December, the second-highest monthly total of the pandemic.
Olathe Health reported 21 COVID-related deaths in December alone.
KU lost a COVID patient on Tuesday, one of about 690 COVID deaths since the pandemic began. “So anybody who thinks you’re not going to die of COVID-19 now because it’s omicron, that’s just wrong,” said Stites. “We still are seeing a lot of deaths.”
The Salina hospital had 15 COVID deaths in December, one nearly every other day, said Freelove. It was one of the hospital’s worst months for COVID fatalities, he said.
At Liberty Hospital, “The worst part is in the last week we have lost eight patients,” one of the highest, one-week death tolls of the pandemic, said Dr. Raghu Adiga, chief medical officer. “People think this is not serious enough. We are still seeing deaths.”
This story was originally published January 5, 2022 at 12:00 PM.
.jpg)