Overwhelmed by COVID-19 patients pouring into medical facilities, hospital leaders urged California Gov. Gavin Newsom to temporarily suspend some regulatory requirements so that doctors and nurses “can focus on patient care and not on paperwork.”
“It is challenging when we are in the circumstance that we are in, especially in Southern California, in the San Joaquin Valley, where we have zero ICU capacity left,” said Carmela Coyle, president and chief executive officer of the California Hospital Association, in a teleconference Friday with news reporters. “We are creating surge capacity within those hospitals taking care of those who are most acutely ill, and yet we are still having to deal with day-to-day regulations that we might deal with under normal circumstances”
The hospital association represents dozens of health systems and single-site hospitals, large and small, around the state. Not every community is experiencing the shortage of hospital beds, Coyle said, so some state residents are oblivious to the fact that 40,000 Californians are becoming COVID-positive each day.
“We’ve got 23,000 in California’s hospitals today with COVID,” she said, “and we are anticipating another 15,000 individuals between now and the 18th of January needing in-patient hospital care. This is a situation that is tough. It is tight. It is tense.”
The Bay Area is now at 3% ICU availability, the Southern California and San Joaquin Valley regions are at 0% availability. The Greater Sacramento region is at 6.4% and Northern California at 27.5%.
Perhaps a better way for people to understand the impact, she said, is for them to understand just how many of the hospital patients in the hardest-hit counties have been diagnosed with the respiratory illness caused by the new coronavirus.
In Imperial County, on the state’s southern border, she said, two-thirds of hospital patients are being treated for the disease; in Santa Barbara and Riverside counties, 44%; in Los Angeles, 37%; in Fresno County, 36%; and in San Joaquin County, 29%.
There have been instances, she said, where all hospitals in Los Angeles County have put out orders to divert patients to other hospitals and so paramedics have had to tend to patients in ambulance bays until room can be made for them in the emergency rooms.
‘Watching that tsunami come at us’
These are unconventional times, Coyle said, and hospital leaders are urging the governor to acknowledge that they are in a crisis mode and once again defer regulatory requirements as his administration did earlier in the pandemic. Among the rules they are seeking suspended are that that restrict what can and can’t be built or moved or placed in a room, she said, and rules about employees and how things need to flow.
“The moment that we find ourselves in now is standing on that beach, watching that tsunami come at us,” Coyle said. “We have more people than we will be able to care for under normal circumstances, but if we don’t flex some of these requirements, it means that people will not get the care they need and worse, people may die.”
Suspension of some hospital rules have not gone without controversy. Newsom raised the ire of nurses by suspending nurse-patient staffing ratios amid the surge of COVID-19 patients, allowing patient loads for medical-surgical nurses to increase to seven from five, for intensive care unit nurses to be assigned three patients rather than two and for emergency room and telemetry nurses to get six patients rather than four.
Repeat of past missteps?
In an op-ed published Jan. 8 by The Sacramento Bee, California Nurses Association President Sandy Reding decried the suspension, noting that before the ratios were implemented, some patients in hospital beds had called 911 because of the delays they faced in care.
“Two decades later, the memory of those days seems to have vanished in Sacramento, even as nurses are working exhausted, for multiple extra shifts, struggling to keep up with the flood of gravely ill patients overwhelming hospitals in the midst of this deadly pandemic,” Reding wrote. “Incredibly, state regulators have handed hospitals blanket permission to make conditions worse, and more dangerous, in California hospitals.”
While Coyle holds up the dangers of Californians being unable to find a hospital bed, Reding and other registered nurses around the state have taken to radio and social media to warn of the risks of having patients who can’t get the care they need in hospitals.
Coyle said critical care nurses are in short supply nationwide because COVID-19 cases are rising dramatically around the country. Hospital leaders are hoping to work with the Newsom Administration to allow nurses to work in teams.
“It’s about maximizing space, maximizing staff resources, beginning to cross-train and provide nursing care in different ways,” she said. “Here’s another place where we need the help and need to partner with this administration to allow nurses to work in teams.
“If we don’t have enough nurses for the intensive care unit, as an example, how can we take one of those critical care nurses and partner him or her with other nurses throughout the hospital, where they’re all practicing at their level but working as a team, and will allow us to care for more Californians.”
On Friday, California recorded more than 600 daily deaths from COVID-19 for the first time, and has recorded more than 500 deaths in a single day four times since Dec. 31.
The state now has a seven-day average of 411 new deaths and 42,340 cases. During a summer surge from June through August, California peaked at 215 deaths and 16,521 new cases in a single day, according to The Mercury News in San Jose.
The U.S. also set a grim record on Thursday, topping 4,000 coronavirus deaths in a single day for the first time.
Overall, the pandemic has killed more than 365,000 Americans and caused nearly 22 million confirmed infections. More than 132,000 people nationwide are hospitalized with COVID-19.