The Senate Committee on Health & Human Services met on August 10 to hear invited testimony from the Texas Department of Emergency Management, the Department of State Health Services, hospital systems around the state, and South Texas RAC on COVID response and hospital capacity.
This report is intended to give you an overview and highlight of the discussions on the various topics taken up. It is not a verbatim transcript of the discussions but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.
Opening Comments
- Kolkhorst – Gov took a series of actions yesterday related to todayâs discussion just after 6 pm, hoping to talk about this
- Will not be taking public testimony
Chief Nim Kidd, Texas Division of Emergency
- Provides overview of national response framework, history of COVID response; currently have an abundance of PPE, vaccine, mobile infusion teams, etc.
- Has been reported that this is a âpandemic of the unvaccinatedâ and will likely continue to see those numbers
- Out of the 1,100 cities eligible for the >$1 billion ARPA funds, most have responded, only ~180 havenât, roughly 30 communities have declined funding; TDEM is planning to put this on the web so citizens know that money is available for response, first responder salaries, etc.
- Highlights partnership of FEMA and positive benefit
- Perry – Glad you brought up the points I wanted to hit, money is available
- Perry – Some smaller areas arenât sure theyâre aware of allowable costs & are fearful of claw backs, would like info
- This is a good point, for Hurricane Ike, etc. allowable costs were hard to determine
- Everything from FEMA says CRF and ARPA funds will not be counted as duplicative so long as you donât try to count the same cost twice
- Perry – Small counties donât have lists of nursing availability, TDEM through the call centers and RACs handled that need; do you believe that you can do this & deploy it quickly? Waiting on direction from the Gov to make this available?
- Short answer is yes, will get plugged back in
- Gov made it clear that intent is to support health care system and get it shored back up
- TDEM will always be the âswitchboardâ operator from local govs to state agencies, job is to ensure connections are made
- Perry – Thatâs critical to handle what weâre facing
- Our goal is to have staffing to support critical needs, will be following data from DSHS; will likely see nurses in the field in 3-5 days
- Perry – There is money available, unfortunately some have chosen not to access that; for those that have, we believe they will be able to make use of this
- Highlights importance of local communities utilizing federal dollars available
- Seliger – Few calls may be due to sense of skepticism because many cannot fathom that all they need is to contact TDEM for help
- Seliger – Are there enough nurses out there? Are you getting calls about the shortage of nurses?
- Yes sir, getting calls from every part of the state
- Hall – Asks after infusions What are the results of those patients receiving therapeutics, infusions
- Every person receiving an infusion has felt rough for an hour, but better than they felt before
- Make people feel better faster and keep people out of hospitals
- Hall – And they get it earlier?
- Yes, earlier the better
- Hall – How many do you think know about this service? Havenât seen anything informing about this service
- Federal gov has started pushing these medications to providers and this has accelerated, TDEM will continue to provide mobile infusion services
- Hall – Going to spend hundreds of millions of dollars on vaccines, but we know have a treatment that is as close to 100% effective as you can get; need to look at this area
- Hall discusses effectiveness of antibody treatment
- Kolkhorst notes that hearing is focused on hospital capacity and response
- Hall – If money was made available, would you be able to muster teams?
- Yes
- Campbell – I know you didnât mean to say weâre putting people on respirators and letting them die? Depending on multiple variables is how bad it hits them, people come into the ER depending on presentation
- Campbell – Monoclonal antibodies are not a panacea, also under emergency use authorization & doesnât provide long term immunity; I believe people have an option and can choose, but I do believe in the vaccine
- Campbell – Think it is correct to say this is a âpandemic of the unvaccinated,â vast majority of the vaccinated do not see serious illness
- Hall highlights the effectiveness of antibody treatment
- Campbell – Asks about money for first responders and staff; they either donât have it because they havenât asked, or itâs sitting there and not used on nursing personnel
- Yes; a couple districts are not using funds on staff
- Campbell – Youâre standing up infusion centers?
- Yes, centers are being established in communities around the state
- Powell – Agrees with local-focused response, sometimes hamper the ability of local officials to respond to situations; have spoken with federal leadership and local authorities, red tape associated with federal funds needs to be reduced
- Perry – Have put money into developing a nursing network for 10 years; asked THECB to respond on nursing shortages, is a political turf issue
- Perry – Should encourage people to make use of free-standing ERs if space is available
- Seliger – Mobile vaccination efforts made a big difference in my areas
- Kolkhorst – $5.36 billion spent on providing personnel to hospitals?
- Correct, flowed through DSHS & FEMA
- Kolkhorst – State took a lot of action as cases rose, state stepped and became a buyer of PPE and sourced personnel; did hospitals ever have to reimburse us for personnel we provided?
- No
- Kolkhorst – And they were paid for each COVID patient, regardless of insurance
- Thatâs my understanding
- Kolkhorst – Weâve created a disruptor in the market forces, have agencies offering many times higher pay for nurses; in July you wrote a letter to hospitals saying the state would no longer be an HR agency and they would need to hire their own personnel?
- Certainly this is how it was interpreted
- Kolkhorst – Weâve created a new market and weâre stealing nurses that have otherwise worked in a hospital system; one hospital administrator said we will create a wasteland of health care providers because they can be placed at agencies; where do we go from here?
- An enormous problem, will take all stakeholders coming together to work on an answer
- Kolkhorst – What percentage do the staffing agencies take?
- Difference in percentage the take versus cost of getting nurses to the hospital or area
- 23k were employed over last two surges, 6.5k had a Texas address, e.g. someone we took from an area in Texas to another
- Donât know how many have left Texas or gone elsewhere
- Paying for a service and not sure how we continue
- Kolkhorst – $5.36 billion is not PPE or other services, just putting staff in hospitals in other settings, this came from federal dollars, do we have that money right now or will we have to partner with hospitals
- Kolkhorst – Question is how we get personnel to create capacity & who pays for it
- Clearly state dollars had been appropriated to start the personnel response, agencies moved dollars around
- Kolkhorst – But it was reimbursed by the feds?
- Or still in the process of being reimbursed
- Our COVID expenditures for the entire response is roughly $9.5 billion, Congress put $10.5 billion to locals directly
- Kolkhorst asks for these figures to be reiterated
- Kolkhorst – Not only do we want beds for COVID patients that are critically ill, but also want beds for trauma, cardiac issues, cancer, etc.; need to figure out how weâre paying for this
- Kolkhorst – Federal government ran funds through the state at first, but now ARPA funds are going directly to local govs and must be requested
- No rules or regulations from a state perspective for much of this funding
- Kolkhorst – All of us will need to get together to see how we get the market back & stop stealing nurses
- Perry – Shouldnât institutionally change things that we know work long-term; want to remind nurses that demand is high during a pandemic, unconscionable behavior to take advantage of the enticements
- Campbell – Testing for K-12, how is that going to be done? Parental consent?
- TEA will work through consent with the ISDs, TDEM will continue to provide testing resources when requested
- Campbell – So youâre just supplying material?
- Yes
- Blanco – Has the state asked for resources and staff for alternate care sites from FEMA or National Guard?
- Still have 2k National Guard engaged
- Have weekly conversations with FEMA on reimbursement, response is always that they will send contact info
Dr. John Hellerstedt, Department of State Health Services
- Provides data on deaths during the pandemic
- Of the metrics we have, only hospitalizations and fatalities have entire population in mind, both are lagging indicators but very firm
- Seeing increases in deaths, pediatric hospitalizations
- Have exceed total pediatric hospitalizations in a very short period of time, part of this is due to Delta variant which will cause very rapid rises of those in hospitals, rapid rise stresses capacity
- Before vaccines, hospitalizations trended upward with age, vaccines quickly reduced overall number of hospitalizations; currently the 30-49 age group is a major contributor to hospitalization, 70-80 age group is going up, but no longer as rapidly
- Clear that Delta is spreading rapidly and inducing need for hospitalization in relatively younger age groups
- Nursing facility population was roughly half of overall fatalities in early parts of pandemic, but rose as the overall rate rose; nursing home fatalities correlate with overall spread, introduction of vaccines helped bring this rate down
- Blanco – What can the state do for those 12 and under who arenât able to receive the vaccine to help mitigate infection?
- DSHS recommendation is that individuals take every precaution they deem helpful; masking, distancing, sanitation, etc. are additive and absolutely work
- Vaccine availability is the way to get us where we need to be
- Blanco – In your medical opinion, should masks be mandated for those unable to get the vaccine for those 12 and under?
- Mandate is a leadership decision, can make medical recommendations
- All prevention measures are additive, masking in an indoor environment will absolutely increase safety of that environment
- Campbell – I think schools boards and ISDs need to make their own decisions for masks and other things; highlights
- Seliger – Asks after best practices in schools
- Would ask superintendents and schools to adopt every mitigating measure they have the power & authority to do
- Job of leadership to balance interests
- Seliger – Asks after booster shots
- Full biological license would allow off-label uses; emergency use does not allow use for things like boosters
- Hall – Have you been aware of the success of the infusion program?
- Very aware, spoke with Gov in Lubbock about promoting use
- Hall – Why arenât we doing more to promote this, why are we talking about spending hundreds of millions to convince people to be vaccinated when we could spend a few millions to get info out; should be the number one priority
- Donât agree that this should be number on priority; number one priority should be vaccination, infusions only provide a limited period of immunity
- For every 20 infusions, you prevent 1 hospitalization, but no data to say those receiving infusions see any different hospital outcomes
- If anything, infusion will block ability to generate natural immunity as it prevents the bodyâs antibodies from activating
- Hall – And you have clinical data to support all of this? Weâre tracking patients?
- Saying that we donât have data to say that those who end up in the hospital do any better than others
- Very clear it prevents hospitalizations if they receive treatment early
- Not sure giving infusions to everyone would be any less expensive than mass vaccination
- Hall – In reacting to fear of what will happen, shut down a lot of other medical services; what are we going to do to make sure people have access to needed treatment?
- Simple answer is sufficient staffing; no directive now to stop âelectiveâ procedures, now requesting hospitals look at services provided and assess based on staffing available
- Hall – But leaving it to hospitals to make that decision?
- Gov in his press release yesterday requested that hospitals look at if services can be postponed
- Hall – Weâve relied heavily on the CDC and FDA, theyâve reversed position that PCR test is gold standard, what is the real test?
- Not aware they had changed position on PCR, still a very valid test
- Hall – Has been a lot of talk of people who died with COVID or of COVID; do we have real knowledge of how many people died due to COVID?
- Yes, switched to death certificates and these must say COVID was a major contributing factor to the death
- Hall – Previously asked who the state was getting clinical advice from, has the state consulted with or used doctors with clinical experience? Previously used Dr. Birx and Fauci?
- I get regular feedback from clinicians
- Gov had a panel of four doctors, but did not include Dr. Birx or Dr. Fauci
- Campbell – Is the capacity issue due to patients or lack of staff?
- Both, but most critical thing will be staffing
- Campbell – With pediatric admissions, how much of this is RSV or other sources?
- Data provided earlier was just COVID, have heard of units that are stressed by RSV in addition
- RSV is a very common virus that can cause severe wheezing and viral pneumonia in some cases
- Campbell – Monoclonal antibodies just attack virus, do the monoclonal antibodies decrease natural antibodies
- Yes, if you had monoclonal antibodies it is highly encouraged to get the vaccine after a wait period to ensure the antibodies donât block efficacy of vaccine
- Campbell – What is the reasoning of getting vaccine after this?
- Very good evidence showing that vaccination after this time produces the highest number of neutralizing antibodies
- Campbell – So there is an increase in immunity?
- Yes
- Blanco – Are we tracking demographics of unvaccinated people presenting to hospitals?
- Will need to ask staff
- Blanco – What is the state doing to address vaccine hesitancy?
- Have an extensive information campaign, focus group
- There is an increase of those getting vaccinated since spread of Delta, isnât as fast or as much as weâd like; now at 60k/day, but peak was 100k/day
- Now have all the vaccine we need, canât miss opportunity to use these vaccines
- Campbell – African American population is only 37% vaccinated?
- Not in front of me, but we do have that data
- Campbell – In rural ERs, 30-40% are vaccinated and COVID is breakthrough; do we have an accurate number of breakthrough COVID cases?
- This is an area of intense medical and epidemiological study, definitely a higher risk of breakthrough illness if youâre only partially vaccinated; study on breakthrough with Delta is being study
- Campbell – We know that vaccinated individuals do not get as sick, but are we recommending them get monoclonal antibodies?
- Donât see any reason not to
- Campbell – But we only recommend antibodies for those with moderate symptoms?
- Correct
- Kolkhorst and Hellerstedt discuss pediatric admissions data
- Kolkhorst – How many total under 18 patients in hospitals? Want to ensure parents donât panic
- 25 new admissions in a day
- Kolkhorst – Do we have data on how many of the hospitalized cases are vaccinated?
- We can look if DSHS can gather this data, definitely studies in other places where it is very clear that especially in the more severe cases it is largely unvaccinated individuals
- Kolkhorst – Introduction of 4th vaccine with Novavax should help move needle
- Kolkhorst – Nonmedical interventions are important, has Vitamin D been shown to be effective
- Not aware of a double-blind study covering Vitamin D
- Kolkhorst – Highlights diet, exercise, sanitation; need to push mitigation efforts forward
- Kolkhorst – Asks after staffing
- Contractors were required not to âstealâ personnel from hospitals in the state, vast majority came from out of state
- Kolkhorst – 23k total, 6.5k from in state addresses, so some
- Kolkhorst – Tell us what weâre going to do on staffing
- State Operations Center will manage with funding available
- Kolkhorst – What if we donât appropriate these dollars; do you have the ability to be an HR agency if we partner with local communities or hospitals?
- Not completely, our contracts with the staffing agency require funds to go through us
- Kolkhorst – How many hours of service did we provide?
- Donât have service hours, overall in the last surge it was roughly 14k staff we contracted with; broad range of types
- Kolkhorst – Asks for data with breakdown by profession
Harris Health System & Parkland Panel
Dr. Esmaeil Prosa, Harris Health System
- Thanks state leadership for response, Govâs continued support in resources
- COVID pandemic brought to light many factors, including disparate impact on communities of color; impact is exacerbated among poor, indigent, and uninsured
- 63% of all ICU patients at Harris Health System hospitals are COVID positive
- Staff are being hit heavily, have lost staff to fatigue, retirement, COVID infection, and much higher wages offered by temp agencies
- Approached recently by an agency with a rate of $286/hour, staffing costs have increased dramatically over the last year
- Number of hospital COVID admissions has never increased this much, this fast; Delta variant is far to contagious for this degree of vaccination to have a moderating effect
- Need more vaccinations now to prevent a catastrophe
- Provides data on deaths of unvaccinated or vaccinated COVID patients; no patients who are fully vaccinated lost their lives, 98% of those who were admitted were unvaccinated
- Kolkhorst – Was there an age variant in this data
- Numbers were small, but general theme of this being a âpandemic of the unvaccinatedâ makes sense; age cohort is generally lower as those 60 and above are very receptive to the vaccine
Dr. Joseph Chang, Parkland
- Over 400 positions currently unfilled, high rates for nursing, etc. outside of the system has made it very difficult for Parkland to retain staff
- Staffing crunches hurt non-COVID patients, during this COVID surge Parkland is completely full on non-COVID patients; more patients are willing to visit hospitals now
- Parkland studied its own charts for COVID admission; for the 6 months from January 15th to July 15th, had 1,100 admissions for COVID, 27 were vaccinated, 7 needed oxygen, none died
- Kolkhorst – Studies like this could be of great value; highlights the data on Parkland admissions
Questions for Harris Health System & Parkland
- Seliger – Dr. Porsa, you challenge the state to do what?
- Porsa – More of informing the public of continuing the practices that have worked, incl. masks, distancing
- We are in a crisis based on rate of increase in admissions, no intervention will have an impact on these number in a short amount of time
- If everyone got vaccinated today, couldnât expect changes in trends within a month
- Harris Health System and the region cannot handle this rate of increase if it continues
- Kolkhorst – But 25% of your beds are shut down because you donât have personnel, how many beds could you open if you had the staff?
- Hospital has plans to change some available beds into ICU beds depending on severity of surge, hope to have the staff to utilize surge capacity as available
- Seliger – Concerned about statements that nursing wages are being paid in excess; wages are based on demand and hospitals shouldnât be exempt from market forces
- Should be and have been paying nurses more, but cannot compete with private markets; tried to implement hiring and retention bonuses, hazard payments, etc.
- However, given an estimate yesterday for $150k for a nurse for 13 weeks, safety net hospitals like Harris Health System cannot meet this, would be $20 million for 13 weeks
- Seliger – Point is weâre in a market displacement caused by COVID
- Chang – We were already down on nurses before the pandemic, already had a ~100 FTE deficit; currently a 407 FTE deficit
- Crisis is driving us to a place that is unsustainable, cannot compete
- Seliger – Given size of the system, arenât you always short of nurses?
- System always tries to adjust to compensate
- Seliger – Gov has talked about banning elective surgery, is this necessary at your hospital?
- Definition of this is key, initially this essentially applied to everything not immediately endangering life, but ha real trouble given conditions that were threatening
- Appreciates nuance of language in the Govâs release yesterday
- Kolkhorst – You saw someone offer $286/hour, how much would that agency get and does the nurse get paid?
- Porsa – That is a secret
- Kolkhorst – Similar to PBMs, all about the black box; if the government is paying for this, we need to know
- Willing to bet itâs not the nurses
- Kolkhorst – Looking at this not only as a cost factor, but also an absorption of the marketplace; also should look at educating and training new nurses
- Chang – Would also ask how much of the $5 billion spent by the state went to the nurses
- Other benefit of having more centralized control of this vital resources is to put control on constant back and forth bidding war
- Kolkhorst – Money is now going from ARPA directly to counties and cities, so who would pay for nurses?
- Porsa – More than happy to share the cost, help of the state would be to take advantage of the scale and control the cost to prevent bidding wards
- Chang – Would agree, willing to bear some of cost, but needs to be more efficient, price canât be so high that we only get a few nurses
- Kolkhorst – Part of what is making it difficult for rural areas; youâre both very large systems and your counties are getting billions, if you would allow us to use our scale and work together
- Absolutely
- Powell – Do you take transfers from outlying areas?
- Porsa – Absolutely do
- Chang – Yes
- Hall – Asks after vaccines and hospital populations
- Porsa – Patients getting intubated, etc. are now 40 and 45 year olds, many are not getting vaccinated because they had heard the vaccine is killing people
- Didnât have vaccines a year ago, now we do
- Hall – Last year people were told to go home until they got sick enough; are those coming to you without severe illness being sent home with outpatient protocols?
- Every patient sent home is enrolled in house call program with regular checkups, sometimes they return to the hospitals
- Harris doesnât do infusions, but does take advantage of infusions in the area
- Use therapeutics that have proven to be effective, but cannot diverge from medications that have been approved for treatment
- Hall – But you do have off-label use; which therapeutics are you recommending for COVID?
- None
- Hall – Is level of seriousness of illness on admittance the same level as it was a year ago?
- Yes
- Hall – Is there any financial advantage to the hospital for COVID patients over other patients
- Not for the safety net hospital system
- Chang – Serve large unfunded populations, goal is to not have people in the hospital
- Kolkhorst – An amendment on SB 968 prohibited government from stopping elective surgeries, did this with respect to the hospital systems; if you need to slow down surgeries to serve the public on a surge, we trust you as the experts
- Appreciate that trust
- Seliger – You can determine what volume and what type of surgeries staff can handle, only constraint is state wonât provide PPE
- Kolkhorst – State probably needs to get out of hiring nurses, market is messed up; we and the Gov will answer the needs of hospitals, need to work to get health care economic forces back in check
- Kolkhorst – Have you seen adverse reactions to vaccines?
- Porsa – Have seen allergic reactions, but no deaths or injuries; this happens with every vaccine
- Chang – Less than 10 required ER admission for allergic reactions, mostly just rashes, etc.; monitor for 15 minutes after administering vaccines generally
- Kolkhorst – Have two MRNA vaccines, one more traditional; have you seen data driving effectiveness?
- Chang – Saw initial data that said J&J has lesser effectiveness than the MRNAs
- Kolkhorst – Are there more vaccines coming to market?
- Porsa – There are
- Chang – Know of 8 or 9 vaccines in development, but many a long way from being tested in humans or being given to humans
- Kolkhorst – Asks after infusions
- Therapeutics like antibodies are given after youâre already infected, only thing to prevent is the vaccine, no antivirals
- Kolkhorst – Do either of you offer infusions?
- Porsa – We do not
- Chang – Parkland has an infusion center
- Kolkhorst – Need to be looking at this, especially in light of Govâs release; early intervention is the key & need to work with local providers in pushing this
- Hall – Do you have a mandatory vaccine req on personnel now?
- Porsa – Not now, but once it is out of EUA, it will be mandated
- Hall – So you would forgo having adequate personnel in favor of those vaccinated
- Yes, believe that vaccinated personnel are the best practice
- Campbell – Do you divert?
- Chang – Meet criteria for diversion at all times, but we never close
- Porsa – Patients mostly transport themselves, so diversion doesnât really have an impact
Houston Methodist
Dr. Marc Boom, Houston Methodist
- Provides overview of hospital operations, have given 800k vaccinations at Houston Methodist, last month has been about begging people to get vaccinated
- New variant has lessened protective behaviors, with lack of capacity and low vaccinations this is contributing to the current issue
- Getting very close to previous peaks, difficult to answer where this is going
- Staffing is the dramatic limitation now, other things like PPE are doing well, systems are doing a number of things to boost retention
- Having an organized approach that doesnât pit hospitals against each other is what is needed
- Need consistent messaging on masks, distancing, etc. to protect hospital resources
- Kolkhorst – Asks after staffing shortage and elective surgeries
- Doing well right now, if we follow India or Britain we will break the curve in about 3 weeks, but this is a hope and not a guarantee
- Will make it work and find additional beds
- Kolkhorst – Placement agency numbers?
- Going rate right now is about $130-$140/hour, view is that maybe 2/3rds goes to the nurses which is not great
- Agency nursing is difficult to detach from, in normal times try to use no agency nursing; goal after the pandemic is to move back to zero
- Answer is state level coordination, this is an issue particularly for smaller rural hospitals and safety net hospitals
- Kolkhorst – Do you ability to go to Harris and Houston, say the state will be a high level coordinator, and ask them to participate with a private hospital?
- Ultimately this is about caring for citizens, would be willing to be part of the dialogue to sort these issues out
- Kolkhorst – Hearing from some constituents that larger hospitals arenât taking transfers right now, need to attack the problem and everyone needs to have a stake
- Kolkhorst – With Biden admin pushing funding at a local level, need to find a new way to coordinate and move forward
- Two issues, staffing and how you pay for it
- Need to attract out of state nurses and figure out how to pay for this; dialogue can happen on how to use the funding available to do this
- Kolkhorst – Houston and Harris got $1.5 billion last Friday, money is available
- Perry – Do you think there is a willingness to share this funding with private hospitals?
- Short term issue is getting the staff in, payment is the follow up
- Perry – If TDEM is dispatching nurses, would be pretty easy to assign a cost and establish that arrangement with the county; thinks there will be a resistance from local govs to using money they are getting and paying nurses
- Powell – How to drive vaccination
- We know vaccines are the answer out of this pandemic, need consistent messaging from state leadership that this is what we do to protect the health of the state
- Unvaccinated people are endangering those with other conditions, causing delays
- Seeing uptick in people getting vaccines because they are afraid, but not nearly enough uptick
- Need to keep safe practices short term, encourage FDA to get their business done, 350 million doses have been administered so more than enough data is out there
- Vulnerable populations are being failed, vaccines donât work very well, canât get them a booster, and community around them is getting sick
- Dr. Boom discusses vaccination statistics, some factors could be contributed to elderly vaccinated individuals getting sick, such as low immunity generation, waning immunity with lack of boosters
- Campbell – Staffing agencies can charge what is reasonable, but do you think there is gouging going on?
- Happened with PPE
- Normally, if nursing is $30/hour, the hospital will spend $75/hour on agency hires
- All of this needs to go away when weâre out of the pandemic
- Campbell – Percentage of African Americans that are vaccinated?
- Tends to lag, saw significant disparities with employees initially; most getting vaccine at the outset were Asian or white
- Campbell – Can you explain the disparity?
- Complex answer, vaccine hesitancy, lack of access, well-earned mistrust of the health care system, lack of insurance, etc.
- Campbell – Messaging on this?
- All hospitals have done significant outreach
- Campbell – Is this disparity among the inpatient cases?
- Spring surge was very disproportionately African American, summer surge was largely Latinx, winter surge tracked population, currently looks to track population
- Kolkhorst – Path forward off of depending on agency nurses? Important to find a way to produce more nurses, have had some issues with the THECB, need to look at clinicals
- In non-COVID times the nursing shortage is not profound
- Need to be concerned also about lost workforce out of the pandemic, need to work on schools and training, recruitment from out of state
- Not a place in the country that hasnât experienced this to some degree, but we were much worse hit
- Kolkhorst – Time for us to look at how we produce nurses, settings, how to revamp this; need to look at ratios, donât want to compromise quality for quantity
- Perry – Asks that data from hospitals is transparent, e.g. reporting nursing shortage versus how many are typically actually employed
- Hall – What was the date you saw an 85/15 vaccinated mix?
- July, looks like efficacy of preventing hospitalizations
- Hall – Getting calls from my district that itâs more like 60%
- Not at all
- Hall – Would you fire workers who do not get vaccinated?
- We mandated a long time ago, glad we did because we do not have illness issues; did fire some employees
- Hall – Would you have this policy even if it exacerbated ability to serve patients?
- It hasnât done this, has helped ability to serve patients as employees are not getting sick
- Hall – If the surge says you need to hire outside, you would only accept vaccinated employees?
- Correct, have only hired vaccinated employees since March
- Hall – We get lots of reports of vaccinated people testing positive for COVID, do you have evidence these people arenât shedding the virus
- Great question, still unknown; is a possibility
- One of the reasons why weâre suggesting protective measures
- If it acts like India and Britain, what we would
- Hall – If you are vaccinated and can shed, it diminishes difference in transmission among vaccinated and unvaccinated
- If it is the case, however vaccinated people do not get hospitalized at high rates & would not be in a capacity crisis
- Hall – A lot of doctors would say we could get here with other treatments
- Fundamental preventative treatment is to be vaccinated, secondary preventative is monoclonal antibodies
- Would like nothing more than another medication, but data isnât there
- Kolkhorst – You run infusion centers?
- Yes, partner with several organizations
- Kolkhorst – If we could find a way to coordinate agency nursing, would you participate?
- Yes
Rural Hospitals Panel
Mike Olson, Citizens Medical Center
- Provides overview of hospital operations, county hospital but do not receive taxpayer funding, 1,200 employees
- Need staffing desperately to be able to take care of additional patients, agree that payment needs to be figured out; depending on state to help figure this out
Rebecca McCain, Electra Memorial Hospital
- Staff has worked through some of the most difficult times seen since the beginning of the pandemic, had 4 staff members call in sick in March of 2020 and 75% of staff in one clinic that came into contact with an index case; saw significant uptick in high acuity patients
- Latest surge has hit us much harder and faster than before
- Tertiary hospital in Wichita Falls stopped accepting critical transfers last Friday due to staffing shortage
- Hospital in Canadian had a patient with transfer needs, called 60 hospitals in 6 states but no hospital would take the patient and they passed away
- TDEM staffing was greatly appreciate before, thankful that Gov changed his stance yesterday, but no details yet
- Need state coordination of staffing resources at a reasonable rate
Ted Matthews, Eastland Memorial Hospital
- Busy rural hospital, especially on the outpatient side
- Issues right now are primarily in the emergency department, county has a 20% positive rate
- Having difficult transferring patients, individual needing intubation took >40 hours, lost one patient before transfer was possible
- Staffing issues are due to ability of staff to make so much more than the hospital can pay, not even getting applications now
- Started an LVN program with Ranger College, hoping to expand this to an RN program
Questions for Rural Hospitals Panel
- Campbell – LVNs and LPNs are underutilized
- Matthews – Actively recruiting LVNs
- Olson – Havenât historically used LVNs, but have started recruiting LVNs
- Campbell – Canât do the intake, but can pass treatments, watch monitors, etc.
- Olson comments that 98% of COVID patients are unvaccinated, Citizens Medical Center was doing infusions, but needed to move this to outpatient due to staffing issues
- Campbell – Can we utilize paramedics to start this or monitor this?
- Olson – Absolutely
- McCain – Hard to find paramedics, the ones we have are on the trucks, but we do use them in ER and testing drive thru; using everyone we can but we donât have a lot of people
- Perry – Delta is more contagious, but are patients staying the same length?
- Olson – Seeing similar lengths of stay, they either get well quickly or tend to linger
- Perry – So ICU beds you have are all COVID?
- No, 16 beds, 9 COVID
- Kolkhorst – Are you having issues with supplies?
- McCain – Highlights case of 33 year old almost maxed out on oxygen, transfer would be difficult
- Kolkhorst – The patient who needed transfer but couldnât find one in 60 hospitals contacted?
- This was in Canadian
- Kolkhorst – If we statewide coordination, who pays?
- Would hope it is the county for Electra Memorial, but would be willing to partner in the payment as could get Medicaid reimbursement
- Slippery slope in needing to pay nurses more to keep up with agency hires, but knowing that this would
- Kolkhorst – What do you get paid for a COVID patient?
- Depends on how long theyâre there, differs
- Matthews notes Eastland has some federal dollars, but judge was uncomfortable dispersing for staffing without guidance
- Kolkhorst – Met with Chief Kidd about this yesterday
- Olson – COVID patients are reimbursed, but there is a lot of cost associated with length of stay
- Everyone will need to step up to pay for staffing coverage, but need the staff now
- Hall – Are you implementing a mandatory vaccine requirement?
- Matthews – We are not, strongly request it
- Olson – We are not, have a 75% vaccine rate and want it higher
- Hall – Appreciate commitment to individual rights
- Perry – Need numbers on how much reasonable rates are for nursing, also need something sent to counties reminding them of federal dollars and staffing needs
- Campbell – Gov should not mandate vaccines, but if unvaccinated workers get COVID, it decreases the ability to serve patients
- McCain – For us it is any department, not just nurses at threat; e.g. dietary staff, environmental services staff
- Perry – Need to resolve hospital needs and staffing messaging before the end of this week
- Kolkhorst – Not out of this yet, but there is a role for everyone to play; rare for everyone to ask for help in coordination
Regional Advisory Council
Eric Epley, STRAC
- We are at crisis now, 15 patients away from peak number in summer per todayâs number; curve is not slowing and need urgency
- RACs are positioned between stakeholders, difficult to coordinate forces
- Stopping bidding wars will provide parity for haves and have nots, rural hospital staffing issues are widespread
- Ability of RACs to coordinate staffing is crucial
- Hospital COVID patients that are unvaccinated in the RAC are about 88% today
- Have tried to create a regional network to find placements for patients needing transfers though the Regional Medical Operations Centers, will be harder as COVID affects us all at the same time and as we move into hurricane season
- Perry – Is there a pipeline of nurses that you will pull from?
- Probably a question for TDEM
- Perry – If you put yourself back into contact for staffing, can we do it?
- Kolkhorst calls Chief Kidd back up
- Perry – Is the RAC the best place to contact if we want to send a message to counties that they should be spending dollars on nurses
- Not sure if RACs are best to deliver fiscal discussions
- Perry – Respect this, but there is nothing wrong with floating a balloon, maybe message that state officials will be contacting local government about the money they receive
- Perry – Do we have an alternative resource to the $240/hour pay
- Kidd, TDEM – I donât believe state agencies are paying these rates, can get this data
- Received word from Christus of 4 nurses who were hired away, needs to stop
- DSHS is the best place for contracts to stay, RACs are the best place for local coordination, but not the best place for financial discussion
- Perry highlights that every industry is seeing an aging workforce, have a generation that believes work isnât valuable; workforce is not regenerating because we donât put value in hard work
- Campbell – When you override a diversion, what is the ultimate solution?
- Epley – We donât do diversion override for places with a single hospital
- Campbell – Where will we get the nurses?
- Kidd – One of the staffing companies have been recruiting out of state, they will move once order comes in
- Have 23k humans move through, 70% of these came from out of state, but canât see which nurses left to work with agencies we donât work with
- Campbell – Are we looking with contracting with more agencies?
- DSHS contracts had been pre-bid, likely will start new process if we get to point where demand canât be met
- Campbell – I think weâre close to that
- Campbell – Are you looking at portable structures? I donât think we utilized these much?
- Short answer is yes, Beaumont EMR tent is set up
- Campbell – Are they using it?
- Not using it to capacity, will always use our tools in the toolbox
- Campbell – Asks after purchasing beds
- Epley – talking with ambulatory surgical hospitals, already working with freestanding ERs; not set up for these patients, but better than a tent
- Campbell – Should reach out to Texas Nurses Association and ask them for contacts
- Kolkhorst – $10 billion wired to the state?
- Kidd – To local govs, one half deposited