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Health care workers warn care is suffering as unvaccinated patients push hospitals to capacity and beyond.

COURTESY PHOTO: DREAMSTIME - Hospital intensive care beds are in short supply across Oregon as the delta variant sweeps through the state. COVID-19 is now killing Oregonians who haven't even contracted the disease.

As unvaccinated people with COVID-19 fill Oregon hospitals to their capacity and beyond, other patients are dying because they can't get needed care.

{img:314077}Erik Thorsen, CEO of Columbia Memorial Hospital in Astoria, has had several patient deaths in his 25-bed facility during the recent pandemic spike. They died, he says, because they could not be transferred to larger, more specialized hospitals for the more complex care they needed.

"They're folks that need a heart specialist or need to go to a (cardiac catheter) lab," he said of the patients who've died, adding that they were "all non-COVID."

Thorsen and other health care officials say the situation is worse than ever. With the more contagious Delta variant ripping through Oregon's unvaccinated, the state's hospital system is on the brink of collapse.

Hospitals are short-staffed, with many providers having left due to burnout. And a crucial part of the system, being able to transfer patients or divert incoming patients to other hospitals when crowded, is broken, state officials, health care workers and executives agree.

That's because within many hospitals, intensive-care units and emergency departments have no room for transfers. They are full to capacity.

On Thursday, Aug. 19, Mercy Medical Center in Roseburg reported that a patient died in the emergency room because its intensive-care unit was full.

Earlier on Thursday, Gov. Kate Brown and several health officials announced a stiffer vaccination mandate for frontline workers, as well as measures to help beleaguered hospitals.

However, she has so far rebuffed an Aug. 12 request by hospitals to waive minimum staffing requirements to open more beds for patients, including at long-term care and skilled nursing facilities. The latter change, they say, would take the pressure off hospitals by allowing more patients to be discharged.{img:314076}

The governor's response echoed concerns voiced by both nurses and doctors.

"Oregon's nurses and health care workers have been working incredibly hard over the past year and a half," said Brown spokesman, Charles Boyle. "Any changes to staffing ratios must be balanced with acknowledging the immense workload Oregon's nurses and health care workers already have. … We are still in conversations regarding long-term care nursing ratios, though we have the same concerns about the immense workload of workers in the field and the potential for workers to leave the field, which would exacerbate the current crisis."

Brown also has urged hospitals to use federal funding they have received to support workers, such as with retention bonuses.

Hospitals say that the state's fixes so far do not go far enough.

"We have provided the governor's office with our best thinking on strategies that could relieve the immense pressure on hospitals so that they can provide the best care every time, to every patient," said Andy Van Pelt, executive vice president of the Oregon Association of Hospitals and Health Systems. "We have asked, and ask again, that she implement all of them, because they will all be needed as we avoid collapse."

He said hospitals already have paid retention bonuses and taken other steps to help workers.

"Hospitals received federal funds in 2020, that were used to keep their doors open to patients during the pandemic," he said. "The deadline to spend those funds was earlier this year, so they are not available to hospitals now."

No quick fix

Many health care workers say there are no easy answers. The state needs more qualified people to counter a year of attrition at hospitals, including among nurses.

Virginia Smith, a board member of the Oregon Nurses Association who works at Providence Willamette Falls Medical Center in Oregon City, said 18 months of stress on the system has created an untenable situation in smaller hospitals — which at times are seeing a bigger patient load than larger counterparts elsewhere in the state.

At her hospital, the volume of incoming patients is more than double their normal peak.

"It's people that are very sick, in their 30s, 40s and 50s, and all the way into (the) elderly who are unvaccinated" she said. "There have been nights where there's been more patients in our emergency department than there were at St. Vincent's (in Washington County) or Portland Providence Medical Center.

"We are a 20-bed emergency department. So to have 50 patients in both the department and (overflowing) in the lobby is so overwhelming."

Nurses in small hospitals pride themselves in providing a quality of care just as high as provided by their larger counterparts, Smith said. But the effect of short-staffing in smaller hospitals can be larger. In a small intensive-care units filled with intubated patients, a sick day for a single nurse can create a "dangerous" situation, she said.

Quality of care compromised

During a Thursday, Aug. 19, press conference, Oregon Health Authority Director Patrick Allen said that the system is almost at a point where the quality of care is being compromised.

But some health care professionals say things are well past that point.

Jeff Abalone, the top physician for St. Charles Health System, said at the same conference, "We've had to postpone or cancel close to 3,000 scheduled surgeries. These are not cosmetic surgeries. These are very necessary critical surgeries for the patients that we serve. These are patients that have cancer, heart disease, neurological disease surgeries that are necessary to preserve life and function, and they're being delayed right now."

"I don't want to mince my words: We are rationing care. Only patients that have the most severe needs for surgical care are getting that care in our hospitals today. And many, many, many more are waiting."

Smith, the Nurses Association board member who is tasked with monitoring quality of care in her hospital, said some emergency departments are being "completely overrun to the point where they're unsafe. … There's only so many patients you can take care of all at once."

She is telling her family members to avoid risks to make sure they stay away from hospitals.

"I keep telling my whole family: 'No ladders, no chainsaws,'" she said.

"I would never discourage somebody from coming to the hospital if they think they need it, and that's the thing. Everyone who's in a waiting room right now, they need to be there," she added.

"It's a daring feat to go to the hospital right now, when everything is the way it is."

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