The Los Angeles ICU bed shortage seems more like a budget problem
Covid-related admissions and deaths have nearly doubled since Dec. 1; but the state can handle them better than we think
“Surge Capacity - hospitals can flex additional beds to serve ICU/Isolation patients as needed.
Several large hospitals that do not routinely receive 9-1-1 transports also have additional beds that would increase bed capacity in the system.”
By Tatiana Prophet
LOS ANGELES — The L.A. Times, the Guardian, and every medium in between have told us that Southern California ICUs are as good as closed - 0 percent capacity. How could we question them?
Because the word “capacity” is nebulous. Capacity of what? Licensed beds? No. Medical personnel to staff those beds? Yes, that’s it.
“There are still hospital beds, it’s a question of staffing,” said Cathy Chidester, director of L.A. County’s Emergency Medical Services agency, in a telephone interview. “We ask the state for staffing.” By “we,” she means the four hospitals directly under her purview.
She added: “All of the hospitals are looking for staff,“ indicating that the hospitals that operate outside of DHS have their own staffing registries.
Chidester’s department falls under the L.A. County Department of Health Services. It is that agency that publishes statistics on how many beds are available. The service area currently with the least capacity is Newhall, and like more rural counties, the issue is that they didn’t have many ICU beds to begin with, across three hospitals. But there’s a little fine print at the bottom of the Newhall chart, and the chart for every other service area in the county:
Surge Capacity - hospitals can flex additional beds to serve ICU/Isolation patients as needed.
Several large hospitals that do not routinely receive 9-1-1 transports also have additional beds that would increase bed capacity in the system.”
The California Hospital Association, instead of hiring more staff, is lobbying for waivers to the nurse-to-patient ratio required by California, which is currently 1-to-1 in the ICU. This is because of a nationwide shortage of critical care nurses and “intensivists,” or ICU doctors, as well as respiratory therapists.
We checked with the American Association of Critical-Care Nurses, which directed us to a database run by George Washington University. According to that database, there are 495 intensivists who are active but not working in the ICU, and there are 1,051 who are “inactive.” For critical-care nurses, there are more than 21,000 critical care nurses in California who are available and 12,000 “potential” critical-care nurses who carry that specialty but are not included in the available supply. It seems like something is stopping them from being called up in this moment of crisis.
The bigger problem is the shortage of ICU doctors (intensivists).
The nurses who are working at L.A. hospitals are stressed, Chidester said, as they work to provide the same level of care to non-Covid patients.
“We’re very stressed, but somehow the hospitals are managing within our normal-type patient care following all of the licensing and regulatory requirements,”’ she told us. “But it’s not like you picture a war movie and people are laying down on the ground or in the halls.” (The Washington Post did report today on the town of Apple Valley, Calif., in San Bernardino County, where patients were shown being treated in the halls of St. Mary’s Medical Center. We haven’t determined if this was because of staffing/budget decisions, or that all resources are truly tapped out).
So who is making the decision to keep staffing so tight? Is it the shareholders of the hospital corporations, or the executive directors of non-profit hospitals, or the government officials who run the public-private hospital partnerships? All of these comprise the decision-makers for the roughly 100 hospitals in the county.
And they all determine the outcome. According to the county’s ICU stats, the beds are there but the staffing is not. For some reason, all of them are waiting to hire more nurses to staff more beds. But for whatever reason, the figure of “0% ICU capacity” came screeching across our screens Thursday night. Some media, like the L.A. Times, said the figure applied to Southern California, while the Citizen app said there was “0% capacity” in ICUs for the county of Los Angeles.
Source: Los Angeles Department of Healthcare Services hospital bed census. PUI stands for “Patient Under Investigation,” meaning they are symptomatic with Covid-like illness and/or they are waiting for test results.
The Southern California figure is probably the more accurate, since we have crunched the numbers for Los Angeles, and the official capacity of countywide ICUs is 3 percent. Our hunch is that smaller counties are skewing the region-wide result because they quickly show zero capacity under any strain. In their case, struggling to place ICU patients is most likely due to their capacity not being very much to begin with. We’ve seen this situation before in both Texas and Florida.
WE ARE NOT IN DENIAL; THIS IS A REAL VIRUS
The virus is hastening our most vulnerable to early deaths, and this is unacceptable.
But the exact nature of the problem shouldn’t be cause for distress; it should be cause for a workable solution. Breaking it down: Reporting bed capacity alone, or by contrast the number of cases alone, is meaningless if you don’t look at the number of deaths, age demographics, comorbidities — as well as excess deaths (the amount of 2020 deaths over the average of the last three years). All of these things serve to qualify the very real fact that more Covid-positive patients are going to the hospital, and more are dying with Covid as a comorbidity.
Specifically, the number of hospitalized Covid patients in Los Angeles County has nearly doubled since Dec. 1, from 2,600 to just over 5,000. Factually, the number of Covid patients in intensive care has also nearly doubled, from roughly 500 to just over 1,000. Likewise, the number of Covid-positive patients admitted daily to the ICUs in LA County has roughly doubled since Dec. 1, from 74 to 152; and the other side of the coin is that the number of dialy discharges, including deaths, has nearly doubled, going from 295 to 516.
Latinos continue to experience an overwhelming number of cases and deaths. From what we can tell with our research, the biggest factor is income level and location of residence; the more compact the living situation, the higher the cases and deaths. The West Los Angeles service area — where home prices (and rent) are extremely high, has by far the fewest hospitalizations and deaths.
And citizens over the age of 65 comprise by far the greatest portion of those being hospitalized, suffering on ventilators, and dying. Out of 138 deaths yesterday (Dec. 16), 100 had “underlying health conditions including 37 people over the age of 80”; while 94 were over the age of 65. Does this minimize the gravity of the situation? Of course not. What it does show, though, is California’s lax approach to protecting our most vulnerable. With more than half the deaths occurring in patients at Skilled Nursing Facilities, something is amiss in the targeted solutions that so obviously need to be applied to the elderly and Latinos in the greater Los Angeles area.
Why is it important to get an accurate picture of just how dire the hospital situation is?
The entire region is under new “stay at home” orders, according to tweets by our celebrity crushes and political leaders, and headlines by our thought leaders, because of the ICU capacity being at or close to zero. If the cause of this situation is portrayed as something that can’t be helped, our trusting citizens are prepared to lay off workers and refrain from gathering together because of this messaging.
OPINION:
Those who believe masks are the best way to flatten the curve, slow the spread and save lives, appear to believe that it is irresponsible to dig for context when it comes to Covid data. But those who have been looking for solutions that will help the entire community thrive and be safe at the same time, are asking whether we could have made better decisions for our most vulnerable — from the beginning.
Protecting the sanctity of the skilled nursing facilitiy and not inviting recovering Covid patients there, would have been a better choice in both New York and California and inbetween. So too would have been targeted emergency legislation toward helping the vulnerable shelter at home, with groceries and other essentials being delivered by staffing made possibly through stimulus. Instead, we’ve thrown money at small businesses to help them stay closed.
After all, in one week, we went from health officials estimating that 1 in 5 L.A. residents have had Covid, to 1 in 4. With better choices and leadership in our state, along with a vaccine for those who wish to take it, herd immunity could arrive a lot sooner, and our children and businesses getting back to the human contact they need so much.
How many surge beds are there in L.A. County?
We obtained internal data from the CHA but we did not misrepresent ourselves to get it.
