We've heard plenty of horror stories about the state of US hospitals at present, both from the perspective of COVID-19 and the state of health care in general. A reader who's a nurse wrote to me this week describing conditions at her hospital. She gave me permission to share her message, provided she was not identified in any way.
There are no inpatient beds; we're swamped.
Last weekend, we were holding 16 admissions on gurneys in our ER that there were no beds for upstairs. Some KungFlu, some other stuff. The biggest problem is that admin never replaced the staff they laid off during the lockdown. We are running with skeleton crews in ER and inpatient units, and just waiting for a Sentinel event. We're usually taking 4 patients each in ER; now we have 6-8. Inpatient is worse; I recently handed off a patient getting blood (vitals every 15 minutes) to a nurse who already had 9. I felt so bad for him, but there wasn't anything I could do.
Plus, they cut our housekeeping staff, and now nursing has to clean all the rooms as well.
And they cut our respiratory therapists by half, so when we get a patient in respiratory distress, good luck finding an RT for breathing treatments.
And, I discovered, there are no ambulances to transport between facilities anymore either - we used to have them in house, to take patients to other hospitals, or back to the nursing homes. Now they wait for hours, taking up ER beds.
And, most of our security guards have quit, they won't say why. This is particularly concerning to me, as the level of incivility right now is off the charts. I found out that a drug seeker who shoved me into a wall the last time I had her, brought a gun with her the following week. And the medical director insists that we can't ban her bc it would be rayciss, and she has sickle cell, so acting out is how she shows she's having pain. Ugh.
I just don't know where the employees have gone.
Which leads me to night before last, when one of the hospitalists (not local) came to see a covid admission I was holding in the ER. He said he was sick of covid.
I tend to keep to myself at work, but I just smiled and said, but we're only 18 months into two weeks to flatten the curve!
This pissed him off. Then he read her chart and found out that she was not vaxxed, stood at the nurses desk outside her room, and started on a rant about people who won't get vaxxed, and how they shouldn't be allowed to even come to the hospital, and how people like YOU (me) are making the pandemic all about politics, and how great Biden and Fauci are. (I never brought them up.) Then he segued into a bunch more rants about how whypeepo in jacked up pickup trucks with their American flags make him uncomfortable, and how the American flag is a symbol of oppression…
He went on for SO long, and was so loud, that I just left and started going into random patients' rooms to check on them. Came out, still ranting. He stood there shouting for so long that the patient actually got up and left. I really hope she went to another hospital.
When the doctors are driving patients away bc of their race and vacc status…
I'd be interested to hear the reactions of other nurses to her comments. Is your institution as bad, or worse, or better? Paging Aesop…
Peter
36 comments:
Look up the Kelly Turnbull books.
That fictional USA is becoming more real every day
My guess is they are keeping staff short so they can complain about how full the hospitals are because of covidiocy.
God bless the ones who are sticking it out.
You all be safe and God bless.
Twice in the last month or so, we had late shift ambulance transport calls. Although the ER wasn't swamped with patients, there wasn't enough staff on duty. Both times it took at least 35 minutes after rolling the stretcher through the door, to transfer care and give a report to a nurse. Our EMS rules prohibit abandonment, meaning you can only turn care over to someone of equal or higher certification. Both times it was the same nurse (who kinda has a reputation for being snotty but I have never had a problem with her) who apologized profusely for tying us up for so long. Our electronic patient care report has 5 metrics about delays; Dispatch, Response, Scene, Transport, and Turn Around. They are check boxes with choices for things that abnormally affect providing service like staffing, weather, traffic, breakdowns, etc. I bagged the hospital both times under Turn Around Delays with "ED Overcrowding/Transfer of Care." That particular hospital is our medical control, as well as has direct electronic assess to our reports, so they will see it. We only run one ambulance, so when it is tied up like that, someone calling 911 will have a delay waiting for an ambulance to come mutual aid.
Not just in California, it's US wide... sigh
Out of staff is not equal to out of beds.
@steve, especially when you are firing staff for not getting vaxed
There seem to be regional variations.
This past Sunday, around 0230-ish, the local "big" city ER wasn't swamped, and the staff were friendly and efficient. It's almost like the hospital hasn't been firing people.
And none of the medical types with whom we've interacted this year have pushed the Wing Bat Flu vaccines. (I think most of the older folks around here are vaxxed, but there's no push to unperson or coerce the unvaxxed. Also, mask enforcement in other-than-medical settings seems to be pretty much nonexistent.)
Hospitals here are talking about being swamped but also offering close to a six figure signing bonus for nurses. Sounds like the issue is more about staffing than about the Great Unvaxxed Hordes.
The US health care system isn't good anyway, it spends more money to provide worse results than almost any other system, hybrid or even to a degree socialized. Itsq a great mirror of the general dysfunction in our society
Not a nurse but logic would suggest its mostly about a shortage of nurses.
Its a job that requires a certain measure of IQ, temperament, discipline and tolerance for unpleasantness and absurdity.
Globally the number of people who can meet the criteria is limited.
On top of that its expensive to train for and basically a blue collar job. This means a lot of people who could do the job, knowing they'll have a lot of debt would rather seek a higher status , lower yuck job and rightly.
As these conditions into rampant population aging,a less healthy younger population moron administrators who laid off nurses over cost cutting and/or vax mandates and yes a bit of COVID fear and you have the recipe for a regional failure.
As to MNW's Turnbull rec, I haven't read them but saying "we won't treat you without a vax passport." is an excellent way to end becoming a legit target from some desperate or angry and you could get a lot of John Q scenarios or just outright attacks on medical personnel off duty.
It won't get reported, Cthulhu in DC wouldn't be but the staff will know.
Try to stay healthy and not get injured if you can because if we don't get adults in charge real soon, we many not have hospitals or medical care worth a damn and if it goes hot, that might last a few decades till whoever in charge fixes it, if they can.
@stoneman Quote: The US health care system isn't good anyway, it spends more money to provide worse results than almost any other system, hybrid or even to a degree socialized.
worse results than anywhere else? that's why so many new drugs and procedures are developed here, and why the rich and famous from all over the world come to the US for their treatment, because the results are worse than "almost any other system"
Every system has to ration care, medical folks aren't slaves who can be ordered to work for free. I'd much rather have a system where the poor can get donations to pay for what they want than a system like in England where a court ordered that a baby had to die, even though there was a hospital in Israel willing to attempt treatment and the parents had raised the money to pay for it on the say-so of local 'experts' who testified that the child's life wasn't worth living.
If the last two years have taught us anything, it should be that we should not just blindly take the word of any 'expert', especially in the medical field.
Unknown, that is a dollar per year of life expectancy measure. There are other measures you can use if you like.
I'd also rather note tie to employment or ration it based on how much a workers are paid or whether they have a large income.
All developed nations and many second tier ones have managed by various means to cover all citizens to a good degree and wealthier people still have more options.
An example from our end, there is no reason our guy Mike from Cold Fury should be out begging for money , period. Ignoring the recent political madness for a second, in normal times in most normal countries he would have to worry about hospital bills.
Now I realize that it won't work here, America isn't really a country any more and we simply lack the honesty or social comity or wealth distribution to do it. So be it.
Its still not the right thing.
1) That was us, 10+ months ago.
2) Haven't had a COVID+ pt. hereabouts in weeks. At this point, Omicron is just @$$-gas, and less serious than the original version. Stay tuned.
3) We tried to tell you (and tell you, and tell you) that 2-3% critical/fatality cases is indeed a small thing, in the grand scheme of things, until they all crash at once.
4) Hospitals aren't "keeping staff short", there's no one to be had for love or money, and many said "Eff This!" months ago, and won't be coming back, ever.
5) We lost 50% of our ICU staff, and 25% of our ER staff, due to COVID burnout. We're just now starting to refill the ER ranks, but the ICU here is still running at 50%, even with $25K sign-on bonuses for full-time staff. It's worse for the youngsters just starting out, because they think this is how it's going to be forever, they get depressed, and punch out of nursing.
6) If any doctor went on a rant like that for more than about 60 seconds in my presence, I'd invite him outside by the nearest ear I could grab, and offer to activate his dental deductible on the spot if he didn't STFU for life, keep his opinions deep down inside his piehole, and get to work. SERIOUS AS A HEART ATTACK ABOUT THAT. "What would they do, fire me?" It is to laugh. Make my day.
7) The Vaccinated are driving this pandemic. 90% of all the COVID cases we've seen since July have been "fully vaccinated". The 75% vaxxed healthcare staff don't want to talk about that unpleasant reality. Some are on jab #4 or #5. Thety might as well buy a rabbit's foot. Shame and foolishness are powerful motivators to shut up.
8) Wash your hands to protect yourself, and wear a snot-catcher mask in public, to protect others. If you're not carrying COVID, symptomatically or asymptomatically, someone else is, and you going maskless means they go maskless, and here you are.
Exactly like we warned you you'd be.
It's not like flu, in that winter and summer have no real effect on it.
9) Every version of the vaxx is worse than the disease, sooner or later. Avoid the jab like the plague.
We're at something like 300-400K deaths from the not-a-vaxxes, and counting. And VAERS understates reality by anything up to 100 times actual.
Stop getting boosters, and rolling the dice to see if this one is the one that screws you up.
We told you this was a real thing.
We told you the second- through tenth-level follow-on problems would make the pandemic the least of your worries.
We have yet to be wrong on either count, and the haters have both index fingers jammed in their ears to the third joint at this point.
If you like your pandemic, you can keep your pandemic.
@stonegames, I call BS on the idea that someone with a problem like Mike has would have no worries in 'civilized' countries. Or rather, I'll argue that he would have no worries because there is a good chance that the wait for treatment would have meant that he would be dead instead.
Even if he survived, the idea that all his bills would be taken care of is nonsense (or if the bills are taken care of, the amount of care provided would be much less)
anyone who needs emergency treatment in the US is treated, period, full stop. Medicare/medicaid cover people who can't afford any insurance.
I would love for the tie between employment and insurance to be severed, but that's not the root cause of the problem. IMHO the root cause is that people view health care as being paid for by "someone else" and so they feel entitled to the best possible care at no cost to themselves. IF they had to make a cost/benefit tradeoff, they would make different decisions (and if they were able to, it's impossible to find out ahead of time what your bill would be at different facilities as a practical matter), since everything is run through 'insurance' and the insurance negotiators get bonuses based on how big a discount they negotiate, health providers play the game and give a bigger discount, by raising the base price more.
What's needed is something that I call a 'cash is king' rule, where prices need to be transparent, and if you are willing to pay at the time of service, you cannot be charged more than a small percentage more than the lowest amount they would accept from an insurance company.
I very much do NOT want to put these 'experts' in the position to be able to say 'we pay for your medical care, so we get to dictate your lifestyle choices to manage costs' or 'well, you don't want to do the healthy thing we mandate, so you don't get care' (they are already floating the idea of not giving care to the dirty unvaxed
@aesop, how many people did these shorthanded hospitals just fire (or have 'resign') over the vax mandate. In at a lot of the cases of shorthanded hospital systems, there is a direct causation between 'vax or find another job' and how shorthanded they are (acknowledging that no hospital ever has as many, or as good a staff as they would like to have)
I think the Wu Flu is just like other Flues winter and summer do have an effect on it. In the summer, southern states have people spending more time inside for the AC and so have more cases, in the winter those people get out, while in northern states people are out in the summer and in the winter they are inside for the heaters. Whichever season has people more crowded togther sees more cases.
David Lang (posting as unknown so I can get the email notifications, I can't figure out how to do it otherwise, and while it knows my google account, it still calls me unknown)
Similar happenings at Seattle hospitals. Seattle station KING-5:
https://www.king5.com/article/news/local/hospitals-full-covid-patients-washington/281-9e983f35-579d-4ed2-8eba-99631977ab90
Washington hospitals beyond full but not because of COVID-19 patients
The take-away:
“Our hospitals are bursting at the seams,” she said. “But they're not filled with COVID-19 patients. Remarkably, they are filled with patients who do not need hospital care.”
Briley described the patients that hospitals can’t be moved out of hospitals as those who have “complex, long-term care needs,” for which a facility can’t be found due to staffing shortages.
Additionally, Briley said the process for patients to get evaluated and placed in facilities outside of a hospital by the state’s Medicaid program can take weeks and months.
Also, some of these patients qualify for a post-hospital treatment facility for things like dementia or other mental health needs but they don’t have a family member authorized to consent to their transfer.
@stonegames -- disagree with all of your comments about the US healthcare delivery. Others have made excellent points in response. Far from perfect, but much, much better than almost any other country.
Our rural, tertiary care hospital is actually in fairly decent shape -- staffing, beds, etc. The organizational and social cultures are pretty strong.
That said, half of what the original poster described is not far off from what we've experienced during the 'busy' months of winter for years. The closest equivalent level of care is 100 miles away, diversion is not an option. We work hard to manage and provide the care needed.
Thankfully, we've been able to manage the mix of 'normal' emergencies and the periods of higher covid volumes.
Unknown, I want to be clear. I am aware that other systems are not right for the US for a tin of reasons and I'm not pushing for them here.
However I suspect that with a few exceptions (Italy is a big one and the UK less so) you'll find that what you were taught about non US health care is a mix of half truths and outright propaganda by big medicine in the US. I spoken to enough folks over there and read enough on both systems top come to the conclusion that fair amounts of what I was taught is nonsense and that's its better to just cover everyone in those nations.
Its far from perfect but it is dollar per year cost a lot less and they have solid life expectancy and for the most part will not be begging for money .
Again, won't work here but our system isn't that great
from statisti
The United States spends more on health care than any other country. Annual health expenditures are forecast to exceed four trillion U.S. dollars in 2020, and overall spending on health care was estimated to be around 10,500 U.S. dollars per resident.
If we got really good results for this, it would be fine but the country isn't getting those results, our childhood mortality is 3rd world and its very unevenly distributed.
That said it is what it is and even if people wanted to we could not change the system effectively. Too many hands out, too much corruption and no one rightfully trusts the USG any more
Let me get this straight, the administration at this lady's hospital allows racist shitbags to verbally assault patients, and other racist (and armed criminal) shitbags to physically assault staff?
Yes, it is a true mystery why no one wants to work there.
David Lang wrote:
>Medicare/medicaid cover people who can't afford any insurance.
They cover some people. Not us. My husband's 62. I'm 59. We're not old enough for Medicare; we don't qualify either for Medicaid or for any Obamacare subsidies.
I'm not eligible for traditional insurance and so not eligible for short-term insurance. And we certainly can't afford to pay over ~$12,000 a year for coverage that has a five-figure deductible and then pays only 60% after deductible, which was our cheapest option on the Obamacare marketplace the last time I looked, which was pre-Covid. We're older now and the Marketplace has doubtless collapsed further, so I expect it's even worse now than it was then.
This is not to imply that we would fare better under the systems in Canada or Britain, but current U.S. health care is by no means as good as you're claiming it is.
@Unknown 8:46,
We fired exactly no one. Zero. Zip. Zilch. Nadie. Niemand.
People quit outright, long before there was even a vaxx to be had.
And the hospital granted every single vaxx exemption requested.
Go to my blog and read what a total sh*tshow COVID was from about Halloween 2020 to February 2021, then get back to me.
The wonder is that we only lost the numbers of staff we did. As it was, we were about five minutes and the skin of our teeth from sorting out the over-70 patients to stay outside and die, and the under 70s to be brought inside for further treatment.
Check out Samaritan Ministries health share plan.
"The biggest problem is that admin never replaced the staff they laid off during the lockdown",
The only statement that matters. Greedy fuckin hospitals. Yeah, do no harm. Phuck You.
@meridith, sorry, I did not intend to imply that the US system was perfect (and I fully agree that the obamacare stuff is a fiasco), but lack of insurance != lack of access to medical care.
I've been in the boat of no insurance with medical emergencies (most recently December 2020)
I was more pushing back against the notion that the US has worse health care than the rest of the civilized world or that in other countries with socialized medicine that it's all sunshine and rainbows with nobody having to worry about medical care.
People in the US see the costs and grumble about them. I think that in some of these other countries people are so used to the waits and other lack of availability (in the boiling frog viewpoint) that they don't realize the cost that they are paying.
David Lang
@mark, I looked in to medishare a couple years ago, and while I really like the idea, I really didn't like that they were asking for a statement of faith and a testimonial from your pastor to sign up.
as I said earlier (I think all the unknown posts are mine) I see the biggest problem in costs being the effect of insurance companies demanding ever bigger discounts, so the providers raising the base price that they are discounting from. If I could pay the price that the insurance companies pay, I would only need to get insurance for really big medical problems, and could put aside money for the routine things, rather than paying large amounts of money to an 'insurance' company to have them pay out for routine treatments.
Medicine is the only place where 'insurance' covers routine, predictable, and preventative actions. Everywhere else it's a pretty simple bet that the insurance company bets that there won't be a claim and you bet that there will be a claim.
IMHO the way to fix medical costs is to get the insurance companies out of the loop for the simple stuff and have them reserved for the big stuff.
David Lang
"... the effect of insurance companies demanding ever bigger discounts, so the providers raising the base price that they are discounting from."
Bingo! It's a racket, and the government is a major participant, by way of Medicare/Medicaid.
When the government (or the rest of the oligopsony) will only pay 10% of list price, the list price has to be 10 times a reasonable price.
Get rid of the inflated pricing with huge discounts of institutional payers, and costs start looking a lot more reasonable.
But if prices were more reasonable, people might question the need for comprehensive health plans, as opposed to old-fashioned major medical insurance.
@eric, exactly
that's why I advocate for a 'cash is king' law
exclude government programs like medicare/medicaid, and make it so that if someone pays at the time of service, they cannot be charged more than 20% the lowest reimbursement that the care provider would accept from any insurance.
(20% being flexible, covering the amount credit card companies pay, etc. I'd even be willing to go up to double the lowest reimbursement. I routinely see reimbursement at 10% the list price or lower
David Lang
"It's not like flu, in that winter and summer have no real effect on it."
Now that's misinformation. We're already seen the evidence in the case load rotation from south to the north between this summer and fall in the US.
Did IT work for a large hospital corp during the worst of COVID. 1) The place had 2 ICU units that were indeed shut down due to budget concerns. The rest of the ICUs were 100% occupied. 2) They were losing nurses at a rapid rate as the nurses found better jobs, or became traveling nurse$$$$. 3) While I there they did a bunch of temp scanning and mask requiring, but as far as I know, they never filtered out a single case of COVID at the door. 4) Meanwhile, next door, at the associated university, they were publishing a paper on how the masks didn't work.
@Dave:
“Our hospitals are bursting at the seams,” she said. “But they're not filled with COVID-19 patients. Remarkably, they are filled with patients who do not need hospital care.”
Don't get me started on that absolute abuse of the 911 system. Our rules and regulations say that if they call WE HAVE TO TRANSPORT THEM if that is what they want. It pisses us off to no end to have to transport someone that is not critical, can walk, and the relatives follow behind the ambulance to the hospital. Uh... hey brainless, did it ever occur to you to drive grandma to the hospital yourself? We only run one bus, so when it is tied up for this type of nonsense it is unavailable for someone that may truly need it. They will have to wait for one to come mutual aid. Then there are those that do need the ambulance, repeatedly, because they should not be living on their own because they can't take care of themselves. We have many residents, that if there is ever a fire in their house, they will be a fatality before we even get there.
Yes, majority of medishare programs are religious. That being said, if one is healthy and is an active participant in remaining so, they are fantastic.
Often, if you call them with a question they ask to pray with you before they ring off.
@mark, I have no problem with them being a religious based group, or praying with you when you call, it's the 'get a letter from your pastor' portion that turned me off from giving them a try.
I read an article not long ago that made an awful lot of sense about the state of health care in the US. I wish I still had the link. The author proposed that there is a gap between what people think of as "health care" and actual health care. Right now, when you speak to people about the quality of health care in this country, people dismiss that and immediately think about the corporatization of the health care industry. Doctors and nurses actually provide health care, but they don't have much flexibility thanks to insurance companies, corporate-run healthcare facilities, the government, and yes, the lawyers. A typical doctor in an office-type environment is told he has 14.5 minutes to spend on each patient. For some strange reason, people think a General Practitioner is going to be able to manage all of their healthcare needs in that amount of time, once every six months or so. Are you kidding me? THIS is what the government, lawyers, and insurance companies have decided our 'healthcare' should be. Doctors and nurses don't have the real-time available to actually provide healthcare because they have to respond to their bosses and minimize costs, be more efficient, and move people through offices and hospitals like a cattle run. I don't know how they do it. We will return to top-notch healthcare once we get the government, insurance companies, and bean-counters out of the business and let the doctors and nurses actually treat patients.
@JohnnyL,
Fact is not disinformation. Bummer for you.
Annual flu tends to wane and disappear in warmer months in temperate climates.
COVID has done no such thing, nor have the tropics proven immune to it either. Completely unlike "flu season", COVID season has proven to be twelve months a year, to date.
I could be wrong about that, and you could be right, because only working at the pointy end of healthcare for 25+ years, I don't know everything about my own business.
The only difference in case load has been variations in close-hand social interaction, proving once again that school, work, and family get-togethers drive every pandemic since ever, and irrespective of the weather or the season.
QED
Viruses don't low-crawl up your driveway in the dark of night and climb in over your windowsill.
You get them from your co-workers, classmates, friends, and family. Like always.
Because people are people.
If we got really good results for this, it would be fine but the country isn't getting those results, our childhood mortality is 3rd world and its very unevenly distributed. -@5stonegames
That is flatly not true.
https://ourworldindata.org/child-mortality
You can look at the Child mortality rate, 2019 chart. The USA is below 1% just like all of Europe, Russia, Canada, and Australia. Go to the tables tab and just looking the raw numbers at the bottom.
Ukraine 0.84%
United Arab Emirates 0.75%
United Kingdom 0.43%
United States 0.65%
Uruguay 0.71%
Uzbekistan 1.74%
Vanuatu 2.59%
Venezuela 2.42%
Vietnam 1.99%
Yemen 5.84%
Zambia 6.17%
Zimbabwe 5.46%
The USA's rate is very close to other first world nations and way below the 3rd world.
You get them from your co-workers, classmates, friends, and family. Like always.
Because people are people.
Great, @Aesop! Then let's save everybody by torturing them (since extended solitary confinement is considered torture under Geneva) until they all kill themselves. That would be an excellent way to stop the pandemic just like setting a patient on fire is a way to cure cancer.
re: infant mortality.
It's well documented that the US uses a much stricter definition of this that much of the world, no the US numbers skew high.
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