State, County Officials Say Hawai´i Headed For Healthcare Disaster

Hawai´i’s healthcare system already hit its tipping point. Now, officials say, it has passed it.

Nearly 300 patients statewide were admitted due to COVID-19 infection as of Friday, Aug. 13, and hospitals across the islands are nearing capacity. Several have begun adding bed space and requesting emergency personnel additions in the face of a rising tide of coronavirus infections that approached 1,200 yesterday alone.

Hawai´i is in the midst of a healthcare crisis, Department of Health Director Dr. Elizabeth Char said, and headed for worse if trends don’t change immediately.

“We are there. We are on fire. When we have hospitals that are really worried about being able to take care of people, that’s a crisis,” Char said. “When we see this exponential growth in the amount of people that are getting infected with COVID every day, 2,000 people in the past three days, that’s a crisis.”

“And at the point at which we overwhelm our resources, that’s a disaster. That’s where we’re heading.”

Despite what has proven over the last several weeks to be the worst stretch of the pandemic, residents and visitors to Hawai´i are subject to almost as few restrictions as they have been at any point since the coronavirus first appeared in the islands almost a year and a half ago.

Governor David Ige continues to hold fast against mandatory lockdowns, the abandonment of in-person learning and enhanced travel requirements.

In the meantime, Hawai´i’s some 2,000 frontline healthcare workers continue to put in ungodly hours as they wait for a Federal Emergency Management Agency (FEMA) relief program to provide aid. Char said that in the next few days, FEMA will be sending the first of approximately 500 supplemental healthcare workers the state has requested to deal with the crisis it faces now, and the disaster it could soon be staring down.

Big Island Resources Stretched Thin

As of Saturday, the Big Island was home to 1,345 active cases, while 25 individuals were hospitalized due to coronavirus infection. The highest that hospitalization number has been in recent days is 27.

A total of 50 emergency healthcare workers are set to arrive over the next few days, including 35 at Kona Community Hospital (KCH) on Monday, Aug. 16. The additional medical staff members are meant to help alleviate personnel shortages that state and county health officials say are among the most immediate and dire of coronavirus-related concerns.

“If the hospitals are so consumed with taking care of patients with COVID, that means there are less resources to take care of other patients,” Char said. “It’s the staffing for those hospitals, not so much just the physical bed space. It really is about people and resources and staffing. That’s where we’re falling short.”

Kona Community Hospital and Kohala Hospital

Judy Donovan, marketing and strategic planning director at KCH, echoed Char’s sentiments when speaking specifically about the facility in South Kona.

“We have been short staffed for a couple of weeks,” Donovan explained. “The staff has gone above and beyond to cover each other’s units, working tons of overtime, so departments have been strained.”

The problem at KCH, much the same as at other healthcare facilities across the county and state, is two fold. The first reason for the shortage is that traveling agency staff, which would normally come for months at a time to meet employment demand in Hawai´i, are choosing to stay on the mainland and take jobs elsewhere. It is the exorbitant cost of living, Donovan said, that is changing minds.

The other half of the problem is a spike in coronavirus patients, who often require an intense level and nature of care if sick enough to be hospitalized, along with staff members being forced into isolation due to possible coronavirus exposure.

“COVID patients are extremely high acuity, it is a lot of work,” Donovan said. “It is a much higher level of care.”

KCH’s initial supplement of 35 new healthcare workers, which will include 32 critical care nurses and three respiratory therapists, will be on hand for four weeks. They were paid for by a private donor who has asked to remain anonymous, Donovan said. Future supplemental workers will be financially compensated through the aforementioned FEMA relief program.

Donovan said Friday there are no firm numbers of how many additional hospital employees FEMA will provide, or the specific dates on which they are expected to arrive. She said KCH was told last week that it would be no sooner than 8-10 days.

The hospital has also set up a two-room mash tent outdoors, equipped with beds, air conditioning and the facility’s electronic medical records system to serve as supplementary space if necessary.

Donovan said that the entire second floor of KCH could be converted for COVID care, should that prove a requirement, which means a total of 33 beds. There is also the Intensive Care Unit (ICU) with nine beds, along with however many the hospital is able to set up under the outdoor tents.

The north end of the Emergency Department, a total of six beds, has been set aside for people who may have a coronavirus infection. It is equipped with negative pressure, which makes it a safe setting for the potentially infected to reside in while their statuses are determined.

Outdoor mash tents are more likely to be used for Emergency Department overflow, not for extra COVID beds, as the strain the coronavirus puts on hospital resources can impact even those who come to the hospital for a separate reason.

“If you crash your car and you are a trauma patient, and you get taken to a hospital and they’re really short staffed, and there’s no beds and everybody’s busy working on other things, it’s going to impact you even though you had nothing to do with COVID,” Char explained.

None of these scenarios have yet to present at KCH. The fear is, if infection trends don’t turn around, they could become unfortunate and potentially fatal realities.

“We have not reached the point of being unable to care for standard patients,” Donovan said Friday. “Non-COVID patients generally stay less than a week. We are discharging them home in a pretty timely fashion.”

Some non-COVID patients linger, however, due to skilled nursing centers and long-term care centers struggling with the same staffing shortages plaguing KCH, as well much of the rest of the county and state. Those patients no longer need to be hospitalized, but there is no safe place to which they can be discharged.

Due to all contributing factors, KCH has reinstituted its no visitor policy. A few “compassionate exceptions” will be made for people dealing with end-of-life circumstances. Expecting mothers are also allowed one support individual while in labor, Donovan said.

Kohala Hospital, which operates under the umbrella of KCH, went back into lockdown Thursday. Kohala has a high ratio of elderly patients and Donovan said the facility can not risk admitting visitors of any type.

The hospital has seen an increase in visits to the Emergency Department due to the pandemic. Those patients who are not discharged home for management of symptoms are transferred to KCH, as Kohala is not currently housing patients positive for COVID-19.

Hilo Medical Center

Hilo Medical Center has also set up a COVID unit within its facility, which includes 16 beds within the 50-bed Medical Unit on the third floor. The ICU there is a separate 11-bed unit.

Elena Cabatu, director of marketing, legislative and public affairs at HMC, said the COVID unit can be expanded or contracted if necessary. As of Friday, it was not yet at capacity, housing seven patients with nine beds still available. The ICU, however, was at capacity. All 11 beds were full, including three occupied by coronavirus-positive patients.

HMC, like KCH, will also address staffing concerns through supplemental hires.

“We are expecting about 12 relief staff to care for COVID patients for eight weeks until the first week in October,” Cabatu told Big Island Now. “We may get a second wave based on the COVID census.”

“Employees are strained due to the high acuity of patients and number of patients that have returned to the same amount pre-pandemic,” Cabatu said. “The higher the acuity, the sicker they are, and (the) more difficult to care for. It’s an emotional strain feeling like we were in the clear and seeing the demand for vaccination take off, then drop off, and (the Delta variant) come in and surge, especially when vaccination is available.”

HMC is dealing with similar problems as KCH. One such concern involves the housing of several patients who are able to be discharged but have nowhere safe to go when they leave the hospital. Long-term care facilities in East Hawai´i are also either full or holding off new admissions until they sort out COVID situations at their own facilities.

“We are working closely within our hospital leadership to have in-house solutions that we can take to free up more beds, like cancel elective surgeries, but we are not there yet,” Cabatu said. “We would have to exceed our census with 10 holds in the Emergency Department with no place to send them.”

“We are also working closely with Healthcare Association of Hawai´i, HI-EMA, the county and other partners to have the capability to adjust to a patient surge, like setting up additional beds housed in an Acute Care Module or Alternate Care Facility,” Cabatu continued.

Queen’s North Hawai´i Community Hospital

QNHCH has 35 beds in its facility, as well as four ICU beds. That does not include the bed count in its Emergency Department. All in all, the facility is still on solid ground despite the uptick in the pandemic.

Lynn Scully, marketing and communications manager for the hospital, said the small number of patients it admits overall, as well as the small number currently residing there with COVID, can create potential medical privacy concerns if the hospital reports the number of cases of the virus being treated within its facilities.

“While large numbers are usually okay to release, very small numbers in a small community like ours increase the chance of a patient being identified,” Scully said. “If there was a public safety need for the release of these numbers, we would reconsider our position, but at this time that is not the case.”

“We provide COVID testing outside our ER, and we are seeing an increase in numbers,” Scully continued. “We’re testing on average anywhere between 40-65 (individuals) a day. Most of these are people who think they may have been exposed.”

Vaccinations are offered twice a week at QNHCH, and interest in the shot has increased slightly since the pandemic began to rage again with more fervor across the islands, Scully said. Testing is conducted from 9 am to 1 pm Monday through Friday.

“We currently have adequate beds, staffing and supplies to care for any patients who need care — outpatient or inpatient, COVID or non-COVID,” Scully said. “We anticipate four FEMA nurses coming later this month as part of the statewide request for staffing assistance. They will be supporting primarily in the ER and ICU.”

“QNHCH is well prepared and will care for whoever needs care,” she continued.