Health care inequities add to frustration as hospitals face fifth COVID surge

·10 min read

On a recent morning at Loretto Hospital on Chicago’s West Side, beds and recliners were lined up in the hallway of the emergency department.

All 14 rooms in the ER were full, and the hospital needed a place to put patients during the afternoon rush. One patient was already lying in the hall. He’d been in the ER eight days, unable first to get a room upstairs and then, after he’d healed enough, to find a care facility that would take him.

Other hospitals might be able to help handle the ER overflow, but redirecting patients isn’t easy. The state has stopped Loretto from diverting ambulances to other hospitals, and the state also hasn’t forced hospitals with more room to take more patients to even out the burden.

The crammed hallways at the Austin hospital led the union representing some of its health care workers to hold a news conference urging other facilities to voluntarily accept transfers of patients from financially strapped safety-net hospitals like Loretto. “We just don’t have the room,” said Wellington Thomas, an ER technician.

Loretto’s struggles are just one sign of the way long-standing inequities in Chicago’s health care community are affecting COVID-19′s fifth surge. While hospital executives have joined others in saying they want to close the gaps, that ambition can sometimes seem at odds with the competitive nature of the health care industry in the Chicago area.

“I just feel like it’s one of the ways where there’s a lot of talk about racial equity, but in some of the ways that could actually be affected, by helping poorer neighborhoods, it’s just not happening,” said Claire Laurier Decoteau, a sociology professor at the University of Illinois at Chicago who has studied health inequity.

It’s also difficult for the public to know, in real time, which hospitals are in the most dire situations. What government data exists for each hospital comes from a snapshot taken a week or so earlier, and the Tribune found it can contain errors.

Still, that federal data broadly illustrates gaps in available space, with some hospitals overflowing with patients and others, though busy, with open beds.

Gov. J.B. Pritzker has asked, but not ordered, hospitals to delay nonemergency surgeries to help keep beds open. The state also said it has sent or is set to send roughly 2,000 state-funded workers to select hospitals across Illinois.

Data from earlier this month suggests many of these workers did go to hospitals that had been reporting problems. But the Tribune also found some hospitals reporting serious space issues didn’t receive help at that time, while some workers went to bigger hospitals that reported having more room.

Pritzker’s administration has said it’s doing its best to coordinate with hospitals while also praising health care workers dealing with staggering patient loads.

“They need help,” Pritzker told reporters Wednesday, “and I’m doing everything that I can to support them as they tackle this latest surge.”

Gaps in available beds

Each day, most hospitals fill out online reports to the federal and state governments listing the number of beds they can staff and the number of beds occupied by patients.

The state then totals the data each day for each region to see what percentage of beds remains available, in both inpatient wards and intensive care units. The state considers regions to be stressed if the rates fall below 20%, which has been the case in all of the Chicago area for weeks, if not months.

State officials won’t release daily data for each hospital, saying the law doesn’t force them to release it and, regardless, they worry that changing numbers would confuse the public. The federal government does release some figures for each hospital, and, though the Tribune found errors, the data on 59 Chicago-area hospitals shows bed availability can vary.

According to the data, nearly half of hospitals reported more than 20% of their adult ICU beds were available in the seven-day period ending Jan. 6. Meanwhile, nearly a fourth averaged less than 5% availability. That difference generally held true even when looking at the larger numbers of inpatient adult beds.

In the same week, five hospitals reported no available ICU beds: Mount Sinai, St. Bernard and South Shore hospitals in Chicago, along with Amita Health St. Francis Hospital Evanston and Amita Health St. Joseph Hospital Elgin.

“All the other facilities that we have called, when we’ve tried, they’re all so full they can’t accept our transfers due to space,” said Rosenda Barrera, chief nursing officer at Amita St. Francis. “They’re having the same struggles too.”

But the Tribune found the data is not well vetted. Stroger Hospital, for example, was shown for weeks as completely empty. Nobody caught that mistake until a reporter asked.

NorthShore University Health System said it’s not sure why federal data showed its Evanston hospital had so many inpatient and ICU beds open, since it’s been running at or near capacity. Loretto also said it’s busier than the data suggests.

Rush University Medical Center told the Tribune it had about 20% of its staffed inpatient beds and 33% of its ICU beds available Thursday. Federal data also indicates Rush has had some open beds. But a hospital representative said those numbers came after Rush extended its ER into its lobby and sent some patients, who were awaiting discharge, to another Rush facility.

“I don’t want to give the picture that Rush has all these empty beds,” said Angelique Richard, Rush’s chief nurse executive. “I do think we have put forth some creativity around how to expand and create capacity quickly while facing some of the same things that everybody else is facing.”

Long-standing inequities

Even with some of the federal figures in dispute, there’s little debate that some hospitals are faring worse than others, part of a generations-long racial and ethnic divide researchers have documented in access to quality health care.

One reason for that divide: Hospitals can better grow and expand by chasing more lucrative groups of patients, not necessarily the sickest or neediest ones.

The Chicago hospital landscape includes large hospital systems, facilities tied to universities, and others that struggle to operate independently in lower-income neighborhoods. That mix has affected hospitals’ options in adapting to the pandemic crush.

Hospitals that are part of larger systems say they have been able to transfer patients among their own facilities to try to even things out, while bigger hospitals have looked for ways to expand capacity. But for safety-net hospitals, the options can be more limited.

Transferring patients to less busy hospitals carries risks: A patient could get sicker on the ride there, or a hospital could run out of space in the time it takes to complete the paperwork and travel. Some fuller hospitals, such as Mount Sinai and Holy Cross, said they aren’t often transferring patients elsewhere to make room, partly because bed availability across hospitals is so tight and constantly in flux.

Some transfers do happen. Rush, for example, said it has approved the majority of the roughly 20 requests it has averaged each day since October. NorthShore said it has limited transfers from hospitals outside its own system but still takes some on a case-by-case-basis.

Still, Greg Kelley, president of SEIU Healthcare Illinois Indiana Missouri & Kansas, said more transfers could help Loretto and other safety-net hospitals.

“When poor hospitals need to transfer patients, they all too often find that richer health systems ... won’t take them,” he told reporters at Wednesday’s news conference.

Kelley singled out Northwestern Medicine, a health system anchored by the region’s largest hospital, Northwestern Memorial, which confirmed it has paused taking transfers from hospitals outside its system. The most recent federal data shows Northwestern Memorial averaged nearly 200 open inpatient beds of the 940 it could staff, and about 24 of 115 ICU beds. That equates to about 21% availability for each metric, slightly above the state threshold signaling stress.

Northwestern spokesman Christopher King said that in response to the latest surge the hospital has rescheduled 65% of surgeries and procedures that would require an inpatient bed. And he cautioned the federal numbers are a snapshot in time that don’t reflect the fact that some beds are open only to certain types of patients, like for psychiatric care or women’s health.

King said Northwestern serves many lower-income Chicagoans and communities, noting that more than 40% of the hospital’s COVID-19-positive inpatients live on the city’s South and West sides.

State actions

When the pandemic hit nearly two years ago, Pritzker issued an executive order directing all hospitals to cancel nonemergency surgeries. In that order, he also directed hospitals “to render assistance in support of the State’s response to the disaster.”

Now, with hospitals saying they’re in even worse shape than 2020, the governor has not gone so far. He recently asked, but didn’t require, hospitals to cancel nonemergency surgeries. New York, by contrast, recently directed dozens of hospitals to suspend nonessential elective surgeries.

Perhaps the biggest regulatory step the Pritzker administration has taken is one that’s frustrated several safety-net hospitals: making them accept arriving ambulances even when they feel overwhelmed.

Before the pandemic, full ERs could get 911 dispatchers to divert ambulances to other hospitals. Now, with hospitals so busy across the board, the state won’t allow that except for extreme situations, and some hospital officials who spoke with the Tribune said they’ve tried to take that step but been denied.

A state health department spokesperson said the agency is working with an industry trade group, the Illinois Health and Hospital Association, “to encourage appropriate interfacility transfers.”

The hospital association told the Tribune no single entity makes the decision to transfer patients from one hospital to another. Rather, doctors at different hospitals and within a region often talk to one another when deciding whether to transfer patients. Typically, they transfer patients based on patients’ medical needs and not just to make room, said association spokesperson Amy Barry.

That said, regarding the current transfer situation among hospitals, she told the Tribune: “We know it’s a problem.”

It’s not a new problem, either. WBEZ reported in June 2020 about problems overwhelmed hospitals had making transfers during the first COVID-19 surge. Since then, Chicago hospital leaders confirmed, an online dashboard has been developed for hospitals in the city to get real-time data on peers’ availability, but that information is less helpful now because so many facilities are reporting high patient loads.

Even if it’s not coordinating transfers, the Pritzker administration said it’s trying to even things out by paying private staffing agencies to supply workers to hospitals in need.

But the Tribune found the state hasn’t always sent staffers to hospitals reporting the lowest availability. Several smaller safety-net hospitals didn’t receive help — and four of them were reporting inpatient and ICU availability below the state threshold, signaling stress.

The state health department did not respond to questions about how it distributed staffers.

In the next week, 892 state-supplied staffers are to join 1,156 already placed at health care facilities or sent as part of special quick-strike forces.

Loretto is one of the hospitals slated to get staff from the state, with 24 workers expected to arrive later this month to help handle what’s become the worst surge yet for the hospital.

ER patients often have waited four to eight days for rooms to open up elsewhere in the hospital, workers said. Some are discharged after spending all of their time in the ER.

By Wednesday evening at Loretto, six more patients had joined the man whose bed was in the hallway. Paramedics soon arrived with another. To outfit a new bed for the arrival, nurses had to maneuver a recliner holding another patient into a tight space.

But there was good news for the man who had spent eight days in the ER: An ambulance had arrived to take him to a care facility.

That left 21 patients in the 14-bed emergency department, and a waiting room full of others set to be evaluated.

The Tribune’s Brian Cassella contributed reporting.

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