'Huge influx': Florida Capital Hospital hit record patient levels while TMH was offline

HCA Florida Capital Hospital saw a record influx of patients — even topping COVID-19 pandemic surges — during the nearly two-week-long cybersecurity incident at Tallahassee Memorial HealthCare.

Capital Hospital, a 288-bed, acute care facility on Capital Medical Boulevard, normally runs at around 82% capacity with a daily census of around 200-220 patients. But that spiked to 117% and 338 patients — an all-time high — after the cybersecurity incident prompted TMH to divert patients elsewhere.

Dr. Monique Butler, chief medical officer for HCA’s North Florida division, said the hospital saw a “huge influx” of patients into the emergency room and a much higher patient volume than seen in the past.

“The community needed care, so we had to accommodate them in the best way possible,” Butler said in an interview with the Democrat. “We’re thankful that we were able to have the resources of HCA to be able to help provide for our community when they needed us most.”

Doctor delays. Inaccessible records.Patients tell of 'frustrating' effects with TMH offline

TMH, the largest hospital in the region with 772 beds, was forced to shut down computer systems and implement downtime procedures in response to the incident, which began Feb. 2. The hospital canceled non-essential surgeries and diverted EMS and other patients, many of whom flooded into the city’s second-biggest hospital.

How did Tallahassee's HCA accommodate the patient increase?

Capital Hospital, one of 180 hospitals in the HCA chain, staffed up to meet the jump in demand, bringing in nearly 50 additional personnel, including doctors, nurses, therapists and other staff, from HCA hospitals in Gainesville, Ocala and across the Panhandle. Nearly 20 senior leaders manned command centers in Tallahassee and Nashville, Tennessee, HCA’s headquarters.

Background:FBI working with TMH to 'assess the situation;' computers still offline after cyber incident

The hospital set up alternative care sites for patients using outpatient rooms and other spaces for overflow. Relying on HCA’s supply chain operation, it brought in additional beds, stretchers and supplies. TMH donated beds as well, Butler said.

“It showed that our partnership between TMH and Capital is strong,” she said. “There were daily conversations with the leadership at TMH and Capital ... to ensure that they knew that we were all in this together and that we would do whatever was needed to be able to take care of the community.”

Patients who contacted the Democrat described crowded conditions at Capital Hospital — with patients and stretchers lining hallways — but praised hospital workers. John Van Gieson, who went to the ER after hitting his head and gushing blood, said he was among throngs of visibly sick and injured people.

“It was a scene out of a horror movie," he said. "Every bay in the ER was filled and many of us occupied beds in crowded hallways. It took six hours before the ER doctor stapled my wounds shut and discharged me. I would add that the HCA staff did a good job under difficult circumstances.”

More:'IT security event': 'All-hands-on-deck' at TMH with law enforcement investigation underway

Another patient, Terry Ryan, who went in for a heart issue, described a similar scene.

“All in all ... Capital (Hospital) is like absorbing a 700-bed hospital into a 280-bed one,” he said. “Staff are performing admirably though.”

With TMH down, Capital Hospital took 95% of EMS patients

TMH, which boasts the area’s only Level II trauma center, continued to take trauma patients, women in active labor and certain heart attack and stroke patients in the immediate aftermath of the cyber incident.

But the number of Emergency Medical Services patients arriving at TMH via Leon County’s ambulance service dropped dramatically, according to EMS records provided to the Democrat. TMH and its northside emergency center normally handle roughly 70% of county EMS patients, with the other 30% going to Capital Hospital or its emergency centers at Lake Jackson and SouthWood.

During the crisis, Capital Hospital’s daily share of EMS patients jumped to as high as 95%. On Feb. 7, TMH took only 4 of the county’s 94 EMS patients, with Capital Hospital handling the rest. From Feb. 3-8, no EMS patients were transported to TMH’s northside emergency center.

Capital Hospital deployed extra doctors and nurses and worked with county EMS to keep the system flowing and minimize the time it takes for ambulances to offload patients and return to service.

“We wanted that to be quick,” Butler said. “We didn’t want them to have to wait around because we knew that we were the only resource in the area. So our EMS offload processes to get EMS back on the road for the community was a priority for us.”

Experts:What happened at TMH? Experts say incident has telltale signs of a ransomware attack

Leon County EMS Chief Chad Abrams described patient drop times as “really good,” hovering around 30 minutes at the main hospital and just under that at Capital Hospital’s emergency centers.

“This is a great example of when your community has good relationships during the good times, when something like this happens, you’re able to communicate quickly and react to those situations,” Abrams said.

Tara Beth Anderson, chief nursing officer at Capital Hospital, said the hospital, operating under surge plans, ultimately treated an additional 600 patients over a two-week period. The hospital got help from numerous community partners, including nursing students who were unable to continue their clinicals at TMH.

“Another moment we will never forget during this was being able to care for our tiniest patients — we delivered two sets of twins that needed NICU care during this event!” she said in an email.

Capital Hospital: No serious safety incidents throughout cybersecurity ordeal

On Wednesday, 13 days after the cybersecurity event began, TMH announced it had fully restored its computer systems and returned to normal operations at all locations. In a statement, TMH gave special thanks to Capital Hospital.

More:TMH says all systems restored, operations normal after cybersecurity incident

TMH has not disclosed the exact nature of the security incident, though experts say it bears hallmarks of a ransomware attack. The hospital also hasn’t said whether any private data was compromised or a ransom paid.

“We continue to work with law enforcement and state and federal agencies to manage the investigation and recovery from this event,” TMH said.

Butler said no industry is immune to cyberattack and that HCA trains all employees on cyber safety. She said vigilance and “staying on top of the trends” are key.

“We have many cybersecurity experts at HCA Healthcare as one of the largest systems in the network,” she said. “We have sophisticated systems and expert teams that work around the clock to ensure that our systems are secure.”

Butler said Capital Hospital experienced no major problems or serious safety event throughout the incident. She added that the hospital team was “excellent.”

“We were able to really become much more operationally efficient,” Butler said. “The Capital leadership team worked day in and day out. The amount of teamwork that was established — I could not be more proud of the team.”

Contact Jeff Burlew at jburlew@tallahassee.com and follow @JeffBurlew on Twitter.

This article originally appeared on Tallahassee Democrat: TMH cyber incident leads to record patient load at HCA Florida Capital