Although many people think hospitals are busy places these days due to the COVID-19 pandemic, the reality is very different.
Some Valley-area hospitals are reporting low patient numbers resulting in implementation of employee furlough plans and other staff reductions due to a lack of work. According to local health officials, this predicament has been caused by a huge drop in emergency room patient volume and the intentional halting by hospitals of non-emergency surgeries and procedures during the pandemic.
Any surge of COVID-19 patients that has taken place at these hospitals has not made up for the loss of other patients and resulting revenue.
For nurses at these facilities, seeing hospitals having to initiate staff reductions amid a pandemic has brought confusion and frustration, although they are understanding of the situation the hospitals are in.
Dr. Bernie Klein, chief executive at Providence Holy Cross Medical Center in Mission Hills, said his hospital as well as Providence Saint Joseph Medical Center in Burbank and Providence Cedars-Sinai Tarzana Medical Center had been successful in warding off staff reductions since the pandemic began several weeks ago but it “isn’t sustainable.”
Furloughs, Flexing Begins
Beginning this week, furloughs and so-called “flexing off” of staff is happening at those hospitals because of lower patient volume.
“At this time there are no layoffs,” Klein said, adding that they will evaluate the situation again in six weeks.
Furloughs are unpaid time off due to a company’s economic conditions. Flexing off is when an employee works a reduced workday due to low patient census. Klein said the furloughs are voluntary. Employees will still have their health insurance coverage and will have the option of using any paid time off they have accumulated or applying for unemployment to cover the week that they are furloughed.
Klein said where the furloughs or flexing will happen in Providence hospitals will depend on how busy a department is, and no specific positions are targeted.
Henry Mayo Newhall Hospital in Santa Clarita issued a statement announcing staff reductions:
“The COVID-19 pandemic has had a significant negative financial impact on every hospital in the country, as a result of sharply reduced surgical volumes and substantially lower emergency department visits. Henry Mayo has not been immune to these same financial pressures. To maintain our financial and operational strength, we had to make the difficult decision to reduce our workforce. While such a decision is painful at any time, it is especially so now, given that all our employees have performed so heroically responding to the COVID-19 pandemic. We sincerely thank all our departing employees for their dedicated service and wish them the best in their future endeavors.”
Hospital officials would not elaborate further on the reductions.
Even before the coronavirus outbreak, many hospitals were already struggling financially.
The California Hospital Association reported this week that state hospitals have lost up to $14 billion by postponing elective surgeries and other procedures to clear space in anticipation of a flood of coronavirus patients that didn’t arrive, and people steered clear of the emergency room.
Hospitals Expected to be “Overwhelmed”
Nerissa Black is a registered nurse at Henry Mayo and has been one of the workers assigned to take care of COVID-19 patients. When the pandemic started several weeks ago, Black never thought that weeks later her hospital would be laying off some employees. She thought the hospital would stay busy because there would be many sick people to take care of, and she didn’t anticipate that a byproduct of the COVID-19 crisis would be an overall loss of business for the facility.
“I thought we were going to be overwhelmed,” she said. Black added that Henry Mayo did experience a surge in COVID-19 patients a few weeks back and turned two acute care units into COVID-19 units.
She said the hospital did a good job in preparing for an onslaught of patients with the virus. Like many other people, what she didn’t expect is that patients would stop going to the ER due to what health officials believe was a fear they would catch the virus there.
Black said she has been flexed off but that was at her own request, and that actually resulted in her taking the place of someone who would have been involuntarily flexed off. Other nurses working in areas that have had reduced work capacity such as elective surgeries have been furloughed or have had their hours reduced drastically, she said.
Hospital departments rotate the forced time off throughout the staff, she said.
Chelsi Schriver, public affairs representative at Kaiser Permanente Panorama City, said that so far there have not been any staff reductions at her facility but did say that they had experienced a drop in patient visits to the ER by more than half since shelter in place orders were issued in March due to COVID-19.
Schriver said Kaiser has postponed some elective procedures and has ramped up telemedicine capabilities allowing patients to communicate from home with their caregivers. She said the company has closed some medical office buildings and consolidated to fewer locations so that it can meet a potential surge in the number of people who need hospitalization because of COVID-19.
This consolidation also helps the facility conserve personal protective equipment (PPE) and guard against potential staffing shortages and limit exposure to the virus for patients and employees, Schriver said.
Several other Valley hospitals did not respond to The Sun’s inquiries on possible staff reductions.
Patients Have Delayed Medical Attention
Klein said that the highest COVID-19 caseload at Holy Cross was 60 cases at one time, which has now receded to about 40.
But as the hospital has been taking care of those numbers of COVID-19 patients, he said many patients without the virus have delayed coming to the hospital’s emergency department to get care for other urgent medical problems apparently out of fear that they might catch the virus.
“We have seen a marked decrease in our ER volume,” Klein said. “It is slowly picking up but nothing to the extent that we used to see prior to COVID.”
Klein said the Holy Cross emergency department normally sees about 300 patients every 24 hours. But during the height of the pandemic a few weeks ago that number fell to about 110 patients and is currently about 175 patients.
This prompted Holy Cross officials last week to issue a press release advising patients to not delay coming to the emergency department and elaborate on the safety precautions taken at the hospital to guard against the virus.
Klein said the overall occupancy rate of the hospital had fallen to a low of about 50 percent during this pandemic compared to a normal rate of 85 percent. It is currently about 70-75 percent full, he said.
The lower rate can also be attributed to the stopping of all non-emergency surgeries at the hospital when the pandemic worsened.
“We did that to preserve our PPE and we had to be prepared in case there was going to be a large surge of COVID patients,” Klein said.
Holy Cross is now slowly ramping up the number of non-emergency surgeries it is performing such as joint replacements as well as diagnostic procedures like MRIs, biopsies, and endoscopies.
All of this is being done in a very controlled way, Klein emphasized. All patients’ COVID-19 status is checked, and all staff wear the appropriate personal protective equipment. Anyone entering the hospital including employees has their temperature checked.
There is a limited visitor policy in effect at the hospital and all employees, patients and visitors must wear masks.
“When we started to see a decline in COVID, we started to see an increase in non-COVID patients coming in very, very sick because they had delayed care,” he said.
At Providence Saint Joseph, registered nurse Tana Clark said patient volume has picked up noticeably in the past few weeks.
“I think people can only hold out not going to the hospital for so long,” she said.
Because of this, she is confused by the timing of furloughs at her hospital.
“Now that we are starting to get busy again, they’re going to furlough us?” Clark said, but also acknowledged that she felt hospital management tried to hold out as long as it could in implementing furloughs.
Clark said many nurses who were in areas of the hospital where business fell off have been used as “runners” or “safety officers” on the COVID-19 floors. Some of these nurses stand outside the doors of the COVID-19 units, getting materials for the nurses in the unit so that those nurses don’t have to keep taking their gowns off and then putting them back on as part of the elaborate safety procedures implemented due to the virus.
She hopes that assistance is not compromised due to the furloughs.
“It could get really dangerous if they don’t have those people there helping,” she said.
Morale Still Holding Firm
Clark said that up to now, morale has been holding up at her hospital.
“I think everybody’s tired but grateful to have work,” she said. “When the furloughs begin, we’ll be talking a different story.”
Both nurses, Clark and Black, are in the process of dealing with working on the frontlines of a pandemic. But they’re also accepting the business realities hospitals are coping with during the current situation.
Those realities can be complicated and are often misunderstood by the public.
Black said that although some nurses in certain sections of the hospital such as the ER have been underemployed during the pandemic, critical care nurses have been very busy. But not all nurses are qualified for critical care duty.
“Just because a nurse from the operating room has been furloughed doesn’t mean that nurse can take care of a critically ill patient,” she said.
Yet the staff at her hospital, despite the frustration and trepidation caused by the work reductions, is keeping a good attitude.
“We enjoy working with each other although the work is hard. We are a team,” Black said.
Klein said he anticipates that his hospital’s volume of business will continue to grow as it has recently.
“There’s a lot of pent-up demand that we need to meet,” he said.
He added that he hoped that the number of furloughs and staff flexing would be limited, and that layoffs will not be necessary.
“Obviously, I don’t have a crystal ball,” he said.