[ California’s hospitals struggle once more to find beds for
desperate patients. In Los Angeles County, the average number of
available hospital beds slipped to its lowest level since the pandemic
began.]
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IT’S THREE YEARS SINCE COVID ARRIVED, AND SOME THINGS HAVEN’T
CHANGED  
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Mark Kreidler
December 22, 2022
Capital & Main
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_ California’s hospitals struggle once more to find beds for
desperate patients. In Los Angeles County, the average number of
available hospital beds slipped to its lowest level since the pandemic
began. _

ERs are again being swamped with seriously ill patients., (Kaiser
Health News)

 

IN LOS ANGELES COUNTY, THE AVERAGE NUMBER OF AVAILABLE HOSPITAL
BEDS slipped to its lowest level since the pandemic began
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A UC San Diego hospital in La Jolla made plans to convert conference
rooms
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patient areas and ease the expected crunch, while overflow tents were
put into use outside the emergency department of a facility in nearby
La Mesa.

Up and down California, the scenes of hospital overcrowding eerily
evoke the early days of COVID-19’s arrival. To some of the people
trying to provide care for waves of patients during this most recent
surge, that is a huge part of the problem.

Three years in, almost nothing has changed.

“The hospital industry has once again failed to prepare for the
surge in patients needing care for respiratory viral infections,”
said Sandy Reding, an operating room registered nurse at Bakersfield
Memorial Hospital and a co-president of the California Nurses
Association (CNA). “Long before the COVID pandemic, nurses talked
about hospital employers intentionally short-staffing units and
failing to prepare for winter respiratory surges that we knew were
coming.”

The current bed shortage was predictable, critics say, the result of
years of workforce and space reductions as hospital systems squeezed
profit and asked remaining health workers to do more with less. The
pandemic pulled back the curtain on the caustic effects of that
approach, but many hospitals continue to operate in near-crisis
conditions that increasingly appear to be the way they’ll do
business going forward. 

Los Angeles County Department of Public Health Director Barbara Ferrer
said last week that the average number of available beds in the
county’s hospitals in December was “the lowest we have seen in the
past four years.” 

 
COVID-19 provided a stress test for California’s health care system,
“and we failed,” Dr. Jeanne Noble told Capital & Main one year
ago. But Noble, who directs COVID response for the emergency
department at the UC San Francisco Medical Center, also correctly
predicted what is happening now: “Any future surge will also
overwhelm us.”

THE RESULTS ARE IN. HOSPITALS CAN ADD ONLY SO MUCH bedspace after
years of contraction, and the industry’s broad general plan to work
at the lowest possible staffing levels leaves workers vulnerable to
being pushed beyond their limits in _any_ community-scale medical
emergency.

Los Angeles County Department of Public Health Director Barbara Ferrer
said last week that the average number of available beds in the
county’s hospitals in December was “the lowest we have seen in the
past four years.” On one day last week, she said, that number was
just 242 beds, with data collected from 90 hospitals.

As Ferrer noted and every source contacted for this story affirmed,
what is happening right now isn’t strictly attributable to COVID.
There are increased numbers of seasonal flu and respiratory syncytial
virus (RSV) patients — and beyond that, some hospital beds are
already occupied by patients who have finally undergone medical
procedures they put off during the most fearful months of the
pandemic.

Still, “The hospital bed shortage in L.A. County is the product of a
health care system that is designed to maximize profit all the time
instead of providing the best possible care during a crisis,” said
Sal Rosselli, president of the National Union of Healthcare Workers.
(Disclosure: Both the NUHW and the CNA are financial supporters of
Capital & Main.)

According to research by the Kaiser Family Foundation, California in
2020 had only 1.84 hospital beds per 1,000 people, the sixth worst
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ratio in the nation. But even that definition of capacity is
irrelevant if there aren’t enough nurses to tend to the patients who
would occupy the beds that do exist. Years of reducing nursing staff,
combined with job flight that has accelerated during the pandemic,
have exacerbated the problem.

TO THOSE WHO REPRESENT THE INTERESTS OF THE HOSPITALS, staffing is the
crux of the issue. Since the pandemic, “more health care workers
across the country have left their jobs than at any point in the last
20 years,” said Jan Emerson-Shea, a spokesperson for the California
Hospital Association. “In California, 78% of hospitals have
experienced an increase in staff turnover since the end of 2019.
Hospitals can’t hire workers who don’t exist.”

For years, California hospitals reduced bedspace in an effort to
shorten patient stays and lower costs, but Emerson-Shea said that
doesn’t tell the whole story today. “You can’t really put a
cardiac patient in a labor-delivery bed,” she said. Too, chronic
staff shortages at skilled nursing facilities and behavioral health
providers have led to more of those patients staying at hospitals
longer than they otherwise would, further backing up emergency
departments, Emerson-Shea said. 

“The hospital industry has embraced and normalized crisis standards
of care to increase their profits and excess revenues. This has set
the stage for the current surge to become another crisis.” - Sandy
Reding, operating room registered nurse

 
To many health care workers, the staffing issues were in play long
before COVID hit. Health care unions were protesting staff cuts for
years prior to the pandemic, and perhaps only California’s
nurse-to-patient staffing requirements
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the only such mandates in the country — have prevented more drastic
workforce reductions.

“The hospital industry has embraced and normalized crisis standards
of care to increase their profits and excess revenues,” Reding said.
“This has set the stage for the current surge to become another
crisis.”

Without a doubt, nurses and other health care professionals have been
burned out by the pressurized demands of their jobs and the safety
risks of going to work. Months into the pandemic, workers at
facilities up and down the state were still protesting their
hospitals’ refusal to provide adequate personal protective equipment
(PPE) to keep nurses and other workers safe on the job.

The nursing shortage itself, meanwhile, remains very real. A 2021
study by UC San Francisco’s Health Workforce Research Center on
Long-Term Care put the shortfall of registered nurses in California
at more than 40,000
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a gap expected to continue for years. But nursing unions say the issue
in hospitals isn’t a lack of nurses — it’s a lack of nurses
willing to work under the deliberately short-staffed conditions that
permeate the industry in the state.

“When a health care system incentivizes hospitals to reduce
capacity, it’s not a system that’s good for patients or
caregivers,” Rosselli said. In California as across the country, a
for-profit health care landscape virtually ensures that such
incentives will continue — and, once again, make for a long,
difficult winter for health workers and their patients alike.

_[MARK KREIDLER is a California-based writer and broadcaster, and the
author of three books, including Four Days to Glory
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* COVID-19
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* public health
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* pandemics
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* coronavirus
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* Healthcare
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* hospital industry
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* hospitals
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* emergency rooms
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* ERs
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* hospital systems
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* private profit healthcare
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* healthcare capacity
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* privatization
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