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The latest news about the novel coronavirus and COVID-19 in Montana.

Staff shortages plague hospitals as COVID patients fill half of Montana’s ICU beds

A COVID-19 patient in the Billings Clinic ICU lays in the “prone” position that helps them breathe, Oct. 05, 2021. Billings Clinic’s 24-bed ICU has swelled to 40-plus patients at times, and the hospital has regularly been unable to take more patients.
Aaron Bolton
/
Montana Public Radio
A COVID-19 patient in the Billings Clinic ICU lays in the “prone” position that helps them breathe, Oct. 05, 2021. Billings Clinic’s 24-bed ICU has swelled to 40-plus patients at times, and the hospital has regularly been unable to take more patients.

As COVID-19 cases and hospitalizations decline across the country, the pandemic in Montana has continued to get worse. The average number of hospitalizations grew by nearly 40% over the past month. Health care workers are trying to keep up, and some are pushing the state to do more to help.

Thirty-three-year-old Brandon Brigham says he wasn’t taking the pandemic seriously before he landed in the ICU at Billings Clinic.

“[I] Just didn’t think it was a big deal, hanging out at the bar, playing pool,” Brigham says.

Hooked up to oxygen, Brigham spoke to me from his hospital bed on speakerphone.

“You know, yesterday I thought I was going to die. It’s pretty terrible.”

Looking through his ICU window, Brigham says if he makes it out of here, he plans to get vaccinated, and he hopes stories like his get others to do the same.

“[I] Just didn’t think it was a big deal, hanging out at the bar, playing pool ... You know, yesterday I thought I was going to die. It’s pretty terrible.”

Elsewhere in the Billings Clinic, ICU staff are monitoring another patient’s vitals on a bank of computer screens as an alarm goes off. The COVID patient’s oxygen levels plummet and a clerk calls for a nurse.

Billings Clinic ICU has been caring for 40-plus patients in recent weeks, nearly double the number of beds in the ICU.

Billings Clinic serves as a regional hospital for Montana and northern Wyoming. When the ICU and other areas of the hospital are stretched beyond capacity like this, the hospital can’t take patients from around the region.

Billings Clinic CEO Dr. Scott Ellner says the largest barrier to opening more beds is a staffing shortage, and his hospital has had to rely on traveling clinical staff that can cost about $200 an hour on average.

“We have to spend that money because we need the resources. The challenge is that if we don’t, we’re not going to be able to serve our communities.”

A sign just outside of Billings Clinic’s ICU asking visitors not to be aggressive. Staff say they’ve been regularly yelled at, spat at and even assaulted over COVID-19 visitation restrictions.
Aaron Bolton
A sign just outside of Billings Clinic’s ICU asking visitors not to be aggressive. Staff say they’ve been regularly yelled at, spat at and even assaulted over COVID-19 visitation restrictions.

Billings Clinic isn’t alone in its struggles. For the last three weeks, COVID-19 hospitalizations in Montana have bounced around from the low to mid-400s, getting closer to last fall’s peak. But patients are sicker this time around because of the delta variant, and the Montana Hospital Association says COVID patients are taking up over half of the state’s ICU capacity.

Republican Gov. Greg Gianforte’s administration has sent about 140 National Guard troops to hospitals across the state to help with non-clinical work. The administration also says it’s helping hospitals get federal reimbursement for costly traveling medical staff, but hospital officials say that reimbursement is only for COVID-related care.

Head of the Montana Democratic Party and former Director of the Montana state health department Sheila Hogan says the state proactively contracted over 200 medical staff last fall to help hospitals keep up.

“This is the first time during this pandemic that our hospitals, our health care facilities are reaching a breaking point. We’re really seeing a crisis of leadership,” Hogan says.

The Montana Hospital Association has asked the Gianforte administration to use federal COVID relief dollars to contract traveling staff like nurses and respiratory therapists, especially for small critical access hospitals that can’t afford them right now. Gianforte’s administration declined to do that. Spokesperson Jack O’Brien says the administration will find other ways to help hospitals obtain staffing, though no additional details were provided.

“The worst thing is that we had so much hope when the vaccine came out. We thought we’d never be here again.”

However, it’s not just staffing resources that are needed, says former state health department epidemiologist Jim Murphy, who worked in both the Bullock and Gianforte administrations. He would like to see the return of weekly press conferences providing updates on the pandemic and pushing the importance of masking and vaccines. Those kinds of press conferences are not happening under Gov. Gianforte.

“It’s a different approach and we’re definitely at a different phase in the pandemic, but with the numbers where they’re at, it looks like the need for that is still there,” Murphy says.

Gov. Gianforte declined MTPR’s interview request for this story.

While Gianforte has said vaccines are the way out of the pandemic, public health officials and medical organizations say bills passed by the Republican Legislature and signed by Gianforte have hampered the response by banning vaccine mandates and enforceable mask rules at the county level.

Lauren Wilson is the Vice President of the Montana Chapter of the American Academy of Pediatrics. She says Gianforte and other Republican officials’ pushback against masks in schools also hasn’t been helpful.

“Pediatricians started seeing more children in their offices probably in August before school started, but we’ve seen the rate of new infections definitely rise after school started.”

Wilson says that increase is because many schools aren’t requiring masks. Wilson adds that an emergency rule the Gianforte administration issued about masking in schools is particularly problematic. The emergency rule claimed that studies have not proven masks to be effective and could even harm children, counter to what federal health officials say.

“And I find it hard to believe they took any advice from people with a scientific background, an epidemiology background, in coming up with this list of literature, which really is either cited inaccurately or is not part of the scientific literature that really strongly supports the positive effects of masking and preventing transmission,” Wilson says.

Billings Clinic emergency department staff have set up temporary stations to see patients when the waiting room becomes too full. They've also added several beds in the hallway, and at one point were treating patients in a conference room.
Aaron Bolton
Billings Clinic emergency department staff have set up temporary stations to see patients when the waiting room becomes too full. They've also added several beds in the hallway, and at one point were treating patients in a conference room.

An internal letter from DPHHS epidemiologists, first reported by the Montana Free Press, said the evidence presented by Gianforte’s administration didn’t support its claims about masking and “contributes to the spread of misinformation.”.

Back at the Billings Clinic ICU, nurse Laurie Sutphin sees the consequences of the pandemic daily and says the onslaught of unvaccinated patients just isn’t sustainable.

“One of the nurses said something; She misses seeing her patients get better and walk out of here.” And that’s happening less and less, Sutphin says.

Sutphin and other medical staff here are pleading with Montanans to get vaccinated. Otherwise they say waves of hospitalizations and death will just keep coming.

“The worst thing is that we had so much hope when the vaccine came out. We thought we’d never be here again.”

Montana’s vaccination rate has been slowly ticking upwards and sits at 53%, a rate below the national average.

While there’s hope vaccines will eventually get Montana out of a cycle of COVID surges, case numbers continue to tick up, and hospitals like Billings Clinic say they are inching closer to rationing care.

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