Montana’s rural critical access hospitals are struggling as COVID-19 patients fill beds and strain staffing resources. Larger hospitals are at times unable to take patients.
Dr. Kelli Jarrett is opening the door to the Libby’s Community Health Center where she’s a family physician. The building sits just across the street from Cabinet Peaks Medical Center, one of 49 critical access hospitals in Montana. Jarret is also a fill-in hospitalist at the medical center.
"We've already at this point experienced a situation where we weren’t able to transfer somebody."
Jarrett explains that Cabinet Peaks is the only critical access hospital in the northwest corner of the state. That means it relies on sending patients who need ongoing care to Kalispell Regional Healthcare in the Flathead Valley. But that wasn’t an option with a recent COVID-19 patient.
"Thankfully that person got remdesivir and was able to be discharged without ever getting close to ventilation, but it could have gone differently," she says.
Patients at critical access hospitals like Cabinet Peaks usually don’t stay longer than 4 days. The hospital only has 16 beds, fewer than the 25 bed limit needed to become designated as a critical access hospital and receive benefits from the federal government to help them stay open.
Jarret says Cabinet Peaks will likely assume a bigger role in providing more than short-term care as larger hospitals' inpatient beds fill and the number of COVID-19 cases around the state grow.
Dr. Brian Bell with the Cabinet Peaks Medical Center says the inability to transfer even one COVID-19 patient can impact the help other people seeking care receive.
"If we are taking care of an active COVID patient, we basically are using twice the number of nursing staff to take care of that patient than a patient without COVID."
According to the Montana Department of Public Health and Human Services’ latest report on hospital capacity in the state, most Cabinet Peaks inpatient beds are open. But that wasn’t always the case as COVID-19 cases increased in recent weeks. Over 90 percent of its inpatient beds were full for a time in early October. Bed numbers can quickly change.
"We have approached other regional facilities: Spokane, Coeur D’Alene, Missoula, who are more than willing to take patients if we need to," Bell says.
While beds are now open at Cabinet Peaks, other facilities like Frances Mahon Deaconess Hospital in Glasgow are in a much more dire situation.
During Wednesday’s Valley County health board meeting, the hospital's CEO Randy Holom said many staff are in quarantine, making it hard to care for the hospital’s 14 COVID-19 patients.
"If this pattern continues we are going to exhaust our capability of caring for the community and have to divert patients to other communities. As Dr. Mallard already mentioned, there’s no beds in other communities either."
Holom says the hospital ran out of beds this week and is asking the state for help.
President and CEO of the Montana Hospital Association Rich Rasmussen says critical access hospitals across the state are struggling with staffing and could be overwhelmed as providers are exposed or test positive for COVID-19.
"Our caregivers, in serving these very small communities, they don’t have a very deep bench of nurses, certified nursing assistants and others."
Gov. Steve Bullock has requested medical staffing from other states and the National Guard, but so far those calls have gone unanswered.
Back in Libby, Michelle Boltz is the only nurse practitioner hospitalist on staff and she’s worried about what would happen if she and other providers, such as the hospital’s only general surgeon, are exposed.
"Say there’s a car accident; a lot of times those kinds of injuries are time sensitive and they require an immediate response, and we would not potentially have a surgeon available in that situation."
If a respiratory therapist isn’t available, that could mean providers who haven’t touched a ventilator since med school could be asked to operate one in an emergency situation, with someone walking them through the details over the phone. Again, Dr. Kelli Jarrett.
Dr. Jarrett says, "It’s definitely something that — I know I, and probably every provider that lives in this community — would be pretty uncomfortable with.”
Jarrett says there may be no avoiding that situation as cases rise and hospitals across the state and region scramble to keep up.