COVID-19 has pushed an Oklahoma hospital to the brink

By Michael Kinney

 LAWTON, OK. — Dr. Scott Michener saw it coming. The chief medical officer at Comanche County Memorial Hospital knew the rising COVID-19 infection rate in Oklahoma had left his hospital with scarce lifesaving and at some point, they would run out.

On Nov. 10 CCMH was nearing that breaking point when Michener saw they had just one ventilator left that wasn’t being used. During the middle of a pandemic, they were one surge away from having to make some dire decisions.

“If two people come in during that time, we’re scrambling around trying to free up a ventilator,” Michener said. “If two people come in that both need a ventilator, you’re rationing care. You are saying, ‘We don’t have a ventilator.’ We don’t want to be there. No hospital does.”

Fortunately, Michener didn’t have to make that decision. But as the COVID-19 positive cases continue to spiral up and ICUs fill up with patients, these are the difficult decisions he’s had to prepare CCMH to make. 

“We have an allocation protocol that I actually wrote it based on New York’s protocol. You take emotion out of the equation. You can’t be emotional,” Michener said. “The way it’s written, if you have to decide, if you have names and personal information off the table and have three physicians review the case and if you’re 90 and you’re going to die anyway, you’re not getting a ventilator or if you’re 30 and it’s likely you’re going to recover without a ventilator, you’re not getting a ventilator. That’s everyone’s logic. Try to close down both ends; those at the end of life and those that will probably get by without one. That’s the strategy, but it’s not good, man.”

That is the situation statewide hospitals like CCMH find themselves in after COVID-19 infection rates spiked to record highs this month. The influx of hospitalizations has created an environment with limited resources and staff.

As of Nov. 17, more than 158,000 Oklahoma residents have tested positive for COVID-19 since March. That includes 1,544 deaths.

Comanche County has seen its totals rise to 3,574 cases and 27 deaths while Jackson County has tallied 1,534 cases and 22 deaths as of Tuesday.

CCMH is one of several hospitals throughout the state that has been placed in the tier 3 surge plan. Areas in tier 3 are advised to cancel non-emergency operations.

The possibility of having to ration healthcare services has weighed on Michener.

“We’re at the point now where if you live in Lawton and you’re needing hospitalized for COVID, we were looking at the list this morning,  Woodward had a bed, Alva had some beds, Integris Enid had a bed,” Michener said. “If we’re full and you need COVID care, you could be sent from here to Alva or here to Woodward or here to Enid and that’s the governor’s plan of trying to even out the workforce, but once they all get full, then there’s nowhere to go.”

Michener said CCMH does not want to send residents to other hospitals unless they have to. But the rate of hospitalization due to the spread of COVID-19 has gotten so high that the only way hospitals are finding beds for patients is if either some recover and are able to go home or they succumb to the virus and die.

Michener said CCMH had four deaths in one day during the weekend. They were between the ages of 60-72.

“The problem is we went on emergency room divert (Monday), which means telling the ambulance don’t come here. However, Southwestern is on ER divert, too, so there’s nowhere for people to go,” Michener said. “Obviously, we would not turn someone away. We have 34 ER rooms and we had 20 of them taken up with patients. Fourteen of them are critical care patients. Our ER is down to 10 rooms. That makes it extremely difficult to provide good care. On the trajectory we’re on, it’s a bad trajectory. If we don’t do something to change the course, I don’t think it’s going to be well.”

Michener said nurses and doctors are doing everything they can to provide the type of care patients need. Yet, the numbers are unrelenting and staffs that were already stretched thin are being pushed even further. “Healthcare providers are being infected as well with COVID or they’re being quarantined because they have a family member that has a direct contact,” said Brandie Combs, the District 5 Regional Director for the Oklahoma State Health Department.  “So you may have more hospital beds available in a particular hospital, but if you don’t have the nurses to work those beds, then you can’t allow an admission of a patient.”

Nurses at Comanche County Memorial Hospital

According to Combs, the strain the healthcare workers have been under as the COVID-19 threat continues to grow is immense.

“Our public health workforce, the nurses that are doing all of the testing and the case investigations and trying to track people down to let them know that they have tested positive and working with the schools, some of our nurses haven’t had a day off in months and they are fatigued,” Combs said. “The whole system, our healthcare system, our public health system is stretched and it’s just about at capacity as far as workforce, as far as being able to handle the demand. I mean, there’s just a lot at play right now.”

Yet, with the holiday season approaching, Michener fears those numbers they have already seen will be dwarfed and the healthcare system won’t be able to handle it.

“The problem is if it’s much more, and hospitals have limited resources, I mean, we have limited ventilators, we have limited nurses,” Michener said. “There’s going to be a point there where we can’t. And it’s just a straight-up fact. It’s not that we’re going to not want to it’s that we can’t.”

Michener is asking residents to start wearing masks and socially distancing if they haven’t been doing so. He says there is still time to turn things around, but it’s on the public to make it happen.

“Give us time. The vaccine is coming,” Michener said. ‘We need time. We need a month. We need a month or six weeks to try to get our numbers down because the trajectory that we’re going on is not going to be good. I don’t know if we’re going to plateau or go down, but I don’t know what we’re doing to change the pattern that we’re on. That’s the situation we’re in. I hope something changes, but I don’t know what it’s going to be.”

Michael Kinney Media

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