On today’s episode of the 5 Things podcast:
Keeping a hospital fully staffed on a day to day basis is no easy task. Throw in an emergency like an outbreak, a hurricane or a pandemic and the situation gets critical. In fact, a USA TODAY analysis shows there has been a steep decline in hospital beds around the country. That means fewer patients can be treated at hospitals at any one time.
We sat down with Jim Kaufman the CEO of the West Virginia Hospital Association who talked about some of the challenges in keeping the right amount of workers during the COVID-19 pandemic. We also spoke with USA TODAY’s National Correspondent Donovan Slack and USA TODAY’S Investigative Reporter Erin Mansfield about a little known workforce deployed by the government to work in hospitals during times of emergency. But is it enough? Will it be enough for future emergencies?
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Hit play on the player above to hear the podcast and follow along with the transcript below. This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.
James Brown: Hello, and welcome to 5 Things. I’m James Brown. It’s Sunday, April 3rd, 2022. On Sundays, we do things a bit differently, focusing on one topic instead of five. This week, we’re learning how the system that’s designed to support your local hospitals in emergencies isn’t working well. It’s not easy keeping hospitals staffed in good times, let alone in major emergencies like outbreaks, hurricanes and pandemics. Jim Kaufman would know, he’s the CEO of the West Virginia Hospital Association. He spent most of his career representing the interests of medical facilities. He says, keeping the right amount of workers has gotten harder during the COVID-19 pandemic.
Jim Kaufman: I think one of the things that you’ve seen due to COVID just the sheer pressure on frontline caregivers and the sheer number of patients that they were burnt out mentally, physically, spiritually, and may have decided to retire early. So this has been a problem that’s actually been exacerbated with COVID.
James Brown: A USA TODAY analysis shows that there has been a steep decline in hospital beds around the country. That means fewer patients can be treated at hospitals at any one time. Then came the Omicron variant of COVID-19 back in December. As concerns that hospitals would be flooded with new patients reached the White House, President Joe Biden announced how his administration intended to address the surge.
Joe Biden: Since this summer, we’ve worked with Republican and Democratic governor as many Republican governors, as democratic governors to deploy what we call surge response teams. These team’s work, they provide needed staff for staff overruns that is badly needed staff where overrun hospitals are handling more patients than they can handle for their emergency rooms and intensive care units who don’t have a personnel available. They help provide lifesaving treatments and communities in need like monoclonal and antibody treatments. We have over 20 teams deployed now. Today I’m announcing that we’re going to triple that, more than double. We’re going to get to 60 teams ready to deploy in states experiencing the surge cases over the course of this winter.
James Brown: USA TODAY national correspondent, Donovan Slack says these little known workers are the last resort for stressed hospital systems.
Donovan Slack: And what we found was that the federal government failed to hire enough workers to be able to fill those needs, particularly during the Omicron variant. That variant as you know, it was just really difficult. It really laid bare these tragic shortfalls that already existed within this reserve of medical personnel. So we found hospitals were asking for this federal help that just wasn’t there.
James Brown: So who are these workers? There are three varieties. USA TODAY investigative reporter, Erin Mansfield explains.
Erin Mansfield: The federal government has a couple of pots of workers. There’s big one, it’s a branch of the military that you’ve never heard of because they don’t carry guns. I keep saying they carry stethoscopes or other medical equipment.
James Brown: One of them is known as the US Public Health Commissioned Corps. It’s part of the Department of Health and Human Services.
Erin Mansfield: They have day jobs, maybe they read inspections for the FDA, maybe they’re tracking diseases and data at the CDC. Maybe they’re working on an Indian reservation, helping people get their basic vaccinations. All kinds of day jobs like that within HHS. And then a hurricane comes, any other disaster that requires a public health response comes and the secretary of health can say, “Hey, you guys all you, you’re going to Puerto Rico, you’re going to New Orleans, you’re going to Houston.”
James Brown: Another pot is the National Disaster Medical System.
Erin Mansfield: A lot of them have jobs in emergency rooms or other places in hospitals, within their communities, public and private hospitals and so on.
James Brown: There are little like the army reserves, but the trouble is, the system isn’t working as promised. Donovan Slack explains.
Donovan Slack: The government was able to send out obviously certain teams of workers, for example, they sent out 2,000 workers during the height of Omicron from the few days after Thanksgiving through actually a few days ago, but you had like 1,200 hospitals asking, not necessarily asking, but certainly needing this help. They were facing critical staff shortages. And you can see that in the HHS data. It’s just no one expects this reserve to be able to fill every need or fill every shortage. But they had so few compared to the need and compared to what they set out to hire a few years earlier. It just became really evident that there just weren’t enough.
And Erin can talk to you about years ago, under the Trump administration, they set goals to hire thousands of these, but the need goes back much further.
James Brown: So let’s go there, Erin.
Erin Mansfield: BY barring going all the way back to, the invention of the wheel or any other problems we stopped at basically Hurricane Katrina, that’s as far as we went. So that’s about 17 years ago. And I think a lot of us remember Hurricane Katrina in one way or another, whether we experienced it or watched the devastating toll it took. But back then, there were not enough medical workers. There were field hospitals that were there trying to set up, trying to help people, doing wonderful things that everyone considered heroic, but there weren’t enough of them. And that was under George W. Bush, that was 17 years ago.
And they came out with report after report, after report saying there are not enough people, and acknowledging there are heroic efforts from these federal medical workers, but pointing out, we need more. And it kept going. They tried to create something new in 2010 that would augment it. I don’t know if anyone remembers the law Obamacare. There was something in there that was going to expand, create a new pool of federal medical workers. That didn’t happen. Their law was poorly written, it was badly designed, it just did not happen. We can fast forward to the Ebola outbreak. That was something in 2014, our fear under Ebola was that it was going to come from Africa to the United States.
So the US sent a lot of personnel to West Africa, sent them to West Africa to have them treat patients, treat the doctors who were treating patients, because who’s left to treat the doctors if all the doctors are treating patients? And they came out after that and said, “This group was really best suited for a domestic emergency.” They couldn’t do this. Did they do great things? Absolutely. But they found a shortfall there. And then the next high point would probably be 2017 with the hurricanes that devastated Puerto Rico in the Virgin Islands, namely Hurricane Maria, which was the second in this series.
And 2017 was a really bad hurricane season. There was Harvey, and then there were two in the Caribbean, in our US territories. And it fluxed the system. They tried really hard, they were leaning on the Pentagon to provide care to people. And what they found was, it’s great to send the military in some ways because it’s great to have doctors, but if you’re a military doctor, you’re probably really good at gunshot wounds. And these really critical, this trauma care, you’re not really there to say, take care of an older person who they’re in the hospital sure, because of the hurricane, but they also, maybe they didn’t have like their medicine because they had to evacuate their house.
So what they were finding then was they were leaning on DoD and it just wasn’t appropriate for people who needed just a different type of care, a lot of people who also happen to be elderly, and not a lot of elderly soldiers out there, it’s just a different population that the Pentagon deals with. They tried to fix things after that, I spoke to two men who ran some of these pools in the Trump administration, who very, very earnestly were trying to improve this situation. One of them, he got hiring authority and he was able to speed up this bureaucratic mess that he was going through, but by the time it ran out, he didn’t have enough people. He didn’t reach the goal.
Another pool of federal workers, he actually spent a couple of years just trying to stop his medical workers from being cut, just trying to stop budget people from cutting his budget, from cutting his personnel. And then was like, “No, we’re going to try to increase it.” And then the clock ran out, then pretty much COVID hit. And now we’re in this mess where hospitals call for help that just isn’t there. They get some, they’re happy for it, but it’s not enough by any stretch of the imagination.
James Brown: So it sounds like a cascading failure by that’s bipartisan, administration after administration, it doesn’t matter who’s in power, they’re all making similar errors.
Donovan Slack: Yeah. And I think it’s key to point out that errors were made here, and the government accountability office came out with a scathing report saying that as earnest as these men were trying, at the end of the day, it was a bunch of bickering and inter-agency finger pointing that screwed up, bungled the hiring effort, delayed it, they made decisions that didn’t work. One of them that I remember is that they decided to hire people to be these key federal medical workers in cases of disaster, but they only hired them for a two-year period, meaning, so they barely are getting people on board and then they have to renew them and go through another hiring effort. And then after four years, they have to rehire them all over.
So, if anybody knows anything about the federal hiring process in the first place, it’s really cumbersome. And then as Erin said, they got this critical authority to skip some of those steps and speed it up, but then they made these kinds of decisions about not actually appointing them to permanent position, which previous administrations had done. And when the GAO went in there and said, “Why are you guys doing this? Why are you appointing them to these two year things when you just have to redo it all over again?” And one office said, “Oh, it was the other office.” And then that office said, “Oh, no, it was this office.”
There’s a quote in the report that says, “This alone illustrates the problems and what has plagued this effort and why it’s screwed up.” So that is before COVID hit. And then you’ve got COVID, and GAO did issue this report, and it says, “The federal government, you guys need to do more. You need to do more to make sure you have enough of these federal medical workers.” But when President Biden took office, his main focus was vaccination. Clearly, we were just getting those vaccines out, it was so important to get them into arms, but in this 200 page plan that he released the day after he was inaugurated, nowhere in there does it mention the need to expand the ranks of federal medical workers.
So it just appears to have fallen off the radar, and at the end of the day, it’s the patients who are lined up in those hallways, it’s the staff that are suffering burnout. I think we’ve all heard those stories. Certainly we had some in our story this week, one of them showed a nurse in Wisconsin. Take Wisconsin, this is a state that applied for more than 200 federal workers, they got 23. Now, we talked to this nurse, an executive who described how a nurse who’s really dedicated show up to a meeting, and she just crumpled in tears because she learned how many people had died the week before.
She said, “I didn’t become a nurse to watch people die.” Now this happens obviously, and has happened all over the place during COVID. But when you have a possible lifeline that could have possibly helped, you have to ask the question.
Erin Mansfield: And our story really combined how the federal government could have helped fix, let’s say situations that people like the CEO of the Hospital Association in West Virginia are feeling. It’s pretty universal. We talked to 19 states, granted there are 50 states, but we heard a very similar story throughout, burnout. The state trying to hire people, albeit with federal money, but the state literally going to temp agencies, hiring people saying, “Okay, now we’re going to send these people to X hospital and Y hospital, and Z hospital. And that’s how we’re going to do it.”
In West Virginia. One of the things that was very interesting is their hospital association found the same thing we did in the HHS data, which is that they have fewer beds as a result of having fewer staff. Because think we talked before, if you can have as many beds as you want, but that is a mattress store, that’s not a hospital if you don’t have workers who are there taking care of those people,
James Brown: Jim Kaufman, the CEO of the Hospital Association, Erin mentioned says staffing has been the biggest issue of the last two years, but that’s not exactly a new problem either.
Jim Kaufman: People don’t realize we’ve actually lost a large number of clinical staff, not just nurses, but doctors, therapists, and even environmental workers and other non-medical staff within the hospital, simply due to exhaustion, they’re burned out, they’ve retired early, or they’ve moved to other states for greater financial opportunity than they can receive in West Virginia.
James Brown: Burnouts and money for the most part.
Jim Kaufman: That’s exactly right. One of the challenges in West Virginia is the average hospital, 75% of our pay patients are covered by governmental programs like Medicare and Medicaid that all reimburse hospitals significantly below the cost of care. So the West Virginia Center for Nursing noted, the biggest reason nurses did not renew their license in West Virginia was compensation. They could go elsewhere in the country because the national demand for healthcare professionals and get a higher compensation than they can in West Virginia. And the hospitals are limited what they can pay because of what we’re getting reimbursed by Medicaid and Medicare, these governmental programs.
James Brown: Based on the conversations you’ve had, would you say this was compounded by COVID-19 or was this already existing phenomena?
Jim Kaufman: That’s a great question. Actually, it’s been exacerbated by COVID. We knew across the country, we had a graying healthcare professional workforce. For example, about half the nurses in West Virginia or over the age of 50. So we knew not just in West Virginia, but across the country, a lot of healthcare professionals were approaching retirement. So I think one of the things that you’ve seen due to COVID just the sheer pressure on frontline caregivers and the sheer number of patients that they were burnt out mentally, physically, spiritually, and may have decided to retire early. So this has been a problem that’s actually been exacerbated with COVID.
James Brown: Has this affected the level of care that folks have received overall? I know things are delayed, but are folks simply not getting those procedures instead of delaying them?
Jim Kaufman: What was happening before, in West Virginia, during the peak of the COVID surge, we had a significant number of our hospitals and what they call Crisis Fingertip Care, where they were literally trying to figure out how to best care for their community. You may see patients that would traditionally be transferred to larger institutions that have more resources. They may not be transferred because they don’t have the space, so they may be staying in smaller hospitals. Now, what I appreciate was the hospital community, even though it’s a free market, and it’s very competitive, it’s unlike any other market because I’ve never seen people work together.
I may be competing with you one day for patients, but I’m going to make sure you have the resources to the best of my ability to care for your community. So what you were seeing was instead of patients being transferred, traditionally, they may be using telehealth services or providing other support so that smaller hospital who may not have traditionally cared for that level of patient has more resources to better support that patient. So to your point, yes, there has been some changes during the peak, simply due to lack of resources.
James Brown: It seems like it would oversimplify things to simply say, “Hey, let’s just get more resources.” So what steps could be taken to alleviate some of this pressure?
Jim Kaufman: Actually, and I got to be thankful to Governor Justice in West Virginia and policy makers at the state legislature, because they recognized this challenge and they actually worked with us on two fronts. One, our Governor Justice announced To Save Our Care Initiative back in the fall, to provide some emergency funding for hospitals, to help compete with increasing salaries and to help hospitals pay retention bonuses overtime and the increasing cost for temporary staff. So that was an immediate help to try to deal with that. Now, it wasn’t a 100% funded, but it was dollars to help alleviate some of that pressure.
Simultaneously, he announced an effort to try to increase the number of nurses and other health professionals over the next couple of years. So he announced the higher education effort to look at how do we increase the number of staff with the goal of increasing 2,000 nurses over the next two years. But what I appreciate was instead of just looking at the traditional programs, he charged a Higher Education Policy Commission with looking at new models, how can we get young people to licensure fast? How do we provide some of that support faster. Simultaneously, the hospitals are looking at how do we help retain those folks? How do we provide the emotional support, the mental support that they need as they’re caring for patients?
But also looking at new models of care, what does team-based care look like? How can we use other health professionals? So we’re truly utilizing the few number of clinicians we have to the maximum capability while not burning them out.
James Brown: I would imagine with issues like you’re describing that convincing someone to commit their lives to an industry roles that people are burning out from left and right would be difficult, even if the compensation did go up. Is this something that’s… Go ahead.
Jim Kaufman: I think one of the challenges we have is, people see what’s been going on in the hospitals and with COVID and I think some may say, “Oh, wow, that’s not the professional for me.” But then again, others look and go, “Wait a minute, I’m here to take care of other people. My goal in life is to help support and care for people.” And some of the national numbers that I’ve seen, we’ve actually seen increases in medical school and nursing school applications. And that’s one of the things I’ve always been appreciative of is people that look to these professions and they recognize that they want to care for their community. And we just got to make sure we’re taking care of them as well.
And that’s why I’m always appreciative when I hear anybody say, “The frontline caregivers, thank you for all that you’re doing.” But it’s not just doctors and nurses, it’s also environmental staff, nutritional services, these nonclinical folks that make a hospital run. I always joke around hospitals are small cities. We employ everything from IT to security guards, to housekeeping. All of them are critical to making sure that community value, that community benefit called a hospital is there when needed.
James Brown: If you like the show, write us a review on Apple Podcast or wherever you’re listening, and do me a favor, share with a friend. Thanks to Donovan Slack, Erin Mansfield, and Jim Kaufman for joining me. Let us know what you think. Our contact information will be in a description along with links to more pieces on the US government’s emergency medical personnel. Thanks to Alexis Gustin for editing this episode. Taylor Wilson will be back tomorrow morning with 5 Things you need to know for Monday. For all of us at USA TODAY, thanks for listening. I’m James Brown. And as always, be well.
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George is Digismak’s reported cum editor with 13 years of experience in Journalism