“Hospitals across the country are grappling with widespread staffing shortages, complicating preparations for a potential Covid-19 surge as the BA.5 subvariant drives up cases, hospital admissions and deaths.
Long-standing problems, worker burnout and staff turnover have grown worse as Covid-19 waves have hit health care workers again and again — and as more employees fall sick with Covid-19 themselves.”
“The argument here is not about whether nurses should be held accountable for their errors; everyone I spoke with about Vaught’s case agrees she bears responsibility for her actions and should face consequences. The real issue is that criminalizing a nurse’s error lets hospitals off the hook for the systemic changes that would improve patient safety.
“Almost no mistakes happen in a hospital by just one person,” said Gatter. Systems exist to prevent medical errors, he said. If those systems don’t work or exist only on paper, errors will happen.
In this case, the system failures were clear: During an unannounced visit to Vanderbilt University Medical Center in late 2018, federal investigators found multiple deficiencies, some of which placed patients at “serious and immediate threat,” according to the 105-page memo documenting the details. For example, hospital policies didn’t require that a second nurse sign off on the use of a highly dangerous medication like vecuronium, nor did it require that patients receiving sedatives be hooked up to a heart and lung monitor. Focusing the blame on one nurse’s error shifts the attention away from those deficiencies.
“I’m quite concerned that this nurse is getting thrown under the bus, and in the hubbub of giving her a jail sentence, that the system itself will escape close examination,” said Gatter.
Even if a nurse were solely responsible for a medical error resulting in patient harm, the way to prevent that nurse from causing further harm is to revoke their license, said Gatter. It’s much harder to explain how punishing a nurse with jail time further prevents them from endangering others.
However, it’s easy to see how that type of punishment can itself create and compound safety risks, he said.
That’s because severely punishing individuals for systemic problems has a chilling effect on others’ willingness to report mistakes.”
“Less transparency in error reporting also means hospitals have fewer opportunities to correct big problems. That means faulty systems stay in place, which translates into more vulnerability and stress for health care providers and less safety for patients.”
“The consequences for professional malpractice should ideally deter wrongdoing without discouraging people from entering the profession altogether — but finding that balance is challenging.”
“American nursing was under enormous strain well before the pandemic. But with the US population aging, surging retirements among bedside nurses and nurse educators, and nurse staffing levels reduced ever lower to contain costs, the pandemic has tipped parts of the country into a full-on nursing shortage.
The last thing the profession needs is another reason for nurses to leave jobs providing direct patient care, but that’s exactly the effect the Vaught ruling is having”
“Late last year, Laura Wing-Kamoosi visited her 79-year-old father at the hospital in northern Michigan. To her surprise, a worker asked her to remove her N95 and replace it with a surgical mask. She declined, layering the surgical mask atop her N95 instead.
She saw no staff wear N95s, among the best respiratory protection available, while they treated her father for a tear in his aorta and other medical issues, she told POLITICO. One doctor wore his surgical mask under his nose, she said. Her father, who was hospitalized for about a month, contracted Covid-19 during his stay, and while he survived, the virus slowed his recovery.
The hospital, Munson Healthcare, said it requests visitors wear the surgical masks it provides to ensure people are using quality masks and that it allows visitors to layer one over their own. The hospital is following guidance from the Centers for Disease Control and Prevention — and for many public health advocates, that’s exactly the problem.
They fear that surgical masks put the most vulnerable people at higher risk of catching Covid-19. N95s, which seal tighter to the face, offer better protection against the airborne virus, studies show. For more than a year, many have called on the Biden administration to change its guidance to offer more protection inside hospitals, even as mitigation measures have been dialed back and case counts decline.
And yet, patients across the country say they are often told to replace their N95s with surgical masks as they enter hospitals.”
“Residents of Fort Mill, South Carolina, had to wait 18 long years for construction to start on a hospital that state regulators determined in 2004 was necessary—and then proceeded to hold up in an absurdly long legal battle that eventually went all the way to the state Supreme Court.
Hopefully, that saga won’t ever be repeated.
The state Senate voted 35–6 on Tuesday to repeal most of South Carolina’s Certificate of Need (CON) regulations that require hospitals and other health care providers to obtain permission from the state before expanding facilities, buying new equipment, or offering new services. Often, those regulations gave de facto veto power to existing providers, which lobby health policy bureaucrats to block the approval of new competition.
That’s exactly what happened in Fort Mill, where plans for a new 100-bed hospital were tied up for more than a decade and a half, in part because a rival hospital wielded the state’s CON laws in an attempt to block the new facility, as Reason previously reported.”
“If the bill becomes law, the Charleston Post and Courier reports, it would clear the way for 28 projects that are currently tied up in legal battles despite having won preliminary CON approval. Another 34 projects awaiting review by the state’s Department of Health and Environmental Control would be able to proceed as well. The paper estimates that those delayed projects represent more than $1 billion in health care investment in the state.”
“that doesn’t include the loss of projects that never materialized in the first place.”
“As part of his emergency order issued when COVID-19 first struck in March 2020, Gov. Henry McMaster (R) suspended enforcement of CON regulations—making South Carolina one of several states to do so because of the pandemic. When it became obvious that the sky wasn’t falling in the absence of those rules, some state lawmakers rightly began to question whether they were needed in the first place”
“Before the pandemic, the flu alone could sometimes push hospital systems into crisis mode, where they cancel elective procedures and limit other kinds of care. Now there’s Covid-19, which has done the same thing on its own.
Suddenly conjuring more hospital capacity every winter to handle the expected surges of flu and Covid-19 is not going to happen. Thousands of additional hospital beds are not coming in the next few years, and the US would not have the doctors and nurses to staff them anyway. It will take much longer — years or maybe decades — to improve the gaps in America’s health care infrastructure and workforce that have been exposed during Covid-19.
This means the imperative to “flatten the curve,” to limit the spread of these viruses to stop hospitals from being overwhelmed, will be with us for a long time. But the makeup of the curve will change, measuring multiple diseases instead of one.”
“Vaccination is the best way to stop a bad Covid-and-flu season before it starts.”
“Surveillance is critical, starting with early-warning systems. Public health institutions have long monitored the flu and they are already tracking Covid-19 in a similar manner. Monitoring the amount of virus detected in local wastewater has proven to be a reliable leading indicator of new Covid-19 waves during the pandemic. And widespread, reliable testing will be essential — including at-home tests for both Covid-19 and the flu.”
“Frequent testing lets people know that they should isolate. If they are at higher risk of severe illness, they can get on antivirals quickly. The current therapies are most effective at stopping serious symptoms that could require hospitalization if they are taken within the first few days of an illness. Research in the last decade has found that flu antivirals are too often underprescribed for patients who would benefit most; improving prescription rates is only more critical now that the health system will be contending with both the flu and Covid-19 going forward.”
“The omicron variant has helped drive the United States into uncharted territory for the pandemic. The country was reporting an average of more than 400,000 new Covid-19 cases every day as of January 3, easily eclipsing last winter’s record of 250,000. And infections are still spiking, with the number of newly reported cases quadrupling since the beginning of December.
There is still a lot of uncertainty with the omicron variant: We’re still learning exactly how transmissible it is, how likely it is to cause severe disease and for whom. But we know more now than we did when it first began spreading in the US.
All the early indications were that omicron was even more transmissible than its predecessors, at least in part because of its ability to partially evade preexisting immunity, and that has proven to be true. While earlier CDC estimates that the variant took over in the US in mid-December turned out to be overstated, omicron now appears to have surpassed the previously dominant delta variant in its share of new US cases.
With cases rising, so is the number of patients in the hospital with Covid-19. But, at least so far, hospitalizations are not rising as rapidly as infections, lending credence to the theory that omicron leads to less severe disease, particularly for vaccinated people. Deaths have barely budged over the last month, with about 1,250 new deaths being reported every day as of January 3, essentially unchanged from the 1,125 daily average on December 3. While there is always a time lag between new reported cases and the data showing more serious illness, the evidence, including biological research findings, that omicron poses less of a threat to each individual patient is only growing.”
“One hospital being overwhelmed isn’t a one-hospital problem, it’s an every-hospital problem. Even if your community is not awash with Covid-19 or if most people are vaccinated, a major outbreak in your broader region, plus all the other patients hospitals are treating in normal times, could easily fill your hospital, too. That makes it harder for the health system to treat you if you come to the ER with heart attack symptoms or appendicitis or any acute medical emergency.”
“Before being able to break ground on a new hospital there, Piedmont Medical Center had to navigate the state’s Certificate-of-Need (CON) process, which in this case required going all the way to the state Supreme Court to fend off a legal challenge from a competitor. All that to build a 100-bed facility that the South Carolina Department of Health and Environmental Control had determined, all the way back in 2004, was indeed needed in the region.
Unfortunately, “need” is not enough in many cases. Like how zoning laws and mandatory environmental reviews might be well-intentioned policies but are frequently wielded by “not in my backyard” (NIMBY) activists as a way to tangle new development in costly piles of red tape, the CON laws on the books in many states can be used by existing hospitals to delay or prevent new facilities from opening.
That’s exactly what happened in Fort Mill. A hospital chain based in Charlotte challenged Piedmont Medical Center’s plans for a new facility, then sued to block the state’s decision to give Piedmont permission to build the hospital. The litigation cost thousands of dollars and delayed construction by several years. Researchers at the Americans for Prosperity Foundation, a free market think tank, argue that even the threat of such lengthy, expensive reviews ends up deterring investments that would otherwise take place.”
“Artificially limiting the supply of health care services can be a major issue when a pandemic or other emergency strikes, of course, but CON laws harm public health even without the help of a novel coronavirus. States with CON laws have higher mortality rates for patients with pneumonia, heart failure, and heart attacks, according to research published in 2016 by the Mercatus Center, a free market think tank that argues for repealing CON laws. Other studies show that CON laws contribute to health care shortages in rural areas because they force medical providers to focus on wealthier, more populated areas in order to make up for the added costs imposed by the CON process.”
Adding extra critical-care beds in other departments or buildings takes precious time, resources, and space. But adding trained staff is much more difficult, especially deep into a pandemic.
When trained staff are in short supply, it’s even harder for hospitals to best meet the needs of critical-care patients. These patients include people very sick with Covid-19, but also many who need to be in the ICU for other reasons, such as those who have had a heart attack or stroke, are recovering from major surgery, or are sick with the flu, among others”
“it is not just ICU physicians and nurses who are in short supply. “Critical care is more of a team sport,” Garner said. “This means physician-delivered care and interventions, but also careful medication selection dosage with pharmacists, skilled nursing care, respiratory therapists, midlevel providers, nutritionists, early mobilization with physical therapists.” To that list, Nagle also adds all of the other hospital staff needed to perform other essential tasks in ICUs, including bathing patients, changing linens, and other functions.”