Steven Hannah, 52, couldn’t have taken over the job as CEO of a small, rural hospital at a worse time. Because of the COVID-19 pandemic, from his first day at the helm of Hazel Hawkins Memorial Hospital on Nov. 1 he has been scrambling to keep the facility safe and operational as people continue to test positive for the virus.
“This is probably the biggest challenge we’ve seen in our healthcare systems in my career,” he told BenitoLink on Dec. 7. “It’s a significant and serious time for Hazel Hawkins. For the most part, COVID stretched our resources to the thinnest level.
“The good news side,” he continued, “we’ve got excellent people that predate me. I joined a team already in place who have addressed the issues and will continue to do so. I feel I’m as prepared as any CEO coming into this type of environment.”
On Dec. 4, Gov. Gavin Newsom issued an executive order declaring a state of emergency throughout California. The state’s public health officer ordered all residents to stay home if intensive care unit availability drops below 15%.
As part of the order, San Benito County—along with Merced, Kings, and Stanislaus counties— is included in what is called the San Joaquin Valley Region. As of Dec. 9, the region had 4.2% ICU availability.
A total of 2,264 people in the county have tested positive for the coronavirus since February. There were 358 active patients, 1,887 have recovered and 19 have died. The county’s positivity rate is 8.4%.
As of Dec. 9, Hazel Hawkins ICU availability was zero and it was 100% of normal capacity, meaning all four ICU beds and the remaining 21 regular beds in the hospital were filled with patients. While this might seem dire to San Benito County residents, Hannah said the hospital maintains “surge capacity,” meaning that each day hospital staff monitors the number of beds that can be made available.
To be clear, he said, “Just about every bed is filled, but we still have some capacity in our OB unit, and we have a little bit of a revolving door with patients. However, today (Dec. 7) we have some really sick patients that are non-COVID and we have six or so patients who have COVID.”
None of the 25 beds in the hospital are specifically designated for COVID-19 patients. One wing, though, is set aside for a potential surge. There are seven COVID-19 patients as of Dec. 8, with one on a ventilator.
In hindsight, Hannah said the decision to seek out the critical access hospital designation that called for a reduction in beds from 45 to 25, was “the right thing to do” because even though the term “critical” is now attached, he said the hospital doesn’t really change in its overall mission.
“We’re still an acute-care hospital,” he said. “We still have emergency services, in-patient services, surgeries, and the full gamut of services. What changed is how we’re reimbursed by the Medicare program. Our bed licensure has been mandated to be 25 or below, but historically it’s been well below that. But now we’re being paid by Medicare at a rate that at least covers our costs in providing care to Medicare patients.”
The hospital can get a waiver to increase its bed capacity should there be a surge, but this would be dependent on available staffing. Hannah said the beds that were taken away are still available should they be needed.
“The real bottleneck, though, is in the staffing,” he said. “No hospital can expand its capacity beyond what it can provide staff for additional beds.”
There is some help with medical staffing, though. There are approximately 470 part- and full-time employees at the hospital, including nurses. The number of doctors fluctuates because most have private practices and contract to work with the hospital.
“We do have some traveling nurses in-house, but the challenge is that other parts of the country had their COVID second surge before we did, so much of the traveler base is being used there,” he said. “As California comes into its second surge of COVID patients the supply of travelers is much less now.”
The hospital also has memorandums of understanding with nearby hospitals and the San Benito County Office of Emergency Services to find additional staffing throughout the U.S. with the understanding that staffing is already in short supply nationwide and could take weeks to find someone.
Hazel Hawkins has not yet reached the point that it has to ask for outside help, Hannah said.
“We’re seeing an uptick in patients coming into the ER with COVID-like symptoms, but we’re also seeing more standard patients who are sick and need hospital care,” Hannah said. “Right now, we’re at capacity, but we have a stable environment in the sense that we aren’t going beyond our current ability to staff our beds. The surge plans that are in place do have triggers for various decisions that would be made, but we’re not at that point.”
Hannah said the hospital’s goal remains to provide the care residents need.
“We aren’t turning patients away,” he said. “Our in-patient capacity is essentially at its limit, but we have a continual discharge and admission process that fluctuates throughout the day. But when we need to have patients go out, we’ll send them to Santa Clara or Monterey counties.”
He continued, “We may have any number who test positive through our ER, but by far most do not need hospitalization.”
Rather than constantly focusing on the number of positive test results, Hannah said the state government should have been looking, instead, at ICU availability.
“That’s where the rubber meets the road,” he said. “If people are in the ICU that means they reached the level of acuity that they need to be admitted to the hospital. That makes sense to me that it became the trigger point for this most recent lockdown.”
Though 11 employees are currently recovering from COVID-19, Hannah said the hospital’s staff is holding up under the pressure. He said that to his knowledge, no doctors associated with the hospital were out sick with the virus.
Hannah has worked in the healthcare industry for 25 years. He started his career in Southern California as an administrator in a skilled nursing facility. He moved over to acute care hospitals in 1999, working as a consultant or CEO of hospitals of similar size as Hazel Hawkins. He said a third of his career has been in “system hospitals,” with several of the nation’s larger healthcare systems in Florida and Colorado.
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