BISMARCK — North Dakota risks running out of staffed hospital beds in some medical centers — only 22 intensive care unit beds are available statewide — as a chronic nursing shortage collides with the spiking coronavirus pandemic.
The bed shortage is perhaps most dire in Grand Forks, where Altru has no available ICU beds and 17 inpatient beds as of Tuesday, Sept. 29, according to state Department of Health records obtained by Forum News Service.
Bismarck’s two hospitals, Sanford and CHI St. Alexius, have a combined two available ICU beds and 15 inpatient beds. However, Sanford Bismarck announced Tuesday it is opening a new unit with six ICU beds and eight regular beds.
Fargo’s Sanford, Essentia and VA hospitals had just 12 available ICU beds and 31 inpatient beds among them.
Most of the remaining 192 open inpatient beds in the state are tucked away in rural areas like Belcourt, Bowman and Fort Yates, where hospitals often have very limited capabilities to care for patients with serious ailments.
The total of 255 available inpatient beds and 22 ICU beds around the state as of Tuesday, according to the state’s database, cuts in stark contrast with the picture of hospital capacity painted by the health department’s public-facing coronavirus dashboard.
The gaping disparity exists because the figures the department reports to the public are for licensed beds — not beds that actually are staffed, although that information now is reported to the state, according to spokeswoman Nicole Peske.
As of Tuesday, the dashboard listed 348 available inpatient beds and 152 ICU beds, which are figures for licensed beds, not necessarily staffed beds.
Republican Gov. Doug Burgum has regularly noted at weekly press conferences that the state has plenty of hospital capacity despite the growing severity of the state's COVID-19 outbreak.
When asked about the misleading information on the state's dashboard, Burgum spokesman Mike Nowatzki said Tuesday the health department collects data on capacity and supplies it to the governor. Nowatzki said he didn't know why there is a wide gap in what the state reports publicly and the internal records obtained by Forum News Service, but that the department is "working on deconflicting the data."
Shelley Lenz, who is running against Burgum on the Democratic-NPL ticket, accused her opponent of "data maneuvering" to make the pandemic's impact on North Dakota seem less severe than it is. Lenz added that the situation with hospital capacity is so out of control that massaging the numbers won't make it look any better.
"The numbers are abjectly wrong. Whether that’s incompetence or nefarious, either way the results are the same and people are dying," Lenz said.
Still, health officials say the lack of available hospital beds is not completely unprecedented and there's no reason to panic.
“It’s important to note that hospitals are often full,” said health department Emergency Preparedness Chief Tim Wiedrich. “We’ve had hospitals say that this is not that unusual, especially during influenza season when capacity is higher. There are still measures hospitals can take to reduce capacity such as eliminating elective procedures."
Coming to a head
The scarcity of beds in major medical hubs — Fargo, Bismarck, Grand Forks and Minot — is so great that rural hospitals like the Mountrail County Medical Center in Stanley are preparing to receive low-acuity patients, if called upon.
Elsewhere, hospitals including CHI St. Alexius Dickinson have had to transfer patients because they are full.
“We’re having to send all over the place,” including to hospitals in Fargo and Billings, Mont., because the 25-bed St. Alexius Health in Dickinson has been full at times, said DeeAnna Opstedahl, vice president of patient care.
“Lately we have had a need for all of our beds to be filled,” she said. Even requiring nurses to work an extra shift per pay period is not enough. “It’s a short-term solution,” Opstedahl said. “We’re hoping that after six weeks we’ll be through the surge.”
Efforts to hire traveling nurses to fill in have been unsuccessful, she added. Also, gowning properly with protective garb to prevent coronavirus infection reduces the number of patients that nurses can care for, compounding the difficulties.
“This is spreading so rampantly that we can’t keep up,” she said of COVID-19 cases, which started to rise after the Sturgis, S.D., motorcycle rally in August.
St. Alexius Dickinson is reluctant to send patients to other hospitals, sometimes hundreds of miles from their families, Opstedahl said.
“We’d like to keep them here if we could,” she said. “I hate to send patients so far away. We want to take care of our community.”
The chronic shortage of health-care workers, especially nurses, has been exacerbated by the additional strains imposed by the pandemic, said Rich Laksonen, medical director of the emergency department at Mountrail County Medical Center in Stanley.
“I would say nursing is the No. 1 issue when it comes to staffing these beds,” he said.
The pandemic is adding a layer of patients to those that hospitals ordinarily must treat, Laksonen added.
“This isn’t just COVID patients,” he said of the spike in hospital admissions around the state. “There are a lot of people who are getting really sick right now. It’s kind of half and half.”
Pressure on North Dakota’s hospitals is likely to continue with no sign that the pandemic is easing in the state — which continues to lead the nation in per-capita infections, 51.9 per 100,000. As of Tuesday, Sept. 29, a pandemic-high 105 COVID-19 patients were hospitalized around the state.
In the spring, the state designated several sites for field hospitals in the event medical centers are overwhelmed by patients. However, as of Tuesday, the state has no plans to deploy additional resources for hospital overspill, though it is ready to do so if needed.
“So while we’re on alert and monitoring capacity carefully, it’s no reason to panic, but it is a good reason for people to take active steps to prevent COVID,” Peske said in a statement.
Hospital administrators say the shortage is more one of a lack of adequate staffing — especially for nurses — than of beds. The limitation is the number of nurses available to care for patients in those beds, which limits the number of patients a hospital can accept.
A lack of current information about staffing for beds around the state was such a pressing issue, in fact, that state health officials called an urgent meeting with hospital administrators around the state late Friday, Sept. 25.
At the meeting, health officials announced refinements to the online reporting tool enabling hospitals to report not only beds, but staffing to make those beds available, providing a more accurate picture of bed capacity.
Hospital administrators consult the database to see where they might be able to transfer patients if they run out of beds.
The dire strain on North Dakota hospitals might seem like the fever pitch of capacity concerns, but experts project the approaching winter months could make matters even worse.
Projections compiled by the Centers for Disease Control and Prevention predict that the state will add an average of about five to 15 new COVID-19 hospital patients per day through Oct. 22.
Influenza season, which usually starts in October and intensifies later in winter, will impose additional demands for hospital beds, along with other respiratory viruses that become more prevalent during cold weather.
During the 2019-20 flu season, 549 flu patients were hospitalized in North Dakota, with the weekly peak reaching 90 hospital cases, according to state figures.
Many smaller rural hospitals, which generally don’t admit patients with COVID-19, still have bed capacity.
McKenzie County Healthcare System in Watford City, which has 24 beds but lacks an ICU, is preparing to accept low-acuity patients from Minot, if asked, said Sam Perry, director of operations.
“We’ve been preparing for the storm,” he said. “It’s smart, especially for the health-care system, to prepare for the worst and hope for the best. If worst comes to worst, we are ready and can help.”
If asked to accept transfer patients, “We still definitely have space,” Perry said. One reason hospital beds are becoming more scarce, he believes, is because nursing homes often are not accepting transfer patients from hospitals because of the pandemic.
“I think that’s one of the contributing factors,” he said. So far, McKenzie County Healthcare System hasn’t encountered a COVID-19 patient who required hospitalization, but infections in the county are rising, partly because activity is starting to pick up in the Oil Patch.
CHI St. Alexius Williston, with 25 beds, still has beds available, according to spokeswoman Dubi Cummings.
"We do have capacity in our facility and we have a surge plan in place," to convert an old obstetrical unit into a surge capacity unit, but so far have not had to take that step, she said.
Administrators of the state’s major hospitals have acknowledged the high demand for hospital beds, but have maintained that they are able to manage without restricting elective procedures to restrain admissions and have surge plans in place.
“We routinely flex our scheduling as part of the normal course of business and have no concern about meeting the health care needs in our communities,” Dr. Doug Griffin, Sanford’s chief medical officer in Fargo, said last week.