BBRMC struggles as coronavirus approaches

The Big Bend Regional Medical Center in Alpine. Photo by Stephen Paulsen.

ALPINE — Rural hospitals were struggling long before the coronavirus, and at the Big Bend Regional Medical Center in Alpine, coronavirus has made financial problems worse.

Over the past week, BBRMC has announced worker furloughs and financial restructuring. It’s a microcosm of a problem nationwide and especially in Texas, which has seen at least 20 small-town hospitals close since 2013.

Ruth Hucke, a spokesperson for the hospital, confirmed there had been furloughs in an email Monday. Furloughing workers is an “unfortunate but necessary step” as the hospital works to “conserve resources wherever possible,” she said.

BBRMC did not respond by press time to questions about how many workers had been furloughed. But Hucke stressed the furloughs do not include “medical personnel,” and the hospital looks forward to welcoming back laid-off workers “when the pandemic subsides.”

Then, in an email on Tuesday, BBRMC announced that its parent company, Quorum Health, had filed for Chapter 11 bankruptcy. The news release stressed that BBRMC is “unaffected” and will continue caring for patients and paying staff and suppliers while the parent company restructures its debt.

The company said financial restructuring is necessary to protect the hospital’s “long-term financial stability” and ensure it has “the resources and cash flow needed to address the COVID-19 crisis and continue caring for patients and the community.”

“I couldn’t be prouder of our dedicated physicians, nurses and other team members,” Rick Flores, CEO of BBRMC, said in the statement. “We are grateful for the community’s loyalty and continued support through this challenging time.”

A pandemic might seem like a strange time for hospitals to downsize, but BBRMC isn’t alone.

In states across the country, including Texas, officials have suspended elective surgeries and other non-essential medical work during the pandemic. And while those moves are intended to keep beds and resources free for coronavirus victims, they’ve also deprived hospitals like BBRMC of much-needed income.

That has added to a slew of other economic challenges facing rural hospitals, from uninsured patients to shrinking rural populations. And while BBRMC’s circumstances are troubling, other hospitals are faring worse.

In Vidalia, Georgia, a hospital cut employee pay, citing a pause on elective surgeries and other profitable medical interventions. In Wellington, Kansas, the city’s only hospital closed outright last month, just as coronavirus was arriving in the community.

Money challenges are not the only issue facing BBRMC, though. On everything from supplies to triage guidelines, the hospital is stuck in a limbo until it finds its first case of the deadly new disease.

For example, the hospital can’t start stockpiling supplies while other hospitals across the country (including ones in coronavirus hotspots) have a more dire need for face masks and other equipment. “PPE [personal protective equipment] is being allocated where there’s a need,” said Ekta Escovar, a member of the local COVID-19 task force and the local health authority for Brewster County. “We don’t qualify for that yet.”

Other hospitals — especially in coronavirus hotspots like New York — have developed tiered “triage guidelines” and “surge plans” to help medical workers deal with surging patient loads during the pandemic. On the low end, that can mean finding ways to increase bed capacity and call in more doctors and nurses. On the high end, that can mean rationing medical equipment and making unthinkable decisions about who gets lifesaving care.

And while BBRMC always has disaster plans ready — the hospital can, for example, set up extra beds or call in extra medical workers from Big Bend National Park and elsewhere — local health authorities have been hesitant to set up higher tier guidelines for rationing equipment, Escovar said.

Part of the reason, she said, is psychological. She wants doctors and residents to approach the coronavirus crisis “from as optimistic a viewpoint as possible” — especially while the tri-county region braces to find out if social distancing has spared communities in the Big Bend from the worst.

But part of it, she said, is also practical. Until health workers know the demographics of coronavirus victims in the area, they don’t want to develop guidelines they have to later “throw out the window,” she said.

For example, the hospital could formulate rules prioritizing lifesaving equipment for otherwise healthy young people. But those rules wouldn’t make sense if the area’s critical patients turn out to be mostly young people or mostly old.

“I don’t mind helping to make those decisions, if the time comes,” Escovar said. “But it’s not something anybody would look forward to, and there are so many variables that would come into play.”

But it’s not all bad news for the Big Bend, Escovar said. Historical data shows that in pandemics, disease rates in rural areas typically peak about two weeks after their nearby cities. For the tri-county, that’s El Paso and Midland-Odessa.

Ideally, that means BBRMC could rely on help from big-city hospitals if cases spike here. If El Paso hospitals are past their peak, they’ll be more prepared to take in patients from Presidio, Brewster and Jeff Davis counties.

And as the coronavirus pandemic continues, health workers and scientists continue to learn more about how to best treat the disease. One important discovery, Escovar said, is that machines that improve lung pressure (like CPAP machines) improve health outcomes from coronavirus just as much or more than machines that affect lung volume (like ventilators).

As The Big Bend Sentinel and others have reported, BBRMC has just two ventilators. But “ventilators are not the only thing we have to provide respiratory support,” Escovar stressed.

Instead, she said, the hospitals can rely on more common oxygen-delivery systems, like CPAP machines and nasal cannula. And BBRMC has equipment to supply oxygen in every room, she said.