July 1, 2020 546 PM
WEST TEXAS — The Big Bend region saw its first death from COVID-19 last weekend when a man in his 70s succumbed to the illness after days of hospitalization. The state’s website ticked one death in Brewster County, but the region’s only hospital, the Big Bend Regional Medical Center, continued to report zero hospitalizations.
The man died in the Critical Care Unit at the Medical Center Health System in Odessa, almost 150 miles from his home and family in Alpine. MCHS accepted three patients transferred from BBRMC, but in a policy shift on Wednesday evening, the hospital announced it would operate on “county diversion” for at least the next week.
“This means the hospital will not be accepting transfers of patients from outside Ector County,” MCHS said in a press release. The decision will be reevaluated next week to determine “if the diversion needs to be extended.”
The first COVID-related Big Bend death comes amid a growing coronavirus outbreak in Brewster County, where cases have surged in recent weeks after months of flattening the curve. At press time Wednesday, there are now 140 cases reported by the county judge’s office, and 51 of those cases came in on a single day, Tuesday.
New daily updates from Brewster County are tracking the rapid rise of local cases on their official Facebook page, sharing case counts along with tri-county data that estimates how many tests have been taken, how many negative results have been reported and how many local hospitalizations have occurred. That last number has stayed at zero.
In the post’s disclaimers, the county notes, “Hospitalization and patient transfer numbers have been requested, but the information we have is limited by what is provided and released by BBRMC.”
In another post, the county explains that they requested numbers from BBRMC but that “privacy laws prevent our hospital from publishing that number.”
Last Wednesday, when the county sat at just 18 cases, a resident in a local Facebook group focused on the pandemic solicited any information about hospitalizations, including a request for information about a rumor that COVID-19 patients were being transferred out of BBRMC.
Ruth Hucke, a spokesperson and marketing director for BBRMC, responded. “We’ve been quite blessed,” she wrote. “To date, Big Bend Regional Medical Center has not had any positive COVID-19 patients hospitalized.”
It’s unclear whether any patients had yet been transferred at the time of Hucke’s post, but by the end of the week, Odessa’s MCHS had three Brewster County patients, all transferred from BBRMC. One passed away Sunday, one was discharged, and, at press time, the third patient remains hospitalized in the critical care unit, though not on a ventilator.
“Transfers always go on, even before COVID, and it’s once it gets out of our scope of care, it goes to a higher level of care,” Hucke told The Big Bend Sentinel this week, adding, “We are a Critical Access Hospital.”
Hucke declined to comment further on BBRMC’s Critical Access Hospital status and what that means for residents seeking care in the Big Bend, requesting any further questions be emailed. At press time, the hospital has not responded to that email, a follow-up or phone calls regarding the hospital’s designation as a CAH or at what point a COVID-positive patient exits the scope of care at BBRMC and needs a higher level of care.
CAH is a designation from Congress for rural hospitals, created to improve rural healthcare access by offering benefits that reduce financial risk for rural hospitals. To meet the criteria, the hospital must have 25 beds or fewer, keep hospital stay averages for acute care patients below 96 hours and be more than 35 miles from another hospital.
Trevor Tankersley, director of public relations at MCHS in Odessa, said their hospital is also wondering why BBRMC has apparently transferred every COVID-19 patient needing hospitalization.
“In Alpine, we had to have our regional coordinator see what’s going on,” Tankersley said in an interview on Monday. He had not heard a report back from the coordinator on her findings.
Tankersley noted that their hospital has a good relationship with BBRMC and expected that MCHS would be their first call when looking to make transfers, especially given the worsening COVID-19 situation in the other nearby metro area of El Paso.
BBRMC has a total of 25 beds and two ventilators. In March, Dr. Ekta Escovar told The Big Bend Sentinel that the hospital’s capacity would depend on the condition of incoming patients and is not necessarily up for handling 25 COVID-19 positive patients, especially a large volume of critical patients. Aside from coronavirus, local doctors are still handling non-coronavirus related hospitalizations, from accidents and births to non-COVID-related emergency medical needs.
But on Monday, Tankersley wasn’t sure MCHS would be capable of absorbing a high volume of transfers from the Big Bend region. The hospital has 30 beds on 7 Central, their non-critical floor, and 20 beds in the Critical Care Unit, for a total of 50 COVID beds. “We’re getting lots of calls from hospitals, Tankersley said this week. “We’re starting to be overwhelmed.”
On Tuesday, Tankersley reported 29 COVID-19 patients in-house, at 58% capacity, up from 48% the day before. By Wednesday, the hospital had climbed to 34 COVID-19 patients, 68% of the capacity. It was the most the hospital has had at one time. “We do have a surge plan in place should we continue to see an increase in COVID patients,” Tankersley wrote in his daily email update.
While he did not provide a copy of the surge plan, Tankersley did share some details. “For critical care, we’d have to stop some elective surgeries,” he said — adding that would be “brutal” for the hospital in terms of lost revenue from such procedures.
In other parts of Texas, hospitals in larger cities are struggling to continue accepting out-of-county transfers as COVID-19 surges among their local population. In cities like San Antonio and Houston, hospitals are shuffling patients to less affected areas to avoid hitting their full capacity, while also facing transfer demands from smaller counties.
Tankersley had asserted Monday that ceasing out-of-county transfers was a part of the surge plan. “I’m sure at some point we’re limiting [transfers], and we have turned some down when they aren’t showing symptoms. I don’t think we’re at that point yet, but we’re not just letting anyone come, either.” Two days later, the cessation came to pass.
Late Wednesday, the Odessa hospital announced it would not be accepting any further transfers from out-of-county hospitals for the next week. At the same time, it added a new floor dedicated to COVID-19 treatment, with 28 additional beds and suspended all elective surgeries that require an overnight stay for the next two weeks.
UPDATE: On Thursday, 7/2, Tankersley clarified that the idea that BBRMC was trying to send every COVID-19 positive to MCHS was a miscommunication. The story has been updated to reflect that.