Local COVID-19 hospitalization data skewed by undisclosed transfers

At least 8 tri-county residents have been hospitalized for coronavirus, but BBRMC is leaving transferred patients out of its reports.

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UPDATE: After The Big Bend Sentinel on Wednesday reported that hospitalization numbers were skewed by undisclosed patient transfers — and that the total number of hospitalizations had been at least eight — the Big Bend Regional Medical Center on Thursday morning provided further data on hospitalizations and transfers.

Since June, the hospital has treated and transferred a total of nine patients. “We continue to have adequate capacity and the necessary equipment to care for COVID-19 and non-COVID-19 patients,” said Ruth Hucke, a spokesperson for the hospital. And of the locally hospitalized cases, she said none “have been critical, nor have they required a ventilator.”

ALPINE — Big Bend Regional Medical Center reported its first three coronavirus hospitalizations on Sunday, rising to four on Monday before returning to three on Wednesday. But these numbers do not reflect the true hospitalization rate of coronavirus patients in the Big Bend. Interviews with two Odessa hospitals have revealed at least four additional Big Bend coronavirus patients have been transferred from BBRMC to area hospitals for medical care.

The Medical Center Health System, an Odessa hospital, told reporters last week that it had taken three transfers from BBRMC, including one who later died and two who have been discharged. Brewster County officials have tried to clear up confusion over hospital transfers, noting with a disclaimer on their social media infographics that while people have requested “hospitalization and patient transfer numbers,” such information is “limited by what is provided and released by BBRMC.”

Rohith Saravanan, the chief medical officer at Odessa Regional Medical Center, said his hospital took in a BBRMC patient on June 27, along with another one on July 3. Saravanan didn’t believe either of those patients had coronavirus, citing anonymized information he had on those patients, which he said typically specifies whether a patient was transferred to the hospital’s coronavirus unit.

On July 2, though, BBRMC tried unsuccessfully to send a coronavirus patient to ORMC.  As hospitals across Texas have started feeling the strain of coronavirus, ORMC — like other hospitals — does not always have room for out-of-county transfer patients. The hospital had a waitlist, and it had to decline, Saravanan said.

Within hours, ORMC had the capacity to take in that patient. But when they called BBRMC back, they learned the patient had already been transferred elsewhere.

Saravanan couldn’t provide any more information on that patient or their status. At the time, neighboring MCHS had already stopped accepting transfers, and it is unknown to where the patient was transferred.

BBRMC did not respond to requests for comment this week about the hospital’s current capacity, and it is unknown how many of the hospital’s 25 beds are open for COVID-19 patients. The state has allowed elective surgeries to resume, making it unclear how many beds are occupied by patients in the hospital for other reasons.

Also unclear is how the public local hospitalization numbers are tabulated or how many local patients there have been in total. For example, when BBRMC dropped from four hospitalizations to three on Wednesday, that could have been the result of one patient being discharged.

Alternatively, it’s also possible that BBRMC discharged all four local patients, only to take in three new ones. Without more information and clarity from BBRMC, it’s hard to get a read on how many total hospitalizations have resulted from COVID-19 diagnoses.

Odessa-area hospitals are providing regular updates on their in-house testing, their daily bed availability and whether any of their COVID-19 patients are in critical condition, on a ventilator or recovered. But BBRMC has not provided this information to the public, citing what it says are patient privacy concerns.

Regionally, the state has grouped the Big Bend and Midland-Odessa metroplex under the umbrella of “Trauma Service Area J.” Covering an estimated population of 526,736, The Department of State Health Services says Area J has a total of 1,163 staffed hospital beds, with 581 of those currently available. There are currently 85 COVID-19 patients hospitalized, with 27 ICU beds open and 213 ventilators available.

In a weekly news conference with Odessa-area hospitals, Saravanan provided more context on the strain at his hospital as well as around the region. While ICU doctors at ORMC normally tended to two patients at a time, Saravanan said they are now tasked with four.

Saravanan also recounted a phone call he received from a doctor who had three patients eligible for Remdesivir, an antiviral drug used for severe coronavirus patients, but only had enough of the drug for one patient. The doctor was seeking guidance on how to provide care with insufficient resources. “Just the fact that we’re having those conversations is what I’m bringing up today,” Saravanan said.

All of which raises the question: How many Big Bend COVID-19 patients in total have ended up outside the tri-county, and how many can other regions take?

With 170 cases in the tri-county, the reported figure of four local hospitalizations might sound minimal. But coronavirus cases in the tri-county have resulted in at least eight hospitalizations — almost 5% of confirmed cases in the area. And even that number doesn’t account for any transfers The Big Bend Sentinel may have missed at other hospitals across West Texas.

Then there’s the logistical issues. For months, BBRMC has stressed that, while its capacity is limited, it can care for coronavirus patients. In a statement this year, the company said it had “the resources and cash flow needed to address the COVID-19 crisis and continue caring for patients and the community.”

The hospital has received support throughout the crisis, including a $10,000 gift from the Judd Foundation, the Chinati Foundation and Ballroom Marfa in April. And the company has acknowledged they’re short on resources: Just days before receiving that donation, BBRMC’s parent company, Quorum Health, filed for Chapter 11 bankruptcy, announcing furloughed workers and financial restructuring.

But the unknown number of transfers outside the region have made it less clear what capacity BBRMC actually has, both in terms of limited resources and in ability to treat severe cases of coronavirus. As out-of-area hospitals deal with outbreaks in their own areas, it’s critical that local officials understand the local hospital’s true COVID-19 capabilities.

Last week, MCHS temporarily stopped accepting transfers, citing high demands for medical care in their own city. At press time, the outcome of their weekly re-evaluation of this policy had not yet been announced.

Saravanan, the ORMC official, said that it was common for local hospitals to transfer patients to higher-care hospitals. That practice exists not only in cases of coronavirus, he said, but in other critical-care situations like bad car accidents.

But while hospital officials in Odessa share these insights, BBRMC has so far declined to explain what scope of care it is able to provide for COVID-19 patients. The hospital has repeatedly cited health-patient privacy rules like the Health Insurance Portability and Accountability Act (HIPAA) as the reason why they can’t even give basic, anonymized statistics on transfers and whether patients are in critical condition or on ventilators.

The Big Bend Sentinel has asked BBRMC and Quorum Health to provide more information on its interpretation of HIPAA. Last week on social media, The Big Bend Gazette said it had also asked for the same.

Ruth Hucke, a spokesperson for the hospital, said last week that transfers occur when patients exit the hospital’s “scope of care” but did not say what scope the hospital is able to handle. Rick Flores, the CEO of the hospital, was not available, she said.

BBRMC did not respond by press time to a range of recent questions from The Big Bend Sentinel, including inquiries on transfers and the breakdown of hospital occupancy data. Dr. Escovar, a doctor at the hospital’s adjoining Big Bend Rural Health Clinic and the volunteer health authority for Brewster County, also did not respond to questions about transfer and hospitalization numbers.