Safety concerns, pay, and internal strife prompt exodus from Big Bend Regional Medical Center, say former staffers

ALPINE — Like many hospitals across the country, Alpine’s Big Bend Regional Medical Center has been facing a staffing crisis for some time. In July of last year, a shortage of nurses trained to deliver babies forced the labor and delivery unit to go on diversion, intermittently closing and diverting patients to farther-away facilities. The problem persisted, with the unit regularly going on diversion for days at a time; in December, the wing closed for two weeks straight, then-Presidio EMT Director Malynda Richardson said at the time. 

Then, at the end of January, a lack of staff prompted a dramatic restructuring — what had previously been the med-surg unit, which offered general care for hospitalized patients, was absorbed into the emergency department, forcing both departments to share limited space. Locals sounded the alarm over safety concerns — patients treated in the newly-combined wing and an EMT who brought patients into the facility told the The Big Bend Sentinel similar accounts of an overcrowded facility, with patients relegated to gurneys in the hallway and COVID patients sharing space with non-COVID patients.

At the time, hospital spokesperson Ruth Hucke insisted the restructuring was temporary and attributable to the nationwide problem of staffing shortages. But former employees tell a different story. In interviews with The Big Bend Sentinel, eight healthcare workers who have left the hospital since 2020 — most of whom requested anonymity — insist hospital leadership has exacerbated staffing issues by declining to give raises to overworked staff, rebutting safety concerns and fostering a low workplace morale.

Former employees said that the hospital made little effort to retain staff and recounted that Rick Flores, the hospital’s CEO, had told staff at meetings that they were replaceable. 

“He has said it in every meeting, every town hall meeting and every private meeting: you are replaceable,” said Nurse Karen Ramirez, who left the hospital in July of 2021 after 21 years. 

For 18 of those years, Ramirez had worked as an obstetrical nurse before moving to the operating room in 2019. Now, she works the front desk at a hotel in Alpine. She said she would like to return to the hospital, but not under the current administration.

Ramirez said she worked seven days a week, picking up shifts in obstetrics even after transferring to the OR in order to patch together a paycheck, since she had a hard time acquiring sufficient hours in each department. Her base pay was roughly $40 per hour, she said. If she was not needed in OB, she would choose to go on call to gather more hours, which earned her $2 per hour while she made herself available to be called to work.

Meanwhile, travel nurses — nurses who pick up short-term contracts to fill roles at hospitals — were being brought in to ameliorate the staffing shortages that had worsened since 2020. Those nurses, who signed onto 13-week contracts with the possibility of renewal, made significantly more than staffers who had been with the hospital for years, said Ramirez. 

But for Ramirez, it wasn’t about the money — she insists she was content to work more for less. The problem was that she had some serious concerns regarding the quality of care provided by some travel nurses — she recalled one that she felt was not following safety protocols who worked nights, which was of particular concern because “you don’t have any backup at night.” When she brought these concerns to hospital leadership, she says she was rebuffed. “I was told, ‘We don’t want to hear it, Karen.’”

These concerns were compounded by a number of incidents in which she was yelled at by a supervising nurse in front of other staff, she said. She decided she could not tolerate the work environment anymore. The administration made no effort to keep her, she said — CEO Rick Flores, she said, told her she was the “problem.” 

“I felt pushed out,” said Ramirez. “And some other people that cared for their jobs and cared for their license got pushed out too.”

Accounts from former employees who requested anonymity when speaking to The Big Bend Sentinel bolstered this narrative — long-term employees were denied raises while working overtime and tackling areas of work outside of their job descriptions, they said. But the heart of the matter was not about pay, said one former employee — ultimately, it was that staff felt unappreciated.

“[Flores’] view was that people were leaving the hospital to go travel because they were offering a lot of money, which is true — traveling pays very well, especially right now with COVID prices — but that’s not why we were leaving,” said the former employee, who asked not to be named. “We were leaving because he did not appreciate us. All he had to do was say, ‘Hey, what will it take to keep you?’” 

Jennifer Wilcoxen, a med-surg nurse who left the hospital in November of 2020, said she was expected to perform the duties of a registered nurse, a higher rank than her actual rank of licensed vocational nurse, though her pay was not adjusted accordingly. She recounted being expected to take on a patient load of 11 to 12 patients, which did not allow her sufficient time to tend to all their needs. 

Ultimately, she left because the hospital would not accommodate her schedule, but also because she felt she was unable to properly care for her patients. And though she asked multiple times about a salary increase in light of her taking on additional work, she was told a pay raise was not possible.

“They’re addressing the nursing shortage by hiring travelers or contract nurses, then they’re leaving and they’re back to a nursing shortage instead of treating their employees correctly in the first place — then we’d stay,” said Wilcoxen, who now works as a travel nurse and part-time at Highland Drug in Alpine.

Wilcoxen recalled Flores telling staff they were replaceable during meetings. “He’s said it many times: ‘We will replace you.’ Just like that.”

Another nurse who left the hospital near the end of 2020, Donna Hernandez, recalled similar language from Flores in meetings. “Rick hosted a meeting with all of us in the ER, and he made it very clear that we were very replaceable,” she said. “And so we either be satisfied that we had a job, or just know that we were easily replaceable.”

The irony, of course, is that the departed staff were not replaced. An employee who left with a recent wave of departures — at the end of February, approximately a month after the hospital combined the med-surg unit with the emergency department – described the staffing shortage at the time of their departure as “very dire.” 

The combination of med-surg and the ER was the last straw for the former employee, who requested anonymity. The restructuring sacrificed the quality of patient care, they said — by putting med-surg patients in the limited number of ER rooms, the resources available for emergency patients, who needed more consistent monitoring, was greatly decreased. As a result, emergency room patients now sometimes wait hours for a bed; meanwhile, the designed med-surg floor sits empty.

“I don’t understand it,” said the former employee. “It doesn’t make any sense.” Furthermore, they said, ER rooms are not equipped for med-surg patients — they are not private and are not equipped with bathrooms and showers.

The former employee put the situation, as they saw it, succinctly: “Our hospital is already six feet under, and there’s no way we can get it out.”

In a lengthy statement, Hucke said that the hospital could not speak to personnel matters publicly as a matter of policy, but said that “investing in our people is a top priority” and detailed efforts to recruit and retain staff in the face of staffing challenges. Those efforts, according to Hucke, include implementing “more than $230,000 in pay raises.” Hucke stated that the hospital had recently announced “an across-the-board pay increase that will be in addition to forthcoming merit increases,” and that the hospital routinely gives out bonuses to those who work extra shifts or provide support for short-staffed departments, when possible. Hucke further stated that the hospital offers employee referral bonuses to employees, in addition to awarding sign-on bonuses for new hires. Per Hucke, these measures are part of the hospital’s “aggressive recruitment strategies.”

Despite this, Hucke said that ongoing staffing shortages have necessitated the hiring of travel nurses and the utilization of federal and state resources. The hospital has brought on six temporary staffers from the Federal Emergency Management Agency, she said.

Let us be very clear. It will always be our strong desire to hire full-time, long-term team members,” said Hucke.

Hucke further stated that the hospital welcomes feedback from staff. “Because we are all in this together, we speak openly with our staff and involve them in decision making,” she said. “To properly prepare and involve our staff, CEO Rick Flores, discusses staffing and resource needs in town hall meetings. We respect our staff’s input, and it is openly solicited both in these town halls and in clinical department-specific meetings.”

As for the combined med-surg unit and emergency department, Hucke said the decision was made “under best-practice guidance and to ensure we could safely continue to provide care to as many patients as possible. The hospital had sought feedback from the Trauma Regional Advisory Council of Texas in making the decision, she said. The hospital hoped to end the consolidation in April, she said.

“As with any hospital, our volumes fluctuate, but we maintain patient staffing ratios in accordance with industry standards,” said Hucke.

Hucke did not address former employees’ claims that Flores had told staff they were replaceable. Though The Big Bend Sentinel asked to speak with Flores, the CEO was not made available for an interview. Flores himself did not return a call seeking comment by press time.