The Gray County Commissioners Court met Friday morning in an emergency meeting with Edwin Leon, chief executive officer for Pampa Regional Medical Center, and Dr. Kevin Sieck, Gray County Health Authority, to discuss the situation at PRMC and to potentially use funds from the American Rescue Plan Act to aid in staffing the hospital as COVID-19 cases surge.
Leon said from October 2020 until mid-January 2021, Pampa experienced their biggest surge of the fall/winter but was able to handle the cases with help from the State of Texas and the Federal Emergency Management Agency.
“We had 37 health professionals,” Leon said. “Most of them were RN (Registered Nurses), but a few were respiratory therapists. We had a lot of help. Our census tripled during that time but we were able to provide the care needed. It’s been pretty quiet since then.”
After the 20 admitted Covid patients in January, the admissions dropped to less than a handful each month from February until June. Then in July, the admissions climbed to 12 and halfway through August there are 18 cases in the hospital. For what it’s worth, the State Health website is reporting 91 total active cases in Gray County as of 1 p.m. Friday.
“As of [Friday], I have 11 Covid patients on the medical floor and four of them are on ventilators in ICU out of 20 total,” Leon said. “So we’re over 50 percent of our capacity. It’s maxed out. We can’t take anymore. Last week, we had a really close call. We had four additional Pampa residents in the ER who could not be moved up to a bed because we were full and didn’t have the staff.”
While last year supplies such as PPE (Personal Protection Equipment) and drugs to combat Covid were the primary concerns, this year it’s staffing. As a result, PRMC has been using contracted nurses, but the price to keep them in Pampa has been the problem.
“There’s a lot of price-gouging going on,” Leon said. “We have six registered nurses on contract because I was already short-staffed before the surge, but of those six, three of them have already said they are leaving because they can go get more money with a crisis-contract. We assume the other three will do the same, because why would they stay if they can go double what they make with a crisis contract?”
Leon added that with the six he has under contract, he is still short-staffed. The amount of tests coming back positive have gone from 14 percent in June, to 14 percent in July and halfway through August tests are coming back positive at 31 percent. As cases continue to climb state-wide, hospital associations are suggesting the medical professionals work with their Counties to secure ARPA funding.
“That’s what we’re here to ask for,” Leon said. “I’m not asking for 100 percent pay-out. I’m asking for you to split it. I’ll pay 50 percent of the contracts and the County helps me with the rest. Without you I (PRMC) can’t do it on my own.”
Leon broke down the situation for the Regional Advisory Committee A (Amarillo area) and B (Lubbock Area) assigned by the State of Texas. Lubbock’s UMC has 97 Covid patients and are 100 percent locked down (not taking transfers), Covenant has more than 100 and is locked down, BSA in Amarillo had 79 Covid in-house with 29 waiting in the emergency room for a bed (not taking transfers) and Northwest Texas had more than 50 Covid in-house and 19 waiting for a bed (not taking transfers).
“I’m giving it to you straight,” Leon said. “We’ve gotten calls from as far as San Antonio looking for beds. I got a call at 7:30 a.m. this morning from Central Texas asking for an ICU ventilator bed. This is a very difficult situation.”
Leon said that the situation isn’t that there are no beds, it’s that there is no staff.
“I could mobilize another 30 or 40 beds tomorrow if I had more staff,” Leon said. “For the most part with Covid patients, we try to do four patients to one nurse because Covid patients are pretty intensive. The ICU can be 1-1, 2-1 or 3-1 depending on their condition.”
PRMC has been putting in requests of up to 20 different staff members with a variety of professions, was almost immediately told RAC is prioritizing the larger, metro areas.
“Which makes sense because they have to accept the more complex cases that we can’t handle here,” Leon said. “Yesterday, we got notice they plan to give us two more nurses but they don’t know when.”
Dr. Sieck said nurses are working more than their usual three 12-hour shifts a week and because of how much nurses were paid by FEMA during the pandemic last year, the rate contracted nurses are asking for has been inflated.
“We’re well above 50 percent of what they normally make,” Dr. Sieck said. “But FEMA paid these nurses $160/hour to go do this last year and $180/hour last year. So nurses quit and left, understandably so. Now we’re asking nurses to come back to work at a normal rate and they are saying, ‘no.’ FEMA and the State have come and said, ‘We’re not paying these nurses those rates. We’re out.’ Now we have a contracting company saying to make a deal for $140/hour.”
There is a concern of a trickle-down effect hitting other departments and roles in the hospital. Dr. Sieck and Leon said if the ER fills up with patients who are supposed to be in-patient, then that presents the possibility of the ER closing its doors.
“Last week, I got four admissions in the ER who waited almost 24 hours to get upstairs,” Leon said. “If that were to continue with just two or three more holding in the ER, I would have had to shut down the ER, make that ER doctor a hospitalist to care for those patients and have those nurses take care of those patients.”
Commissioner Logan Hudson asked about the corporate structure of the hospital (in regards to their network) and if the parent company has received any government aid.
“We received some funds last year like every other hospital did and they were depleted,” Leon said. “There has not been any other governmental, state or federal, support for this.”
Leon said the hospital is fine from a financial perspective and can pay the staff he has right now.
“I can keep doing what I’m doing, but I can’t do more,” Leon said. “If this surges past where I’m at today at 100 percent capacity and somebody comes to the ER today, they’re not getting a bed. A resident comes to the ER and are sick, they are staying in the ER for I don’t know how long.”
Dr. Sieck added the core staff (non-contract) at the hospital has been treated well financially with sign-on and retention bonuses, but there aren’t nurses applying to work anymore.
“There are going to Krucial (contract company) and want that payment,” Dr. Sieck said. “Instead of what is still an inflated payment because we have raised salaries and done everything we can to retain nurses.”
Hudson said you can’t put a price on saving even one life (in regards to dispersing ARPA funds), but he wanted to know how the money would be spent should the County agree.
“It would be spent on supplemental staff,” Leon said.
Hudson asked if it would be possible to pay the local nurses the contract rate instead of out-of-town contracted nurses.
“We surveyed our own nurses to ask them if they were interested in receiving more money,” Leon said. “We have crisis pay beyond what I’ve ever seen. But their answer to us was that they don’t want more money. They’d rather have the supplemental staff to come in so they don’t work seven days a week.”
Leon said there are eight different firms they can hire contracted nurses from and are different from FEMA nurses in that when they are contracted to Pampa, they stay in Pampa during the length of the contract. FEMA nurses would sometimes be pulled from Pampa to another location.
There was some conversation in what insurance companies will pay for, which doesn’t include the cost of the nurses. Another challenge for Pampa is some of the contracted nurses are not needing to work because of what they made last year, or not necessarily work in Pampa.
“We’re Pampa, Texas,” Dr. Sieck said. “Wheeler, Perryton, Amarillo, Houston, Dallas, etc. needs them. But also Ft. Lauderdale, Fla., Miami, Fla., New York City. They are flying everywhere. They are paid a per diem. They aren’t paying hardly anything out of pocket.”
“They’re not desperate,” Leon said. “It’s the demand. They made a lot of money last year. Some may not have to work.”
Commissioner Jeff Haley asked if Leon has been having the same conversation with other hospital directors to which he said he was.
Haley had asked about the funds that should be available through the emergency declaration passed every month. Porter said at the moment there hasn’t been anything released at this time. Leon said if the government does release funding for the hospital, they would obviously use that ahead of the fund provided by the City and County.
Hudson asked if the County did fund this, how many of the beds would be used on out-of-town versus Gray County area patients.
“Is it going to completely fill up from out-of-town? Probably not,” Leon said. “Will there be a few from out-of-town? Probably yes. We’re mandated by the State and Federal Government if we have the capacity, we have to provide care.”
The parties discussed what would help and arrived at 10 nurses at 72 hours/week and $150/hour for four weeks. That adds up to $432,000. PRMC will pay half. City Manager Shane Stokes was present and Porter had said the City of Pampa had agreed to chip in as well at half of the County’s cost. The County and City each will be paying not to exceed $108,000. There will be a line of communication between all parties with invoices that will allow documentation for the federal government on the grant.