State requests use of VA hospital beds to cope with COVID surge

The John L. McClellan Memorial Veterans Hospital in Little Rock (Credit: Matt White)

With the number of COVID-19 hospitalizations reaching a record high this week, Governor Hutchinson has requested that the Central Arkansas Veterans Healthcare System open up 10 beds at its Little Rock hospital to non-veteran COVID patients. 

The request — for five intensive care unit (ICU) beds and five general medical-surgical beds — was made Wednesday to the Federal Emergency Management Agency and announced Thursday by the governor at a press conference. During national emergencies, with approval from FEMA, the federal Department of Veterans Affairs can provide resources to states that ask for help, including for non-veterans. State officials are now awaiting a response from FEMA and hope that it will be approved within the next 24 hours, Hutchinson said.

“The request would allow hospitals in other areas of the state to transfer patients to the 10 requested beds,” said Melody Daniel, public information officer for the Arkansas Division of Emergency Management. “This would help alleviate strained hospital resources due to the impact of COVID-19.” The beds are not currently needed, Daniel said, but would be made available for 30 days if necessary.

Hutchinson has expressed confidence that the state’s hospitals can manage the COVID-19 surge. But in a recent story by the Arkansas Nonprofit News Network, some doctors and nurses sounded the alarm that the system is close to a breaking point. Given the trajectory of new cases, hospitals eventually will not have enough ICU staff to keep up and the quality of care will suffer, warned one Central Arkansas doctor, who asked to remain anonymous in order to speak candidly.

“Outcomes will change,” the doctor said. “People will die that wouldn’t normally die.”

The request for the VA beds is the latest effort to increase hospital capacity in response to the pandemic. Over the last two months, according to the Arkansas Hospital Association, hospitals have added at least 122 ICU beds, 174 ventilators and 452 beds in negative pressure rooms designed to keep COVID patients quarantined. Some hospitals are delaying or reducing non-emergency procedures that require an overnight stay in an effort to preserve staffed beds. 

As of Thursday, 1,072 people in Arkansas were hospitalized with COVID-19 — more than double the number two months ago — and the state’s ICUs were around 93% full, leaving just 79 staffed ICU beds available statewide.

Chris Barber, president and CEO of St. Bernard’s Healthcare, which operates a 438-bed hospital in Jonesboro, said at the Thursday press conference that the next two or three months will be “very challenging.” 

“The health care system in the state will be stretched and challenged at a level we’ve never experienced before,” said Barber, who is a member of the governor’s Winter COVID-19 Task Force.

The 10 requested VA beds will cost $1.9 million over 30 days. If the request is approved, the state will pay $500,000, with the federal government picking up the rest of the tab.

Hutchinson said the plan has been under consideration for the last week and hospital administrators on the task force recommended that the state move now to pursue the extra beds.

Requests to FEMA are made through the Arkansas Division of Emergency Management and initiated by local offices of emergency management. At the behest of the Metro Healthcare Coalition, the city of Little Rock placed the request with ADEM on Tuesday. On Wednesday afternoon, with the approval of the governor, ADEM sent the request to FEMA on behalf of the state.

The 250-bed John L. McClellan Memorial Veterans Hospital in Little Rock has 33 ICU beds, but the hospital has retrofitted other areas of the hospital to accommodate any needed surge capacity, said Chris Durney, public affairs officer for the Central Arkansas Veterans Healthcare System. The hospital is currently treating 17 veterans who have tested positive for COVID-19.

The VA provides health care, benefits and memorial services for veterans as its primary missions. During a national crisis, as part of its “Fourth Mission,” the agency offers support services to states who request help, including providing resources for other health care systems. The VA’s activities under the Fourth Mission, typically enacted in response to natural disasters or other emergencies, offer help to non-veterans in addition to ensuring continued service to veterans.

“The Central Arkansas Veterans Healthcare System in Little Rock stands ready to support the department’s ‘Fourth Mission’ to surge capabilities into civilian health care systems in the event those systems encounter capacity issues,” Durney said. Such assignments to provide care to non-veterans are only undertaken when they do not hinder the VA’s first priority to provide care for veterans, he said.

Hutchinson and Arkansas Department of Health officials have stressed that the state’s hospitals have surge plans in place and are adept at adjusting to manage capacity. They have frequently pointed out that the number of patients in the ICU is fluid, and ICUs at larger hospitals may run at or near capacity even in normal times.

Still, state officials are bracing for a new wave of cases after the Thanksgiving holiday. “I’m sorry to say this, but I think you all have to have a realistic view of what's going to happen in the next weeks,” health secretary Dr. José Romero told a legislative Public Health committee on Tuesday. “We are about to enter a surge upon a surge.”

Asked on Thursday whether the decision to request new beds suggested that hospitals might be reaching a crisis point, Hutchinson said, “It’s really preparing for what could be challenges in the next three weeks. While I’m confident that our hospitals can meet the need of today — with stress, not easy — but they’ve been flexible to accomplish it. This gives some added relief.”

Barber applauded the request to add beds. “We’re concerned when you see the numbers go up [about] the next two to four weeks,” he said, “because hospitalizations are typically a lagging indicator.”

The VA request follows an announcement last month that Arkansas Children’s Hospital will begin admitting adult trauma patients to help other hospitals with capacity issues during the pandemic. Normally, the hospital only treats patients up to age 18. 

Arkansas Children’s is working closely with the Arkansas Trauma System to accept patients with severe injuries up to age 30 to make room in adult hospitals for critical COVID patients,” Children’s spokeswoman Hilary DeMillo said on Thursday. “During the four-day Thanksgiving holiday weekend, the Arkansas Children’s trauma team activated care for 17 cases, a third of which were adults. As a system built to serve children, we are responding to extraordinary circumstances.”

In some states, the VA has already loaned beds to non-veterans to help relieve pressure on other hospitals. As of mid-November, the VA had admitted 345 non-veterans in the U.S. for care as part of its Fourth Mission during the pandemic. It has also loaned medical staff to state-run facilities, provided personal protective equipment (PPE) and assisted with testing across the nation.

According to the VA’s COVID-19 response report in October, “During the COVID-19 pandemic, the Mission Assignments under the VA’s Fourth Mission grew to the greatest scale and scope in VA’s history.”

As part of its Fourth Mission in Arkansas, the VA has previously offered testing support for the state health department and conducted testing and daily COVID-19 screenings at state-managed long-term care facilities for veterans. Two weeks ago, it began providing seven nursing staffers to the State Veteran Home in Fayetteville in response to a COVID-19 outbreak among staff at the facility.

This reporting is courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans.

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