St. Charles showing battle scars

In the war against COVID-19, St. Charles Health System (SCHS) is fighting not only a lethal and spreading disease, but also a critical worker shortage. That was the principal takeaway when The Nugget sat down last week via teleconference with Dr. Doug Merrill, chief medical officer for the Bend and Redmond hospitals, two of the four in the system and the sole hospitals serving Deschutes, Crook, and Jefferson counties — an area the size of Connecticut and Rhode Island.

It is a problem that began long before COVID reared its ugly head. Dr. Merrill cited a study in 2018 that forecast a shortage of 1 million nursing professionals by 2025. Merrill thinks that number will be considerably more. This is, of itself, a crisis in the making.

In “normal” times St. Charles would employ 4,300, which includes 350 medical staff members and 200 visiting medical professionals. In last week’s Nugget we reported on the growing trend of travel nurses, who on average earn two to three times the pay of the resident staff nurses alongside of whom they serve. Merrill is begging for more nurses from any source, provided that they are accredited.

What’s worse, Merrill says, is the trickle-down effect:

“We have had as many as 45 COVID patients who could be discharged, but have no place to go. The staff shortage at assisted-living centers and extended-care facilities is equally bad.”

If there is insufficient housekeeping or food-service staff at such facilities, much less health workers, they cannot ethically discharge a patient to their care.

St. Charles has seen the departure of 300 nursing professionals in the last three years. Most recently, nurses eligible for early retirement are opting to leave in the face of overwhelming workloads and heartache exacerbated by COVID. SCHS has current openings for 160 nursing staff.

Regarding burnout, Dr. Merrill said, “The daily grind of the losses, of having to pronounce (death), facing family members, and the constant changing of PPE (personal protective equipment), just wears you out… But it is doing all of this in the face of a large number of people, some quite loud in their refusal, who will not get vaccinated or scoff at masking, that is the most distressing,” he added.

St. Charles, Merrill said, has done a good job in increasing the footprint to meet the surge. The Redmond hospital for the most part remains off-limits for the treatment of COVID cases except for those who present at the emergency department. Once triaged, they are moved to the Bend campus, where the full range of treatment capabilities is available, such as interventional radiology.

St. Charles can now move some recovering COVID patients to Redmond, where beds have been designated for such care including the repositioning of the Redmond birthing center, which closed in 2019. Even the SCHS Madras hospital can now handle some COVID-related cases. Likewise, in Bend, more beds have been adapted but are not technically ICU-rated, primarily due to the lack of qualified ICU nurses.

Dr. Merrill and his team have benefited from the arrival of around 130 Oregon National Guard members who are deployed in all four campuses to cover non-professional or non-licensed clinical positions.

Many of the 500 St. Charles volunteer corps have been returning to limited duty in Bend, taking some pressure off medical staff.

Any day now Merrill expects more relief from Oregon Health Authority and FEMA that includes nursing and other clinical resources. They are hoping for more high-capacity-style ventilators. Of the 58 ventilators in the St. Charles network, only 20 meet that definition.

Dr. Merrill was quite cautious in making any predictions as to when we might see the peak in the current surge. St. Charles’ data scientists in co-ordination with their statewide peers are currently modeling somewhere between September 10 and 17 for the peak.

“These are only models,” Merrill warns, subject to a lot of variables, chief among them vaccination rates currently standing at around 71.7 percent of the total state’s eligible population.

Our interview concluded with Merrill emphasizing “not to dither” if you are feeling poorly. The earlier you get treated, the less the severity of the disease and the faster the recovery.

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