Why Are California’s Hospitals So Overwhelmed?

The shortage of nurses and doctors to take care of all the incoming COVID-19 patients is an even bigger issue than the limited ICU beds, experts told me. Doctors can warehouse patients temporarily in a hospital tent or empty building, but patients still need someone to come hook up their ventilators and monitor their vital signs.

When some California hospitals closed, their health workers lost their jobs. Add to that a meager number of trainee primary-care doctors and a high cost of living, and “we just don’t have enough doctors, nurses, allied health professionals to take care of everybody here,” Kristof Stremikis, an expert on the state’s health-care system at the California Health Care Foundation, told me. “That’s something that was an issue that we were dealing with before, and that we’ll be dealing with after.”

The pandemic has exacerbated this shortage, as some nurses have fallen sick, others aren’t working because they’re in a high-risk category for COVID-19 complications, and the reserves of short-term “traveling” nurses have already been tapped. California legally limits how many patients each nurse can take care of, and though the state overrode those limits in December, the new rules haven’t entirely solved the crunch. “There are hospitals with empty beds, and it’s because we can’t staff them,” says Renee Hsia, a professor of health policy at UCSF and an attending physician at the San Francisco General Hospital.

If hospitals had seen this coming, they could have postponed elective surgeries more quickly, and cross-trained nurses and doctors to work in ICUs, Coffman said. They could have held on to the temporary nurses they hired in the spring. But really, the time to prepare for the strain on California’s health workers, Stremikis and others say, was years ago. In 2019, a panel of health experts recommended that the state boost the number of nurses and doctors by providing additional funding for scholarships and loan repayment, increasing residency slots, and expanding the scope of practice, among other things. But “these are long-term investments rather than short-term fixes,” Stremikis said. “It’s like planting trees or putting money in a 401(k). You might wish you had done more of it 10 or 20 years ago, but the second-best time to do it is right now.”

The office of California Governor Gavin Newsom, a Democrat, did not make officials available for interviews for this story, although his office and the state’s health department both released statements saying they had taken “aggressive” steps to deploy additional staff and beds.

Last week, Newsom did ask for 500 federal medical workers to be deployed to California to help, but as of Friday the request was “still awaiting adjudication by federal officials,” the governor’s office told me. These workers could have been in place before the state reached a crisis point, but the federal government has refrained from coordinating any element of the pandemic, whether testing or contact tracing or vaccine distribution. It has also failed to control the coronavirus, which is really the only way to keep a hyper efficient hospital system like California’s functioning during a pandemic. And now, much like states have been on their own to handle other parts of the pandemic, California is on its own to find enough nurses, too.

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