During COVID surges, rural hospitals struggle to transfer patients: Shots

It had only been around six months since Katie Ripley completed radiation therapy for stage 4 breast cancer. But now the 33-year-old was back in hospital. This time it wasn’t cancer – she was still in remission – but she had caught a nasty respiratory infection.

It wasn’t COVID, but her immune defenses had been weakened by cancer treatments and the infection had turned into pneumonia.

Cancer survivor Katie Ripley needed specialist intensive care, but there was no bed to transfer her to the area during the omicron surge.

Kai Eiselein


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Kai Eiselein


Cancer survivor Katie Ripley needed specialist intensive care, but there was no bed to transfer her to the area during the omicron surge.

Kai Eiselein

By the time Ripley arrived at Gritman Medical Center, the local hospital in Moscow, Idaho, on January 6, her condition was rapidly deteriorating. The disease had begun to affect his liver and kidneys.

Her father, Kai Eiselein, remembers the horror of that night when he learned that she needed specialist care in the intensive care unit.

“The hospital here didn’t have the facilities for what she needed,” he says. “And no bed was available anywhere.”

Ripley didn’t just need a bed. She needed a type of dialysis – known as continuous renal replacement therapy – which is used for critically ill patients and is in high demand in hospitals dealing with a lot of COVID.

Normally, she would have been airlifted to a larger hospital within hours. Like many rural hospitals, Gritman relies on its ability to transfer patients to larger, better-equipped hospitals for care it cannot provide – whether it’s placing a stent after a heart attack or treat a life-threatening infection.

But hospitals in the Pacific Northwest at the time were overwhelmed by a wave of COVID-19 patients. And like health care systems in many parts of the country, the patient load means there is often nowhere to refer even the most critical cases.

Katie Ripley had survived months of cancer treatment – ​​surgery, chemo and radiation – getting a new chance to live with her husband and two young children. Her father is devastated to see her face a new crisis, aggravated by overcrowding in hospitals.

Ripley was her only child. She had followed him into journalism: he was a newspaper publisher and she became a reporter. “She was just a sweetheart, I don’t think she had a bad bone in her body – a wonderful mother, an exceptional writer,” Eiselein recalled.

As hospital staff searched for an open bed, Eiselein was also on the phone with a friend who worked at a large western Washington hospital looking for a bed.

Hours passed and nothing opened.

“Then it got to a point where it was pretty clear that even if we found a bed, she probably wasn’t going to make it,” says Eiselein. “It was kind of a hard pill to swallow because you try so hard to save your child’s life – and you fail.”

More than 20 hours later, Ripley died of sepsis in the emergency room at Gritman Medical Center.

Eiselein says there is no way to know if her daughter would have ultimately survived if she had been transferred to another hospital.

“But she never even had the chance,” he says. “That’s the thing that attracts me.”

Hospital staff at Gritman Medical Center in the northern Idaho city of Moscow were unable to find Katie Ripley an open intensive care bed at a larger hospital as her condition deteriorated.

Don & Melinda Crawford/Education Images/Universal Images Group via Getty Images


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Don & Melinda Crawford/Education Images/Universal Images Group via Getty Images


Hospital staff at Gritman Medical Center in the northern Idaho city of Moscow were unable to find Katie Ripley an open intensive care bed at a larger hospital as her condition deteriorated.

Don & Melinda Crawford/Education Images/Universal Images Group via Getty Images

Small, rural hospitals — also known as critical access hospitals — struggled with an influx of critically ill COVID-19 patients during the omicron surge. But they have fewer clinical resources, which means they have suffered disproportionately from the effects of a congested healthcare system.

During the omicron surge, staff at small hospitals often have to scour the area for available beds while patients wait, making dozens and dozens of calls.

“It’s the nail biters, can you find somewhere these people can go before their condition harms them?” says Dr. Lesley Ogden, CEO of Samaritan North Lincoln Hospital and Pacific Communities Hospital, two rural hospitals on the Oregon Coast.

While Gritman Medical Center wouldn’t comment specifically on Katie Ripley’s case, spokesperson Peter Mundt says on some days they make calls throughout the West — Washington, Oregon, Colorado, Montana and Utah — to find a open bed for a patient.

“Our nurses and health supervisors work on the phone as if it were a trading floor,” says Mundt. The patient transfer system, he says, “has been extremely stressed and extremely strained”.

Knowing that a patient who needs a higher level of care is wasting valuable time is distressing for bedside nurses and physicians.

“It creates more distress,” says Mari Timlin, head nurse at Gritman. “They feel we’re not providing the exceptional care that every patient needs.”

And in some cases, doctors have no choice but to offer emergency workarounds. At his Oregon hospitals, Ogden says they’ve had to perform surgeries that their support staff have never been trained to perform.

“We do a risk analysis with the patient who could suffer a very bad outcome or even death, if we don’t act,” says Ogden. “If that means two surgeons getting together to do a job that normally takes one, can we just get everyone together and save that patient?”

And even if a bed can be found, transportation can also be a problem, as ambulance companies have also been hit by the outbreak, says Dr. Donald Wenzler, clinical director at Mid-Columbia Medical Center, a rural hospital in about an hour and a half outside of Portland, Oregon.

Most of those who are hospitalized and die during the omicron surge continue to be unvaccinated. Their risk of being hospitalized is 16 times higher than that of vaccinees, according to the latest data from the Centers for Disease Control and Prevention.

In Katie Ripley’s obituary in the local paper, his father Kai Eiselein wrote of his love for his family, his athletic achievements in high school, and his career as a newspaper writer—the fifth generation of their family to embrace the profession.

And he wrote of her death, “surrounded by family members after spending over 20 hours waiting for an intensive care bed to open somewhere in Idaho, Montana or Washington.”

The second line of the notice pointed to: “There were no beds available, thanks to unvaccinated COVID-19 patients.”

Eiselein’s words attracted a lot of attention. He even received “hate mail”, with some people writing to him online and basically calling him a liar. But overall the response has been sympathetic, he says.

After reading about his daughter, a friend of a friend even went out and got vaccinated the next day.

“No parent should ever have to watch their child take their last breath of life,” he says. “The best way to honor my daughter’s life is to spread the message to get vaccinated.”

About 3,000 people are still dying from COVID every day, but other lives are being lost as well.

“I want people to understand that it’s not just people who get COVID and end up sick and even die,” Eiselein says. “They’re not the only ones dying here.”

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