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Rural Coronavirus Patients Are Straining Kansas City Hospitals Beyond What State Data Suggest

Research Medical Center, in Kansas City, Missouri, is not publicly disclosing information about COVID-19 patients or capacity.
Alex Smith
KCUR 89.3
Kansas City area hospitals have been seeing increasing numbers of COVID-19 patients from rural areas.

Hospital workers say that capacity is already reaching tipping points.

Updated: October 29, 2020 at 4:21 PM CDT
This story has been updated with additional information from Kansas City area hospitals and statements from the Missouri Hospital Association.

Hospitalizations for COVID-19 are near all-time highs in the Kansas City area, and local hospital leaders say admissions are being pushed over the top by patients coming from rural areas.

Official data from Missouri shows that hospitals still have plenty of room, but doctors and nurses say their facilities have been reaching capacity, forcing hospitals to turn patients away in some cases.

Health officials say the availability of health care for people in the Kansas City area is now being threatened by this influx of patient from communities that lack mask mandates.

“We’ve had this huge swing that’s occurred because they’re not wearing masks, and yes, that’s putting pressure on our hospitals, which is unfair to our residents — to our residents that might be denied an ICU bed,” says Dr. Rex Archer, the head of the Kansas City Health Department.

Pascaline Muhindura, a nurse at Research Medical Center, has been treating COVID-19 patients for seven months, but she’s been especially concerned about a type of patient that has been showing up for care with increasing frequency.

Many COVID-19 patients in critical condition because they didn’t receive adequate COVID-19 treatment early on are being sent to the hospital from rural communities and small towns, she says.

“They are going to the local hospital initially, and are given a medication, sent home and then they get worse,” Muhindura says. “So that delay — what I would call a delay in care — you would be sicker if you don’t get treatment quicker.”

Missouri has the eighth highest number of hospitalized patients in the country right now, far exceeding hospitalizations in many more populous states, including New York, Massachusetts and Pennsylvania.

An average of 116 COVID-19 patients are admitted to Kansas City area hospitals each day. New case numbers here have been increasing slowly, but in the southwestern, southeastern, northwestern and central parts of the state, cases have been surging.

People from communities outside of the Kansas City area make up just over a quarter of the total COVID-19 patients this week at Saint Luke’s Health System in Kansas City, and two-third of those patients require treatment in intensive care units.

“Not only are we seeing an uptick in those patients in our hospital from the rural community, they are sicker when we get them because [providers in smaller communities] are able to handle the less sick patients and we get the sickest of the sick,” says Dr. Marc Larsen, who oversees COVID-19 treatment at Saint Luke’s.

ICU-level patients require an average of two weeks in the hospital, according to Larsen, using bed space that could be used by other patients.

But critically ill patients in rural areas often have few options. Around 68% of counties in Missouri lack intensive care units. Missouri has the 4th highest number of counties without ICUs in the country.

Missouri Gov. Mike Parson has dismissed requests from health care providers to implement a statewide mask mandate. At his last COVID-19 briefing on Oct. 21, when the state health department reported a record high 1,548 people hospitalized, Parson insisted that hospitals could manage the surge.

“While this is higher than previous levels, overall, our health care system is still stable and meeting the demand,” Parson said.

Official data from the state appears to back him up. This week, the Department of Health and Senior Services’ COVID-19 dashboard showed that nearly half of hospital beds, more than a third of intensive care units and two thirds of ventilators are available for use.

But some hospital leaders argue this paints a false picture of where things stand.

Larsen says that the capacity bed counts typically include any overflow or surgical bed that has ever been available, regardless of whether it can realistically be used for treatment by trained health care workers.

“There’s a difference between a physical bed that’s physically available versus having a staffed bed that’s able to [provide] the level of acuity that we need,” Larsen says.

In the past two weeks, some hospitals in the Kansas City area have had to stop accepting ambulances and patient transfers from other facilities for periods of time due to capacity concerns.

Some hospital leaders have expressed growing concern about capacity as seasonal illnesses add to demand for hospital care and flu season draws closer, though they insist the area hospital system is still able to provide care for those who need it.

At the same time, some hospitals continue to resist disclosing data about capacity, according to Archer, of the Kansas City Health Department.

“They have almost an unconscious fear of reporting data and concerns about their competitors and their market share,” Archer says. “It’s just not a priority to report accurately.”

Several hospitals and health systems, including KU Health System, Truman Medical Centers and Saint Luke’s Health System provided patient and capacity data to KCUR for this story.

HCA Midwest, a for-profit health system that operates several Kansas City-area hospitals, including Research Medical Center, Menorah Medical Center and Lee’s Summit Medical Center, did not respond to requests for information.

Missouri Hospital Association spokesman Dave Dillon responded to an inquiry from KCUR and said that hospitals in the state would be shifting to a “staffed bed” model of reporting.

Dillon said that COVID-19 was “likely” a factor in the management of capacity but argued that hospitals had no incentive to not be transparent.

He acknowledged that hospital reporting had been complicated by frequent changes in federal requirements.

“Unfortunately, our targets continue to move as HHS and the Trump administration announce sudden changes on the data reporting platforms and guidance on how hospitals should interpret what they’re mandated to report,” Dillon said in an email.

Many hospital workers, however, say the problem is even worse than some of the more candid hospital leaders are admitting.

Three emergency room nurses at hospitals across the metro area who asked for anonymity due to concerns about losing their jobs said that they were regularly tasked with caring for more critical ill patients than in the past.

Pascaline Muhindura, the Research Medical Center nurse, says that hospital workers are also struggling with exhaustion and mental health issues.

She says she had expected that seven months into the pandemic, government and health care leaders would have made more progress in slowing the coronavirus.

“Personally, I feel like it could’ve been handled from the top a lot better, which would’ve trickled down,” Muhindura says. “We could’ve done a lot better.”

As a health care reporter, I aim to empower my audience to take steps to improve health care and make informed decisions as consumers and voters. I tell human stories augmented with research and data to explain how our health care system works and sometimes fails us. Email me at alexs@kcur.org.
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