Copyright © 2020 Albuquerque Journal
SANTA FE – It’s no secret when someone dies in Guadalupe County, a rural area in eastern New Mexico with just under 5,000 residents.
So when two patients in their 30s at Guadalupe County Hospital died of complications from COVID-19, it left the hospital’s small staff emotionally shaken. Many had known the patients personally.
“In Albuquerque, there’s a chance you’ve never seen this patient before,” said Mandy Cordova, director of nurses at the hospital. “But here, if it’s somebody who’s a local, it’s devastating for us.”
That toll shows no sign of easing anytime soon. For Guadalupe County and other rural hospitals in New Mexico, there are too many patients and not enough staff – and both numbers are trending in the wrong direction.
COVID-19 cases have risen sharply across New Mexico, leading to a surge in hospitalizations that has plunged the state’s health care system into a potential crisis.
Many hospitals in urban areas, including Albuquerque and Las Cruces, are at or near capacity, and Gov. Michelle Lujan Grisham recently said hospitals could start rationing care to the sickest patients. Administrators of rural hospitals told the Journal that as a result, they’re treating patients for longer periods of time, many of whom are much sicker than patients they usually treat. That’s because they have to wait for a bed to open up at a larger hospital, where a patient can receive more specialized care.
Guadalupe County Hospital – which has zero intensive care beds – had four patients with COVID-19 on Friday. Three were inmates from the local prison, which has had more than 100 cases of its own.
“We have patients that are so sick that our staff is really stressed to manage them,” said Dr. Randal Brown, the hospital’s chief of staff. “We really would be overwhelmed if we had more patients in those beds.”
At Miners’ Colfax Medical Center in Raton, at the state’s northern border, CEO Bo Beames said his facility went from having zero COVID patients a month ago to 3 to 5 every day.
Rural counties in New Mexico are having some of the largest per capita increases in COVID-19. In smaller health care settings, the addition of even a couple of patients can tip the scales for what workers can handle.
Brown said the few patients his hospital has are too much for his staff and any more would make it almost impossible to manage.
Nearly all patients came in after having Thanksgiving gatherings, and Brown expects that number to rise in the coming days.
And staff members are not immune to the spread.
Rural hospitals often run on small staffs, meaning the loss of even a few workers can be a serious detriment.
About 20% of the staff Nor-Lea Hospital in Lovington has tested positive since the pandemic started, CEO David Shaw said. At some points, staffers have had to treat some of their ill colleagues.
In response, the hospital shut down its surgical wing and pain clinic so nurses could fill the gaps left by those who are sick.
“We don’t really have sufficient public health support in our area,” Shaw said.
Stephen Stoddard, executive director of the New Mexico Rural Hospitals Network, said that at one time 25% of the staff at Roosevelt General Hospital in Portales was sick or quarantined.
Officials from the hospital did not respond to requests for comment.
The overload in patients also stems from difficulties in transferring them to other facilities. Rural hospitals typically transfer patients who need specialized or intensive care, but many transfer sites have no more room, leading to longer wait times.
A transfer typically takes a few hours to complete, but now some hospitals are reporting transfers taking as long as 48 hours. The impacts go beyond just those with COVID-19.
“Recently, we had a non-COVID patient that needed to be seen,” Guadalupe County Hospital administrator Christina Campos said. “It took us about 48 hours to find a receiving hospital, and when we did it was one in Amarillo.”
Even when they’re able to secure a bed, it can take hours before the patient can be transported.
Nor-Lea Hospital usually relies on hospitals in West Texas for its transfer patients. However, cities including Lubbock and Amarillo are having some of the nation’s worst outbreaks, with hospitals there having to keep an overflow of patients in the emergency room, local outlets have reported.
Beames said hospitals in Colorado are also no longer accepting transfers.
University Medical Center, one of Lubbock’s largest hospitals, is rejecting around 25 transfer requests a day, a spokesperson told the Journal in an email.
For Shaw, that means his patients now have to go to Albuquerque if there’s room, either by airplane or helicopter. Ambulances can’t carry all the oxygen necessary to keep a patient alive for a five-hour drive, he said.
But with demand soaring for medical aircraft to transport patients, it can take just as long to find a plane as it does to find a free bed.
“Patients have had to wait in the hospital 24 hours or more while we wait for a fixed-wing aircraft,” Shaw said. “There’s just not enough.”
And with residents of urban areas having easier access to larger hospitals, Brown said, rural patients often have to wait longer.
“We don’t get to the front of the line with our patients,” he said, adding that it’s not the fault of larger hospitals.
Guadalupe County, meanwhile, has no paramedics in the area capable of transferring patients, meaning crews have to make the two-hour drive from Albuquerque.
That was on full display Friday, as a patient in Santa Rosa who needed transportation to Lovelace Medical Center in Albuquerque waited 24 hours for an ambulance to arrive after poor weather delayed paramedics from making the trip over.
Meanwhile, rural staffs are stretched thin, logistically and emotionally. Cordova said they’ve started bringing in grief counselors to help nurses cope with stress after the death of a patient.
Asked what it was doing to aid rural hospitals, the state Department of Health referred all questions to the Rural Hospitals Network. A spokesperson for the Governor’s Office wrote that the limited capacity at hospitals emphasizes the need for New Mexicans to stay home.
Brown said it’s becoming vital for people to stay home and wear a mask when they do go out. Hospitals can’t take much more.
“If we have any increase in volume over where we’re at right now, we will really be in a disaster,” he said. “That’s the answer.”