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‘Code Purple’

Copyright © 2015 Albuquerque Journal

University of New Mexico health care and administrative officials will soon seek state approval to build a state-of-the-art replacement facility for the flagship but aging and overcrowded university hospital on Lomas Boulevard.

UNM Health Sciences Center Chancellor Paul Roth painted a grim picture of overcrowded conditions at the existing facility to his board of directors Wednesday afternoon. The chief problem at the only hospital of its scope and capabilities in New Mexico is capacity, he said.

Roth described a hospital that was at maximum occupancy – or “Code Purple” – 90 percent of the time last year, turning away hundreds of patients from other hospitals around the state and keeping patients in the emergency department for up to three days because there were no beds available in regular wards.

The hospital has 308 adult beds, and “that’s where the crunch is,” Roth told an audience of about two-dozen administrators and members of the UNM Board of Regents.

At similarly situated hospitals nationwide, the average occupancy rate is about 72 percent, he said. That percentage, at UNMH, would equate to 222 beds. Instead, the occupancy rate at UNMH is often as high as 90 percent.

When that rate surpasses 85 percent, problems with the delivery and quality of care – including patient safety – begin to emerge, Roth said.

Even back in July 2012, he said, “we already knew we were getting into a problem with capacity.”

Nearly three years ago, UNMH sought permission to build a 96-bed, $146 million facility for expansion purposes. The HSC board of directors, the UNM regents and the state Higher Education Department all gave the required OKs, but the proposal stalled at the State Board of Finance, which has the final say.

Serious overload

Since then, the capacity problem has only worsened, Roth said. In some months, especially since last autumn, UNMH admits close to 400 patients, even though it only has 308 adult beds, he said. Some patients are kept in the emergency department; others are placed in recovery rooms.

“Remember, these are really sick patients,” he said.

The nursing and medical staffs are worried about the quality of care they can provide, Roth said. Since July 2013, the number of emergency department patients that are admitted as in-patients has increased, ” but there is no bed,” he said. “We’re in dire straits.”

Nationally, the average waiting time for admission as an in-patient from an emergency room is between six to eight hours, Roth said. In March, at UNMH, the average wait was 15½ hours.

As a result, UNMH has had to send patients to Lovelace Hospital on a number of occasions, the chancellor said, “anywhere there was an appropriate bed.” Lovelace, he added, “bent over backwards to help.”

Still, last month some patients had to wait longer than three days in the UNMH emergency department.

“Anyone would look at these data and say, ‘What?’ ” he said.

Turning away patients

Because UNMH is the only Level 1 hospital in the state, other medical facilities routinely transfer patients there who require special care. But in 2014, because of occupancy, 529 such patients had to be turned away.

“That is not good patient care,” Roth said. “A lot of the hospitals have given up on us.”

Suzanne Quillen, chairwoman of the HSC board of directors and CEO of Advanced Care Hospital of Southern New Mexico, said her facility in Las Cruces, out of necessity, now transfers more patients to hospitals in El Paso, Texas, than it does to UNMH and has even begun sending people to Arizona.

“We cannot get patients here … it’s always Code Purple,” she said.

Board member Mel Eaves said the task he and his colleagues now face is to convince the State Board of Finance to take a step it was reluctant to take two years ago.

“That’s the final approval we couldn’t get,” he said.

UNMH is working with the management consulting firm Kurt Salmon Associates in developing a plan for the new hospital. A proposal is expected in a few weeks. It is hoped that it can be reviewed and approved by the regents and HED by July and by the State Board of Finance in October.

No bed count yet

It is too soon to say how many beds a new facility would house or how much it would cost, but it is sure to be considerably larger and more expensive than the $146 million price tag the proposed 96-bed facility carried.

That earlier proposal was not without its detractors.

Two years ago, New Mexicans for Equal Health Care Access said the approval process had not been transparent and that the planned downtown hospital’s mission was unclear. It asked the regents to revisit its approval.

Also, Bernalillo County Commissioner Art De La Cruz asked UNM to take another look.

“We do not believe there has been proper time for evaluation or public comment on the issue,” De La Cruz wrote in a letter to President Bob Frank at the time.

Commissioner Wayne Johnson, meanwhile, questioned whether the county should continue to allocate $90 million in annual property tax revenue to the hospital, which had accumulated enough cash surplus to pay for the construction of the new facility.

Previous objections

The Rio Grande Foundation, a think tank that advocates for limited government, also complained that the approval process was less than transparent.

“I just think we need to have a more robust discussion about what we want out of UNMH and whether they’re going to take business from other hospitals in the area,” said Paul Gessing, its president.

UNM Hospitals CEO Steve McKernan argued at the time that the hospital project had been publicly discussed at numerous meetings, including those held by the HHSC directors, the regents Finance & Facilities Committee and the full Board of Regents.

Two years ago, Lovelace Health System opposed the hospital, offering instead to make beds available at its own downtown location.

“We can tell you this as far as Lovelace is concerned – given the current health care environment, a new big hospital in the downtown area is not what is needed at this point,” Lovelace President CEO Ron Stern said in a letter to Johnson that was made public.

Instead, UNMH should enter into a bed-sharing agreement in which Lovelace would take patients at Lovelace Medical Center when UNMH’s emergency room was full, Lovelace argued. To make up for the lack of space – and beds – UNMH has moved all joint replacement operations, such as knees and hips, to its Sandoval County Medical Center, Roth said. Other functions also have been transferred there, he said.

Moreover, UNMH now spends $5 million annually to discharge patients to other care facilities.

The hospital has worked to improve efficiency in managing the patient load, to more effectively discharge post-acute-care patients and increase the number of beds.

“If we could build bunk beds in hospitals,” Roth said, “we would do it.”