Oregon rural hospitals losing revenue, laying off workers

By ANDREW SELSKY

SALEM, Ore. (AP) — Rural community hospitals in Oregon are seeing revenue plunge and resorting to laying off and firing employees to cope with a ban on elective surgeries while health officials battle the coronavirus outbreak.

Some hospitals have seen revenue decline as much as 60% in a month, said Becky Hultberg, CEO of the Oregon Association of Hospitals and Health Systems.

“Staffing is one of the hospital’s most significant costs. So as revenue declines, some hospitals have been forced to furlough or lay off staff,” she said.

Hospitals in the state have enough capacity to handle an expected peak in virus cases later this month, according to projections, but the association says it’s too early to relax the restrictions.

Hospitals in other states are also losing revenue. On Wednesday, 19 U.S. senators — Democrat and Republican — warned that “without intervention, COVID-19 will close hundreds of rural hospitals across the country, and tens of thousands of rural patients will lose access to their nearest emergency room.”

The senators, including Democrat Jeff Merkley of Oregon, told U.S. Department of Health and Human Services Secretary Alex Azar that a $100 billion federal relief fund for health care providers should prioritize rural facilities, with 20% directed to the operations.

Oregon Gov. Kate Brown on March 17 ordered that all elective and non-urgent medical procedures be cancelled or rescheduled until at least June 15 to preserve masks and other protective equipment for the state’s COVID-19 response.

Some hospitals also lost revenue because fewer people visited emergency rooms, opting instead for virtual visits with a medical professional, fearing an ER could expose them to the virus.

Claims for unemployment insurance reflect the scope of the job losses. In the past week, the Oregon Employment Department received 8,800 unemployment claims from workers in health care and social assistance fields, up from 396 three weeks earlier. Only accommodation-food services workers filed more claims.

In Oregon’s remote southwest corner along the Pacific Ocean, Curry Health Network has laid off, furloughed or cut back the hours of 192 employees. That’s more than half of the staff who work in the network’s hospital in Gold Beach and several medical clinics. Managers, meanwhile, took a 20% reduction in pay.

“We work on a very small margin,” said Cheryl McDermott, a spokeswoman for Curry Health Network. “If we can’t do elective procedures, patient volume is dropping and it has a very strong financial impact. Additional funding is definitely needed for us and other hospitals throughout the United States.”

Sara Dickerson, a family nurse practitioner, was laid off by the network on Tuesday.

“What is most upsetting to me was the treatment of my medical assistant, who was terminated on March 31,” Dickerson told the Curry Coastal Pilot newspaper. She said the assistant now has no medical insurance.

The Oregon Association of Hospitals and Health Systems has asked the governor for $200 million in new state funding to be allocated directly to hospitals to address urgent needs and keep providing services.

The state, however, is also expected to have less money because the newly unemployed are no longer paying income taxes.

Hultberg said her group recognizes that significant budget challenges lie ahead but added: “People count on hospitals in a crisis.”

U.S. Rep. Greg Walden, a Republican representing a wide swath of eastern and central Oregon, has also urged that rural hospitals be prioritized for money approved by Congress.

“Our rural community hospitals are struggling financially right now in large part because the governor shut down any elective procedures,” Walden said.

Oregon is not expected to see a big spike in COVID-19 cases as long as people keep staying home and maintain social distancing when out on urgent errands, state health officer Dean Sidelinger said.

“We know it comes at a huge sacrifice,” Sidelinger said about the manageable number of cases. “People have lost their jobs. Our small and large businesses are suffering.”

The peak of the outbreak is expected around April 22 in Oregon, according to a projection by the Institute for Health Metrics and Evaluation, noting there should be more than enough hospital beds and ICU beds available.

Hultberg, however, is not advocating that restrictions on elective procedures be relaxed.

“I would rather be having the conversation today about hospital sustainability than the conversation about mortuary capacity,” Hultberg said. “It is too early to talk about changing course.”

___

Andrew Selsky is on Twitter at https://twitter.com/andrewselsky

Virus sparks prison riot, hits more WA long-term care homes

SEATTLE (AP) — Inmates at a Washington state prison staged a large protest following new coronavirus diagnoses at the facility and health officials say they continue to see high numbers of cases in the state’s long-term care facilities.

More than 9,600 people have tested positive for COVID-19 and at least 446 have died, according to the Department of Health.

State Health Officer Dr. Kathy Lofy said there are signs that the state has begun to “flatten the curve” but said people should continue to stay home and keep their distance from others.

“We are no where near being out of the woods here,” said Secretary of Health John Wiesman. “This virus can easily spring back.”

Lofy said as of April 5 authorities had identified the virus in 126 of long-term care facilities. Washington’s first large coronavirus outbreak was at the Life Care Center in Kirkland, Washington, which has been linked to dozens of deaths.

Inmates at the Monroe Correctional Complex held a demonstration on Wednesday night after six inmates tested positive at the prison, according to the Washington State Department of Corrections. The latest two cases at the facility that can house up to 2,500 inmates were men aged 68 and 28.

Corrections officers used verbal orders, pepper spray and rubber pellets to get the demonstrators under control, but the inmates ignored those efforts, officials said. Both housing units were evacuated and the situation was under control soon afterward. No one was injured.

The six men who tested positive were transferred to an isolation unit, where the health care team provided monitoring and support. Corrections officials are conducting an internal investigation.

Five correctional staff members have also tested positive.

Gov. Jay Inslee said Thursday that he recognizes the concerns inmates and their families have about the virus inside correctional facilities, and is trying to balance inmate needs with public safety.

“DOC has been working closely with the Department of Health to implement strategies around testing, social distancing, quarantine, isolation and other practices to prevent the spread of this virus,” he said.

A handful of inmates at the Monroe facility are asking the state Supreme Court for help. They previously filed a petition asking the court to order Inslee and corrections Secretary Steve Sinclair to immediately release inmates over the age 50, those with underlying medical conditions and inmates who are within 18 months of their release date.

On Thursday, they filed an emergency motion, asking the court to immediately act on their requests and test everyone who’s being held at the prison.

“It appears that DOC may be using a show of force rather than take other more appropriate public health measures to resolve the legitimate concerns of people trapped in MCC-MSU,” their motion said. “People living in MCC-MSU are scared and not being appropriately protected.”

The Washington Supreme Court responded to the emergency motion Thursday with a letter saying the state must respond to the motion by 9 a.m. Friday.

Inslee and Sinclair held a press conference Thursday afternoon to discuss the way the state is handing the prison system as the COVID-19 continues to grow.

Corrections officials are screening all people in the prison system for symptoms and they stopped visitations weeks ago, Sinclair said. They’re also working to release some non-violent offenders who are within 60 days of their release, he said.

Inslee said that group of offenders would include people who are over 60 and have underlying health conditions that make them more vulnerable to a negative outcome should they contract the disease.

Sinclair said they were following the health department’s guidelines on testing for COVID-19, and are only testing people who have symptoms. He later said that they have had six inmates test positive and they are awaiting results on 54 other cases.

Two residents at the Spokane Veterans Home tested positive for the disease and one of those residents died on Wednesday, officials said. The residents were roommates and were isolated when their symptoms appeared.

The resident had been on end of life care for some time and had underlying medical conditions, officials said. The other resident who tested positive remained at the facility and symptoms have lessened, officials said.

“I want to say how incredibly grateful I am to the staff at the Spokane Veterans Home, who are coming to work each day to serve our veterans and their families,” said Patrick McNabb, administrator of the Spokane Veterans Home.

State health officials continue to distribute personal protective equipment to front-line workers across the state, Wiesman said. As of March 16, they had shipped 2.2 million items to health care providers, including N95 masks, surgical masks, gloves, gowns and face shields.

They have 3.8 million items that are being processed for shipment, he said. Hospitals, EMS workers and long-term care facilities that are handling positive cases are getting top priority for these supplies, he said.

▶️ COVID adds another, potentially lethal, layer to homelessness

Homelessness during a pandemic.

It can be hard to understand how the COVID-19 crisis is impacting the lives of people already in a vulnerable population.

Service providers say the virus adds yet another layer to the plight.

It’s making resources, stretched thin, even thinner.

Central Oregon Daily’s Cody Rheault takes us to a homeless camp near Bend and talks with service providers about the new challenges they all face.

 

La Pine woman arrested on drug, weapon charges after chase

A 34-year-old La Pine woman was arrested Thursday on weapon and drug charges after leading deputies on a forest road chase, the Deschutes County Sheriff’s Office said.

Sgt. Kent Vander Kamp said the incident started around 10 a.m. when a deputy was monitoring traffic at the intersection of Highway and 97 and State Recreation Road in the La Pine area.

At the same time a dodge pickup driving east on State Rec Road crossed over the highway speeding and ignoring the stop sight, Vander Kamp said. The truck, driven by Emma Pickett, narrowly avoided a collision with traffic heading south, and headed east onto Forest Road 9735.

After watching this, the deputy tried to pull over Pickett as she sped away on the forest road, Vander Kamp said.

The deputy chased Pickett for six miles into the forest before her truck became stuck in some snow. Speeds ranged between 35-55 mph and no other traffic was around, Vander Kamp said.

He said deputies found a user amount of meth and a large dagger at the scene.

Pickett was taken into custody at the scene, but released on her own recognizance. She was charged with attempt to elude by vehicle, reckless driving, felon in possession of a prohibited weapon and possession of meth.

▶️ ‘I cried’… School closure hitting local teachers hard

By ANYSSA BOHANAN
CENTRAL OREGON DAILY

“I cried,” said Jaime Speed, a 4th and 5th-grade teacher at Juniper Elementary in Bend. “I could cry now.” 

Gov. Kate Brown’s announcement Wednesday, that Oregon schools will remain closed for the rest of the year, was expected. 

But for educators, it didn’t make the reality any easier.

“Seeing our kids and being with our kids is really important to us, and we worry about them,” Speed said.

“We’re really bummed, we really thrive on working with our kids,” said Sisters School District Vocal Music Director Rick Johnson. “As a music teacher, I was really looking forward to having my year-end concerts and celebrating the seniors as we always have.”

“The sad thing for me is that we’re no longer going to be able to celebrate all of the awesomeness that happens in our building,” Silver Rail Elementary Library Media Manager Ann Marie Anderson said.

Education will continue to take place virtually, a new normal that has, and likely will continue to take some getting used to.

“Unfortunately technology isn’t that great when you have a bunch of people trying to make sound into a Zoom or a Google meeting!” Johnson said. “It’s probably not going to sound all that great while we’re doing it, but the kids are going to continue learning.”

“It’s been great to be able to connect that way,” said Speed. “It’s just not as authentic as it is in the classroom.”

Even with the rapid changes and uncertainty, many are looking to the positives in the current situation.

“I was invited to a virtual class with a 3rd-grade cohort and just seeing all of their faces and having them all wave at me was so amazing, so special,” Anderson said.

“I’m kind of looking forward to finding a new way to do all of this,” Johnson said.

And though they can’t be there in person, every educator’s message to students is no matter what happens, they’re here.

“We can do it, I know we can if we all pull together, and help one another, and stay communicating,” Anderson said.

“I think we can have a lot of fun this way with learning music and sharing beauty in a time of a little bit of darkness,” Johnson said.

“We are here for your success and we love you,” Speed said.

▶️ How are you doing? La Pine edition

We’re now three weeks into the new world of COVID-19.

Your favorite restaurant is take-out only, you can’t park at the trailhead of your favorite trail and your kids’ school is closed UNTIL FALL.

Any one of those things would be enough for a blood pressure spike.

Put them together with everything else we’re dealing with and, well, it’s understandable if we’re inching toward our breaking point.

We’ve visited with folks in Bend, Madras and Prineville, so today Central Oregon Daily News Photojournalist Steve Kaufmann went south to La Pine this morning to ask one simple question:

How are you doing?


See our past stories here:

How are you doing: Bend

How are you doing: Prineville

How are you doing: Madras

Oregon COVID-19 Update: 82 new cases, 6 more deaths

The State Emergency Coordination Center in Salem on Wednesday reported 82 new cases of COVID-19 and six new deaths, bringing the Oregon death toll to 44.

Deschutes County reported five new cases, bringing the total to 50. Crook County still has one reported case of COVID-19 and Jefferson County on Thursday reported its first positive case, although the patient is currently living out of state.

Statewide, 1,321 people have now tested positive for COVID-19. More than 24,300 people have tested negative, including 1,118 in Crook, Deschutes and Jefferson counties, according to the Oregon Health Authority.

The new COVID-19 cases reported today are in the following counties: Clackamas (6), Columbia (1), Curry (1), Deschutes (5), Jackson (4), Klamath (1), Lane (2), Linn (3), Marion (17), Morrow (2), Multnomah (16), Polk (1), Tillamook (1), Umatilla (3), Washington (16), and Yamhill (4).

The office of Oregon Emergency Management is now releasing updated COVID-19 figures daily.

New numbers show 400 people with COVID-19 or suspected of having it have been admitted to the hospital and 64 are currently on ventilators. The state has 794 ventilators available for patients.

You can access the new Oregon daily update document here.

New weekly report on COVID-19 cases in Oregon

The OHA has started posting a weekly report that represents a snapshot of COVID-19 risk factors, clinical and demographic characteristics, and includes data on cases with pending investigations. You can review the report here.

Deschutes County has been providing more demographic information on its patients, although those numbers sometimes aren’t in concert with the state reports and are reported at a later time.

Here are the latest numbers as of 4/8/20.

COVID-19 – BY THE NUMBERS

Positive

Negative

Deaths

Oregon 1,321 24,306 44
Deschutes County 50 937 0
Crook County 1 91 0
Jefferson County 1 90 0

Additional Deschutes County demographic information as of 4/9/2020

Total Number of Deschutes County COVID-19 Cases who have Recovered 20
Deschutes County COVID-19 Cases by Sex
Female 23
Male 27
5
Deschutes County COVID-19 Cases by Age Group
Age 29 or younger 6
Age 30 to 39 7
Age 40 to 49 6
Age 50 to 59 9
Age 60 to 69 11
Age 70 or older 11
22
Deschutes County COVID-19 Cases by History of Travel
Travel history (domestic or international) 21
No travel history 29
15
Deschutes County COVID-19 Cases by Hospitalization Status, Ever
Ever hospitalized 18
Has not been hospitalized 32


Global response
: The World Health Organization guides the global response.
United States response
: The Centers for Disease Control and Prevention leads the U.S. response.
Oregon
 response
: The Oregon Health Authority leads the state response.Stay informed about COVID-19:

▶️ St. Charles expands COVID testing thresholds

St. Charles Health System officials on Thursday said the hospital has expanded the thresholds for COVID-19 testing, but widespread testing still is not available to everyone with symptoms.

Since the early stages of COVID-19 in Central Oregon, patients needed to meet a narrow set of criteria in order to be tested.

This was a point of contention throughout the community as people believed they had the disease but weren’t able to get fully checked out.

In mid-March hospital officials said the swabs are running very low throughout Oregon “and we believe it’s unlikely we’ll be able to get more.”

“Therefore, we simply cannot test people who are worried but feel fine,” President and COE Joe Sluka said at the time.

But during a virtual public forum on Thursday, Executive Vice President and Chief Physician Executive Jeff Absalon said more tests have become available and they are now able to test anyone who has worsening clinical symptoms of the disease such as fever, cough and shortness of breath – regardless of age or other other medical conditions.

Additionally, the new criteria shows tests will be given to those with 100.4-degree fever in the past 24 hours AND a cough or chest pain AND:

  • Older than 60
  • Children under 1-year-old.
  • Ay child with household contact at high risk of severe COVID-19 illness.
  • Patients with underlying medical conditions including hypertension, diabetes, cardiovascular disease, lung disease and others.
  • Pregnancy
  • Patients who had contact with a patient with a COVID test pending or with confirmed COVID-19  infection.
  • Healthcare workers, including scribes and EMTs, first responders, any worker in a vial infrastructure role such as employee of an electrical, gas or other utility, water or sewer treatment facility
  • Any patient with worsening symptoms (e.g. this could be a repeat visit to the ED or office, or no improvement in fever, cough, chest pains in the last 48 hours.)

“It’s really important for us to get the word out now that we are expanding our criteria for testing and help us identify who has the disease, how we isolate them and how we can appropriately manage this pandemic,” Absalon said. 

Additionally, as soon as Friday the hospital could begin testing onsite rather than sending swabs to the University of Washington and waiting days for results.

“We are very excited to be able to do testing on-site,” he said. “The turnaround time will be in the number of hours instead of days. This is a big development for us.”

The St. Charles lab alone has tested 938 people with 33 positive cases and 137 cases pending.

Throughout Central Oregon, 52 people have tested positive for COVID-19; 50 in Deschutes County and one each in Crook and Jefferson counties, although the Jeffrerson County case is a patient who currently lives out of state.

Sluka said more testing options are being approved by the FDA and the hospital has had regular contact with state and congressional leaders along with the manufacturers to secure more tests in Central Oregon.

During the town hall, the hospital officials said the state is still in the early stages of the fight against COVID-19 and was lagging behind Portland, Salem and other metro areas in the state.

“If we get to a significant level of surge we may have as short as 6 days supplies of personal protective equipment on hand,” said St. Charles Health System senior data analyst Michael Johnson.

He predicts demand for hospital beds, beds in intensive care and ventilators will continue to rise through the end of this month.  

Absalon said the hospital has plans to increase capacity if needed.

“That could mean we fall back into service rooms that had not been previously used for critical care, doubling up on patient rooms, re-purposing outpatient spaces and visitor spaces,” Absalon said.

Hospital revenues have decreased by 45% since the governor ordered a stop to elective surgeries and expenses have increased.

Chief Financial Officer Jenn Welander says the hospital has about eight months of operating cash and reserves on hand.

Health officials remain adamant that now is the time to double-down on social distancing efforts.

“I think the take-home message is we need to stay the course. Staying home and socially distancing are our best weapon in this fight,” Sluka said.

Doctors quashed rumors that hydroxychloroquine is available to the general public. It is only used in hospitals and not available through pharmacies.

 

 

 

 

 

Rapid virus testing machines delivered to 3 rural Oregon hospitals

Three rural hospitals in Oregon will get COVID-19 rapid testing instruments, Gov. Kate Brown announced on Wednesday. 

The first hospitals to receive the Abbott ID NOW machines are Curry General Hospital in Curry County, Pioneer Memorial Hospital in Morrow County, and Lake District Hospital in Lake County.

The point-of-care COVID-19 testing machines are capable of returning positive or negative test results in minutes. The three hospitals will begin validation testing this week, and rapid testing will not be immediately available to the public, Brown said in a release.

“Expanding rapid testing in Oregon is key to ensuring we have the capacity to track and contain new cases, keep Oregonians healthy and safe, and prevent future outbreaks,” Brown said. “Rather than taking hours or days to return a test result, these instruments are capable of returning positive or negative test results in minutes. This capability is especially crucial in our more remote communities, where rapid testing will help minimize the amount of travel needed for trips to the doctor’s office.”

The U.S. Department of Health and Human Services (HHS) sent Oregon 15 testing machines, the same number being sent to all other states, along with a small supply of testing kits and materials.

“I want to be very clear: the number of testing kits we have received from the federal government for these new machines does not even come close to approaching the need we have in Oregon right now,” Brown said. “I am committed to working with our federal partners to secure additional test kits as Abbott and other companies ramp up their production capacity.”

Although Oregon received 15 Abbott ID NOW instruments, the federal government shipped five boxes of testing kits with the machines, with 24 tests in each box.

Until more Abbott test kits are secured, the additional rapid testing machines cannot be distributed to priority areas.

With limited supplies, OHA will distribute Abbott ID NOW resources based on the following criteria:

  • Areas of the state with no access to COVID-19 testing.
  • Areas of the state with a limited number of first responders.
  • Areas of the state where courier services for the state public health lab and commercial labs are limited or unavailable.
  • Areas with a high population of older adults and other at-risk groups.
  • Areas where hospitals or clinics do not already have access to an Abbott ID NOW instrument.

OHA sees uptick in dating app use, issues sex guide for COVID-19

The Oregon Health Authority on Wednesday released a visual guide to sex during COVID-19 after getting info on increased dating app use during the crisis.

“At a time when Oregonians are spending more time than ever at home, we imagine you may be wondering “Is it still safe to have sex?”  the agency said in a tweet. “In short – Yes. You can still have sex but with precautions. Here are some tips on practicing safe sex during this time.

Tim Wollerman, a spokesman with the Oregon COVID-19 Joint Information Center said they weren’t getting questions about sex specifically, but became aware of a jump in people using networking apps.

“This increase in app use does raise the question of whether folks might be meeting people outside their household to have sex despite the social distancing measures,” Wollerman said. “We released this guidance to provide alternative ways to find sexual pleasure and ways for people to protect themselves if they are indeed having sex with people that are not a part of their household.”

Reactions to to the post ranged from “Are you serious, right now,” to “Great idea, excellent messaging. Thank you!” with plenty of objectionable responses in between.