South Dakota’s largest hospitals are at or above their capacity to care for critically ill COVID-19 patients, forcing some of the sickest patients to be flown out of state to receive care.
The strain of a months-long surge in coronavirus cases has reduced hospital capacity to care for those with severe symptoms, making it increasingly uncertain whether the sickest South Dakotans will be able to get treatment in the state, health providers say. Meanwhile, ICU space is quickly evaporating in neighboring states as well.
Both the Sanford USD Medical Center and Monument Health Rapid City Hospital have reported that their Intensive Care Units are out of space. On Dec. 2, Avera McKennan reported that 6.7% of its ICU beds were available for use. Statewide, the number of available ICU beds has been steadily declining as coronavirus cases have continued to climb.
Major hospitals are still taking patients when they can, but some sick South Dakotans are being sent out of state, forced to use expensive urgent transportation systems to get care hundreds of miles away from their families.
COVID-19 patient Robert J. Sliper of Lead, South Dakota, was flown on an airplane in mid-November to Greeley, Colorado, because there wasn’t enough room in local hospitals, according to an emotional letter written by his son Mike Sliper. The letter, which Mike Sliper posted to Facebook on Nov. 18, detailed Robert Sliper’s life and the anguish his family felt watching him get loaded onto a plane to fly 340 miles to a hospital they couldn’t visit.
Robert Sliper, a Navy veteran and mining engineer who graduated from the South Dakota School of Mines and Technology, died in Greeley on Nov. 13 at the age of 84, the post said.
Sliper’s body was brought back to South Dakota for his funeral. “We want to bury him in the state that he loved so much but near the end didn’t have room for him,” Mike Sliper wrote.
Status changes by the minute
In South Dakota, hospital critical-care capacity was limited long before COVID-19 hit. Rural residents in need of intensive care already were frequently expected to travel up to hundreds of miles by plane, helicopter or ambulance to get lifesaving treatment at major healthcare centers in Sioux Falls or Rapid City.
As the pandemic has stretched on, South Dakota’s three major hospitals — Avera McKennan and Sanford USD Medical Center in Sioux Falls and Monument Health Rapid City Hospital — are now struggling to find or make space to care for the most ill COVID-19 patients and others with serious health problems.
Hospitals are so full, and ICU bed availability is changing so fast at large hospitals, that data reported on the state Department of Health COVID-19 webpage often doesn’t reflect reality, said Dr. Srinivas K. Gangineni, the ICU medical director at Monument Health Rapid City Hospital. The result is that the state’s largest, best-equipped hospitals can’t always guarantee they’ll have space to care for the most critically-ill COVID-19 patients on any given day.
“To be honest, I don’t look at the Department of Health website,” he said. “The data I can give you right now, it could be different in 15 minutes.”
Sioux Falls-based Avera Health system, which owns Avera McKennan Hospital and dozens of smaller hospitals in South Dakota, Iowa, Minnesota and Nebraska, is well into its coronavirus surge plan, said Dr. David Basel, vice president of clinical quality. Avera McKennan has nearly doubled its ICU capacity by postponing some non-emergency surgeries, cross-training hospital staff to work with COVID-19 patients and repurposing some hospital space for intensive care.
Most of the hospitals affiliated with Avera Health, including in South Dakota and neighboring states, are “at, near or above” their capacity to treat COVID-19 patients, Basel said.
Officials with Sanford Health were not made available to speak with South Dakota News Watch for this story.
Hospital capacity data reported by the state Department of Health suggest there is plenty of room in hospital ICU units to handle more patients. The DOH reported on Dec. 2 that statewide about 16% of adult ICU beds in the state were available for use. Roughly 35.2% of all staffed hospital beds were available for use, the department reported.
But much of South Dakota’s open ICU space is in smaller, more rural hospitals that don’t have the staff or equipment to care for the most ill patients, including those with severe COVID-19 symptoms. Those most critical patients tend to stay in hospital beds and intensive care for weeks and often require a level of care that can only be found at major medical centers, experts say.
“A lot of our hospitals would be comfortable caring for a patient with pretty normal lungs after surgery. But these COVID patients are really, really sick and have really complex lungs, and they take an additional skill set,” Basel said. “Not all ICU beds are created equal.”
The states surrounding South Dakota are also seeing strains on hospital capacity. North Dakota Gov. Doug Burgum announced on Nov. 9 that the state’s hospitals had reached 100% of capacity. By Dec. 2, North Dakota’s hospitalization rate had fallen, and roughly 13% of the state’s capacity to treat COVID-19 in hospitals was available.
Hospitals in South Dakota and across the country are also undergoing challenges providing critical care due staffing shortages due to illness and burnout. Across South Dakota, hospitals were enduring long-term shortages of doctors and nurses long before the pandemic. Now, hospitals are seeing dozens of staff forced to take time off due to the virus.
That has left some hospital administrators worried that they may have enough beds but not enough staff to care for critically ill patients if the number of coronavirus cases begins climbing again.
South Dakotans who need hospital-level care, including intensive care, can still get it, though they may be sent far from their homes, including to hospitals in other states. But hospital capacity has tightened across the country amid the nationwide coronavirus surge, limiting options elsewhere. The state’s hospitals may be forced to shut down clinics and restrict or ration care for chronic conditions such as diabetes and hypertension to free up doctors and nurses to treat COVID-19 patients. Even then, hospitals may reach the limit of their ability to care for everyone who gets sick.
“I don’t know what that limit is, but if cases were to double for another month or two, we would be making some hard decisions,” Basel said.
Rose Mary Kor, who lives outside the Black Hills city of Custer, was rushed to the Emergency Room at Monument Health Custer Hospital on Nov. 2 after struggling to breathe for nearly a week. Kor, 70, said she thought her asthma had been acting up. Then, after an emergency X-ray, doctors told Kor that she had pneumonia due to COVID-19 and needed immediate hospitalization at a more well-equipped facility.
The problem was that Monument Health Rapid City Hospital, where critically ill patients from Custer are usually sent, was full and couldn’t accept new COVID-19 patients. Kor had to choose whether to be flown to a hospital in Gillette, Wyoming, or a hospital in Casper, Wyoming. Both options were more than 140 miles from her home.
“I was in disbelief,” Kor said. “The hospital in Rapid City is not small. The question in my mind was, ‘Why are they not prepared for this?’”
Kor is not alone in her experience. Several other South Dakotans from East River and West River who belong to a closed COVID-19 discussion group on Facebook have shared similar stories of loved ones being diverted to hospitals far from their homes.
Monument Health Rapid City Hospital is the flagship hospital for the Monument system in western South Dakota and offers the highest level of care available in the region. The hospital’s 33-bed Intensive Care Unit has essentially been full through much of November, Gangineni said.
The number of COVID-19 hospitalizations rose sharply during November in almost every part of the U.S and was still growing at the end of the month. On Dec. 2, the nationwide number of COVID-19 hospitalizations stood at 98,691.
Ultimately, Kor chose to go to Casper, where she spent nearly two weeks at the Wyoming Medical Center with a high-flow oxygen mask helping her body function. The oxygen mask worked, and Kor narrowly avoided being placed on a ventilator.
One bright spot in terms of hospital capacity is that some rural hospitals have increased their ability to care for COVID-19 patients. When the pandemic began, Avera Health system hospitals started sending all of its COVID-19 patients to Avera McKennan in Sioux Falls because there were more specialists and space at the larger hospital.
The Huron Regional Medical Center was one of the first rural South Dakota hospitals to see a surge of COVID-19 patients. Consequently, the independent hospital pioneered some of the emergency remodeling that other smaller hospitals later used to treat coronavirus patients safely, said Erick Larson, hospital president and CEO.
The hospital’s COVID-19 unit has enough space for 14 patients at a time, with space for up to four patients in intensive care. The Huron hospital’s staff also created a new five-stage surge plan and secured a steady supply of personal protective equipment by working with the state health department and the federal Centers for Disease Control and Prevention.
Hospital staff also formed small groups, or pods, that work closely together but separately from other staff as a way to prevent widespread exposure to COVID-19 if someone gets sick, Larson said.
Monument Health Rapid City Hospital’s ICU has been fortunate that none of its physicians have gotten sick, Gangineni said. The hospital also has a plan in place to bring in another doctor if needed. Nurses, though, are in shorter supply.
“It takes a toll on staff, seeing how sick some of these patients get, how they stay sick for days and weeks, and sometimes months,” said George Sazama, director of the nursing unit at the ICU in Monument Health Rapid City Hospital.