Portside

In Los Angeles County, the average number of available hospital beds slipped to its lowest level since the pandemic began. A UC San Diego hospital in La Jolla made plans to convert conference rooms into patient areas and ease the expected crunch, while overflow tents were put into use outside the emergency department of a facility in nearby La Mesa.

Up and down California, the scenes of hospital overcrowding eerily evoke the early days of COVID-19’s arrival. To some of the people trying to provide care for waves of patients during this most recent surge, that is a huge part of the problem.

Three years in, almost nothing has changed.

“The hospital industry has once again failed to prepare for the surge in patients needing care for respiratory viral infections,” said Sandy Reding, an operating room registered nurse at Bakersfield Memorial Hospital and a co-president of the California Nurses Association (CNA). “Long before the COVID pandemic, nurses talked about hospital employers intentionally short-staffing units and failing to prepare for winter respiratory surges that we knew were coming.”

The current bed shortage was predictable, critics say, the result of years of workforce and space reductions as hospital systems squeezed profit and asked remaining health workers to do more with less. The pandemic pulled back the curtain on the caustic effects of that approach, but many hospitals continue to operate in near-crisis conditions that increasingly appear to be the way they’ll do business going forward. 

 
COVID-19 provided a stress test for California’s health care system, “and we failed,” Dr. Jeanne Noble told Capital & Main one year ago. But Noble, who directs COVID response for the emergency department at the UC San Francisco Medical Center, also correctly predicted what is happening now: “Any future surge will also overwhelm us.”

The results are in. Hospitals can add only so much bedspace after years of contraction, and the industry’s broad general plan to work at the lowest possible staffing levels leaves workers vulnerable to being pushed beyond their limits in any community-scale medical emergency.

Los Angeles County Department of Public Health Director Barbara Ferrer said last week that the average number of available beds in the county’s hospitals in December was “the lowest we have seen in the past four years.” On one day last week, she said, that number was just 242 beds, with data collected from 90 hospitals.

As Ferrer noted and every source contacted for this story affirmed, what is happening right now isn’t strictly attributable to COVID. There are increased numbers of seasonal flu and respiratory syncytial virus (RSV) patients — and beyond that, some hospital beds are already occupied by patients who have finally undergone medical procedures they put off during the most fearful months of the pandemic.

Still, “The hospital bed shortage in L.A. County is the product of a health care system that is designed to maximize profit all the time instead of providing the best possible care during a crisis,” said Sal Rosselli, president of the National Union of Healthcare Workers. (Disclosure: Both the NUHW and the CNA are financial supporters of Capital & Main.)

According to research by the Kaiser Family Foundation, California in 2020 had only 1.84 hospital beds per 1,000 people, the sixth worst such ratio in the nation. But even that definition of capacity is irrelevant if there aren’t enough nurses to tend to the patients who would occupy the beds that do exist. Years of reducing nursing staff, combined with job flight that has accelerated during the pandemic, have exacerbated the problem.

To those who represent the interests of the hospitals, staffing is the crux of the issue. Since the pandemic, “more health care workers across the country have left their jobs than at any point in the last 20 years,” said Jan Emerson-Shea, a spokesperson for the California Hospital Association. “In California, 78% of hospitals have experienced an increase in staff turnover since the end of 2019. Hospitals can’t hire workers who don’t exist.”

For years, California hospitals reduced bedspace in an effort to shorten patient stays and lower costs, but Emerson-Shea said that doesn’t tell the whole story today. “You can’t really put a cardiac patient in a labor-delivery bed,” she said. Too, chronic staff shortages at skilled nursing facilities and behavioral health providers have led to more of those patients staying at hospitals longer than they otherwise would, further backing up emergency departments, Emerson-Shea said. 

 
To many health care workers, the staffing issues were in play long before COVID hit. Health care unions were protesting staff cuts for years prior to the pandemic, and perhaps only California’s nurse-to-patient staffing requirements — the only such mandates in the country — have prevented more drastic workforce reductions.

“The hospital industry has embraced and normalized crisis standards of care to increase their profits and excess revenues,” Reding said. “This has set the stage for the current surge to become another crisis.”

Without a doubt, nurses and other health care professionals have been burned out by the pressurized demands of their jobs and the safety risks of going to work. Months into the pandemic, workers at facilities up and down the state were still protesting their hospitals’ refusal to provide adequate personal protective equipment (PPE) to keep nurses and other workers safe on the job.

The nursing shortage itself, meanwhile, remains very real. A 2021 study by UC San Francisco’s Health Workforce Research Center on Long-Term Care put the shortfall of registered nurses in California at more than 40,000, a gap expected to continue for years. But nursing unions say the issue in hospitals isn’t a lack of nurses — it’s a lack of nurses willing to work under the deliberately short-staffed conditions that permeate the industry in the state.

“When a health care system incentivizes hospitals to reduce capacity, it’s not a system that’s good for patients or caregivers,” Rosselli said. In California as across the country, a for-profit health care landscape virtually ensures that such incentives will continue — and, once again, make for a long, difficult winter for health workers and their patients alike.

[Mark Kreidler is a California-based writer and broadcaster, and the author of three books, including Four Days to Glory.]