‘As we gain patients, we’re losing staff’: Record COVID-19 cases strain Texas health care workers

AUSTIN (KXAN) — COVID-19 rates in Texas have hit record highs, with the number of daily cases rising higher this week than since the pandemic began. Hospitals are also seeing more patients ill with the virus, putting a renewed strain on caregivers across the state.

On Monday, Texas surpassed 20,000 confirmed coronavirus deaths, the second-highest death count in the country behind New York, according to Johns Hopkins University researchers.

In El Paso, funeral homes deployed mobile morgues to keep up with virus-related deaths. In Amarillo, hospitals are past capacity.

“The numbers in the hospital are scary,” Chief Medical Officer of Northwest Texas Hospital Dr. Brian Weiss said. “As we gain patients, we’re losing staff. Bad combination.”

Northwest Texas Hospital in Amarillo is suffering from an employee shortage as over 100 staff members quarantine due to possible exposure.

As Amarillo’s COVID-19 hospitalization rate climbed to more than 30%, the mayor pleaded for patience and cooperation.

“Please be the leader that can step up and postpone your event, delay your event, meet virtually for a few more months, just to help control the population of sick people going into the hospital,” Amarillo Mayor Ginger Nelson said.

Just down the interstate, Lubbock faces a similar challenge with a hospitalization rate that has remained above 15% — the rate set by the governor to determine business capacity — for more than three weeks. Lubbock hospitals resorted to putting up tents to serve short-term patients.

While some Western counties received a boost in resources, that increase has caused problems for other regions. Austin’s Public Health Authority Dr. Mark Escott said his community has sufficient supplies but lacks the staff.

“Why can’t we get those people? Because those people are in El Paso, and those people are in Lubbock and Amarillo and Dallas. They’re in other states around the country,” Escott said.

State health and emergency management leaders have directed medical supplies and additional health care workers to West Texas in the last month.

At 69.7 deaths per 100,000 people, Texas has the 22nd highest coronavirus death count per capita, and so far state leaders have given no indication of forthcoming restrictions to keep people from gathering and spreading the virus.

Instead, Republican Gov. Greg Abbott in recent days has been emphasizing that new therapeutics and vaccines are expected to become available soon. He expects Texas patients will have access to Regeneron’s treatment and another therapeutic issued by Eli Lilly as soon as next week.

“This is really promising news, and that is as soon as next week, we’re going to have new therapeutic drugs that will be able to treat people who have COVID just like the president was treated,” Abbott said. “Bottom line is even before vaccines become available, we will have these therapeutic drugs that will be able to treat people who get COVID and improve them.  And that will reduce the people with COVID, reduce hospitalizations, and it will reduce fatalities.”

Abbott also said Texas is ready to distribute the COVID-19 vaccine once it becomes available and that frontline health care workers, first responders and senior citizens will be first in line.

Who should treat you?

When 7-year-old Betty Wattenbarger died last year from flu complications, her family said she was treated by a nurse practitioner at an urgent care facility in North Texas who did not have enough training. The death is one instance in the ongoing debate over the autonomy of nurse practitioners to treat patients in lieu of doctors.

Nurse practitioners, registered nurses with advanced education and certifications, can treat patients as long as they are under a doctor’s supervision in Texas. State law requires nurse practitioners to meet once a month with supervisors to review charts, but that those doctors can be anywhere in the state while the practitioners operate their own practice.

Yet some doctors say they don’t have the training to practice medicine on their own, and that could put patient safety at risk.

Dr. Ari Brown, a pediatrician at 411 Pediatrics in Austin and a member of the Texas Medical Association, said nurse practitioners play an important role, but their level of training makes a difference.

“I gave up a decade of my life to become a doctor. If you want to function as a doctor, go get the training to be a doctor,” she said. “If you want to function independently and make all the decisions, and with that comes great responsibility, you need to have the level of training to do it safely and responsibly.”

Others say giving nurse practitioners more autonomy would help to close the health care gap in rural areas, especially during the coronavirus pandemic.

David Bushnell is a nurse practitioner in the only hospital in Big Lake, a small town of less than 3,000 people in West Texas. He said nurse practitioners play a critical role in providing support for doctors who care for remote communities.

“Access is an issue for a lot of people,” he said. “The further remote you get, I think the more it is… We are the ER coverage. We are the rural health clinic coverage.”

Ashley Ferguson, a nurse practitioner in San Marcos, operates her own practice under the supervision of a doctor. She agrees that her role provides care for those who may not otherwise be able to access it.

“I see both insured and uninsured patients, but I have a pretty large population that is dependent on Medicaid and a lot of these patients do not have alternatives in this area of people to go to that are openly taking new Medicaid patients,” Ferguson said.

Jo Ann Cabello, 66, has spent years going to Ferguson for care instead of a primary care doctor, and said she does not know where else she would go if not for her practice.

Support for expanding nurse practitioners’ autonomy has support from some lawmakers in the Texas legislature. Democratic State Rep. Donna Howard, a former nurse, pushed a bill last session that would have allowed nurse practitioners to work independently after more than two thousand hours under a doctor’s supervision.

“I think that the pathway may be a little different now with our experience with COVID and the recognition of the lack of adequate provider care for Texans especially in our under-served areas – in our rural areas where we’ve seen hospitals close, clinics close,” Howard said.

Her bill would have allowed nurse practitioners to perform and interpret diagnostic tests, formulate medical diagnoses and manage chronic diseases. It did not make it out of subcommittee.

More than 30 states have moved to allow nurse practitioners to work independently, most recently California and Florida. Half of those states say nurse practitioners can open their own practices after physician oversight for a set number of hours.

Abbott signaled support for nurse practitioners who hope Texas may be next. He proclaimed last week as “Nurse Practitioners Week” in Texas. The proclamation said, “Nurse practitioners are invaluable members of Texas’ health care community and uphold the standards of excellence of the Texas Board of Nursing.”

Yet, the organization Physicians for Patient Protection — disputing studies that nurse practitioners point to as their safety record — is pushing back. They hope to prevent Texas from allowing that autonomy, saying nurse practitioners need stricter requirements than what the state now allows.