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‘A Perfect Storm’ Brewing For Missouri’s Metro Hospitals As Rural Facilities Strain To Meet Demand

A bed in the emergency department at CoxSouth in Springfield, Missouri.
A bed in the emergency department at CoxSouth in Springfield, Missouri.

Earlier this month, Misty Traver of Willow Springs, Missouri, heard a sound she won't likely forget. Her husband of nearly 25 years, who had tested positive for COVID-19, was dry heaving.

"And he went to stand up. And that's when he passed out and I caught him. He had kind of hit his head on the wall," Traver said.

Her husband, Kent, is 50, and Misty says his only preexisting condition is Restless Leg Syndrome.

Another day, she found him on the floor acting out of character.

"And I'm like, 'What are you doing on the floor?' And he was like, 'It's cooler down here.' We have hardwood floor. And he said, 'It's like making my fever feel better.' And I said, OK,'" Traver said.

Misty Traver said she drove Kent to the hospital in West Plains Ozarks Medical Center.

"And he finally got to get his X-ray. They did find pneumonia on his X-rays," Traver said.

Kent and Misty Traver live in Willow Springs, Missouri
Credit Submitted
Kent and Misty Traver live in Willow Springs, Missouri

She said a OMC nurse practitioner told her Kent's oxygen saturation levels were really low—in the low 80s—and that he needed to be admitted.

"So she said, 'The only problem is we don't have a bed.' And I said, 'What about Springfield?' And she said, 'Well, the problem is there are no beds in any hospital for 300 miles. They are all full with COVID patients,'" Traver recalls.

Kent Traver was transferred to Missouri Baptist Hospital in Sullivan, Missouri by ambulance. That's about 140 miles away, near St. Louis. We confirmed that he had been admitted there.

Hospital association: a 'very troubling' scenario unfolding in the Ozarks

"What's going on in all of southwest Missouri and including south-central is very troubling," said Dave Dillon, a spokesman for the Missouri Hospital Association.

"We're seeing that the infection rates in that area, which is a leading indicator of the challenge, are very high there in many cases, well above the 10 percent that the federal government is using as a consideration for a red zone," Dillon said.

A stethoscope is used by medical professionals for listening to sounds inside the body.
Credit File photo, jasleen_kaur / Flickr
A stethoscope is used by medical professionals for listening to sounds inside the body.

As of Tuesday, Howell County's positivity rate over the previous seven days was 28.9 percent, according to the state's coronavirus dashboard. And six other Missouri counties, all of them considered rural, reported positivity test rates over 50 percent last week. The World Health Organization says below five percent is a good level for controlling the virus.

"It would be very easy for a rural hospital to hit maximum capacity and have to begin transferring patients that need inpatient and acute care into these smaller metros," Dillon said.

Data from the Springfield based CoxHealth this week show about 70 percent of COVID patients in the hospital there are from outside Greene County.

Dave Dillon believes statewide mandates on masking and gatherings would help.

"At this point, with those high transmission rates that are occurring in rural areas with a lack of protection for standard public health protocols mandated, we're looking really at, to some degree, the perfect storm of transmission," Dillon said.

Ozarks Medical Center in West Plains declined our interview requests.

In an emailed statement this week, however, the hospital's CEO, Tom Keller, said as of Monday, OMC had 15 ICU patients, 11 of whom have COVID-19. Three ventilators were in use and eight patients were under investigation for COVID-19.

Ozarks Medical Center has been a hub of medical services for south-central Missouri for generations.
Credit Ozarks Medical Center
Ozarks Medical Center has been a hub of medical services for south-central Missouri for generations.

But the hospital wouldn't say whether it still has capacity for new COVID patients. It also declined to answer how many COVID patients have been sent to other hospitals due to volume or staffing.

It's important to note that hospitals transferring patients is nothing new. There's a lot of collaboration, even among competitors, in caring for the sick.

But what local and state leaders are eyeballing right now are some key factors--like availability of COVID beds and trained staff. That information is often fluid, yet it's a critical piece of the puzzle for drafting an effective coronavirus response plan.

A disclosure here from this reporter:  Ozarks Medical Center isn't just another hospital to me. I grew up walking its halls and there's a surgical team of heroes there who have literally saved my life twice.

And that's true of many aspects of life in my hometown, West Plains. Everyone knows each other...or at least knows  of each other. The connections are impossible to untangle, and those connections are in large part how this virus is spreading there.

The federal government's 'heavy handed' approach with hospitals

Dave Dillon with the MHA says the federal government has taken "a very heavy hand" in regulating hospitals, like recently making each hospital report about 140 measures related to COVID-19 and influenza.

World public health agencies have identified that the pandemic disease COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2.
Credit Springfield-Greene County Health Department
World public health agencies have identified that the pandemic disease COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2.

"The federal government has decided that, after a series of reminders or strongly worded letters, that they are currently threatening that hospitals that don't comply at 100 percent rate on all the measures that they have set will lose, potentially, their ability to participate in the Medicare program. That that is almost impossible to believe would happen," Dillon said.

If it did follow through on that punative measure, that would mean patients could no longer claim Medicare as paying for their services and hospitals would not be reimbursed.

Smaller hospitals are likely feeling this pressure more than larger health care systems, which often have more staff to delegate. 

How smaller hospitals could become part of a 'domino effect'

Dillon said hospitals are often seen as local, but now they're part of an important bigger picture.

"And what I think our worst case scenario [would be] is that those smaller metros, like the Springfield or the Joplin community, also hit capacity and then begin to have to send their most acute patients to the urban areas, which would be a domino effect that would would potentially lead to us losing the capacity to care for patients in Missouri as a whole," Dillon said. 

CoxHealth president and CEO Steve Edwards speaks to reporters Tuesday in Springfield.
Credit Jennifer Moore / KSMU
CoxHealth president and CEO Steve Edwards speaks to reporters Tuesday in Springfield.

CoxHealth President and CEO Steve Edwards says there's "not a magic number" for the capacity of his health care system because there are just so many variables.

Kansas City made national news last week when a few hospitals there briefly went on diversion. That means they turned away ambulances because of the high volume of patients. And in Springfield, if one of the two hospitals goes on diversion, then the other can fill up quickly.

Since CoxHealth and Mercy Springfield can't both be on diversion, then they would have to do what's called a "forced open." And that means the hospitals would go back to taking their own ambulances--but they would no longer accept transfers from outlying hospitals. Edwards says the "forced open" hasn't happened yet here during the pandemic. But the Springfield hospitals have needed to go on diversion for critical care on and off over the last two months, he said.

An elderly couple gets split up, 90 miles from home

"So on this particular side of the family, we have had six family members test positive for covid in four separate households," said Amanda Perkins of Willow Springs.

She said her family tried hard to avoid the virus, staying home, washing hands, and wearing masks. But her husband's grandparents got COVID-19 and first sought care at Howell County's other hospital, the small Mercy St. Francis facility in Mountain View. It doesn't admit COVID-19 patients.

"His grandmother worsened. And the same family member who had recently taken her to the Mountain View hospital decided to take her to Mercy in Springfield. They were shocked whenever they arrived at Springfield and there was a line at the emergency room in Springfield," Perkins said.

The grandmother, who's a retired beautician and loves cooking up a storm, had to say goodbye to her husband of more than 50 years when she was admitted to Mercy Springfield alone. And the grandfather, a retired sergeant from the Missouri State Highway Patrol, eventually got pneumonia.

"At Mountain View Mercy [Hospital], they held him that evening until they could find a hospital for transport. They tried to transfer him to Mercy Springfield and they were full. And so they checked with other area hospitals and were able to finally admit him. He met by ambulance that night to Cox," Perkins said.

Within days, this Willow Springs man and woman found themselves in different hospitals about 90 miles from their home, hooked up to noisy monitors and streams of oxygen surrounded by health care workers in head to toe protective gear trying to save their lives.

It's because they could receive that lifesaving care that the couple is now reunited and recovering together in a rehab facility in Rogersville.

Many rural hospitals were already operating on razor thin margins before the pandemic, and they serve populations that tend to be older, sicker and poorer on average than those in urban areas.

And the health care workers who are bravely suiting up each day to start IVs, take temperatures and intubate the sick are doing it all in the midst of a profound workforce shortage, which has been especially severe in rural areas for years.

Note:  this story is part of a four-part series airing this week at 7:45 AM and 4:44 p.m. on KSMU-Ozarks Public Radio.   You can listen to part one by clicking here.

KSMU-Ozarks Public Radio is streaming at www.ksmu.org. From your radio, hear KSMU in the following cities on these channels: KSMU: 91.1 FM - Springfield; KSMS: 90.5 FM - Point Lookout/Branson; KSMW: 90.3 FM - West Plains; 88.7 FM - Mountain Grove; 98.9 FM - Joplin; and 103.7 FM - Neosho.
Copyright 2020 KSMU. To see more, visit KSMU.

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