On June 18, several days after coronavirus cases began to climb in the Big Bend region, a local patient would be transferred from Big Bend Regional Medical Center in Alpine to Medical Center Hospital in Odessa, over 140 miles away.
The resident, a 70-year-old man from Alpine, was placed in critical care and moved to a floor specifically for coronavirus patients that needed extra monitoring. He was intubated and placed on a ventilator before eventually dying from complications from the coronavirus.
Around the same time, in late June and early July, two other Big Bend COVID-19 patients were sent to a separate hospital in Odessa, according to a spokesperson at Odessa Regional Medical Center. Those residents have since been discharged.
It’s unclear exactly how many patients have been transferred from BBRMC to other hospitals in the region. The Alpine hospital has declined to say where patients have been transferred, citing federal patient privacy laws. Marfa Public Radio has requested information from Midland and El Paso hospitals about transfers they've received from the Big Bend region but has yet to receive their responses.
Patient transfers like these are common for rural hospitals like Big Bend Regional Medical Center when local patients need higher-level care. Transfer agreements with other area hospitals long predate the coronavirus pandemic. But as more resourced facilities across the region continue to experience a growing number of COVID-19 hospitalizations, it’s becoming more of a challenge to transfer local residents. That’s led to more patients being treated locally at the Alpine hospital — something that's proven difficult for an area with limited equipment and medical professionals.
“The number of local hospitalizations has increased,” Dr. Ekta Escovar, the head of the region’s COVID-19 taskforce, told Brewster County Commissioners Wednesday. “And there are more and more reports of the hospitals that are in our region that we normally transfer patients to, it’s getting harder to transfer patients to them.”
The Odessa hospital—where Alpine residents, including the 70-year-old man who died, were treated—temporarily closed its doors to patients outside of Ector County, citing the rising number of hospitalizations and “the level of stress that it puts on our resources,” the hospital’s CEO told Courthouse News. But by Tuesday, the hospital began accepting patients from out of county again. Hospital officials said since lifting the deferment, they've received a handful of patients from outlying communities.
Though Big Bend health authorities weren't able to transfer patients to Odessa's largest hospital for nearly a week, BBRMC was still able to transfer at least one patient to another hospital in the area and began treating residents locally.
On July 5, Brewster County officials announced through their Facebook page— the official channel they’ve set up to distribute coronavirus information—that three patients had been hospitalized at BBRMC locally. By the next day, that number slowly climbed to four and then fell back down to three by Wednesday.
It’s unclear if any of the four patients admitted to BBRMC have been placed on ventilators. The hospital has declined to answer questions about the status of patients.
“While Big Bend Regional Medical Center has hospitalized COVID-19 patients currently, we have adequate capacity and the necessary equipment to care for COVID-19 and non-COVID-19 patients,” Ruth Hucke, a spokesperson for the Alpine hospital, told Marfa Public Radio in an email.
Big Bend Regional Medical Center has also declined to disclose exactly how many ventilators the facility currently has access to, citing that the number fluctuates based on need. But an April survey by the Texas Organization of Rural and Community Hospitals, a group that addresses the needs and issues of under-resourced hospitals , shows BBRMC had at least three ventilators at the time.
Across Texas, TORCH estimates the state’s rural hospitals have a total about 600 ventilators, averaging three to four for each facility, though some have none.
With only a handful of ventilators for the Big Bend area, which has a population of nearly 18,000, TORCH’s president John Henderson said it’s important for rural hospitals like BBRMC to rely on bigger facilities that can offer higher levels of care.
“Rural communities in rural hospitals generally serve an older, sicker, less insured population,” Henderson said. “When you stack that on top of the challenges to access care, there's a reason to have a healthy level of concern about that.”
Rural hospitals, Henderson adds, are generally better suited to help patients that are younger and in good health. In Brewster County, health authorities said younger residents in their teens, 20s and 30s were the initial group diagnosed with COVID-19, but that has recently shifted towards an older demographic.
In addition to concerns over limited hospital capacity and equipment in the Big Bend region, just as important is the complete lack of respiratory or pulmonary physicians in the area. These specialized doctors diagnose and treat illnesses affecting the lungs and can perform complicated procedures for patients on ventilators.
According to a survey released earlier this year, there were only 26 pulmonary specialists for West Texas in 2018, an area including Midland, Odessa and El Paso. At the time, that met nearly half of the full demand for specialists of that kind in the region. The Big Bend area has no medical specialists.
The lack of specialized medical expertise could complicate care for patients needing to be placed on a ventilator, according to Dr. Phuoc Le, a doctor and associate professor of Medicine at the University of California who specializes in rural healthcare.
“If you even had one ventilated patient, they need 24/7 staffing with intensivist doctors, ICU nurses [and] respiratory therapists,” Le said. “That's a tall order, I think, for a place that's not used to that degree of illness.”
