The Perfect Enemy | Crowded ERs in some of Alaska’s hospitals lead to lengthy waits, delayed care
December 6, 2022
Read Time:8 Minute

Strained emergency departments in hospitals, including Alaska’s largest, are experiencing severe delays and high patient volumes amid staff shortages and a surge in respiratory diseases.

Providers say the situation is compounded by a moratorium on patient transfers to Seattle due to outbreaks of RSV in the Lower 48 and a backlog of health problems caused by delayed care during the pandemic.

Not every Alaska facility is experiencing such difficult conditions. Capacity and patient loads vary significantly across regions and facilities around the state, according to Jared Kosin, president of the Alaska Hospital Association.

But doctors in Anchorage and Fairbanks this week described emergency room wait times longer than they’ve seen in recent history, and conditions that feel dire.

More than 50 patients waited to be seen or for a bed to become available at the Providence Alaska Medical Center emergency department when Dr. Danny Mindlin arrived for his shift at the state’s largest hospital around Veteran’s Day.

Wait times in the 50-bed unit in recent days have stretched past what is considered typical, even in pre-pandemic times — to six, eight and even 60 hours in the case of at least one patient, Mindlin said.

Some patients have been waiting so long for care that it has gotten to a point where Mindlin said he and other physicians are concerned about their safety.

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“There is an element of moral crisis: we feel like we are unable to really provide the care that we would like to,” he said in interview this week.

‘We thought we were done with this’

Mindlin and others interviewed for this story were careful to note that hospital conditions are not as bad they were during the height of the coronavirus pandemic. Care is not being rationed, physicians are not huddling to discuss which patients to prioritize for a ventilator, and patients are not dying at the same rate.

[Impossible choices inside Alaska’s inundated hospitals]

But unusually full hospitals and long ER wait times are still concerning.

Dr. Anne Zink, Alaska’s chief medical officer, said in an interview that patient volumes around the state are close to what hospitals were seeing during the wave of severe disease caused by the delta variant of the COVID-19 virus.

Influenza and other respiratory illnesses are also hitting Alaska early this year, with cases rising steeply, state data shows. The data is raising concerns about a more severe flu and cold season that could put further pressure on the state’s hospitals.

The Seattle hospitals that normally accept patients from Alaska, often those needing complex care, are already grappling with long waits of their own, complicating patient transfers there.

State health officials recently resumed daily check-ins with hospitals around the state to assess and manage capacity — calls not deemed necessary with such regularity since the height of the pandemic.

[Flu and cold season is off to an early start in Alaska, with cases rising steeply]

Representatives of Alaska Regional Hospital and Alaska Native Medical Center did not answer specific questions about the status of their emergency departments and overall capacity in time for this story.

In Fairbanks, Fairbanks Memorial Hospital’s Chief Nursing Officer Sarah Martin said the facility is now seeing more people show up at the ER who are sicker than they were pre-pandemic. Emergency wait times at the facility once maxed out at 20 minutes.

Now they’re as long as five or six hours, she said.

The strain is happening at a time when health care workers and hospitals are still recovering from the extreme stress put on them during the pandemic.

Alaska’s health care workforce was depleted during the pandemic when many nurses, doctors and support staff retired or quit amid exhausting working conditions.

Hospital officials say they’re still trying to fill the hole left by those vacancies, and that recent state-level delays in background checks have compounded the problem.

[Alaska’s hospitals are relying on Lower 48 nurses to fill empty positions. It’s a costly strategy.]

“Ultimately, I think we have a less resilient health care system,” said Dr. Ryan McGhan, an ICU doctor who treats patients at both Providence and Mat-Su Regional. “It was stressed to the breaking point. And people are tired.”

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‘We’re not seeing this everywhere’

Winter is historically a busy time for Alaska’s hospitals. Some hospital doctors and executives have described the current conditions in some facilities as more challenging than pre-pandemic times.

But from statewide perspective, Jared Kosin, president of the Alaska hospital association said this week that while hospitals are overall quite full, the situation is not as dire as it was during the pandemic.

Capacity and strain really vary significantly by region, by city and by facility, Kosin said.

“We’re not seeing this everywhere,” he said, when asked about the emergency department conditions described at Providence’s emergency department. “Which means we don’t think it’s kind of the widespread threat on capacity that happened during COVID.”

COVID-19, pandemic, Providence Alaska Medical Center, nurse, Thomas Quimby

At Mat-Su Regional Hospital, patient volumes are relatively normal for this time of year, said Dr. Thomas Quimby, chief medical officer at the hospital, who said they’re even able to accept patient transfers from Anchorage and around the state.

Crowding in Anchorage, however, is also compromising some patient care in Mat-Su, where kidney patients needing dialysis have recently needed to wait weeks for beds to open up in Anchorage, McGhan said .

Other important differences between now and the worst surges of the pandemic were that during COVID-19, hospitals were being burdened with a single, unfamiliar illness, Zink said.

“There was one disease that was really straining one part of the hospital: it was mostly adults with respiratory illnesses,” she said. Now, “pediatricians are taking care of kids, and the surgeons are taking care of accidents, and ICU doctors are taking care of ICU patients and cardiologists are taking care of heart attacks.”

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Still, Kosin said he and others are closely watching to see whether a wave of RSV that have overwhelmed Lower 48 pediatric units in recent months “is really going to flare up here, and put more pressure on pediatric capacity.”

Pediatric beds are mostly full in Anchorage now, according to Dr. Matt Hirschfeld, a pediatrician at Alaska Native Medical Center. He thinks that may be because many children were shielded from most viruses due to pandemic precautions and now don’t have as much natural immunity.

Zink said that during a recent shift at the Emergency Department at Mat-Su Regional, a majority of her patients were kids with respiratory illnesses.

What Alaskans need to know

When asked what the recent strain on capacity means for Alaskans, Zink said they should expect longer wait times at emergency rooms, do what they can to stay healthy, and know when to consider urgent care or a pediatrician visit instead of the ER when symptoms are less dire.

Mindlin said he wanted to encourage Alaskans to utilize a free, 24-hour nurse advice line offered at Providence that helps people to decide whether to come to the ER to seek care — 907-212-6183.

Hirschfeld, the ANMC pediatrician, said regardless of busy emergency rooms, there are certain times when parents should bring their children in to seek care as soon as possible:

• If their sick baby or child goes 6 or 8 hours without being able to drink anything

• If their baby or child is breathing faster than 60 breaths per minute

• Or if their sick baby or child is difficult to wake up

The best thing adults can do right now to protect their children’s health is get their influenza and COVID-19 vaccines, he added. Flu can be particularly serious in very young children, and right now, just around 10% of eligible Alaskans are vaccinated against the flu.

Each of the doctors the Daily News spoke to for this story asked the public to also remember that health care workers have been through a lot and are human.

“Be kind,” Martin said. “Everyone is just doing the best they can.”

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Reporter Annie Berman is a full-time reporter for the Anchorage Daily News covering health care and public health. Her position is supported by Report for America, which is working to fill gaps in reporting across America and to place a new generation of journalists in community news organizations around the country. Report for America, funded by both private and public donors, covers up to 50% of a journalist’s salary. It’s up to ADN to find the other half, through local community donors, benefactors, grants or other fundraising activities.

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