State of Texas: ‘As we gain patients, we’re losing staff’ – COVID-19 surge strains health care workers

State of Texas

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

In El Paso, funeral homes deployed mobile morgues to keep up with virus-related deaths. In Amarillo, hospitals are at 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 due to virus exposure among staff. Over 100 staff members in that hospital alone are in quarantine due to possible exposures.

As Amarillo’s COVID-19 hospitalization rate has soared to more than 30 percent, the mayor pleads 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 as their hospitalization rate has remained above 15 percent, the rate set by the governor to determine business capacity, for more than three weeks. Lubbock hospitals have resorted to standing up tents to serve short-term patients.

While some Western counties have received a boost in resources, that increase has caused problems for other regions. Austin’s Public Health Authority Dr. Mark Escott says 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 surged medical supplies and additional health care workers to West Texas in the last month. Governor Greg Abbott says more help is on the way for doctors and patients. He expects Texas patients will have access to Regeneron 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 that Texas is ready to distribute the COVID-19 vaccine one it becomes available and that frontline health care workers, first responders, and senior citizens will be the first in line.

Who should treat you?

When seven-year-old Betty Wattenbarger died last year from flu complications, her family says 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 a pediatrician at 411 Pediatrics in Austin and member of the Texas Medical Association, says 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 says 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 pretty large population that is dependent on Medicaid and 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.

66 year-old Jo Ann Cabello has spent years coming to Ferguson for care instead of a primary care doctor, and says 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 Representative 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,” Rep. 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.

Governor Abbott signaled support for nurse practitioners who hope Texas may be next. He proclaimed last week as “Nurse Practitioners Week” in Texas. The proclamation says “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 is pushing back. They hope to prevent Texas from allowing that autonomy, saying nurse practitioners need stricter requirements that what the state allows now. They also dispute studies that nurse practitioners point to as their safety record.

Digital Divide

When COVID-19 hit in the middle of the spring semester, schools were forced into new learning processes that brought a major problem: getting all students equal access to internet and devices.

In Texas, electric cooperatives are helping to fill the learning gap where that technology is lacking. The group representing the co-ops says they’re serving 39 schools in 18 school districts across the state, including rural areas like Shiner where students’ access is often the most limited.

In Shiner ISD, students took to accessing wifi in school parking lots. A spring survey found 15 percent of their roughly 600 families lacked proper internet connectivity.

“There would be cars spattered throughout the parking lot and… parents sitting there with their kiddo working on schoolwork,” Shiner ISD superintendent Alex Remschel said.

15 minutes away, Moulton ISD found that 20 percent of their 300 students also needed internet help.

“I thought I couldn’t do it because I didn’t have wifi in my house, so my computer wouldn’t work,” Moulton ISD Freshman Nadia Ibarra said. “I would try to do most of it on my phone but some subjects I couldn’t get to do them because it wouldn’t work–it wouldn’t let me–I had a lot of problems doing it on my phone.”

The Guadalupe Valley Electric Cooperative stepped in to help. CEO Darren Schauer says the utility company provided Moulton ISD with 20 hotspots with unlimited data at a price of only $40 per month for each device, down from the usual $200 per device plus $100 for limited data. Schauer says since co-ops are tax-paying, not-for-profit businesses, they are more poised to make those investments.

It’s a challenge to build out these networks in rural areas where population is obviously less, the density is less,” Schauer said. “To be able to financially justify those types of investments is a challenge… Certainly we have to make enough money to earn a return on our investment, but it’s not our primary motivation.”

GVEC also outfitted Shiner ISD’s parking lot with a hotspot at a price of rougly $200,000. But even those investments do not fill the long-term gap for these districts.

According to state data published this year, more than 70 percent of students in middle and high school need internet multiple times a week for homework.

“Some of our families out in the community being able to access information is still limited and we definitely want to get to a point where that’s not an issue,” Remschel said.

Some co-ops and school districts like Shiner are participating in something called “Operation Connectivity” to help with that. The program began in Dallas to address the lack of high speed internet and devices for students at home and launched statewide in May. It has a task force that is supposed to meet every month to review progress and overcome roadblocks.

Shiner ISD says it spent 20 to 30 thousand dollars on connectivity in March. Their superintendent says he feels confident they will be able to give each student a mobile hotspot and device if another emergency hits.

Revisiting Education Reform

President-elect Joe Biden promises sweeping reforms to K-12 education, but some question whether those changes will make their way to Texas public schools at a time when Texas lawmakers face significant funding challenges.

State lawmakers say federal promises only go so far. James Talarico, a state representative of Round Rock and former middle school teacher, says legislative change is most successful when federal and state lawmakers are in alignment.

“If you are concerned about the state of our schools, if you want to see greater funding, improvement in our classrooms, you need to focus your energy on your state lawmakers,” Rep. Talarico said.

Talarico has already filed six bills related to education for next year’s legislative session, including legislation to set a statewide standard for air quality in public schools and a bill to reduce class sizes for Pre-K students. But he says state lawmakers face an uphill battle with a major budget shortfall forced by COVID-19.

House Bill 3, the historic school finance overhaul that state lawmakers enacted in 2019, is in jeopardy. Talarico believes education reform would be one of the first things on the chopping block if the state cannot balance the budget.

“It’s going to be up to lawmakers on both sides of the political aisle to stand up for HB3 and to keep the promise that we made to students, teachers and parents,” he said.

He hopes that a financial injection into the Texas budget, like the one the state received during the last recession, would help reduce cuts and allow the legislature to continue prioritizing public education.

Pot for Profit?

When lawmakers return to the State Capitol in January they will focus on passing a budget and redrawing the state’s political maps. The coronavirus pandemic means they may not have time for much else. But some Texas Democrats believe budget woes and calls for criminal justice reform have opened a new window for those fighting to legalize marijuana.

Hays County Democrat Erin Zweiner is leading the charge on a slew of bills filed for next session that would decriminalize marijuana and create a retail market for its sale.

“I think the revenue and cost-saving issues are always going to be a priority, especially in a budget year like this,” she said.

With the pandemic hitting the oil market with a $4.6 billion shortfall, state lawmakers need to find new money anywhere they can.

“Do we legalize pot and tax it? Do we allow casinos in Texas? Does Texas expand Medicaid in a way that it has been reluctant to do all the way back to when Rick Perry was governor?,” Texas Tribune Executive Editor Ross Ramsey said.

Austin State Representative Donna Howard says legalized marijuana’s potential billion-dollar annual benefit may give it more weight in a crowded legislative session.

“Certainly I think there’s more appetite to look at things like that now more than there may have been in the past,” she said.

Bills to remove regulations on marijuana face strong opposition. Last session, House members approved a bill to lower penalties for possession, but Senate Republicans rejected it. Lieutenant Governor Dan Patrick called it a step towards legalization, which he views as unacceptable.

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