When the patient arrived in Nashville, the swelling in his abdomen had cut off circulation to his legs. He was immediately sent to the operating theatre, where he died on the table.
“We have a residency program in Guyana, on the South American coast,” Russ said. “It’s the kind of thing that [I see] when I go down to work in Guyana. We see it for the Native American population coming out of the villages and needing a canoe to get to, you know, a hospital. It’s not the kind of stuff we’re used to seeing in the United States.
Tennessee lost more than 1,200 staffed hospital beds between 2010 and 2020 despite a population that grew by more than half a million, according to American Hospital Directory and census data. Mississippi, with the most Covid-19 deaths per capita, has lost more than 1,100 beds this decade. Alabama, second only to Mississippi in per capita deaths from the virus, has lost more than 800.
Those beds would have been essential to statewide systems under the stress of the pandemic, doctors and hospital officials said. Small hospitals often refer their most serious patients to larger hospitals, usually located in urban areas, for higher levels of specialist care. But large hospitals also send patients to smaller hospitals when they can get the same level of care, especially if staffed beds are scarce. Without rural hospitals, urban centers were overwhelmed with patients, making transfers more difficult and higher levels of care less accessible.
In Florida, where there have been fewer closings, Tallahassee Memorial Health has been able to ease the crowding caused by Covid-19 by training staff at smaller hospitals to handle cases that would typically require a higher level of care. Nearby rural hospitals have proven to be key to treating patients during the pandemic.
“We need all of them,” Lauren Faison-Clark, regional development, population health and telemedicine administrator at Tallahassee Memorial HealthCare, said of rural hospitals. “We don’t want everyone coming to Tallahassee for health care.”
If the area had seen significant shutdowns through 2020, Faison-Clark said, Tallahassee hospitals likely would have seen overwhelmed emergency rooms with beds in hallways and worse outcomes for many patients.
In Mississippi, where authorities have told drivers to be careful on the road due to an extreme shortage of beds, the closings have led to lower levels of care.
“The whole system is clogged up,” said Claude Brunson, executive director of the Mississippi State Medical Association. “Without a doubt, there are patients who died because we had a bottleneck and we couldn’t establish a very good flow of care throughout the system – because we had lost the number beds that we really needed.
In central Tennessee, transfers have become such a critical issue that hospitals, including Vanderbilt’s, have established a transfer coordination center to maximize system efficiency. But not all states or regions even have this advantage.
“We got calls all summer from Georgia, Alabama, Kentucky, Virginia, West Virginia,” Russ said of Vanderbilt. “Often it’s small rural hospitals that have called over 50 large hospitals in the Southeast to try to get their patient treated and have been unsuccessful.”
No open beds
In Brownsville, Andrea Bond Johnson – who operates an insurance company locally and showed up at State House – saw firsthand the limits of the hospital system when her parents were sick and awaiting the results of their Covid tests.
Her 86-year-old mother was weakening, having to take breaks to rest as she walked between the bedroom and the kitchen.
“Annie, come here,” her mother shouted from her bedroom. “Something is wrong with my heart.”
Fearing a heart attack, Johnson called 911. Fortunately, they lived near the city’s EMS facility. More importantly – and not always the case – there was an ambulance available.