Texas officials are denying emergency staffing funds to hospitals, and are instead directing requests to local governments as the COVID-19 delta variant spreads through the state.
There have been more than 600 medical surge staff requests to the Texas Department of State Health Services by North Texas hospitals, said Crystal Kellan, spokesperson for the North Central Texas Trauma Regional Advisory Council.
The state is not filling medical surge staffing requests, she said, and hospitals are being redirected to work with their cities and counties to leverage federal funds. Kellan said she didn’t know when the majority of those requests were made.
Texas has seen a sharp increase in the number of COVID-19 hospitalizations in the past month. The Texas Department of State Health Services reported nearly 7,700 hospitalizations Tuesday compared to just under 1,700 on July 4.
In the medical region that includes Tarrant County, coronavirus hospitalizations made up 11.8% of total hospital capacity as of Tuesday, state numbers show.
Stephen Love, president and CEO of the Dallas-Fort Worth Hospital Council, said hospital staffing is tight, made worse by medical professionals leaving because of burnout and fatigue, specifically among nurses. Love said that while bed capacity and PPE supply could become pressing issues two to three weeks from now if COVID trends continue, staffing is a problem right now, and it may only get worse if the region enters a fourth surge.
There were more than 1,800 COVID-19 patients in North Texas hospitals by Tuesday, Love said, with Tarrant County leading the region with 676.
According to a July 23 report by the U.S. Department of Health & Human Services, 21% of Texas hospitals are experiencing staff shortages compared to 12% nationally.
The Texas Division of Emergency Management sent a letter to county and city leaders on July 29 informing them that there’s “substantial funding” available through federal COVID-19 relief dollars for hospital staffing.
“The substantial funding from the (Coronavirus Local Fiscal Recovery Funds) is available to support urgent COVID-19 response efforts to continue to decrease the spread of the virus, including enhanced staffing expenses at hospitals, and premium pay for essential workers,” the letter reads. “If you have trouble accessing these funds to arrange and pay for medical staff and hospitalization costs, please let us know.”
The Treasury Department has sent $5.7 billion directly to the state’s 254 counties and $3.4 billion directly to 75 Texas cities, according to the letter.
Carrie Kroll, the vice president of advocacy, quality and public health with the Texas Hospital Association, said the move is a switch in strategy from earlier in the pandemic. She described a process where hospitals would request assistance from the state, which would in turn mobilize support based on the requests and the need throughout Texas.
The directive from last week indicates that hospitals should now look to local officials in cities and counties to mobilize resources to assist them, she said.
One concern is the time it will take to implement the new system as COVID-19 cases spike, Kroll said. Another concern is that cities and counties weren’t sitting on the federal dollars expecting to allocate it for staffing, as the state had previously aided in that.
“In many instances, that money has been either allocated, directed to a particular program or need or it’s been spent,” Kroll said. “So it’s not as if that money is sitting there waiting for us to walk in and use it.”
Love said the decentralized process where each hospital has to negotiate contracts on their own is not as efficient as the state negotiating with large staffing agencies. This decentralized approach drives prices up for staff, he said.
There is also no set structure in place for local hospitals to cooperate with local governments for funding, he said.
City of Fort Worth spokesperson Michelle Gutt said in an email that the city has not received any requests from local hospitals or health care providers about using federal funds to supplement their budgets.
Tarrant County officials were not immediately available for comment.
DSHS Spokesperson Chris Van Deusen in an email said the department spent $5.4 billion from April 2020 through June 2021 to step in and contract with staffing firms to hire health care providers.
“As always, emergency response begins at the local level,” he said. “Encouraging health care facilities to utilize the resources already available within their communities will ensure the response can be as flexible as possible. They can work with their cities and counties to ramp up or shift necessary staffing as needed throughout this phase of the pandemic.”
When contracts for nursing staff were put in place with the state earlier in the pandemic there wasn’t a vaccine and there was very little federal funding available, said Nim Kidd, chief of the Texas Division of Emergency Management. He also described a situation where contractors were hiring nurses away from Texas hospitals and placing them elsewhere in the state.
“Commodities that we have, that we have already procured, we will absolutely continue to support our hospitals and our citizens with, but as it gets into the game of stealing a nurse from one hospital so that I can send them to another hospital, I don’t think that’s the place where the state needs to be,” Kidd said.
Kidd said he’d like to see hospitals working together to manage caseloads and for more facilities to cancel elective surgeries that use members of the workforce. At times in the pandemic, Gov. Greg Abbott has ordered hospitals stop elective surgeries to free up space.
“Hospitals can do those same things again today with their existing workforce,” Kim said. “And we think the healthcare system is best suited to recruit those doctors and nurses whenever they need more.”