Hospital’s operation in an emergency

The only hospital in Kitsap County continues to operate in an emergency.

“We’ve been put on notice,” Greg Wheeler, Bremerton mayor and board president for the Kitsap Public Health District, said at their meeting Nov. 1.

Kitsap fire chiefs brought their concerns about emergency department wait times at St. Michael’s Medical Center in Silverdale. Not only is there concern that their patients are having to wait for treatment, but also that their emergency medical service personnel can’t return to their home bases to help with other situations.

Chad Melton, president of St. Michael’s, said as part of a task force with the chiefs they are trying to fix the problems. About 10% of those taken to the ED there have wait times of from a half hour to two hours.

Poulsbo fire chief Jim Gillard said he wanted to “stay out of mud throwing” because he knows St. Michael’s has a lot of challenges, but they haven’t been “clear and honest about their capacity to care for a patient. They would not tell us.”

Poulsbo Mayor Becky Erickson added, “Let’s make this public so this can be resolved.” Earlier she had asked why patients weren’t being diverted to hospitals without wait times.

Gillard said St. Michael’s would not divert patients to other hospitals. They “try to treat all at their facility.”

He said with better shared communications about EMS calls, the fire districts could predict which hospital a patient should go to. He said those in South or Central Kitsap might be better off going to St. Anthony’s in Tacoma, for example. “The closest hospital that could provide care.”

Dr. Joe Hoffman, medical program director for the county EMS Council, said Department of Health best practices say EMS information needs to be available in real time to get patients where they can best be served. “That’s where I’d like this to get.”

Gillard asked the health board for help in resolving the issues at St. Michael. “The fire chiefs alone can’t force” the private hospital to do anything, he said.

He added the task force has been meeting for months but nothing has happened. “We can’t go month to month” without a solution because of the heavy impact on the community, he said.

Gillard said when patients are taken to St. Michael’s emergency staff is not available to provide care. “It’s having a direct impact on the safety of the community,” he said. “We’re stuck monitoring patients and waiting for staff at ED to take over care.”

Hoffman called it a domino effect when four units stack up at the ED. “It’s a recipe for disaster,” he added.

Gillard said while St. Michael’s is not alone in this problem nationwide or even statewide, it does seem to be the only one locally with the issue.

Melton disagreed. He recalled St. Anthony’s had to divert patients for 20 hours recently. Diverting patients just “passes the issue downstream,” he said.

He added that St. Michael’s has been diverting patients, “probably more than we ever have.” He added if there are 40 people in the waiting area and beds 50% full they make the decision to divert.

County health officer Dr. Gib Morrow said the hospital is “struggling to provide safe, high-quality care.” He said, “We are underserved,” even before COVID, but the pandemic has made health care weaknesses even more noticeable.

The Office of Financial Management says Kitsap County is short of primary care doctors. St. Michael’s also doesn’t have enough hospital beds. And, patients are using EMS and emergency departments because they can’t access health care elsewhere, Morrow said. Problematic health care falls hardest on marginalized populations with the fewest resources, he added.

Gillard mentioned there are also a lack of mental health professionals.

Melton said staffing has been an issue, but that’s a national problem. Burnout has been an issue, especially during COVID. St. Michael’s is focusing on retention and recruiting. It just came to an agreement with the union so nurses get paid at one of the highest rates in the state. He said turnover here is lower than it is nationwide, but it’s more noticeable because it’s so isolated.

The St. Michael’s president said he would like to see the state deal with workforce development. He wants more spots for nurses at Olympic College, for instance. He said there are 70, but there should be at least 90 as 300 apply each year. Gillard said it’s more like up to 120 registered nurses and 30 licensed practical nurses. Either way, it’s important to train locals as 90% of St. Michael’s employees live on the Kitsap Peninsula, officials said.

Melton said the legislature could help by making an effort to bring more doctors to the state. And, some changes in regulations also could help. “We have patients in beds that don’t need to be there.”

Other issues include patients staying in the hospital two days longer than Medicare says they should, and patients on the third floor are parents whose families no longer want to care for them. “It’s the right thing for us to do,” Melton said. “We can’t kick them out.”

Public comments also focused on the hospital’s problems.

Susan Young of Bremerton said the hospital temporarily lost accreditation in mid-July- with 39 areas in need of correction. Some are minor, she said, but others are not, such as staffing. She said if she needs a hospital she will “go to Harborview (in Seattle) because under current circumstances I don’t feel safe” at St. Michael’s.

Robert Jennings said the county needs a public hospital that is “non secular in nature.” As a Catholic hospital, he is concerned that it does not honor “end of life” wishes. He knows someone whose DNR (do not resuscitate) desires were not followed.

Gillard said he’d like the task force to come back in a few months to talk about what policies have changed and what the results have been in the reduction in wait times.

Wheeler concluded, “With the delicate system we have we are very vulnerable.”