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Rural Missouri hospitals urge mask mandate

By Rudi Keller, Missouri Independent

Rural hospitals are facing a “transfer crisis,” with urban health centers refusing COVID-19 patients who need more care than can be provided locally, administrators told Gov. Mike Parson and other state leaders late last week.

Administrators called on Parson to issue a statewide mask mandate to signal that the COVID-19 pandemic in smaller communities is threatening to overwhelm them.

Missouri Gov. Mike Parson speaks to the media from his office in the state Capitol.

And Richard J. Liekweg, president and CEO of BJC HealthCare, one of the state’s largest hospital operators, said his group is unable to transfer COVID-19 patients within its system and is considering cutting back on elective procedures to preserve beds. A decision is expected in the coming week, BJC spokeswoman Laura High wrote in an email.

The Missouri Independent was provided a recording of Thursday’s weekly call between Parson, Department of Health and Senior Services Director Randall Williams and hospital CEOs. Coordinated by the Missouri Hospital Association, it was the 21st such call since the coronavirus pandemic began earlier this year, association spokesman Dave Dillon stated in an email.

The Independent verified the authenticity of the recording in interviews with participants after obtaining it.

The call shows the increasing stress health providers are feeling as Missouri COVID-19 infections and hospitalizations hit record levels. 

“I respectfully ask what is our plan to address the increased cases and hospitalizations?” asked Texas County Memorial Hospital CEO Wesley Murray, who added: “We don’t seem to have a plan to try to decrease the cases and the hospitalizations.”

October was the worst month so far for new infections, hospitalizations and reported deaths. The state health department reported an average of 1,802 new infections every day in October, with a peak of 3,061 reported Thursday

The worst outbreaks this month have been in rural counties. Of the 30 counties with the highest per capita infection rates in October, only one, Cole County, has more than 50,000 people.

Jeff Tindle, CEO of Carroll County Memorial Hospital, asked for help obtaining rapid testing equipment and questioned why schools received priority over hospitals for a supply of Abbott rapid testing kits obtained by the state.

He then described the “transfer crisis” at his 25-bed hospital serving a northwest Missouri county of 8,679 people. Carroll County has reported 85 COVID-19 cases in October and two deaths.

“It’s taken us five or six calls to find an institution that will take a patient,” Tindle said. “And what’s worse is when we get them back through, say, a swing bed program, and they’re healthy enough to go back to the nursing home, zero beds available, no one is taking those patients and it is it has become the unintended consequence of all this that we never anticipated that we can’t get them to a facility.”

Schools got the rapid tests first because that is the direction given by the federal government when it shipped them, Williams said.

He also said the issue of diminishing hospital space is one he is working on. 

“We are acutely aware of the issues with rural hospitals both with testing and referrals and capacity and so Lee (Norman, secretary of the Kansas Department of Health and the Environment) and I kind of joined forces on that to do what we can,” Williams said.

Tindle, reached Friday, confirmed his statement and added that many of the hospitals he would send patients in need of care he could not provide are either full or not accepting patients from outside their area.

Under normal conditions, about 75 percent of the patients transferred from Carroll County are sent to Kansas City hospitals and about 25 percent are sent to Columbia hospitals, he said.

While Tindle did not ask for a statewide mask mandate on the call, he said he supports one.

“Some of the rural communities don’t think it is real,” he said.

On the call, Parson had the first and last word. In his opening remarks, he stressed testing, increasing vaccination rates for flu, and concern for exhaustion of medical personnel.

“But one thing has been a concern to us that we’ve heard now for some time and still hearing it loud and clear, is the health-care workers themselves,” Parson said.

He also said that the state is scouting for locations that can provide ultracold storage for a vaccine the state expects to start receiving as soon as Nov. 15.

Parson made many of the same points in an online COVID-19 briefing Thursday afternoon.

The emphasis on testing is important, Texas County’s Murray said. But it only confirms what providers already know – a lot of people are sick.

Texas County, with about 25,400 residents, saw cases almost double in October, from 321 to 620. The positive rate for tests in the south-central Missouri county is 25 percent and for patients coming to the hospital, it is 35 percent, Murray said.

“It feels like all of our eggs are in the basket of the vaccine waiting to come, which isn’t here yet, which is coming soon,” Murray said. “And I’m glad for that. But my concern is a large percentage of the people will turn down the vaccine.”

The administrators explained their concerns are both with the coming winter, which will drive activities indoors, and the behavior of people in their communities who aren’t changing behavior to minimize their exposure.

“Please understand, we have a percentage of people that will refuse to take the test, even when they’re sick, and refuse the quarantine, even when they’re sick,”     

And in Albany, in northwest Missouri’s Gentry County, a recent Academic Bowl for elementary students was staged in a high school gymnasium to provide space for an audience, said Jon Doolittle with Mosaic Medical Center in Albany.

But the people in attendance sat close together, he said.

Gentry County, with about 6,600 residents, has had 65 cases of its 188 COVID-19 cases in October. Mosaic Medical Center is a 25-bed hospital, Doolittle said.

In the call, he urged a statewide mask mandate, or at least firm rules from the Department of Elementary and Secondary Education and the Missouri State High School Activities Association requiring masks at indoor events. Sports are moving indoors for the winter, he noted.

“It seems that many folks are mindful of following the rule but not inclined to do anything beyond what the rules require,” Doolittle said in an interview. “I don’t believe we are at a point yet where people are taking the precautions that the situation indicates because they haven’t really internalized the level of risk.”

His discussions with school and other local officials tells him a statewide mask mandate would give them cover where it is politically unpopular, Doolittle said on the call.

“And there is this sense that they know that perhaps being more restrictive in a lot of ways is the right thing to do right now, but nobody wants to go first,” he told Parson and Williams. “If things come from the state level, that can help you know, it’s easier to march together towards some of these things. I do believe that it is safer to move kind of when the herd moves.”

Robert Knodell, deputy chief of staff for Parson, said he would take the concerns to both the education department and the association.

“And we’re looking in the next couple of weeks to try to, to try to come out with some revised guidance at the state level that hopefully, you know school districts can consider, to give them the cover they need to make the right decisions to, you know, to operate above all safely,” Knodell said.    

In an email to the Independent, Kelli Jones, Parson’s spokeswoman, did not address a question asking whether Parson heard anything to make him reconsider his opposition to a state mask mandate.

She did offer an assurance that more hospital capacity will be ready when needed.

“Gov. Parson is in regular contact with the Missouri Hospital Association and hospital leaders across the state,” Jones wrote. “If needed, we know that with the help of the Missouri National Guard and the Corps of Engineers we can construct an alternate care site in 11 days.”

At the end of Thursday’s call, Parson made no commitments to change state policies on masks or impose other limits on activities to reduce the spread of COVID-19.

“We’re hearing you loud and clear,” Parson said. “Every day we’re going to fight this virus. What I will say is, we will do what we can to help and still maintain a balanced approach. I’ve said that from day one, and I’m going to continue to do it.”

Missouri Independent is part of States Newsroom, a network of news outlets supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: info@missouriindependent.com. Follow Missouri Independent on Facebook and, at @MO_Independent, on Twitter.