California desperately needs more medical workers at facilities swamped by coronavirus patients, but almost no help is coming from a volunteer program that Gov. Gavin Newsom created at the start of the pandemic. An army of 95,000 initially raised their hands, and just 14 are now working in the field.
Medical workers are stretched thin, and it’s starting to affect patient care. In Long Beach, at least two area hospitals recently took the grim step of convening teams of medical professionals who would decide which patients are given potentially lifesaving care and which are denied it if the current wave of COVID-19 cases pushes local health care providers to that point.
These “triage teams” were put together as the state mandated local hospitals to finalize and publicly post their plans for what they’ll do if the surge in coronavirus cases becomes so overwhelming that medical facilities are pushed into something called “crisis care.”
All hospitals have three levels of operational protocols: conventional, contingency and crisis. Conventional care is business as usual—normal bed counts, normal staffing levels and an abundance of supplies.
But as resources dwindle, and staff is stretched thin, medical facilities alter protocols in attempts to maintain the best patient care, and outcomes, possible.
“At this time, we’re working very hard to ensure that we don’t reach a crisis care situation,” Long Beach Health and Human Services Director Kelly Colopy said during a press conference Wednesday.
And while the volunteer program introduced early on in the pandemic showed promise, very few volunteers actually met qualifications for the California Health Corps. Only a tiny sliver have the high-level experience needed to help with the most serious virus cases that are stretching intensive care units to the limit.
“Unfortunately, it hasn’t worked out, and the goal is laudable,” said Stephanie Roberson, government relations director for the California Nurses Association.
Newsom formed the Health Corps in anticipation of the cascading crises that California and other states are now experiencing. COVID-19 infections, hospitalizations and intensive care needs are spiraling out of control in the most populous state just as the rest of the nation sees a surge, overwhelming the usual pool of traveling nurses.
Similarly, New York had more than 80,000 medical volunteers respond to a call for help early in the pandemic when it was a hot spot, and some were deployed. But hospitals more often turned to temporary workers to fill the gap, said Jean Moore, director of the Health Workforce Research Center at University at Albany.
Other states, including Illinois, Indiana and Pennsylvania, tried variations of recruiting volunteers with limited results.
“A volunteer corps assumes that it’s pretty easy to slot people in,” said Sean Clarke, executive vice dean and professor at New York University’s Rory Meyers College of Nursing. “Figuring out how to do that still hasn’t been fleshed out, I guess.”
California officials say they need 3,000 temporary medical workers but had about one-third of those as of Thursday. As one result, hospitals are waiving the state’s nurse-to-patient ratios, which can mean less care for critically ill patients.
Newsom had envisioned Health Corps volunteers helping fill in the gaps at health facilities. Those who qualified include retired or inactive doctors, nurses and respiratory care practitioners. Though they’re volunteers, they’re paid what the state calls competitive wages.
Of the 95,000 who first expressed interest in the corps, only about a third had valid professional licenses and about 4,600 qualified. Only 850 actually then signed up, a number that has largely remained static despite the governor’s repeated pleas to participate.
Some of the volunteers “don’t have the training at the highest levels to be helpful right now,” California Hospital Association spokesman David Simon said.
“It could just be that nurses know that this just might not be the safest place to work,” Roberson said.
The state Emergency Medical Services Authority in June reported being overwhelmed with the initial crush of Health Corps applicants while employees were busy coordinating other urgent pandemic responses. The program itself proved confusing for local disaster coordinators, wrote Craig Johnson, chief of the authority’s Disaster Medical Services Division.
Despite the shortfalls, the governor said the program “has been incredibly effective,” with members having worked at more than 140 facilities statewide.
About 300 were sent to long-term care facilities early in the pandemic, 450 were used during the summer surge and 530 went to hospitals and skilled nursing facilities in the fall.
Corps spokesman Rodger Butler said some have worked in intensive care units and that the program will keep working “to fulfill unmet needs throughout the state.”
The state has spent nearly $2.1 million on the program, money it hopes to largely recoup from the federal government or private medical facilities that used corps members.
Dr. Charles Moore was one of those who first answered the call in April and May, preparing Sacramento’s former Sleep Train Arena for what corps members were told there could be nearly 400 patients spilling over from hospitals.
Yet the arena’s mission never seemed clearly defined, he said. It treated just nine patients over 10 weeks, and its staff of about 250 medical workers soon dwindled away.
Now, the state has reopened the arena and other facilities to help hospitals facing a tidal wave of coronavirus patients.
The retired internal physician has been in touch with a half-dozen fellow corps alumni and said none had been approached again other than through impersonal mass emails.
“If I got an email that said, ‘Hey, we really have a need at such and such a location because of XYZ, could we convince you to become available?’ I might consider that, but there hasn’t been anything like that,” Moore said.
Butler said the Health Corps’ administrative employees “make direct appeals to individual staff via telephone and email on a daily basis.” They conducted three large direct call campaigns in the last six months to gauge members’ interest in continuing.
Emails, websites and social media also aim to recruit new members, and the state notifies health workers seeking work about the program.
Joanne Spetz, associate director of research at the Healthforce Center at the University of California, San Francisco, said the pool of available medical workers has shrunk since the pandemic’s early days.
The initial flood of tens of thousands of applicants was spurred by “a sense of impending doom,” she said.
But in the nine months since, medical students have resumed classes, health care workers at temporarily shuttered community clinics or outpatient facilities are mostly back at work, and retirees may have found less risky ways to contribute.
Traveling care providers who might have joined the volunteer effort are instead deployed in other hard-hit states that saw surges before California.
“You start adding up those demographic groups and your numbers dwindle down,” Spetz said.