Big hospitals in Chicago with highly trained specialists have treated the most patients during the COVID-19 pandemic, newly released federal data shows.
But the data also shows that when small hospitals that mainly treat low-income people of color were full, these larger hospitals at times had plenty of beds to spare.
During the week of Thanksgiving, this reality was stark. St. Bernard Hospital in Englewood on the South Side had no more intensive care beds for the sickest patients. Neither did Mount Sinai on the Southwest Side in Lawndale, about 10 miles away, a WBEZ analysis of the data show.
Sinai’s sister hospital, Holy Cross in Marquette Park had seven beds left. Roseland Community on the Far South Side had six.
Meanwhile, big teaching hospitals Northwestern Memorial in downtown, Rush University Medical Center on the Near West Side and University of Chicago Medical Center in Hyde Park on the South Side had nearly 200 empty ICU beds combined that Thanksgiving week.
In a highly unusual move, the federal government this week released to the public the massive database showing a weekly snapshot of capacity at hospitals across the U.S., dating back to July.
Medical professionals and academics in Illinois alike were surprised at the release, but touted that this level of detail could help the public better understand how their neighborhood hospital is faring during COVID-19.
In Chicago, Black and Latino residents have been hit hardest by the coronavirus, yet many hospitals in their communities are small and don’t have as many resources as teaching hospitals or medical centers that are part of big health systems.
“For patients themselves, them having access to this public data, they can see where a hospital might look like it might have more open beds for them to go, and transfer them to that hospital,” said Dr. Gina Piscitello, a palliative care physician at Rush University Medical Center.
Data shows community hospitals stretched thin
When an ICU fills up at a small hospital, “We have to really improvise,” Roseland CEO Tim Egan said. “We’re playing chess with patients trying to move them into the right treatment areas, and we’re getting overwhelmed.”
His hospital has used the emergency department as an ICU and outfitted recovery rooms to care for COVID-19 patients. That’s not an unusual story among small hospitals.
Sometimes patients at St. Bernard who need an ICU bed board in the emergency department for a day or so until one opens up, the hospital’s CEO Charles Holland said.
Many hospitals aren’t touting that they have beds to spare, perhaps worried they soon will fill up during the pandemic
“I have not heard of hospitals saying, ‘We have ICU capacity,’” Holland said.
In fact, details about how many hospital beds are full or empty are typically closely guarded secrets. After all, hospitals are businesses that compete for patients, especially those with private insurance.
During the pandemic, the Illinois Department of Public Health has posted regional data online, such as how many hospital ICU beds in a large area like suburban Cook County are available for patients.
But both the state and Chicago public health departments have denied WBEZ’s public records requests for more details, including the number of COVID-19 cases each hospital treats, which is detailed in the new federal database.
The public health departments have argued that hospitals provide this level of detail to them confidentially. In response to a lawsuit from WBEZ, the Chicago public health department said hospital capacity figures are snapshots in time and that releasing those details could hurt the city’s response to COVID-19.
It also could prompt patients to pick one hospital over another, the city argued in court.
“The public’s use of discrete data points to make health care decisions could result in over or under utilization of resources and, therefore, negatively impact CDPH’s ability to combat the pandemic,” the city argued in a court filing. WBEZ lost the lawsuit.
Representatives for neither the state nor the Chicago public health departments responded to requests for comment about the new federal database.
Capacity was known to hospitals, but not to the public
Details about hospital capacity likely aren’t new to hospitals. Across Illinois, medical centers have access to a state database they all contribute to that shows how many beds are available for patients every day.
But that data is a snapshot, usually entered twice a day. And sometimes, it’s not accurate, requiring hospitals to lean on relationships and call one hospital after another trying to transfer a patient. It’s an arduous task.
“You never know what’s happening on the other end, personally,” said Jose Sanchez, CEO of Norwegian American Hospital on the West Side in Humboldt Park.
During the spring COVID-19 surge, Norwegian was among hospitals that were overwhelmed with patients and had a hard time getting other hospitals to take transfers, a WBEZ investigation found. No agency coordinates transfers in Illinois, and public health officials can’t force hospitals to take them.
“It’s no secret out there that transferring a patient has always been a challenge from safety net hospitals to bigger institutions,” Roseland’s Egan said. “And when you add in a pandemic … it becomes a damn near impossibility. Other institutions are planning for a surge and they don’t want to fill their beds with our Medicaid patients while they’re waiting for a surge of regularly commercially-insured patients.”
Egan said his hospital is in talks to work out an agreement to transfer patients more easily to U of C in Hyde Park, one of the big teaching hospitals that had about one-third of its ICU beds available during the Thanksgiving holiday week when Roseland was about 90% full.
Rush took on hundreds of COVID-19 patients from other hospitals during the spring surge, and chief medical officer Dr. Paul Casey said the hospital continues to do so. About 1 in 5 patients transferred through October and November came from small hospitals that typically treat low-income patients of color. These patients needed a higher level of care, and included both people who did or did not have the coronavirus, Casey said.
“I can tell you today … Rush University Medical Center has more COVID critical care patients than any other ICU in the city,” despite not being the largest teaching hospital in Chicago, Casey said during a WBEZ interview on Wednesday.
While Rush had more ICU beds available during the Thanksgiving week than other hospitals, Casey said many medical centers are more comfortable treating patients who have COVID-19 compared to when the virus was new in the spring. That’s when many leaned on Rush physicians for their expertise.
Casey reiterated that one of the challenges is that there’s no central command center that looks across all hospitals to see which ones need more help.
“Unless we hear about a patient who wants to get transferred, or a (hospital) center that’s requesting transfers, it’s not necessarily on our radar in the same way that it would be in an ideal state with this larger coordination amongst hospitals and systems,” Casey said.
There’s also a financial incentive for hospitals to keep COVID-19 patients who have Medicare health insurance. The federal government is paying hospitals more to treat these patients if they’re hospitalized with the virus. Some small hospitals in the spring told WBEZ that money was a factor in not transferring patients.
Casey lauded the federal government’s effort to make hospital bed use public.
“That’s really what we’ve been pushing for from the beginning, is better transparency around the data that would actually allow the coordination between hospitals to know when one hospital is full and another might have capacity,” Casey said.
Rush collaborated with the Chicago Department of Public Health to create a new data hub for hospitals in Chicago that aims to give them more insight into how they’re handling the surge in COVID-19 cases. The hub allows hospitals to see more information about the patients they’re each treating, such as if they have previous medical conditions as well as their race. The city’s data hub is not public.
Airica Steed, chief operating officer at Sinai Health, which operates Mount Sinai and Holy Cross hospitals, said she’ll use the new federal database to collaborate more effectively with surrounding hospitals.
“It gives us a better look [at] our surrounding facilities’ capacity, which is definitely part of our surge plan, so it gives us a much more collaborative angle to partner with surrounding facilities to have a little bit more capacity, that they can relieve some of the strain on some of the smaller community health systems like Sinai Chicago,” Steed said.
The new database could have another use — a tool to help hold hospitals accountable.
“Hospitals have been able to do this privately,” said Piscitello, who is part of a group of local physicians calling for hospitals to better coordinate resources, including to take more patient transfers. “Now to have a public source that we can hold them accountable. If we see that there are significant disparities existing, then we call the hospitals out on it. I think it’s going to be very helpful to have this and hopefully it will lead to more equity.”
The lack of coordination among hospitals during the pandemic weighs heavily on Dr. Monica Peek. She researches health disparities, is a primary care physician at U of C, and is a member of a Chicago public health task force designed to help communities of color during the pandemic.
“We have already been past the point where we needed coordinated action,” Peek said. “We’re long past that point, but we haven’t yet risen to that challenge. The hospitals haven’t. The city hasn’t. The state hasn’t, for reasons that are unclear.”
Long before the pandemic, hospitals across Illinois have worked closely together for specific patients.
“What we have to have in place like we do for strokes, like we do for trauma, is a coordinated system so that during this pandemic where things are moving so quickly, where surges happen, where there’s the potential for chaos, is to have systems in place that don’t lean on individual contacts and an informal system for life and death decisions about very sick people in health systems that are about to be overwhelmed,” Peek said.
Reporter Becky Vevea contributed.