Calling more than 20 larger hospitals trying to find an open bed.
Transferring patients as far away as Connecticut or Pennsylvania.
Families grappling with whether to send their loved ones hours away or to choose palliative care.
As Vermont’s intensive care units become overwhelmed, including a record-setting 31 Covid patients reported in ICUs on Tuesday, medical staff at the state’s smaller hospitals say they’ve faced an escalating crisis in recent weeks. Strained capacity affects what kinds of care they can offer, they say, in part because it’s become increasingly difficult to transfer patients to larger hospitals.
While some patients in the state’s hospitals are suffering from Covid-19 — the vast majority of them unvaccinated — most are not Covid patients. They may be facing anything from kidney failure to a heart attack. Many got sicker while they waited for care because of the pandemic.
Dr. Joshua White, an emergency department doctor and chief medical officer at Gifford Medical Center in Randolph, said current capacity levels are dangerous because they can prevent patients from getting standard-of-care procedures.
If doctors can’t quickly transfer a patient from Gifford to a larger hospital for a complex treatment, then they might have to find another solution.
“You don’t know if that procedure was going to save that patient or not. They may have died anyways, because there’s nothing that works all the time,” White said. “But I know that there are people in Vermont, that the intent was to transfer, they didn’t get that service and they did not survive.”
He used treatment for heart attacks as one example: The best treatment is often a stent, White said, where an interventional cardiologist threads a wire in the artery and opens it up. No more than 90 minutes after a heart attack patient arrives at Gifford’s emergency department, doctors want that person transferred to Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, to undergo the procedure.
But over the past few months, “now there has been more than one instance when our providers have called Dartmouth, and Dartmouth has said no,” White said.
They just didn’t have the space.
“Then we start trying to decide well, how many other places do we call? Do we now start thinking about clot-busting drugs, which are demonstrated to be not as good?” White said. “You end up going down this whole other pathway that you weren’t really supposed to be going down.”
Cassidy Smith, a spokesperson for Dartmouth-Hitchcock, said in an email that the medical center “has never been closed to ALL transfers.”
“However, depending on the circumstances of each day’s, and prior day’s, regional pressures and demands we are occasionally unable to accommodate certain transfer requests,” she said. “That is always the case and always has been the case. The current surge of Covid-19 in both New Hampshire and Vermont has only increased the demands and thereby further diminished the resources for our processes.”
Gifford Medical Center in Randolph. File photo by Mike Dougherty/VTDigger 
Dartmouth-Hitchcock Medical Center as seen from the air in December 2017. File photo by Charles Hatcher/Valley News
In New Hampshire, more than 95% of the state’s ICU beds were full as of Dec. 3, when the state last updated its Covid data.
In Vermont on Tuesday, a total of 90 people were hospitalized with Covid, according to the state Department of Health, including the 31 patients in ICUs. The ICU headcount surpassed the record set the day prior, when there were 25 patients in Vermont ICUs.
At Northeastern Vermont Regional Hospital in St. Johnsbury, providers have called as many as 25 other hospitals trying to transfer a patient to a bigger hospital, said Chief Medical Officer Dr. Michael Rousse.
“We’re delaying what would be standard care,” Rousse said. “We’re taking care of people that are on pressors or on a ventilator longer than we’re typically comfortable with. We can do it, we’re just playing the odds to a certain extent.”
Rousse estimated that people sick with Covid make up less than 10% of their patients. However, these cases turn up the pressure in an already stressed system that’s working with limited staff and EMS transport services. Transferring a patient to Connecticut takes an ambulance out of local service for most of the day.
These challenges aren’t unique to Vermont hospitals, said Jeff Tieman, president and CEO of the Vermont Association of Hospitals and Health Systems. Providers in New Hampshire and Maine are all struggling to transfer patients who need specialized care.
White said Gifford’s record of 24 calls — the most hospitals they’ve had to call to secure a transfer — would be an “easy day” for some of his peers working in Massachusetts emergency departments.
Over Thanksgiving break last week, Rousse said, they had to transfer a patient to Hartford, Connecticut, which took longer than three hours by ambulance.
“In my 30 years, I’ve never been in a situation where we just aren’t able to get patients the care they need when they need it. It’s sort of been the American norm that we can get patients to where they need to go, and there’s always availability and somebody at the other end of the line that says, ‘Yeah sure, we can help you,’” Rousse said.
“And now we’re finding that there isn’t anybody at the other end of the line that says they can help us, because they’re overwhelmed themselves. It’s tearing everybody up.”
Some patients decide they don’t want to endure hours-long transfers to hospitals out of state, Rousse said, and instead choose palliative care.
“We had an instance where we tried 23 different hospitals, there was a bed available in Albany, New York, and the family weighed the pros and cons and said, ‘We’re just not going to transfer, we’re gonna see what happens here,’ and the patient died,” he said.
The backlog isn’t just for patients needing critical care beds, but also at long-term care facilities and rehab, said Dr. Trey Dobson, chief medical officer at Southwestern Vermont Medical Center in Bennington.
He estimated there’s about 10 to 15 additional patients each day who need to be transferred out, both to larger hospitals, and to long-term care facilities. Patients who need to go to long-term care, assisted living or rehab are sometimes waiting days in the hospital, when they might normally just wait a few hours, Dobson said.
“When we get up to numbers like that, it compounds, and that’s the problem,” Dobson said.
State agencies have added more long-term care beds in recent weeks to help ease hospital bottlenecks.
In the first phase this October, the state added 80 beds across three facilities in St. Albans, Rutland and Burlington, Will Fritch, a spokesperson for the Department of Disabilities, Aging, and Independent Living, wrote in an email. By Nov. 11, 80 patients had been admitted to those beds.
Since then, the state has since agreed to open 39 additional beds across three other facilities, Fritch wrote. Of those, 18 have opened and the rest are waiting on traveling medical staff to arrive and get oriented.
Dartmouth-Hitchcock is working to expand their telehealth capacity, ICU staff and bed capacity, said Smith, the Dartmouth-Hitchcock spokesperson.
UVM Medical Center announced it would open five additional ICU beds, and 10 additional Covid beds in Burlington this week, to help ease some of the pressure. But that comes at a cost too, as they had to reschedule elective procedures to preserve staffing capacity.
White is concerned that delays to routine care could compound down the line.
“When they say elective procedures … it’s a misleading term. Your routine colonoscopy is quote-unquote an elective procedure,” White said. “If you miss a routine colonoscopy and you end up with colon cancer, there’s nothing elective about that.”
Philadelphia is the farthest a Southwestern Vermont Medical Center patient has had to be transferred, Dobson said. Southwestern’s ICU was full Monday, and has hovered near capacity for the past month. Transfers that would normally take two to three hours can now commonly take 12 to 24 hours, Dobson said.
Still, he said, they’re managing. All 10 ICU beds are set up with telehealth connections to Dartmouth-Hitchcock, so they can access that additional support even when they don’t transfer a patient. But the strain in the larger health care systems takes a toll on hospital staff, Dobson said, and more time spent making calls to other hospitals means less time at a patient’s bedside.
Dobson worries that the problem could become worse, especially if the numbers of Covid patients needing hospitalization continue to rise. He estimates that 50 to 70% of their ICU patients, on average, are there to be treated for Covid, and most of these ICU patients are unvaccinated.
“We just can’t sustain these additional patients in our healthcare system, and it’s really weighing on our staff,” Dobson said. “And it’s really not fair to those in the community that are vaccinated and trying to seek other types of care.”
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