For the past two months, rural hospitals have been stretched thin, struggling to care for an influx of patients as more seek care not only for the coronavirus but other afflictions.

The latest surge in virus infections across Louisiana has seen many small, often rural, hospitals in the Baton Rouge region grapple with not enough medical staff to care for patients, even though they have the physical space.

At times, too, they have had to keep patients needing follow-up operations longer after they’re stabilized because larger hospitals that could otherwise perform them are at or near capacity.

The number of people being cared for at Louisiana hospitals this month exceeded the point from any other time since the pandemic gained a foothold in the state last spring. Though state Department of Health figures have shown declines in hospitalizations in recent days, intensive care unit capacity is nearing its limits in parts of the state.

In Baton Rouge and nearby parishes, roughly 75% of ICU beds were occupied Sunday, according to the Health Department. The Acadiana region had only 10 of its 159 intensive care beds available.

Larger hospitals have been pinched by balancing their regular patients as well as a swell of COVID-19 patients. That trend has left rural hospitals with fewer places to send people after they’ve been stabilized but still need specialized treatment for things like heart attacks or serious injuries afterward.

"It's been rough, that's for sure," said Dr. Anthony Shields, the emergency department director at West Feliciana Parish Hospital. "It's always a challenge when the bigger hospitals are at or near full capacity."

Hospitals like West Feliciana Parish Hospital play a crucial role in stabilizing people from their region before sending them to receive follow-up care elsewhere. Many such facilities don't have intensive care units and rely on larger medical facilities for specialty operations that often require overnight stays or an intensive care bed.

At Lane Regional Medical Center, doctors have had to reach out to hospitals as far as Oklahoma to find a place for patients needing specialty care or operations that require longer stays.

Nursing shortages, an issue that predated the pandemic, has also left smaller hospitals unable to care for more people.

“Basically, I’ll have a bed, but I don't have enough nurses to take care of them,” said Lane’s Chief Nursing Officer Staci Sullivan.

The coronavirus pandemic has worsened nursing shortages.

With cases high in large parts of the country, some hospitals pay nurses more than what local hospitals can afford. And unlike in the spring, when Louisiana and only a handful of other states were bludgeoned by soaring infections, help from outside is less likely.

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“Sometimes they feel like they’re out there on an island,” said Monica Nijoka, the chief nursing officer at Baton Rouge General.

Baton Rouge General has in recent weeks still been able to take some patients from other hospitals despite exceeding the number of intensive care unit beds.

The hospital has 32 licensed ICU beds, and on Friday, the unit was caring for some 58 patients. Roughly half of them were battling severe cases of COVID-19 and about one-third were patients transferred from other hospitals, often smaller, rural facilities.

Our Lady of the Lake Medical Center, the state’s largest hospital, was at capacity last week and not taking transfer patients from other hospitals, a spokesperson said.

In recent weeks, Nijoka said she gets upward of 20 calls from other hospitals, including some in neighboring states, asking if there’s room to send people.

Ambulance services haven’t encountered many issues with getting people into emergency rooms, and more people are seeking emergency care when they need it, spokespeople said.

“Even though some (hospitals) are full, they’re doing pretty well at processing patients through,” said Justin Cox, a spokesperson for Acadian Ambulance Service. “Nothing is holding up ambulances too long.”

Several emergency service providers raised alarms last year after noticing a troubling drop in the number of heart attack and stroke patients seeking care, leading many to speculate people were riding out those life-threatening problems at home.

In some cases, those patients would refuse to go to emergency rooms, with many expressing worries about the virus. That issue has seemed to go away in recent months, Cox said.

At St. James Parish Hospital, the hospital saw firsthand last spring what an overstretched community hospital can handle when it was caring for more than double the number of patients staying at the facility because of the virus.

“This feels more challenging than the first wave,” said the hospital’s marketing director, Kassie Roussel. “We’re always trying to be creative, 'cause things can change fast.”

Advances in research and a better understanding of the virus and treatments have led to fewer needing to stay at the hospital, but the sheer number of infections in communities is leading to more people getting sick to the point where they need to be hospitalized.

To reduce the number of people needing to stay in the hospital after contracting COVID-19, the facility has allowed people to get antiviral treatments at the facility for COVID-19 so they can recover at home.

Despite the added stresses, Roussel says morale among health workers at the 25-bed facility in Lutcher is still strong.

"We’ve never shied away from a challenge,” she said. “It’s a real small area, so people look to us for things like this.”


Email Youssef Rddad at yrddad@theadvocate.com, and follow him on Twitter @youssefrddad