NEW ORLEANS — When Dr. Lindsey Jackson arrived last month to work a stint at a New Orleans field hospital in response to the coronavirus pandemic, she braced for the hundreds of patients she expected would be waiting for her.
But when she reported for duty at the Ernest N. Morial Convention Center, only a dozen patients were left. And by the time she shipped out a week later, they were down to four. At that point, health care workers outnumbered the people they were caring for by more than 12 to 1, she said.
“There were probably 150 bodies in that convention center at any one time that were staffed to watch 12 people,” said Jackson, an emergency medicine physician from Texas.
With projections of coronavirus in Louisiana, state officials rushed to open the 1,000-bed field hospital at the convention center, trying to ensure that patients would have a place to go if local hospitals were overrun.
The operation, which was geared to expand to 2,000 beds if needed, has amounted to $192 million in contracts to build, staff and equip the center. Staffing for the first two months has cost the state $57 million so far out of the $97 million in contracts that called for hundreds of medical professionals from around the country to help in New Orleans.
But even at its peak patient count, the convention center held just one-tenth of the patients for which it was built, outfitted and staffed. The center reached 108 patients on April 16 and shrank from there, state records show. As of last week the numbers showed around 190 patients had been treated there.
While health care providers who worked there applauded the decision to open the hospital and plan for the worst-case scenario, several said in interviews with The Times-Picayune | The Advocate and WWL-TV that they do not understand why the operation didn’t wind down sooner, given the absurd staffing ratios for just a handful of patients on a steep downward trend over the past eight weeks.
They also described other inefficiencies as the massive price tag continues to mount.
Jackson, for example, said she and other providers offered to have their contracts cut short because of the lack of patients. Many staff members had nothing to do, yet were getting paid handsome sums, including guaranteed 98-hour weeks that came with time-and-half overtime pay. Health care providers who worked at the convention center were guaranteed to be paid for seven shifts a week, working 14-hour days.
Registered nurses earned $243 an hour, nurse practitioners $328 an hour and physicians $350 an hour, according to the staffing contracts. Even EMTs and paramedics, with little or nothing to do, were paid from $105 to $135 an hour.
“We were like, do you want to let one of us go?” Jackson recalled. “Do we need to be here? And they said, ‘it’s a government contract, you need to be here.’”
The overcapacity at the convention center even got the attention of the White House. President Trump, in one of his coronavirus task force press briefings in March, said, “They had a thousand rooms, a thousand beds, and they used a lot of them, but they didn't need the other ones, as we stopped it because we don't want to waste.”
Dr. Joe Kanter, assistant state health officer with the Louisiana Department of Health, said he’s thankful that the field hospital did not reach anything close to full capacity. He compared setting it up to making the decision to evacuate for a hurricane.
“It’s easy in retrospect to say you could have gotten along with less staff,” he said. “Just like it’s easy in retrospect when you leave for a hurricane to say, ‘I could have stayed.’”
Officials with BCFS, the organization with the contract for staffing services, said the number of people they mobilized to the convention center came from the direction of Louisiana officials, who would also provide direction about demobilizing staffers.
On June 6, state officials signed another contract extension for BCFS continue staffing the convention center. But this time they finally cut back from $38 million contract for 30 days to a $21-million extension, with enough staff for 120 beds.
The federal government is expected to pay for 75% of the costs, while the state – already facing crippling money shortages given the virus’s impact on the economy – will pick up 25% of the tab.
Unprepared for the type of patients they received
When the tents went up and the beds were assembled to make the convention center into a field hospital, local officials envisioned it as a step-down facility for coronavirus patients who no longer needed acute hospital care but who weren’t quite ready to be released, or had no place to go.
Medical workers started arriving in late March before the center even officially opened to patients. They said they were told that patients would be able to walk, talk and feed themselves.
But from almost from day one, things did not go as planned. Instead of “walkie-talkies,” as the staff affectionately called them, the vast majority were nursing home patients freshly released from hospitals. The sudden change meant that the staff had to care for people who were bedbound, needed wound care and could not take medicine on their own.
Despite being well-supplied for most medical needs, the operation was poorly equipped for the frail, elderly patients they ended up with.
“We didn't have chucks and diapers, so you get really creative with linens. And we didn't have gowns those first couple of days,” said Staci Lundeen, a registered nurse from Missouri who was there when the first wave of patients arrived.
Nurses got creative, using blankets and sheets in place of diapers and hospital gowns. Lundeen used a bedpan to carry water for baths. And when a single pill crusher meant to be shared within a 120-bed wing kept going missing, she used plastic spoons to crush up Tylenol and poured it into a Jell-O cup for one of the many patients who could not swallow pills.
The patients were also arriving without paperwork, so staffers were given notebooks and told to use them to write down their own notes and charts.
“I had to completely change the way I thought about nursing,” Lundeen said. “I left in tears the first day because I didn’t think I gave good nursing care to these people because I didn’t have the equipment I needed.”
Lundeen said she’s proud that by the time she left in late April, her team of nurses had managed to bring some order to the chaos.
Kanter acknowledged that the convention center wound up receiving a different population of patients than state officials had envisioned. He said the plan was crafted when it appeared hospitals might run out of room. Officials wanted to reserve bed space inside hospitals for the critically ill who needed intensive care units and ventilators and to send less dire patients to the convention center.
“No emergency goes exactly as planned,” Kanter said. He noted that a big factor in the early emergency planning stages were images from Italy in which dying patients were left in hallways and emergency room ramps..
Other aspects of the field hospital operation frustrated workers as well. Jackson, Lundeen and two other health care workers at the convention center facility all said they witnessed staffers who spent most if not all of their time in the “cold zone,” away from patients -- or back at the Roosevelt Hotel, where the staff was lodging under the state contract. While some workers were developing marks on their faces from wearing their N95 masks for weeks at a time, other staffers still had not been deployed into the “hot zone” to work alongside patients.
They were all getting paid the same amount, regardless of how much work they performed. Compensation was based on an individual’s credentials and assigned position, according to BCFS.
“Imagine you bring 300 people to the convention center,” said one member of the medical staff from Texas. “You take 30 of them and send them into the hot zone. And then the other 270 people sit out in the lobby all day. That was the ongoing theme.”
She said some workers flagrantly cheated the system by going to the convention center to sign in, then returning to the Roosevelt by blending in with the departing night shift.
“People were getting off the bus in the morning, signing in, getting back on the bus, getting back to the hotel and hiding all day,” she said.
Lundeen said, “Just the processes that weren't in place and the colossal waste that was going on. Yeah, it was shocking.”
The Texas worker said staffing could have easily been cut by 75%. She was surprised the convention center remained open and fully staffed as a medical monitoring site by the time she left in late April, when fewer than 50 patients remained.
Even as many patients recovered enough to return to their nursing homes, discharging them did not happen quickly, staff members said, leaving many in limbo at the center for weeks. Dr. Jackson explained that early in the crisis, nursing homes began requiring two negative COVID tests before residents could return, but the field hospital started with no testing capabilities.
“We were holding on to them for a lack of place to go or a facility that was ready to accept them,” Dr. Jackson said. “So we had several in-house that had been cleared for some time, and they were just there out of social need.”
Another medical staffer from Arkansas said she worried about the long-term outcomes for patients, especially those with dementia and other memory problems. She said that without the usual day-to-day stability for those patients, some became combative, and staffers were unprepared to handle them.
“That psychosis started setting in pretty quickly when they're looking at the same four white walls all the time,” she said.
Said Lundeen, “There were probably some patients that probably did leave worse than when they came in.”
Kanter said one of the lessons officials learned was that they needed physical therapists to work with patients who had been confined to their beds. He said he was proud of the team that worked at the convention center, saying they did the best they could with the available resources.
‘A mammoth expense’
Across the street from the convention center, individual trailers known as “personal housing units” where people could stay in isolation as they awaited coronavirus test results were barely needed. The U.S. Navy set up 274 of them, but a maximum of six were occupied at one time, on April 9. After that, the number of PHU patients fluctuated between 0 and 2 until April 29, records show, after which it appears the units remained empty for good, though some trailers are still there.
Kanter said state officials wanted to ensure that they did not put patients who wound up testing negative inside the convention center, where they could easily contract coronavirus in the meantime.
Robert Travis Scott, president of the Public Affairs Research Council of Louisiana, said that the moves to build hospital overflow space and to staff them were well-intentioned, given the grim early forecasts.
But he said that by now, given the shrinking number of patients in the convention center, state officials need to send a signal back to Washington that they are trying to be prudent with government dollars. Regardless of whether the federal or state government is paying, taxpayers are on the hook for the mounting bills.
“What we don’t want to do is set a precedent where we don’t look like we’re looking out for the tax dollars for the whole nation,” Scott said.
Lundeen described the operation as a “mammoth expense” with “colossal waste,” with not only medical staffers being paid, but also cleaning crews, security personnel and more. And Jackson said that it’s frustrating as a taxpayer to see how much money was being spent to take care of so few patients.
“It was certainly excessive by the time I arrived,” she said.
Sources at the convention center said that the patient count on Thursday was down to four.