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Law360 (July 2, 2020, 4:27 PM EDT) -- In this edition of Coronavirus Q&A, the Texas Hospital Association's general counsel discusses mounting unease about staffing and capacity, what his group's 500 member hospitals and health systems learned from the pandemic's brutal toll in the Northeast, and efforts to prevent a bad situation in the Lone Star State from getting even worse.
Steve Wohleb
He shared his perspective as part of a series of interviews Law360 is conducting with prominent lawyers regarding the legal and business challenges of COVID-19, which has recently started spreading ferociously across the southern U.S. and infecting Texans in record numbers.
This interview has been edited for length and clarity.
What work are you most focused on for your members?
Right now, our main focus is really the same that it has been since the beginning of the crisis, and that's doing everything we can do to make sure information is flowing in every direction that it needs to be. Whether it's a new executive order, an emergency rule, or a new regulatory waiver or flexibility, or some agency interpretation of those [policies] — we're dedicating a lot of resources to making sure our members, government officials and other industry stakeholders have the information they need to make the critical decisions they're needing to make during this unprecedented crisis.
We think those communications also inform the advocacy efforts we're making on behalf of our members and ultimately improve our state's ability to respond to the crisis. We're partnering closely with state public health officials to prevent the spread of the disease and protect Texans to ensure they don't get to the point of needing hospital care for COVID-19.
We do that in a number of ways through robust social media messaging and driving home precautionary measures every chance we get. We're doing everything we can to keep people safe and mitigate the spread here. Those are our primary focus areas.
Compared to hospitals in the Northeast, hospitals in Texas generally had extra time to prepare for the pandemic. In what ways was that helpful?
It gave us time to think about putting in place pieces of the contingency plan that would be needed if and when Texas cases started to rise, including working with state officials on licensing and other flexibilities that were designed to increase capacity to address the crisis. It also allowed us to see what was going on in other places and to take this disease as seriously as it needed to be taken.
At the association, we started publishing daily updates in early March that included all the information our members needed to prepare, and we quickly convened a multidisciplinary task force to get input on the most critical issues. We were also briefing lawmakers and other officials, and we were able to participate in national calls and hear from other states about the issues they were dealing with and addressing. That information and perspective was critical in a state as big and diverse as Texas.
Early on, there absolutely was uncertainty about the characteristics of the disease and what might ultimately be needed to respond to the crisis. Adding physical capacity to our hospitals and other care settings takes significant resources, and the devastating financial effects of the crisis were being felt very early on, so there were decisions that had to be made about what investments to make and when.
In terms of resources and financial issues, I've heard that hospital staffing agencies are seeing much higher demand and are raising prices. Do your members have enough staff?
That is, and probably will continue to be, a challenge. There are areas of the state where staffing is becoming an issue. The pandemic is taking its toll on the health care workforce in a very real way physically, mentally and emotionally.
There may be situations, if this crisis continues to evolve and deteriorate, where there simply isn't enough staff for the physical environment that may otherwise be available to treat the patients. We're seeing that in Texas just like they are in other states, and it could be a really critical component moving forward in addressing this crisis.
A lot of attention has focused on Houston and Harris County, and there's been some confusion about hospital capacity. Where do things stand?
There's no question that resource utilization in Harris County, and other parts of the state for that matter, is on an upward trend. Everybody has seen those numbers. But there are also parts of the state where health care resources have really only been minimally affected to this point. Texas is a very large and diverse state.
Based on the latest numbers, Harris County still has hospital and ICU bed capacity. There's a clear upward trend of positive test results and hospitalizations — everyone has seen those numbers, and hospitals are moving quickly to make sure they have the staff and resources they need to meet whatever comes.
As the Memorial Day weekend came and went, cases trended upward after that, and we're concerned about the Fourth of July weekend. We're concerned about the impact of people gathering and what that might do to push the numbers up even further, and we're actively working to make sure people follow the precautions and understand the real consequences of this disease.
As you noted, Texas is very large, and the governor has halted elective procedures in a number of counties to preserve capacity. Are there areas aside from Houston and Harris County that you're watching closely?
Several metropolitan areas are showing the same upward trend in terms of cases reported and hospitalization. But this is a regional crisis, and the situation is different in different regions. The state overall has the capacity to respond to the crisis and remains positioned to meet the needs of patients. But we're keeping an eye on the numbers, as everybody is, and would definitely be concerned if we saw the numbers continue to increase on the same trajectory they're on now.
Right now, 244 of the 254 counties in Texas are reporting cases. So we don't have a particular focus on any one region of the state, because we serve 500 members from all corners of the state of Texas. But you can look at the numbers and see that other areas are experiencing the same kind of uptick as Houston and Harris County.
In sum, it sounds like the current situation is manageable, but that if infections don't abate, that could change fairly soon.
You can see the number of hospitalizations, how that's gone up in the month of June. That's obviously not a sustainable trajectory for the state.
--Editing by Kelly Duncan.
Check out Law360's other installments of Coronavirus Q&A.
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