As COVID-19 burned through northwestern New Mexico in April and May, leaving rural hospitals scrambling to meet the demand with limited staff, resources and critical care beds, hundreds of patients were transferred to hospitals in other areas of the state and even out of state, records show.
Documents from the state Department of Health show that as COVID-19 infections surged to peak levels in McKinley and San Juan counties — the state’s worst hot spots in the early months of the pandemic — strained hospitals in Gallup, Shiprock, Crownpoint and Farmington sent scores of patients to Albuquerque and Santa Fe.
Hospitals in the region also sent patients to Flagstaff, Ariz.; Denver; and Durango, Colo., the documents show.
From late April through the end of June, hospitals transferred at least 722 patients to facilities outside the region for what was in many cases lifesaving care.
Because some patient transfer documents were missing or filed with incomplete information, the number is likely higher.
Patients often were sent from one hospital in the region to another to ensure no facility became overwhelmed. But about 75 percent of patient transfers in the area were to facilities farther away, primarily hospitals in Albuquerque.
Gov. Michelle Lujan Grisham talked about the historic magnitude of the patient transfers during an address in late August to a virtual conference hosted by New Mexico Voices for Children, an Albuquerque-based child advocacy organization.
The governor’s talk focused on how the pandemic underscored long-standing inequities in New Mexico.
“Early in the pandemic we were moving patients, one to two an hour, out of the northwest region of the state,” the governor said. “We know they are not equipped in rural New Mexico to meet significant critical care needs of our population.”
The governor’s spokeswoman, Nora Meyers Sackett, walked back Lujan Grisham’s statement in a follow-up email.
“The governor’s comments to the Voices for Children group were more intended to highlight the overall health care access disparities in the region, not to suggest that the transfers themselves indicate that the region is ill-equipped,” Sackett wrote.
She added that “in a broader sense we know that communities of color and disadvantaged families like some of those in the northwest, and other rural areas, need greater and more targeted health care investments, which is true pandemic or not.”
State officials and health care experts say New Mexico was able to rise to the demands of the pandemic by orchestrating a system that allows every hospital to transfer patients so no region would be left unable to cope with the outbreak. The high number of transfers from northwestern New Mexico is evidence of the strength of the state’s overall health care system, they argue.
But doctors and health experts also acknowledge the system was successful largely because the entire state did not experience a surge at once — or a widespread wave that coincided with one in neighboring states like Texas, Arizona and Colorado.
Research has shown patients critically ill with COVID-19 can experience vastly different health outcomes based on which hospital treats them.
In a July study published in the journal JAMA Internal Medicine, researchers found mortality rates for more than 2,200 critically ill COVID-19 patients in 65 hospitals across the country were more than three times higher for those in small hospitals containing 50 or fewer ICU beds than for patients in larger hospitals.
A New York Times investigation found similar disparities in patient outcomes depending on the hospital they went to in New York City, with better outcomes at larger, better-financed and better-equipped hospitals than at smaller hospitals with fewer nurses and fewer ICU beds.
In the beginning of northwestern New Mexico’s COVID-19 peak, the city of Gallup had only 13 intensive care beds, said Ina Burmeister, a top administrator at Rehoboth McKinley Christian Health Care Services, one of the city’s two hospitals.
After the spring surge, Gallup saw the most COVID-19-related deaths per capita of any city in the nation. The city went on lockdown for 10 days in May in an effort to stem the rising caseload. McKinley County, with 250 deaths as of Friday, has had the highest toll in the state, followed by neighboring San Juan County, with 194 deaths.
The outcome might have been more dire without the statewide transfer system ensuring patients could receive critical care elsewhere.
During the virus’s peak in northwestern New Mexico, as many as 15 to 30 patients a day were sent to hospitals in Albuquerque, state Human Services Department spokeswoman Jodi McGinnis Porter said in an email.
Patients also are transferred to Albuquerque from other regions of the state, she said, which “is evidence that our state health care system works — sicker patients are transferred to a higher level of care. Historically the northwest region generally has the most transfers on any given day, but not always.”
Presbyterian Healthcare Services’ hospitals in Santa Fe and Albuquerque accepted patients from the northwest during the region’s COVID-19 peak.
Melanie Mozes, a spokeswoman for the hospital network, said, “Presbyterian is committed to supporting the Navajo Nation which has been deeply impacted by this pandemic. From April to June, we experienced a 25 percent increase in patient transfers from [Indian Health Service] facilities serving the Navajo Nation compared to the same period last year.”
She declined requests for an interview with medical experts at Presbyterian.
Even with the transfers, Gallup hospitals were so strained from the patient load, the city created a temporary hospital in a local high school to expand capacity.
Gallup Indian Medical Center, operated by the federal Indian Health Service, also struggled to maintain staff. Up to 75 percent of its nurses during the city’s COVID-19 surge were temporary or volunteer staff, according to hospital officials.
State Rep. Patricia Lundstrom, D-Gallup, has been a vocal proponent of building a new hospital in Gallup to replace the aging facility. She did not return requests for comment on the effort.
Hospitals in Gallup are now working to create more intensive care units in case another wave of the virus hits this winter. But officials with the Gallup Indian Medical Center acknowledged the hospital would have few options for patients if cases spiked at the same time in Albuquerque, Flagstaff and Phoenix.
“We would have people working around the clock, doing extra long shifts,” said Jonathan Iralu, chief clinical consultant for infectious diseases at the Indian Health Service.
Gallup Indian Medical Center CEO Mark Alford said they would have to consider “flying patients even farther away to other states.”
Stephen Stoddard, executive director of the New Mexico Rural Hospital Network, also expressed concern about a possible Southwest surge in the winter.
“That’s always something that could happen, and everyone has to be prepared for the worst-case scenario,” he said.
Burmeister, of Rehoboth McKinley, seemed more optimistic.
She said in a statement that patient transfers are “standard practice” in the region “when local capacity is exceeded.”
“Should there be a second wave of COVID-19 this winter,” she added, “we would continue to accommodate as many patients as we can locally and continue to utilize statewide partnerships when needed.”