CDPH provides statistics, statements Kaweah CEO’s allegations against Adventist Health are arguably unsubstantiated
TULARE COUNTY – Kaweah Health’s shocking claim Adventist Health’s Central Valley Network did not pull its weight during peaks of the pandemic in Tulare County, and therefore profited by continuing elective procedures, is pretty thin on evidence.
Kaweah Health CEO Gary Herbst made the claims during an interview with the Valley Voice in September. The article, which published on Oct. 22, quoted Herbst as saying Adventist kept its hospitals in Tulare, Selma and Reedley free of COVID patients and instead sent all COVID admissions to its larger hospital in Hanford. A transcript of the interview obtained from Kaweah Health verifies Herbst made the statement in the interview.
“During the height of the pandemic in December and January, the Adventist Health Central Valley Network made a decision to cohort all of their COVID positive patients in their Hanford facility and to not admit any covid patients into Tulare, Selma or Reedley,” Herbst said in the transcript. “At the same time we had to completely shut down inpatient surgery, shutting down almost every procedure so that we could fully support the entire COVID population of the county.”
Herbst further alleged the decision was motivated by money, saying Adventist continued to offer elective surgeries in Tulare while Kaweah was struggling to keep up with COVID admissions just 10 miles up the road in Visalia.
“Tulare hospital advertised itself as the safe, non-COVID hospital and all of our surgeons took their cases there and did their surgery there while we were losing millions here and taking care of the COVID population,” Herbst said in the transcript.
Herbst and Kaweah Health declined to comment for this article beyond the transcript of the September interview.
Herbst’s allegations seems to track with COVID admissions trends on HealthData.gov, a web site managed by the U.S. Department of Health and Human Services. Adventist Tulare has been able to staff between 25-35 beds throughout the pandemic and the number of COVID patients has fluctuated between 0% and 95%. The Tulare hospital only admitted four total COVID patients until the week of Dec. 18, 2020, while Adventist Health Reedley admitted 50 COVID patients prior to December and Adventist Health Selma admitted 36 prior to the winter surge.
At one time, however, the Tulare hospital was handling 25% of all COVID admissions for Adventist’s Central Valley Network. According to the California Department of Public Health, Adventist Tulare had 33, or 94% capacity, in December 2020, 80 in January 2021, well beyond its average number of staffed beds, and 25 in February 2021, which at times may represent 100% of available COVID beds at the hospital. Similarly, the Tulare hospital admitted 56 COVID patients in August and 116, its highest since the pandemic began, in September 2021 during this summer’s surge.
Adventist’s Hanford hospital, the network’s primary COVID ward, had 142 staffed beds and was similarly impacted during the winter and summer surges. During the winter surge, Adventist Health Hanford admitted 147 COVID patients in November 2020, 321 in December 2020, 327 in January 2021 and 126 in February 2021. During the summer surge, the Hanford hospital admitted 221 in August 2021, 236 in September 2021 and 160 in October 2021.
Kaweah Health did admit many more patients than Adventist Network throughout the pandemic. A month-to-month comparison of the winter surge shows Kaweah admitted nearly 600 COVID patients to Adventist’s 400 (between four hospitals) in December and 480 to 460 in January. During the summer surge, Kaweah admitted nearly 400 to just over 300 at Adventist hospitals in August, and in September Adventist admitted more COVID patients than Kaweah, 425 between the four hospitals compared to about 400 at Kaweah Health. Kaweah is also a much larger facility than the entire Adventist Central Valley Network. Kaweah Health Medical Center is a 581-bed facility compared with Adventist’s 348 total beds including Tulare (101), Hanford (142), Selma (56) and Reedley (49).
During the winter (December 2020-January 2021) and summer (September-October 2021) surges, Adventist performed 415 “emergency, urgent and elective procedures” but did not distinguish how many were of each category. Dr. Gurvinder Kaur, Chief Medical Officer for Adventist Health Central Valley Network, said Adventist paused all elective surgeries on Dec. 9, 2021 as hospitalizations spiked and resumed them in early February as the winter surge subsided.
In the interview, Herbst said Adventist only started admitting COVID patients in Tulare after the state threatened to pull their COVID emergency nursing ratio exemption, which allowed hospitals to have fewer nurses treating more patients. Normally, California hospitals are required by law to staff one nurse for every two patients in intensive care and one nurse for every four patients in emergency rooms.
“The State finally stepped in and threatened to pull their exemption from the nurse staffing ratios in Hanford because they were working under an exemption and said, ‘If you don’t start taking care of covid patients and shut down your elective surgeries, we’re going to take this away from you’,” Herbst stated in the transcript. “So good for them. They’ve stepped up and maybe they did it under threat.”
Herbst goes on to say Adventist’s attempt to capitalize on its decision to cohort all of its COVID patients to Hanford was a topic of conversation during weekly phone calls between Kaweah, Sierra View Medical Center in Porterville and the California Department of Public Health (CDPH). Laura Florez-McCusker, director of media relations for Kaweah Health, clarified Herbst’s comments saying the CEO has never had a conversation with the state about Adventist but rather CDPH “questioned Adventist Health on weekly calls as to why it was not accepting COVID patients at its Tulare hospital.”
On Nov. 17, CDPH answered questions posed by the Sun-Gazette regarding Herbst statements. The state agency’s Office of Communications said it has never shared information about Adventist with Kaweah and never threatened to pull Adventist’s nursing ratio exemption. CDPH did say hospitals are legally required to do “prompt assessment and treatment for all patients arriving at a hospital’s Emergency Department” and that any diversion of patients to another hospital are justified if the “hospital is at full capacity with limited resources.” CDPH did not answer whether or not Adventist diverting COVID patients to its Hanford hospital was “reasonable and justified.”
“We never turned away any patient, whether we took them in Tulare, Selma or Hanford or transferred them, they received the care they needed when they came to our door,” said Dr. Gurvinder Kaur, chief medical officer for Adventist Central Valley Network.
Kaur said CDPH was informed of Adventist’s plans to transfer patients within its Central Valley Network to Hanford and that Adventist has not received any complaints from CDPH. She said cohorting COVID patients in Hanford had several advantages. It is the largest hospital in its Central Valley Network, it has the largest ICU, largest emergency room, the most private rooms for quarantining patients, and is home to its infectious disease specialist. The sheer volume of COVID patients was also highest in the Hanford area and it gave them a place to focus their resources, such as military teams deployed throughout the state to provide staffing relief to hospitals struggling to keep up with the vast demands of the virus.
“This meant we could have very little cross contamination and lots of learning about what the disease does, how it progresses and find ways, methods and exercise the safety measures,” Kaur said.
During the first surge in summer 2020, Kaur said Adventist sent all COVID patients to Hanford but by the second surge in the winter began triaging patients by hospital. While acute patients continued to go to Hanford, those patients with oxygen and IVs under a certain medical threshold could not be treated in Tulare.
“We were constantly evaluating what was best for patients,” Kaur said.
By the third surge this summer, COVID patients were able to be treated at the nearest Adventist hospital in Hanford, Tulare, Selma or Reedley. The challenge was coordinating ambulances from other areas, nursing demands, bed availability all coordinated through a Command Center in Hanford. Adventist also brought intensive care into people’s home. Kaur said the hospital created two-person teams of nurses who would go into COVID patient’s homes to provide acute care.
“There were barriers once in a while and we had to explain the reasoning to the patients but most of the time it went very well,” Kaur said.
Kaur said hospitals like Adventist Tulare, which are part of a larger network, have the benefits of scale. They can move ventilators where they are needed, had additional clinical education staff to study all of the data as it came out so physicians and nurses providing care didn’t have to, and were able to procure and store large amounts of personal protective equipment, even when supplies were unavailable to other hospitals.
“We never ran out of PPE,” Kaur said.
Contrary to public perception, Kaur said Adventist does work with other hospitals outside of its network, including Kaweah Health. They have transfer agreements with the Visalia hospital and others out of the area to make sure every patient has a place to seek care.
“We have learned a lot and that helped us develop crucial, successful plans,” Kaur said.