While hospitals around the country and the world have been overwhelmed by COVID patients, the pandemic threatens the financial health of Pershing General Hospital due to a shortage of patients, PGH CEO Cindy Hixenbaugh told the Lovelock hospital’s board of trustees last week.

As local residents avoid the pandemic by delaying routine healthcare and staying home, that means less revenue for the hospital, she explained. The hospital had “no in-patients at all in April so we would expect that our cash collected is lower and also way low in May because April’s money comes in May, generally speaking,” said the hospital’s chief financial officer.

“It’s serious because of the decline in patients because of the COVID situation,” Hixenbaugh told the board. “Our statistics dropped significantly. We are hoping it improves as time goes on but we’re still in limbo with the pandemic as far as people not wanting to come in and be seen. We can only hope that our statistics start increasing again but not for COVID cases.”

According to Chief Nursing Officer Christina Dickerman’s May report, the hospital had one acute admission, one swing admission and 102 emergency visits. There were 10 transfers to other facilities including five medical cases, one mental health case and four “trauma related” cases. The acute emergency department had four returns within 72 hours with the same diagnosis.

In response to the hospital board’s financial questions, Hixenbaugh said only time will tell when the hospital’s patient counts and revenues will return to normal.

“It’s a waiting game, Charlie,” she told board member Charles Safford. “Our lives here depend on patients. They’re not going anywhere else, that I know of. Instead, they’re staying home. So, whether they’re healthy because they’re staying home and masking up or they’re washing their hands and social distancing ... I hope it’s not a new norm.”



COVID CONCERNS

The 25-bed, long-term care facility (nursing home) had 22 residents with one admission last week and one this week on July 1 bringing the population to 24 nursing home patients. But, isolation of nursing home residents mandated by the state presents a constant challenge.

“We await further guidance from the state and federal entities on when we can reopen long term care for visiting,” Hixenbaugh said. “Our staff is doing an amazing job trying to keep residents feeling connected to family and friends. However, it’s still difficult for the residents not to see their loved ones in person. They still do the window visits and the Zoom or Facetime visits.”

As of last Thursday, Hixenbaugh reported 2,690 COVID tests had been performed in Pershing County with six positive tests and zero deaths. County test results include Lovelock Correctional Center prison inmates and prison staff who reside within the county. Positive cases had declined from seven to six due to a county residency correction by the state health department. 

“Yesterday, they had reported seven positives for Pershing County but sometimes they’ll redistribute them based upon where they live,” Hixenbaugh said. “So, that seventh person came off Pershing County’s count. We have six people in this county that tested positive.”

As a precaution, local COVID testing continues in an outdoor drive-through tent located behind the PGH clinic for patients who call and say they are sick. Otherwise, patients who are not sick but in need of “simple health procedures” such as medication refills are admitted into the clinic.

Positive test cases must be quarantined and undergo multiple tests, Hixenbaugh explained.

“Folks that are tested and become positive or who have had an exposure (to COVID-19) might receive up to three different tests within a week’s time,” she said. Those who test negative twice after a positive test are listed by the state as “recovered.”

Pennington Foundation and COVID grants have enabled PGH to order PPE and other supplies for an alternate care site but some items are on back order including an autovent, a Passport (for vitals) and ultraviolet devices for room and countertop disinfection, Hixenbaugh said.



MENTAL HEALTH TRANSFERS

Due to staff shortages at the sheriff’s office, delayed transfers of mental health patients to medical facilities outside Pershing County have become a concern for hospital officials, Hixenbaugh said. PGH does not have facilities or staff needed to treat mental health cases.

Local ambulances, operated by volunteer medics, do not provide adequate patient security. 

“Recently, we had a minor issue between the sheriff’s office and the hospital with regard to transferring those with a mental health crisis,” she said. “The Undersheriff has notified us that we will require a court order in order for law enforcement to transfer community members who are in mental health crisis.”

A “template” court order has been created to compel or expedite transfers, Hixenbaugh said.

“We understand that the sheriff’s office is short-staffed,” she said. “They are the safest transport in Pershing County, at this point. There is no mental health transport available today. There is a group from the state working on mental health transport but that’s going to take a little while to get all the state approvals and contracts in place.”

Since January, 2020, there have been ten local mental health cases, Hixenbaugh said.

“It’s sporadic,” Hixenbaugh told the board. “You see them a little bit more in the winter or the holiday times...We absolutely understand where the sheriffs are coming from but it’s not about Pershing General Hospital. It’s about a person in crisis.”