POST 216. December 1, 2021. CORONAVIRUS. Covid cacophony: as states struggle to address health care staffing shortages, a federal court puts Biden administration health care worker vaccination mandate on hold.

California has reported the first U.S. case of the omicron variant

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With rising COVID-19 cases and a declining workforce, Montana hospitals are overwhelmed.

Now, the state is reaching out to those with expired medical licenses, asking them to renew.

State labor officials will tell you employment has recovered more than 99% from the pandemic and since January, the number of Montanans receiving unemployment benefits plummeted by 87%.

However, that’s not what you’ll hear from Montana hospitals…

The Department of Labor and Industry said in a statement:

“The Department hears regularly from employers, including healthcare providers, who have been impacted by the ongoing workforce shortage. With COVID-related hospitalizations increasing statewide, at the Governor’s direction the Department is looking at ways to mitigate the healthcare worker shortage and ensure there are no unnecessary delays in the licensure process for individuals qualified to provide medical services.”

Some hospitals say that isn’t enough.

At Bozeman Health, there are 400 open positions right now–from janitors to frontline health workers.

“We absolutely need people to apply for positions,” said Kallie Kujawa, incident command lead. “If anyone is looking for a job, we have so many positions that are unfilled and available, which is partly contributing to our need to have emergency crisis staffing here right now.”

Kujawa added there aren’t any expedited processes or waivers in place to make hiring workers faster. She says Bozeman Health is in talks with the state to try and get some of them back.

In the meantime, they’ve put their own measures in place like expedited onboarding.

“We have emergency credentialing procedures that we can follow,” Kujawa said. “So if they’re already licensed, there are absolutely ways that we have expedited them into our system so that they can start working.”  (A)


“New York Gov. Kathy Hochul (D) is considering deploying the medically trained members of the National Guard ahead of an anticipated shortage of health care workers.

Hochul released a comprehensive plan to address staff shortages in New York facilities Saturday, amid concerns that a large number of health care employees will not meet Monday’s vaccine deadline.

“We are still in a battle against COVID to protect our loved ones, and we need to fight with every tool at our disposal,” Hochul said, according to a release on the state website. “I am monitoring the staffing situation closely, and we have a plan to increase our health care workforce and help alleviate the burdens on our hospitals and other health care facilities.

The plan, announced by the state government lays out several options in the event of a staff shortage.

First the governor said that she would sign an executive order declaring a state of emergency to route additional workforce supply into New York. This includes allowing qualified healthcare workers licensed in other states to practice in New York. 

Other options, according to the statement, included deploying medically trained professionals of the National Guard, partnering with the federal government to deploy Disaster Medical Assistance Teams and working with the federal government to expedite visa requests for medical professionals.” (B)


A regional association representing 50 upstate New York hospitals is calling on the state Department of Health to delay implementation of new laws that will require hospitals and nursing homes around the state to establish and maintain minimum staffing levels.

The Iroquois Healthcare Alliance — which represents hospital systems in 32 upstate counties, including the Capital Region — argues implementation of the laws by Jan. 1, 2022 is infeasible given current widespread staffing shortages plaguing health care facilities statewide.

In a letter to state Health Commissioner Howard Zucker last month, IHA President and CEO Gary Fitzgerald said the organization’s primary opposition to the law relates to its timing, as hospitals are currently experiencing “unprecedented” workforce shortages that he says have been exacerbated by the state’s coronavirus vaccine mandate for health care workers and a recent court decision striking down religious exemptions to the mandate.

“The current workforce crisis facing hospitals across upstate New York is dire,” Fitzgerald wrote in the letter.

Hospitals and health systems stretching from Albany to Buffalo had over 2,000 open registered nursing positions prior to the COVID-19 pandemic, he said. After the pandemic hit, some 6,000 workers were furloughed as elective surgeries were canceled to make room for a potential wave of patients, which modeling projections at the time indicated would overwhelm hospitals.

“Today, vacancy rates remain extremely high, and our members are functioning in crisis mode, unable to accept transfers, canceling elective procedures, reducing operating room capacities and a general slowing down of daily patient care, all related to and a direct result of workforce shortages,” he wrote. (C)


“Since the start of the pandemic, Michigan continues to see a surge in patients. But hospitals are unable to meet the rising demand due to a nursing shortage, an issue the 7 Action News team highlighted in July.

Back then we uncovered that there were 165,000 nurses registered in Michigan but only 125,000 were working, many leaving the field due to stress, and burnout among other factors…

Without enough nurses, Michigan’s health care is taking a hit. Right from beds being closed to elective surgeries postponed…

In mid-September, Beaumont Hospitals had to shut down 180 beds while Henry Ford Health closed 120 beds…

According to the American Nurses Association, more than 500,000 registered nurses are expected to retire by 2022. Meanwhile, by next year the shortage is expected to hit 1.1 million.

There are also a lot of nurses who have moved on from bedside nursing to take up home care or even travel nursing.

“I do know that if you pick up a traveling assignment, you get paid maybe twice as much,” said Garcia.

So, what are hospitals in Michigan doing to attract new hires? For starters, shows employment ads for nurses offering a $10,000 signing bonus and pay packages ranging from $70,000 to a whopping $170,000 per year.

There are also health care providers like Henry Ford who announced recently that they will bring in hundreds of nurses from the Philippines.” (D)


“A federal court declined Friday to lift its stay on the Biden administration’s vaccine mandate for businesses with 100 or more workers.

The New Orleans-based 5th U.S. Circuit Court of Appeals granted an emergency stay last Saturday of the requirement by the federal Occupational Safety and Health Administration that those workers be vaccinated by Jan. 4 or face mask requirements and weekly tests.

Lawyers for the Justice and Labor departments filed a response Monday in which they said stopping the mandate from taking effect will only prolong the COVID-19 pandemic and would “cost dozens or even hundreds of lives per day.”

But the appeals court rejected that argument Friday. Judge Kurt D. Engelhardt wrote that the stay “is firmly in the public interest.”

“From economic uncertainty to workplace strife, the mere specter of the Mandate has contributed to untold economic upheaval in recent months,” Engelhardt wrote.

At least 27 states have filed legal challenges in at least six federal appeals courts after OSHA released its rules on Nov. 4. The federal government said in its court filings Monday that the cases should be consolidated and that one of the circuit courts where a legal challenge has been filed should be chosen at random on Nov. 16 to hear it.

Administration lawyers said there is no reason to keep the vaccine mandate on hold while the court where the cases ultimately land remains undetermined.” (E)


“Hospitals in at least 25 states are critically short of nurses, doctors, and other staff as coronavirus cases surge across the United States, according to the industry’s trade association and a tally conducted by STAT. The situation has gotten so bad that in some places, severely ill patients have been transferred hundreds of miles for an available bed — from Texas to Arizona, and from central Missouri to Iowa.

Many of these hospitals spent months building up stockpiles of medical equipment and protective gear in response to Covid-19, but the supplies are of little use without adequate staffing.

“Care is about more than a room with a hospital bed. It’s about medical professionals taking care of patients,” said John Henderson, chief executive of the Texas Organization of Rural & Community Hospitals (TORCH). “If you don’t have the staff to do that, people are going to die.”..

The American Hospital Association’s vice president of quality and patient safety, Nancy Foster, said she’s heard from two dozen hospital leaders over the past two weeks, warning her of staffing shortages in states including Texas, North and South Dakota, Minnesota, Wisconsin, and Illinois. Health care providers in Kansas, Oklahoma, Arkansas, Ohio, Missouri, Michigan, and Utah said they’re facing the same problem, as do local reports from New Mexico, Nebraska, Colorado, Wyoming, Tennessee, Georgia, Alabama, Indiana, Montana, California, Rhode Island, and South Carolina.

The shortages are primarily caused by overwhelming numbers of patients as coronavirus spreads, combined with decreasing staff levels as nurses and doctors themselves fall sick or have to quarantine after being exposed to infected people. Covid-19 is also prevalent in rural areas that have been struggling with a shortage of health professionals for years; hospitals in more remote regions don’t have equipment such as ventilators, and so must transfer severely ill patients to already-overwhelmed urban health care systems. The scale of the problem makes it harder to address: Systems designed to offset shortages by bringing in backup from other areas don’t work when so many states are affected simultaneously.” (F)


(Texas) trying to wind down an expensive, federally paid program of hiring nurses and other health care professionals to keep its hospitals from buckling under staffing pressures and burnout caused by the COVID-19 pandemic.

But the plan could be upended by any spike in COVID-19 cases prompted by gatherings over the holidays. Already, the state decided to keep up surge staffing at hospitals in El Paso and the Panhandle because of recent outbreaks.

After three huge waves of hospitalizations — in each of the past two summers and the big daddy of them all, last December and January — the state has spent nearly $7 billion of federal COVID-19 money for temporary nurses, respiratory therapists and some doctors to maintain operations at hospitals and “alternate care sites.”…

The surge staffing began in July 2020 with just more than 3,500 visiting health care workers helping Texas hospitals. Peak deployment came after last winter’s surge of cases, with almost 14,000 temporary nurses and other workers used during one week in early February. Last summer, the numbers dwindled. From mid-May to mid-August, no surge staffing was needed.

But then deployments kicked back up with the spike of cases caused by the delta variant. By early October, the department’s three private vendors were supplying nearly 7,800 health care professionals a week. As of Nov. 17, that had dropped to 3,176….

As of Nov. 15, BCFS had 1,945 medical personnel working in 235 Texas hospitals, said BCFS spokeswoman Evy Ramos. Except for about 300 respiratory therapists, they were all nurses, she said. None was a physician.”  (G)


“New York Gov. Kathy Hochul has declared a state of emergency ahead of potential COVID-19 spikes this winter due to the already-circulating Delta and newly-identified Omicron variants of coronavirus.

The declaration, which goes into effect on Dec. 3, will allow the state to acquire pandemic-fighting supplies, increase hospital capacity and fight potential staffing shortages. It would also allow the state Health Department to limit non-essential and non-urgent procedures at hospitals.

“We continue to see warning signs of spikes this upcoming winter, and while the new Omicron variant has yet to be detected in New York State, it’s coming,” Hochul said.” (H)


(Massachusetts) “State officials are taking steps to shore up the health care system as hospitals battle staff shortages amid a new surge in COVID-19 infections.

Infections have been rising in recent weeks amid the highly contagious delta variant, despite the state’s highest-in-the-nation vaccination rate. More than 2 million eligible Massachusetts residents have not been vaccinated and immunity is waning for fully vaccinated people who haven’t yet had their booster shots.

Meanwhile, hospitals are wrestling with chronic staffing shortages that have translated into the loss of more than 500 intensive care unit beds across the state.

On Tuesday, Gov. Charlie Baker took steps to ease health care capacity issues by signing an emergency order requiring hospitals with limited acute care capacity to start reducing elective procedures beginning next week.

Under the new guidance, hospitals are required to keep at least 15% of their medical and surgical and intensive care unit beds available for COVID patients.

Hospitals that do not meet or exceed the capacity threshold will be required to “reduce non-essential, non-urgent scheduled procedures performed on a daily basis by at least 30%, as compared to the hospital or hospital system’s 2019 average daily procedure volume.””  (I)


“ A federal judge on Monday blocked President Joe Biden’s administration from enforcing a coronavirus vaccine mandate on thousands of health care workers in 10 states that had brought the first legal challenge against the requirement.

The court order said that the federal Centers for Medicare & Medicaid had no clear authority from Congress to enact the vaccine mandate for providers participating in the two government health care programs for the elderly, disabled and poor.

The preliminary injunction by St. Louis-based U.S. District Judge Matthew Schelp applies to a coalition of suing states that includes Alaska, Arkansas, Iowa, Kansas, Missouri, Nebraska, New Hampshire, North Dakota, South Dakota and Wyoming. Similar lawsuits also are pending in other states.

The federal rule requires COVID-19 vaccinations for more than 17 million workers nationwide in about 76,000 health care facilities and home health care providers that get funding from the government health programs. Workers are to receive their first dose by Dec. 6 and their second shot by Jan. 4…

Biden’s administration contends federal rules supersede state policies prohibiting vaccine mandates and are essential to slowing the pandemic.

But the judge in the health care provider case wrote that federal officials likely overstepped their legal powers.

“CMS seeks to overtake an area of traditional state authority by imposing an unprecedented demand to federally dictate the private medical decisions of millions of Americans. Such action challenges traditional notions of federalism,” Schelp wrote in his order.

Even under an exceedingly broad interpretation of federal powers, “Congress did not clearly authorize CMS to enact the this politically and economically vast, federalism-altering, and boundary-pushing mandate,” Schelp wrote.” (J)