By Cameron Smith

Dennis and Charlotte Harbison

Dennis Harbison, 73, went to the ER at Bibb Medical Center in early August for pain from what he thought was a pulled muscle, difficulty breathing and low blood pressure. At the hospital, Harbison learned his gallbladder was essentially dead. He needed a simple, life-saving surgery.

“If he didn’t get that surgery done, eventually his gallbladder would rupture, and he would become septic and he would die,” said Dr. Laura Lishman who works at Cahaba Medical Care and as an ER doctor at Bibb Medical Center.

“I started calling every hospital in the state of Alabama.”

Each was filled with COVID-19 patients. After about 30 calls, Lishman finally found a hospital with an open ICU bed in Columbus, Mississippi.

“I have an ER shift coming up in a week, and honestly, I’m dreading it because I know it’s gonna be even worse,” said Dr. Lishman on Wednesday.

Rural hospitals in Alabama with limited resources and only one ER doctor on hand are struggling to find ICU beds to care for non- COVID-19 emergencies as hospitalizations surge.

“There are hospitals calling us every day looking for ICU bed capacity, and we just don’t have it,” said Tracy Doughty, president and Chief Operating Officer of Huntsville Hospital.

The state’s larger hospitals normally accept transfers from their smaller counterparts for emergency surgeries, but they are stretching their capacity to find ICU beds for their own patients.

The Alabama Hospital Association has no data on the number of patients transferred out of state for emergency care or on how many people were unable to access care during the pan- demic.

“We’ve had a significant increase in number of cases that we’re transferring out of state,” said Ryan Kelly, executive director of the Alabama Rural Health Association.

During last winter’s surge, the state’s rural hospitals faced a similar difficulty in finding ICU beds for non- COVID emergencies.

“If the rural hospital calls, and let’s say that UAB or Huntsville or one of our larger facilities is full, then they will work with that hospital as they can to connect with other hospitals in the region, they’ll just kind of work down the list to see if there’s a bed.”

Dr. Christine Whiten works ER shifts at a small, 25-bed, rural hospital in Centerville. Lately she’s the only ER doctor in her hospital, and she’s juggling treating some of her patients while calling around the nation for hospital beds and transfers for some others.

“You have multiple emergencies that you’re trying to take care of, and (you’re) having to take the time to call 15-plus hospitals. Taking that three hours to get the patient transferred is time away from your other patients. Meanwhile, your ER is backing up,” said Dr. Whiten.

Her hospital only has one small ventilator that is borrowed from a local ambulance. If the ambulance needs the respirator to transfer a COVID-19 patient, the ambulance must take it back from the hospital

“If you can imagine having a patient in respiratory distress,” she said, “those patients have to be transferred out pretty urgently.”

One of Dr. Whiten’s recent patients had a brain bleed. She needed access to a neurosurgeon for immediate surgery, but it took three hours to get her transferred, and during that time her stability declined.

“She could have died if she didn’t get a higher care.”

 A few weeks ago, Dr. Lishman saw a stroke patient who needed to be transferred to UAB. The hospital had no beds, and she was unable to help him. His family decided to take him to the hospital on their own, because they knew the ER would not be allowed to refuse care.

‘If we show up to their ER, they can’t turn us away, so we’ll just take him up there by ourselves,’” she said. “I never would I have ever imagined letting a family drive their family member who seems to be having a stroke,” said Dr. Lishman.

Dr. Lishman recalls a stroke patient she sent home because she could not find a hospital bed to trans- fer her for weeks during last winter’s COVID-19 surge.

“She ended up going home on hospice care a couple of weeks later, and I don’t know if transferring her out would have changed her outcome, but to this day, it doesn’t sit well with me that she never got to see a neurologist for expert opinion,” she said.

When Harbison’s family finally got a call that he would be transferred to Mississippi for gallbladder surgery, they were hugely relieved after days of waiting.

“The scariest part for me,” said Terry, “What about those people that don’t even have COVID, that can’t receive the care that they need because there are no places for it?”

Due to a shortage of ambulances because of COVID-19, Dr. Lishman had to charter a helicopter to fly Harbison to Mississippi.

“Two years ago, I would have never imagined I’d be transferring somebody by helicopter for a gallbladder, so that is not a normal use of a helicopter,” she said.

The surgery was successful, and Harbison is resting at home, but his family believes his incision was larger than it would have been if he hadn’t needed to wait for surgery.

“We were just concerned with how long is it gonna be?” said Harbison’s son-in- law Bobby Terry.

Now he is recovering from an infection and has been waiting for weeks for an appointment to take the drain port out of his wound.

“How long are you gonna have to lay there doing antibiotic treatments before we can find somewhere to get him to have this thing removed?”