Frustrated emergency doctor says R.I. isn’t doing enough to address health system ‘collapse’

“This is an emergency. This is a disaster. This is a 9/11, this is a Station nightclub fire,” says Dr. Selim Suner

Rhode Island HospitalPat Greenhouse/Globe Staff

PROVIDENCE — Governor Dan McKee’s administration isn’t acting quickly or decisively enough to deal with the capacity crisis in the state’s health care system, a top emergency preparedness doctor said Monday.

“I’m not sure they realize the true state of affairs that we’re facing,” Dr. Selim Suner said in an interview with the Globe Monday night. “I can’t imagine they do. If they understood, truly, what we’re facing, day to day, I think they would do everything in their power to respond.”

He added later: “I think the Department of Health is sympathetic and understands to some degree what we’re going through, but I think when you come to the top of government, they’re less understanding. And maybe because it’s a new administration — I know we worked very well with the old administration, building the field hospitals. It was no-holds-barred at that time.”

Suner is a professor of emergency medicine and the director of the Division of Disaster Medicine and Emergency Preparedness at Brown University, and the chairman of the disaster preparedness committee at Rhode Island Hospital.

In his opinion, the McKee administration’s response to the situation in the state’s health care system so far has been “measured.” He did not mean it as a compliment.

“This is a crisis,” Suner said. “This is an emergency. This is a disaster. This is a 9/11, this is a Station nightclub fire, and it isn’t ending in a week or two weeks.”

McKee’s office said in an emailed statement:

“The Governor’s Office is working with the Rhode Island Department of Health and healthcare stakeholders to review the best options for addressing the health care staffing crisis that Rhode Island, like most states around the country is currently facing. The Governor’s Office and RIDOH are taking all hospital and associated staffing issues extremely seriously and have taken several immediate actions to address vulnerable areas while long-term solutions are executed.”

The steps McKee’s office pointed to: a FEMA staffing request; expediting CNA licenses; granting health care workers licensed in other states licenses to work here as of Monday; requesting National Guard troops to help hospitals with non-medical and administrative functions; potentially limiting elective procedures; and others.

“Rhode Island has one of the most robust medical and public health communities in the country,” the statement said. “The State welcomes feedback and collaboration from our expert physicians and administrators throughout this unprecedented time.”

At a news conference Tuesday, McKee said problems with “staffing, staffing, staffing” was putting pressure on the system.

On top of a nearly two-year pandemic, the system has been feeling the effects of a staffing crisis. It has only gotten worse as nurses and other professionals leave for more lucrative travel jobs, or leave the profession altogether, burned out and suffering from the moral injury of working in a dysfunctional system. (Hospitals in Rhode Island did not lose significant numbers of staff over COVID-19 vaccine mandates.)

“Staffing is clearly one of the most challenging issues right now, not only in the hospitals, but around the health care industry and beyond, and that seems to be the one we really need to figure out,” McKee said Tuesday.

As hospitals buckle, the rise in COVID-19 cases is adding even more weight — and that’s before accounting for the Omicron variant of the virus that causes COVID-19.

Though COVID-19 hospitalizations are still roughly half of their peak from last year, the system is less able to handle them with fewer staff.

Suner said he and colleagues have proposed measures to help ease some of the unbearable burdens on the system.

One idea that Suner and colleagues have proposed is a centralized system that would gather granular data from hospitals about bed availability and make real-time decisions about where to send an ambulance.

A centralized ambulance system like he’s proposed is not simple, but it’s the sort of bold idea the state needs — and is not getting, Suner said.

Other ideas include relaxing rules so ambulances can take patients to urgent care centers, which isn’t allowed now, or outside their normal jurisdictions.

Right now, there are “tweaks” to ambulance diversion plans in the works, Suner said.

“But my response to that is, that would just be putting a Band-Aid on a .45-caliber gunshot wound to the chest,” Suner said.

McKee’s staff said Tuesday that “this spring the State will be implementing a statewide emergency medical dispatching effort that will coordinate EMS providers across Rhode Island.”

Suner, meanwhile, also said the state should implement a more robust mask mandate. Last week McKee announced a mandate to mask at indoor venues of more than 250 people. Venues with less than 250 people can opt to check for proof of vaccination. That didn’t go far enough, said Suner, who called it both measured and political.

The response in late 2021 contrasts unfavorably with the response in 2020, when the state, under the Raimondo administration, put together two field hospitals in three weeks, a “moon shot,” Suner said.

And why aren’t we getting that sort of response now?

“I want action, but there’s probably a political price to pay for that action,” Suner said.

Suner’s comments came a few days after the publication in The Boston Globe of a letter from a colleague, Dr. Nadine Himelfarb, to state leaders. Himelfarb wrote that the health care system in Rhode Island “is currently collapsing.” Suner said he agreed with what Himelfarb said.

“We’re seeing our health care system as we know it collapse in front of our eyes,” Suner said.

Right now, Suner worries about what would happen if the hospital had even a small mass casualty event. A system that once was able to handle the Station nightclub fire in 2003 might not be able to deal with a five-car freeway pileup today.

“Our surge capacity is exhausted — it’s gone,” Suner said.

The discussion about crisis standards of care is no longer a hypothetical, Suner said. All the while, medical professionals worry about legal liability. They do not want to get sued for malpractice when working in a health care setting unrecognizable in 21st century America. They also have not gotten that yet after a previous version of legal liability protection expired.

The COVID-19 patients Suner sees are generally unvaccinated, suffering and full of regret, Suner said. Suner said he hears the refrain every day: “Oh my God, I wish I had gotten vaccinated.”

That regret about inaction could also apply to the state’s response as its health care system falls apart.

“We need to do this now,” Suner said. “We needed to do this last week, or two weeks ago. If we wait any longer, I think we’re going to miss the boat here.”