One Rural Hospital’s Fight Against COVID-19

Hospitals across the Carolinas have been challenged as never before. The COVID-19 pandemic has strained their resources, upended their budgets and stressed out their doctors, nurses and support staff. The challenges are experienced across the board, but can be acutely felt at rural hospitals. To get a view from the front lines of the medical fight against COVID-19, we spoke with Michelle Fortune, Chief Executive Officer of St. Luke’s Hospital in Columbus, North Carolina.

Q. Tell us about St. Luke’s.

A. We have 25 beds and a staff of 275 to 300. We are 100 percent locally and independently owned. We know that makes us a little bit of a unicorn.

Q. Are you owned by the county?

A. No, we are not county-owned. St. Luke’s Healthcare Inc. and St. Luke’s Hospital Inc. are both 501(c)(3) non-for-profit organizations owned by the local citizens. We have a volunteer Board of Trustees comprised of citizens elected from the community. They serve terms and govern the hospital. When I tell people here, ​“This is your hospital,” it really is. We celebrated our 90^th birthday in November 2019.

Q. What are some of the services you offer?

A. We have three operating rooms and do a good deal of elective surgery — mostly orthopedics, urology and cancer care. We offer a rural health clinic. Dr. Jeff Viar is the lead physician there and was recently awarded the 2020 National Rural Health Association Practitioner of the Year Award — first time this honor has ever been awarded to anyone in North Carolina, so we’re extremely proud of that.

Q. Tell us about the area your hospital serves.

A. Polk County is a rural area in the foothills of western North Carolina with a population of 20,500. When I joined the hospital in March 2019, I moved from a metropolitan area in Charlotte. I wanted to be closer to my home, which is an hour from St. Luke’s. Moving to Columbus, N.C., was like coming back home to a small community like the one I grew up in. St. Luke’s Hospital is very much a safety net for our predominantly retirement-aged community. Many residents are reluctant to drive 35 – 40 minutes to access health care services, so we can offer them a variety of services and specialty practices locally, close to home.

Q. How has the pandemic changed life at St. Luke’s? Have you seen COVID-19 patients?

A. We have cared for both inpatient and outpatient individuals who have experienced COVID-19. We are 70 to 75 percent Medicare/​Medicaid as a general rule in our care mix, so we serve a high-risk elderly population already. When we couldn’t fill elective procedures appropriately because of COVID-19, it had a huge financial impact on us because all of those revenues suddenly stopped. We lost millions of dollars in just a couple months. For example, in the month of April alone, we lost $1.8 million. When I first arrived here in 2019, St. Luke’s had had several years of very poor financial performance, where there were significantly large losses. We worked through some cost-saving initiatives and had finally reached a positive operating margin for four consecutive months. Then, COVID arrived and knocked us off a cliff.

Q. Did things improve once the virus restrictions relaxed?

A. We were indeed very concerned until we were able to resume some of the (elective) procedures. That has been helpful. We’re probably seeing about 75 percent overall volumes compared to what we normally we do.

Q. Did you get federal COVID relief dollars?

A. We received the federal Medicare/​Medicaid advancement and funding specifically for small critical access or rural hospitals. I think that’s a big driver as to why we’re still here. We did apply for the Paycheck Protection Program loan and received just over $2 million from that. I cannot tell you how much that has helped us support staff salaries and even provide what people are calling ​‘hazard pay’ for COVID care.

Q. We’ve heard a lot nationally about issues with testing, personal protective equipment (PPE) and ventilators. Have those been issues for St. Luke’s?

A. Yes. We don’t provide testing for COVID-19 on-site. By that I mean, we will pull the test (samples), but we have to send it off for the results. At first, we were waiting sometimes up to two to three weeks to get a result back. It was very, very difficult. Keeping enough testing supplies was difficult. There were days when we were just counting out the tests. ​‘Do we have enough? What are we going to do?’

We were burning through PPE because if we don’t know if the patients are negative, we still have to wear the PPE. We have faced the most challenges with N95 masks and surgical masks and gowns. We have an incredible materials manager. He has done a fantastic job calling other providers to see if we had certain supplies they didn’t have and if we could trade.

We have two other significant challenges. Our aging nurse-call system is the first obstacle. In our ICU, the system only allows bi-directional communication if initiated by the patient. So, when the nurse needs to initiate a conversation, she has to expose herself unnecessarily by donning the PPE, going into the patient room, having the conversation and coming out.

The second challenge is our lack of a badge entry system where doors automatically open and you’re not touching anything. Having worked in an urban area previously where we had all those safety resources, it was difficult for me to learn that St. Luke’s doesn’t have these things that might make virus protection easier and more effective.

Q. What role has telehealth played in helping the hospital respond to the pandemic?

A. It has been gigantic. We ramped up our telehealth within several weeks of the pandemic’s start. We already were using telehospitalists at night and telepsych in our emergency department. We added another tele-unit for our on-site hospitalist to use during the day. That unit, in particular, was dedicated just to COVID-19 possible or positive patients to limit the physical interaction between patient and provider. The physicians are actually here on-site, but are utilizing the teleport. With a smaller hospital like ours, when there is only one hospitalist on-site providing care to medical-surgical patients, you do not want that hospitalist to end up with COVID-19.

Q. How are you feeling about St. Luke’s positioning to cope with whatever comes next?

A. We are seeing numbers increase all around us. Our county has crossed over 100 in the total case count and our per capita (rate) is creeping up, so we’re watching that with health department officials. I think everyone is a little concerned about the fact that summer is here and people are taking beach trips and having family cookouts where precautions are being relaxed. We’re reminding people, ​‘Wear your mask. Sanitize your hands. Limit your contact with people.’ What we don’t know is if we will experience another surge and, if so, will it be even bigger and put a strain on our health care team or cause us to cancel elective procedures again? Much depends on what happens next.

Q. Any final thoughts?

A. I’ve been a nurse for almost 30 years and you always feel like people appreciate what you do. However, during this pandemic, I believe people really have a newfound awareness that all health care workers truly are heroes. I’ve been incredibly proud to be part of a hospital like this during a time like this. Our team has truly risen to the occasion. I could not be prouder of what they’ve done, how they’ve done it and their unwavering commitment and dedication to our patients.