July 8, 2020

This 'SEAL team' of doctors opened a Covid-19 surge hospital in just 2 weeks

Daily Briefing

    In early March, the novel coronavirus was spreading rapidly across Los Angeles, and many hospitals weren't prepared to handle the resulting surge of Covid-19 patients. That's when two doctors stepped in—and in just two weeks, they converted the shuttered St. Vincent Medical Center into a surge hospital that treated some of the "poorest, sickest people" in Los Angeles County, the Los Angeles Times' Thomas Curwen reports.

    Your Covid-19 checklist to expand capacity

    As coronavirus cases surged across Los Angeles, hospitals scrambled to keep up

    As cases of the new coronavirus increased across Los Angeles County in early March, hospitals were scrambling to keep up with surges in patients with Covid-19, the disease caused by the virus. To address capacity issues, health officials in the county began looking to convert large spaces that weren't being used to provide care into units that could handle patient overflow, according to Curwen.

    Soon, officials were eying the shuttered, 366-bed St. Vincent facility, which had closed in January due to Verity Health System's bankruptcy, Curwen reports. City officials contacted Anand Annamalai, who had worked as a physician at St. Vincent and had helped to start a liver transplant and oncology program at the facility, about a plan for the state to lease the facility and set up a Covid-19 surge hospital—and asked for Annamalai's help.

    According to Curwen, Annamalai got to work assembling "a SEAL team dedicated to" Covid-19, and on March 19 called Jamie Taylor, a former physician at St. Vincent who also had helped to launch the facility's liver transplant and oncology program. Annamalai asked Taylor if she was interested in opening an ICU for Covid-19 patients at the former St. Vincent facility, which would now "be known as the Los Angeles Surge Hospital, or LASH," Curwen reports.

    Days later, California officials signed a $16 million, six-month lease with Verity, allowing Annamalai's team to turn the shuttered hospital into LASH. Dignity Health and Kaiser Permanente signed on to help set up the facility and provide oversight, and VEP Healthcare offered to provide physician services for the surge hospital, Curwen reports.

    A 2-week turnaround

    According to Curwen, Annamalai's team had less than two weeks to prepare LASH for patients.

    The facility was empty and filled with boxes of equipment that had been packed in preparation for the hospital's closing. "Now those boxes had to be unpacked and the equipment inventoried, a triage of what could and couldn't be used," Curwen reports.

    Annamalai's SEAL team—which operated under the motto, "just get it done"—worked late nights to prepare LASH in partnership with Dignity and Kaiser, which provided beds, plastic sheeting for ICU rooms, and air ducts for an air-filtration system.

    The team "tested monitors and ventilators, and they sorted supplies: bottles of sodium chloride, Foley catheters, endotracheal tubes, disposable stethoscopes," Curwen reports. They practiced donning and doffing personal protective equipment and created protocols for disinfecting themselves, containing outbreaks, and, eventually, for helping families visit dying patients.

    Taylor told Curwen the set up happened so quickly that "[t]here was not enough time to see the forest for the trees." She said, "[W]e were in the thick of it, chipping away at six tasks at a time."

    Annamalai used his experience with helping under-financed hospitals in Central and South America to help build LASH, Curwen reports. For instance, Annamalai decided that LASH would not have an OR, which would require a complex level of care. Instead, LASH had an ICU and units for patient observation and recovery.

    Serving 'the poorest and sickest' patients

    At its start, LASH had 31 beds and was looking to hire 400 clinicians and other medical staff. "Applications [for the positions] came from as far away as Florida, Texas, and Arkansas," Curwen reports, and "hires from local hospitals" would work at LASH after pulling shifts at other facilities.

    When Los Angeles County's Medical Alert Center was ready to refer a patient to the facility, Taylor would decide within 24 hours whether the patient was suited for treatment at LASH, according to Curwen. "If a patient had Covid-19 but was pregnant or had a heart condition or any diagnosis other than respiratory distress, they were turned down," Curwen reports, noting that Taylor "had to be sure" LASH "provide proper care" for its patients.

    Eventually, LASH grew to have 63 beds and was accepting as many as five patients per day, but the facility only treated about 22 patients at a time. According to Curwen, Taylor believed LASH's low patient volume stemmed from other hospitals in the county being "reluctant to give up patients with insurance plans that guaranteed reimbursement commensurate with the cost of treatment."

    As such, the patients LASH did serve were some of the "poorest" and "sickest" in the county, Curwen reports. And while the work was relentless, Taylor said that, over time, the medical staff at LASH became family. When patients were discharged, staff lined up to cheer them on, "one tear-filled goodbye after another," Curwen reports.

    A 'clinically led socialistic system'

    According to Curwen, LASH closed unexpectedly on May 22.

    Taylor said she originally expected the facility to stay open through the summer, but rumors of the facility's closure surfaced in early in May.

    On May 22, Taylor learned via a text message that LASH was transferring out its last patient that night. And just like that, "[t]he unit was deserted. As quickly as it had begun," Curwen reports.

    The facility, which cost $21.5 million through May 31, served 64 patients within 39 days. According to Taylor, about 90% of LASH' patients were Hispanic, and many of LASH's patients had diabetes as an underlying condition. Of LASH's 64 patients, 28 were uninsured, 33 were covered by Medi-Cal or Medicare, and three were enrolled in a private health plan.

    "LASH was a representation of how [Covid-19] disproportionately affects Latino communities," as well as "a representation of how health care in these communities is struggling," Ryan Barnette, an ICU doctor who worked at LASH, told Curwen. He added, "A lot of our patients, if they stayed at their admitting hospital, they might not have had a shot."

    All told, LASH discharged 55 of its patients and nine died, Curwen reports.

    Annamalai said LASH was successful because its providers didn't have to grapple with insurance companies and hospital administration, which he called the "Goliaths of health care," and instead could deliver care in the way they saw fit. "[It] was a clinically led socialistic system," Annamalai said.

    Taylor said leading the facility helped her remember that "[m]edicine is not just about giving pills or doing a procedure or following a prescribed therapy. Medicine is about human beings interacting at a vulnerable point in someone's life. It is the acknowledgement that a patient is more than the culmination of their disease process."

    Ultimately, LASH "reaffirmed [her] faith in medicine," Taylor said.

    Barnette said although LASH was short-lived, the facility saved "many, many lives."

    "That was the goal, right? Create an environment that could save lives," Barnette said (Curwen, Los Angeles Times, 7/6).

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