Recently, I attended the American Health Lawyers Association (AHLA) annual conference in San Francisco. Attorneys must attend a certain number of continuing legal education (CLE) courses each year and this conference helps.
The first session was entitled, “Year in Review” and lasted two hours. It was a great overview of case law germane to health care over the last 12 to 15 months. And so much has happened! From the U.S. Supreme Court case that changed the False Claims Act (FCA) to a court in Indiana that tried to force a hospital to stay open.
As an attorney specializing in healthcare law, I find myself deeply troubled by the intersecting crises of COVID, nursing shortages, and the resulting closure of hospitals. The recent events in Indiana have left me grappling with the difficult legal and ethical implications of a court order that clashed with the reality on the ground. A northwestern Indiana hospital that was, according to its own records, only days away from closing its emergency room, yet was ordered by a Judge to keep those emergency services operational for another nine months, which would be until September 2023.
Despite the Indiana hospital’s best intentions, the hospital found itself in a seemingly impossible predicament. The confluence of safety concerns and severe staffing shortages forced the hospital’s hand, rendering compliance with the court order an insurmountable obstacle.
An Indiana appellate court reversed the district court decision and lifted the injunction that the city was granted in late December 2022 that had ordered the hospital’s ER to remain open another nine months so the city could find another provider.
The hospital announced the planned closure in November 2022, saying it was averaging fewer than three inpatients a day. I do not have personal knowledge of whether the only hospital in Hammond has closed its doors. According to a cursory Google search, which we all know wherein always lies the truth, Franciscan Health Hammond, which used to be called St. Margaret’s Hospital, is still open. If anyone knows firsthand, I welcome any information. It may have closed its doors temporarily, according to one source online.
The impact of COVID on healthcare systems has been devastating across the country, and Indiana has not been spared. The virus has unleashed unprecedented pressures on hospitals, stretching their resources to the breaking point. Frontline healthcare workers have been tirelessly battling this invisible enemy, putting their lives on the line to save others. But the relentless strain of the pandemic has taken its toll, leaving healthcare professionals physically exhausted and emotionally drained.
Rural hospitals have been disproportionately hit catastrophically. Seventeen rural hospitals closed last year, according to the AHLA “Year in Review” presentation.
Nursing shortages have only exacerbated the crisis. Even before the pandemic, the shortage of qualified nurses was a pressing issue, but COVID has exacerbated the problem exponentially. The demands placed on nurses have skyrocketed, as they find themselves on the front lines of the battle against the virus. The prolonged stress, burnout, and emotional trauma have led many nurses to reconsider their chosen profession or seek alternative employment options. Consequently, hospitals find themselves in a perpetual cycle of understaffing, perpetuating a domino effect that strains resources and compromises patient care.
You may be asking as to how I have firsthand experience about the trauma nurses have endured over COVID? To which I would respond, my best friend is an ER trauma nurse here in North Carolina. Since COVID, she has become a traveling nurse, her income has, at least, doubled. Not that she doesn’t deserve such an income hike! Oh contraire mon fraire! The stories I have heard about the emotional distress that she has endured, experiencing multiple deaths nightly, for more than two years and having to console families, while living away from home for weeks. Believe me, she deserved every extra cent she earned during the public health emergency (PHE), which was officially declared “over” on May 11, 2023. The problem that hospitals are having now, is basically one of supply and demand. Nurses are in demand; therefore, it is difficult for hospitals to decrease salaries and hourly wages without losing the nurses it has.
According to Franciscan Health Hammond, its dire staffing situation made it nearly impossible to maintain safe patient care within the emergency room. The safety and well-being of both patients and employees must always remain paramount, and the hospital administrators were left with an agonizing decision. Ultimately, they made the difficult choice to close the emergency room temporarily, recognizing the potential risks of operating under severe staff shortages.
As an attorney, it is my duty to uphold the law and advocate for the best interests of my clients. However, in situations like these, I cannot help but empathize with the hospital administrators who faced an impossible dilemma. The judicial system must grapple with the reality on the ground and understand the complex factors that contribute to hospital closures.
Simply ordering a hospital to remain open without addressing the underlying challenges, such as nursing shortages and safety concerns, may create an unmanageable burden that compromises patient safety and exacerbates the crisis.
This case in Indiana serves as a sobering reminder of the urgent need for comprehensive solutions. Our healthcare system requires support and resources to address the immediate challenges posed by the pandemic, including expanding nursing education programs, providing incentives for healthcare professionals, and bolstering mental health resources for those on the front lines.
Furthermore, long-term planning and systemic reforms are necessary to build a resilient healthcare infrastructure that can withstand future crises.
As I reflect on these events, I am reminded of the importance of collaboration between the legal, healthcare, and policy-making spheres. Only through a collective effort can we navigate these difficult times and strive for a more robust healthcare system that ensures the safety and well-being of all.
It is my hope that this journal entry serves as a testament to the complex issues at hand, spurring further discussions and actions to mitigate the challenges posed by COVID, nursing shortages, and hospital closures.
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A few weeks ago, during the weekly Monitor Monday broadcast, healthcare attorney David Glaser, presented a great segment that simplified the two-midnight rule into two
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