Doctors called 17 hospitals looking for an ICU bed. He died waiting for a transfer

Doctors called 17 hospitals looking for an ICU bed. He died waiting for a transfer

4:14pm Jan 19, 2022
A photo of Tony Tsantinis hangs in a collage set up for a celebration of his life on the final day that Athens Pizza in Brimfield, Mass., was open for business.
A photo of Tony Tsantinis hangs in a collage set up for a celebration of his life on the final day that Athens Pizza in Brimfield, Mass., was open for business.
Jesse Costa/WBUR
  • A photo of Tony Tsantinis hangs in a collage set up for a celebration of his life on the final day that Athens Pizza in Brimfield, Mass., was open for business.

    A photo of Tony Tsantinis hangs in a collage set up for a celebration of his life on the final day that Athens Pizza in Brimfield, Mass., was open for business.

    Jesse Costa/WBUR

  • Rona Tsantinis-Roy stands behind the counter at Athens Pizza, a pizza shop in Brimfield her father owned for many years. Tsantinis-Roy's father Tony Tsantinis died of COVID-19 last month, when efforts to find space at a hospital that could offer him a hig

    Rona Tsantinis-Roy stands behind the counter at Athens Pizza, a pizza shop in Brimfield her father owned for many years. Tsantinis-Roy's father Tony Tsantinis died of COVID-19 last month, when efforts to find space at a hospital that could offer him a hig

    Jesse Costa/WBUR

Updated January 19, 2022 at 3:03 PM ET

Fans of Athens Pizza in Brimfield, Mass., learned the restaurant's beloved owner was sick via Facebook.

"The [pizzeria] will be closed for the rest of the week," reads the post from Nov. 30, 2021. "Unfortunately we have been exposed to Covid."

Get-well wishes poured in, but Athens Pizza will not reopen. Tony Tsantinis, 68, died at Harrington Hospital on Dec. 10.

His daughter, Rona Tsantinis-Roy, is haunted by many moments from her father's brief battle with COVID-19. Here's one: As a doctor delivered the news that Tsantinis was dead, he "literally looked me in the eyes and said this didn't have to happen," Tsantinis-Roy recounted.

Her notes from the conversation show that this meant her father might have survived if he'd been transferred to a larger hospital. Typically, that's what happens when a patient who arrives at a community hospital needs more specialized care. But with hospitals full — or close to it — across Massachusetts, transfers are harder and harder to arrange. And some patients are dying while they wait.

For Tsantinis, the community hospital in south-central Massachusetts made two transfer attempts. According to Tsantinis-Roy, the first was on Day 4 in the hospital as her father grew worse and needed intensive care. The intensive care unit at Harrington was full, so doctors and nurses searched for an available bed at another facility. Tsantinis-Roy says they called 17 hospitals but couldn't find an ICU that would take her father.

Within a few days, Tsantinis-Roy learned that a bed had opened in Harrington's ICU, and her father had been moved. But then his kidneys started to fail, and Harrington wasn't able to provide dialysis. Hospitals say nurses who specialize in dialysis are in particularly short supply right now.

Harrington Hospital tried to transfer Tsantinis again, but it was too late. A few hours before Tsantinis died, his daughter heard that Hartford Hospital would put him on its waiting list. By then, Tsantinis was too unstable to make the journey.

Harrington Hospital says it won't discuss the details of Tsantinis's case. The hospital is part of UMass Memorial Health, which also declined to answer specific questions about Tsantinis. But the network's president and CEO, Dr. Eric Dickson says there are problems at every level of care right now.

"Everybody wants to believe that the system is holding up just fine but it isn't," Dickson says. "It's breaking down. And when it breaks down, patients are harmed."

Like the majority of people who have died in this phase of the pandemic, Tony Tsantinis was not vaccinated. Tsantinis-Roy says she begged her father to get the shots but "he was old-school and didn't believe in vaccines."

Dickson, while not commenting on Tsantinis, says whether or not a patient is vaccinated, does not affect efforts to transfer or accept them.

Massachusetts hospitals are also crowded with patients who do not have COVID, whose care can be compromised by staff shortages. Dr. Kathleen Kerrigan, president of the Massachusetts College of Emergency Physicians, says moving any patient who needs higher level care is difficult right now if not nearly impossible.

"It's very unfortunate when we can't transfer patients," she says, "it means that our system is broken somewhere in the process."

Governor Charlie Baker's office responded to a request for an interview with an email containing bullet points about activating members of the National Guard to help staff health care facilities and helping organize daily, regional calls with hospitals. The calls are supposed to promote collaboration between hospitals, balance the patient load and flag urgent cases.

Some hospital staff say it's time to impose the crisis standards of care, a set of guidelines that help determine who receives care when the medical system is so overwhelmed by a crisis, doctors and nurses can't care for everyone. Some states, like Idaho and Alaska, were forced to enact these guidelines last year. These standards were drafted by Massachusetts hospital leaders early in the pandemic. If access to ICU beds or dialysis is limited, for example, the guidelines would help hospitals determine who gets that care based on who is most likely to survive.

There are some concerns about using the guidelines now. Despite revisions, they may still give white patients with no physical challenges easier access to limited medical resources. And they were drafted when the focus was on too few ICU beds and ventilators. Now, there are many more shortages throughout hospitals, including staff.

"It's not as simple as not enough ventilators or ICU beds; it's now a much more complicated environment compared to two years ago," says Dr. Michael Wagner, the chief physician executive at Wellforce, the hospital chain anchored by Tufts Medical Center in Boston. Wagner co-chaired the state's Crisis Standards of Care Advisory Committee.

Wagner says the guidelines may need to be amended to address this surge. Even if they are, Dickson says asking hospitals to start using the crisis standards right now would impose more stress on exhausted staff.

"We have to have a conversation among health care leaders and the state about what that would mean and how we would implement it," he says. "But, at some level, care is already being rationed because we don't have enough care for all of the patients who are coming in with COVID."

Dickson says it's almost like a lottery for care. Tony Tsantinis isn't the only patient affected. At hospitals north and south of Boston, doctors describe patients who've died while waiting to be transferred for more specialized care: a gunshot victim and a man with heart failure are among them. A woman who needed surgery to stop a stroke waited eight hours before she was transferred to a stroke center; the ER staff that sent her don't know if she survived. Hospital employees did not have permission to discuss the details of these cases.

It's not clear when the omicron surge will subside for hospitals in Massachusetts.

Kerrigan says the challenge of transferring patients is getting worse. Hospitals in neighboring states are so full they are closing to out-of-state transfers.

"This was the pandemic we were afraid of when the Governor shut down the state back in March of 2020," Kerrigan says.

Which translates to fear that more families like Rona Tsantinis-Roy and her children will lose beloved parents and grandparents. Tony Tsantinis was able to call once, from the hospital. His daughter says she put him on speaker so he could talk to her kids. He assured them he'd be home soon.

"He said 'I'm good, I'm great, I love you guys,'" Tsantinis-Roy says. "He hung up with them, and obviously, they were over the moon."

But to Tsantinis-Roy, her dad's optimism seemed too good to be true.

"We never heard from him again after that," she says. "It felt like a good-bye."

Tsantinis-Roy is still struggling to understand how her dad's death could have happened in a state with health care that is supposed to be among the finest in the world. Dr. Melisa Lai-Becker, who runs a hospital ER just north of Boston, CHA Everett, shares that sense of dismay.

"This feels completely surreal," she says. "I'm practicing within spitting distance of at least five world-class medical centers in Boston, Massachusetts, which is considered one of the world's medical meccas...and yet they've often had to refuse to accept these patients."

For Kerrigan, it is not too late to ask again for everyone to get vaccinated. If more people made that decision, she says, "we'd be in a better situation, we'd have fewer critically ill patients."

This story is from NPR's reporting partnership with WBUR and KHN.

Copyright 2022 WBUR. To see more, visit WBUR.

Transcript

AILSA CHANG, HOST:

Hospitals are struggling to care for a record surge in COVID patients. In normal times, patients who arrive at community hospitals but need more specialized care are typically transferred to a larger teaching hospital. But with hospitals full or close to full all across Massachusetts now, these lifesaving transfers are much harder to arrange. As Martha Bebinger at WBUR in Boston explains, there are cases now of patients who die while waiting.

MARTHA BEBINGER, BYLINE: In the small town of Brimfield, school buses, fire engines, police cars and utility trucks rolled past Athens Pizza in December, paying tribute to pizza shop owner Tony Tsantinis. He died from complications related to COVID.

RONA TSANTINIS-ROY: My father was loved so much by the community. He was my children's, and mine, best friend.

BEBINGER: Rona Tsantinis-Roy is haunted by many moments during her father's 10-day battle with COVID at Harrington Hospital. Here's one of them.

TSANTINIS-ROY: When the doctor literally looked me in the eyes and said, this didn't have to happen.

BEBINGER: Tsantinis-Roy understood that to mean that her 68-year-old father might have survived if he'd been transferred to a larger hospital. On day four, Tsantinis-Roy was told her dad needed an intensive care bed. But Harrington's ICU was full.

TSANTINIS-ROY: And they said they called 17 hospitals, and nobody was able to take him.

BEBINGER: Tsantinis-Roy says an ICU bed did open at Harrington within a few days. But then her dad's kidneys started to fail, and the hospital was not able to provide dialysis. Hospitals say nurses who specialize in dialysis are in particularly short supply right now. Harrington, which is close to the Connecticut border in central Massachusetts, again tried to transfer Tony Tsantinis, but it was too late.

TSANTINIS-ROY: They said that Hartford Hospital accepted him on a waitlist, but he was too unstable at that point to transfer. That was at 2:30. He died at 4 o'clock.

BEBINGER: Harrington Hospital says it will not discuss the details of Tsantinis' case. The hospital is part of UMass Memorial Health, which declined specific questions as well. But the network's president and CEO, Dr. Eric Dickson, says there are problems at every level of care patients need right now.

ERIC DICKSON: And I think everybody wants to believe that the system is holding up just fine, but it isn't. It's breaking down. And when it breaks down, patients are harmed.

BEBINGER: There are daily regional calls among hospitals in Massachusetts to flag urgent cases and balance the patient load. Gov. Charlie Baker has also called on the National Guard to help staff health care facilities.

Some hospital employees say it's time to impose so-called crisis standards of care, where an ICU bed or dialysis, for example, would go to the patient most likely to survive, rather than the one who shows up first. But Dickson says asking hospital teams to decide who gets a bed and who doesn't would be extremely difficult.

DICKSON: I think we have to have a conversation amongst health care leaders in the state about what that would mean, how we would implement it. But at some level, care is already being rationed because we just don't have the beds we need to take care of the patients that are coming in with COVID right now.

BEBINGER: It's almost like a lottery for care. And Tony Tsantinis isn't the only possible victim. At hospitals north and south of Boston, doctors tell of patients who've died while waiting to be transferred for more specialized care. A gunshot victim and a man who needed heart surgery are among them. Dr. Kathleen Kerrigan, president of the Massachusetts College of Emergency Physicians, says it's become even harder to transfer patients since mid-December, when Tsantinis died.

KATHLEEN KERRIGAN: Dramatically, we're hearing stories of 30 phone calls trying to get patients even out of state to get the care that they need.

BEBINGER: ER doctors say it's now virtually impossible to transfer a patient into Boston. And some hospitals in neighboring states are so full they are not taking patients from Massachusetts either.

KERRIGAN: This was the pandemic we were afraid of when the governor shut down the state back in March of 2020.

BEBINGER: Which translates to fear that more families like Rona Tsantinis-Roy and her children will lose beloved parents and grandparents. Tony Tsantinis was able to call once from the hospital.

TSANTINIS-ROY: And he asked to talk to the kids. So I put the kids on speaker, and the kids were all excited. And he goes, I'm good. I'm great. I love you guys. He hung up with them and, obviously, they were over the moon.

BEBINGER: But to Tsantinis-Roy, her dad's optimism seemed too good to be true.

TSANTINIS-ROY: We never heard from him again after that. (Crying) It felt like a goodbye.

BEBINGER: Tsantinis-Roy is still struggling to understand how her dad's death could have happened in a state that prides itself on having health care that is supposed to be among the best in the world.

For NPR news, I'm Martha Bebinger in Boston.

(SOUNDBITE OF KYSON'S "EVERY HIGH - PIANO SOLO") Transcript provided by NPR, Copyright NPR.

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