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New intensive-care beds are stored for later use at UCHealth Memorial Hospital Central in Colorado Springs. The hospital, along with others throughout the state, has been ordering more supplies and shifting staff to prepare for an increase in coronavirus patients during the fall and winter of 2020. (Provided by UCHealth)

Colorado’s three remaining hospital overflow sites were originally slated to close in January but now state officials are working to extend leases and line up staff, still worried about the worst-case scenario they planned for nine months ago.

Two of the original five “alternate care sites” were dismantled in October. And the contracts state officials signed last spring leased the Colorado Convention Center and two other sites into January. The hospital beds set up inside them have been empty for months, waiting for a surge of coronavirus patients that never came. 

Still, the Colorado Office of Emergency Management is working on a contract extension to keep the convention center available until nearly the end of March and plans to decide within a few weeks whether to extend leases for two other sites in Westminster and Pueblo. It’s a sign that even as the first doses of the coronavirus vaccine are on their way to Colorado, public health officials are concerned the crisis could get worse through the holiday season and the rest of winter.

“An alternate care site is the care of last resort,” said Mike Willis, director of the emergency management office and state leader of coronavirus preparedness. “We want all of our community members to get the best care possible. We come to alternate care sites as the last thing we do.” 

The state’s unified command center now gets hospital capacity reports daily — sometimes more than once per day — so officials can make a fast decision if they need to launch operations at an alternate care site. While the locations were built back in the spring, including walls for individual patient rooms and wiring for medical equipment, it would take no less than 14 days to get one ready to accept patients, Willis said.

It would take at least that long to hire the staff, which would come through multiple state contracts with companies that recruit temporary medical personnel, as well as stock the on-site pharmacy and set up food service and garbage disposal. 

The sites have already cost $100 million to build and lease, according to contracts reviewed by The Colorado Sun, and extending the leases through March will add several million more to the total. Federal and state homeland security funds are paying for the sites.

The Colorado Convention Center, which costs $60,000 per day for the state to lease, is the “last resort” of all three of the last resorts, Willis said in an interview with The Sun. Unlike the convention center in downtown Denver, the two other locations — St. Anthony North hospital on 84th Avenue in Westminster and two floors in a medical tower at St. Mary Corwin in Pueblo — were actually, in the past, hospitals or part of a hospital. 

The cost to staff the locations with medical personnel kick in only if the sites are activated, and would depend on how many nurses and doctors were hired. Contracts with staffing agencies peg the cost at nearly $20 million.

Willis, formerly in the U.S. Army and the Colorado National Guard, likens the contracts to an insurance policy. Colorado has to have a contingency plan should its residents need care and all the hospital beds are full, he said. 

“I have car insurance and I pay it every year. I hope I don’t need to use it,” he said, asking Coloradans to “do everything they can to make sure I never have to open” an overflow site. 

Hospitals ramping up capacity, following “surge plans”

Hospitals across the state have been closer to reaching capacity in the last few weeks than any time so far in the pandemic. 

A few reached near 90% of capacity in late November and early December, and one — Park View Medical Center in Pueblo — was so full that it reached out for help via a statewide collaborative. The distress call resulted in 20 patients leaving Park View for other hospitals with vacant beds, mostly in Colorado Springs. 

The hospital collaborative was activated last month, allowing hospitals to transfer patients to medical centers not only within the same hospital system but to other systems, too. The network is part of the state’s effort to avoid opening the alternate care sites. 

Related, the state Office of Emergency Preparedness is using the medical staffing contracts it negotiated for the alternate care sites to hire workers for hospitals facing staff shortages, as well as to send extra nurses to prisons that are experiencing COVID-19 outbreaks. 

The state has hired 62 nurses and other medical staff to dispatch to Colorado Department of Corrections prisons, including in Sterling and Canon City. And it’s sent more than 30 medical workers, along with national guardsmen, to long-term care facilities, including nursing homes. The extra staff is helping prisons and nursing homes provide better medical care on site, with the goal of avoiding hospitalizations, Willis said.

The Colorado Territorial Correctional Facility in Canon City, shown here in a Dec. 9, 2020, photo, is the state’s oldest prison. The state has hired extra nurses to help prisons deal with coronavirus outbreaks. (Mike Sweeney, Special to The Colorado Sun)

Hospitals also have submitted “surge plans” to the state, describing their step-by-step protocols to expand capacity. 

Denver Health, for example, has a surge plan with seven levels. The hospital is now on level 5.1, and preparing to jump to Level 6 if needed.

“We have some more room to go and I think when we get to that level 6 or 7 is when we really need to give the state a heads up,” said Dr. Connie Price, chief medical officer for Denver Health. “My hope is that we won’t have to get there. We haven’t seen the Thanksgiving surge yet and maybe we won’t.” 

The hospital’s surge plan starts with 227 beds at Level 1, then expands capacity until, at Level 7, it has 352 beds. Each time the hospital’s beds are filled, it moves up to the next level, adding beds and doubling up rooms. Each new level requires more staff, so Denver Health is moving physicians and others who normally work in clinics or don’t see patients into the hospital. It also has hired temporary nurses and other medical workers through staffing agencies.

So far, Denver Health has only climbed up its surge levels, never backtracked. The hospital won’t slide back, Price said, “unless we feel like we are totally out of this wave. I wouldn’t do that between Thanksgiving and Christmas.”

Denver Health has always had a surge plan as part of its disaster planning for particularly bad flu seasons or mass-trauma events. But this pandemic is different than any hypothetical disaster the hospital prepared for in planning meetings, Price said. For one thing, it’s lasted far longer than a flu season. 

In typical disasters, “there’s an end,” Price said. “It’s usually not something that goes on for nine months.” At this point, her staff is exhausted.

“They’re so tired,” she said. “Just so tired of this.” The vaccine is a “light at the end of the tunnel,” though. “It gives people hope that one day we are not going to have to be thinking about this all the time.”

The UCHealth System, which includes 12 hospitals, hit a new peak of 469 hospitalized patients with coronavirus on Dec. 1, 2020. (Screenshot of the hospital’s dashboard)

Hospitals in the UCHealth system also have been ramping up capacity, receiving regular shipments at their loading docks of plastic-wrapped ICU beds and medical equipment. The system’s 12 hospitals, which include University Hospital in Aurora and Memorial in Colorado Springs, reached their peak of 469 coronavirus patients Dec. 1. That compares to the spring peak of 263 patients, back on April 7. The state’s modeling before Thanksgiving predicted hospitalizations could double in the next few weeks without a change of course. 

To expand capacity, UCHealth also has begun shifting nurses from outpatient clinics, surgical departments and other areas to care for hospitalized patients as needed, spokesman Dan Weaver said. It’s also postponing nonemergency surgeries that might have required admission to the hospital. 

Where would Colorado find the staff for its overflow sites?

Medical Solutions, an Omaha, Nebraska, company with an office in Centennial, is among seven medical staffing companies that signed agreements with the state to fill its overflow sites with nurses and doctors at short notice.

The company’s agreement, similar to the rest, notes that the nurses the company recruits to work at the convention center or other overflow sites would earn up to $142 per hour, while lab technicians would earn up to $150. There is no promise of a set number of workers.

State officials have used staffing agreements set up for hospital overflow sites in order to send extra nurses to long-term care facilities, including Four Corners Health Care Center in Durango, pictured on Dec. 11, 2020. (Steve Peterson, Special to The Colorado Sun)

How many medical staffers the company could recruit depends on how many areas across the nation at that moment are experiencing a coronavirus wave that busts hospital capacity. For perspective, Medical Solutions had requests for 4,000 to 4,400 jobs before the pandemic — now there are 15,000, said Scott Armstrong, a Denver-based recruiter for the company. 

“It’s more than tripled, as far as need,” he said. “New York was the first one that jumped everything off.”

The bulk of the requests moved from New York and New Jersey to Georgia and other parts of the Southeast, and lately, Wyoming was requesting nurses by the dozens. “Wyoming has been one lately that’s just been ravaged,” Armstrong said. “You follow the news and you can follow the trend.”

Nurses who take the temporary posts range from young people with RVs who want to experience other parts of the country, to empty-nesters looking for a change of scenery. The jobs pay well compared to local, permanent posts, in part to make up for the expense of travel involved.

Medical Solutions has about 5,000 traveling workers in posts across the country right now, including about 60 in Colorado. Experience is required, because they’re expected to walk in ready to work.

“They know they are walking into a storm,” Armstrong said.

G-Force Medical Staffing, which signed an agreement with the state in April, is now supplying nurses to the state’s prisons to deal with coronavirus outbreaks there. As of last week, 15 prisoners in Colorado have died from the virus and there were more than 1,800 active infections. 

The Lakewood company was working so hard to fill the prison requests, interviewing 50 nurses per day, that when state officials asked last month how quickly the company could recruit workers for an alternate care site, G-Force responded that it would have trouble finding people within the requested timeline. “They were preparing for maybe opening a field hospital,” said Dena Karlis, president of G-Force. “At the time, we could not fulfill because there was such a surge at correctional facilities. That was the first commitment.”

Workers build a 2,000-bed makeshift hospital at the Colorado Convention Center on Friday, April 10, 2020. (Jesse Paul, The Colorado Sun)

If Colorado does need to open an alternate care site, Karlis expects state officials will ask each medical staffing company for a designated number of workers, like a wish list. Whether the companies can recruit that many workers will depend on where and how hard the coronavirus is striking across the country.

“If every city has a crisis, plus you have your hospitals that need medical staff, plus you have long-term care facilities,” she said, “you are going to come up short, somehow, some way.”

Jennifer Brown writes about mental health, the child welfare system, the disability community and homelessness for The Colorado Sun. As a former Montana 4-H kid, she also loves writing about agriculture and ranching. Brown previously...