Nurse of the Week: Darius Fulghum, RN is a Healer Who Can Do Some Serious Harm

Nurse of the Week: Darius Fulghum, RN is a Healer Who Can Do Some Serious Harm

Darius Fulghum—like so many of our male Nurses of the Week—seems to enjoy complaining about the toughness of a BSN program. “Getting my degree is probably the hardest thing I’ve done,”  he told Sky Sports, in the halcyon pre-pandemic days of 2019. “I’m going to the Olympics, and I’m still saying it was hard.”

Covid-19 collided with the 6”1” 201-lb boxer’s Olympic dreams, but he’s now making a splash as a promising pro. His BSN, though, still ranks as one of his proudest achievements.

The Texas-born Fulghum was already an outstanding wrestler when he decided to major in nursing at Prairie View A&M University. How did he end up in a program as academically demanding as a BSN? “I started getting serious about my health and being fascinated by the human body and learning about it, and that’s how I got more into science;” nursing seemed to follow naturally. His father (a graduate of Florida A&M; most of the family are HBCU alums) was the one who first suggested nursing. Fulghum says: “My dad was the one who pushed me into it.  When I was in high school, I didn’t really know where I wanted to go, but he said they really need men, and it’s a good profession.  It’s never stagnant.  You always have something to do. The fact that you can help people is the most rewarding thing.”

As a military brat, Darius was well-prepared for the demands of nursing as well as athletics. Of his father, he told the Prairie View A&M blog, “He is the most disciplined guy I know and he made sure that we learned.” And somehow, Darius not only kept up with his BSN studies, he also trained so effectively that he won the Golden Gloves in 2018, the year before he graduated.

In 2019, when Fulghum graduated and passed his NCLEX, he had expected to store his pin in mothballs when he aced his Olympic trials and trained in preparation for Tokyo. When Covid hit, it was a painful blow (no pun intended, and we promise to make no facetious references to knocking people down and being able to patch them up afterwards).

As a boxer, though, Fulgham has had plenty of experience with making himself get up after being knocked down. Will he exchange his boxing gear for hospital PPE at some point? He’s not sure. But, if anyone is ever in need of medical assistance at a Darius Fulghum match, they will be in good hands and we might see him as a Nurse of the Week again one day.

For more on Fulghum, PVAMU, and his story, see the below video or see this article.

Texas Considers Extending Scope of Medical Cannabis Laws

Texas Considers Extending Scope of Medical Cannabis Laws

The Texas House gave approval on Thursday to a bill that would expand the state’s medical cannabis program to include those with chronic pain, all cancer patients, and Texans suffering from PTSD.

House Bill 1535, by Rep. Stephanie Klick, R-Fort Worth, who authored the bill establishing Texas’ initial medical cannabis program in 2015, would also authorize the Department of State Health Services to add additional qualifying conditions through administrative rulemaking, instead of the Legislature needing to pass a law to expand eligibility.

Currently, patients eligible include those with terminal cancer, intractable epilepsy, seizure disorders, multiple sclerosis, spasticity, amyotrophic lateral sclerosis, autism or an incurable neurodegenerative disease. Next, the Senate will consider the bill, before it can be sent to the governor to be signed into law.

When hemp was legalized in 2019, the medical cannabis program was rendered mostly moot — with legally permissible cannabis treatments only being marginally more potent than over-the-counter CBD oils or tinctures.

The bill would also raise the THC, or Tetrahydrocannabinol, cap from 0.5% to 5% and make it possible for those in Texas’ medical cannabis program to have access to much higher doses than currently available. THC is the psychoactive compound which produces a high. The National Organization for Reforming Marijuana Laws doesn’t recognize the state’s current program as a true medical marijuana program, instead labeling it a “medical CBD” program because of its emphasis on cannabidiol, derived from hemp and containing only traces of the psychoactive compounds found in cannabis, over THC for medicinal use.

Texas’ program is called the Compassionate Use Program and has fewer enrolled patients and businesses than most other states with medical cannabis programs. At least some form of medical cannabis is legal in 47 states nationwide, but Texas’ restrictions put it in the bottom 11 in terms of accessibility, according to the National Conference of State Legislatures.

There were only about 3,500 Texans registered with the state to use medical cannabis, though advocates estimate that there are over 2 million people eligible based on current law.

Heather Fazio, director of Texans for Responsible Marijuana Policy, says the increased THC limit is “a step in the right direction,” but it still would limit doctors from being able to decide the proper dosages for their patients.

“There’s an incredibly restrictive cap on THC,” she said. “Low levels of THC will work for some people but it doesn’t work for others. And so what we think is that doctors need to be the ones making these decisions, not lawmakers.”

Fazio said the bill would help bring more Texas patients to the program and help reduce the use of addictive opioids. However, she says the bill still “leaves patients behind who desperately need access to this medicine.”

While Klick’s bill strictly affects the legal use of medical cannabis in the state, lawmakers are also taking up bills that tackle how recreational marijuana use is penalized.

The House passed House Bill 2593 on Wednesday, which would reduce penalties for possession of some marijuana concentrate. The penalty for possession of up to two ounces of those products would be lowered to a class B misdemeanor.

And on Thursday, the Texas House preliminarily approved House Bill 441, which would lower the criminal penalty for possessing small amounts of marijuana and provide a path for many Texans charged with such a crime to expunge it from their criminal records. 

Fazio said the bill would especially help keep young people from suffering criminal consequences.

“Not that we want to condone young people smoking weed, but the punishment for possessing it shouldn’t be harsher than the actual use of the plant,” Fazio said. “The penalties have caused far more harm than smoking marijuana ever could.”

While the House has been receptive to bills related to reducing penalties for marijuana use, the Senate has been less welcoming. In 2019, the House approved a bill that would have reduced penalties for marjiana possession, but Lt. Gov. Dan Patrick declared it dead in the Senate — not allowing it to be brought to a vote.

But in recent years, Texans have increasingly demonstrated a desire to see marijuana use legalized in the state. According to the February 2021 University of Texas/Texas Tribune polls, 60% of respondents supported legalization for at least small amounts of marijuana for both medical and recreational use — compared to 49% in 2014.

“There’s a significant shift happening now, and it’s so wonderful to see,” Fazio said. “To see the shift in the way that this issue is perceived, the seriousness that is given at the legislature and now increased support — it’s very rewarding. It’s such an exciting time to be an advocate.”

TX Legislators Take Aim at Gender-Affirming Healthcare for Transgender Minors

TX Legislators Take Aim at Gender-Affirming Healthcare for Transgender Minors

Before undergoing gender confirmation surgery at age 17, Indigo Giles had to get approval from a doctor, a therapist and the hospital where the surgery would be performed to ensure there were no options left besides surgery. To even get to that point, Indigo’s father Neil said it took time-consuming research and several reflections as a family before going forward with the process.

The surgery’s impact was immediate, said Indigo, now 19, who identifies as nonbinary. They were able to wear the clothes they wanted to, and their confidence in school and with friends significantly increased. Most significantly, the surgery helped alleviate their severe depression caused in part by gender dysphoria — discomfort related to feeling a disconnect between one’s personal gender identity and the gender assigned to them at birth.

“These lawmakers think that we don’t know what we want with our own bodies…”

But under a slate of legislation moving in the Texas Senate and House, Indigo wouldn’t have been able to make such a decision until their 18th birthday. In fact, no transgender child in Texas would be able to pursue puberty blockers, hormone treatment or surgery for the purpose of gender confirmation.

Transgender Texas children, their parents, medical groups and businesses have vocally opposed many of the bills lawmakers are pursuing. Equality Texas CEO Ricardo Martinez said Texas has filed more anti-LGBTQ bills this session than any other state legislature.

“It’s insulting,” Indigo said. “These lawmakers think that we don’t know what we want with our own bodies and we’re not able to say what we want and mean it.”

House Bill 1399 would prohibit health care providers and physicians from performing gender confirmation surgery or prescribing, administering or supplying puberty blockers or hormone treatment to anyone under the age of 18. The House Public Health Committee advanced the bill Friday.

Protect transgender kids rally.
Photo credit: Arthur D. Foreman via Wikimedia Commons (image altered by publisher).

Senate Bill 1311 by Sen. Bob Hall, R-Edgewood, would revoke the medical license of health care providers and physicians who perform such procedures or prescribe such drugs or hormones to people younger than 18. The Senate State Affairs Committee advanced that bill Monday.

The Senate last week passed Senate Bill 29, which would prevent public school students from participating in sports teams unless their sex assigned at birth aligns with the team’s designation. While that bill would only affect students in K-12 schools, two similar bills in the House would include colleges and universities in that mandate.

SB 29 has been referred to the House Public Education Committee, which is slated to meet Tuesday and hear testimony on identical legislation that was introduced in the lower chamber. On Wednesday night, the chair of that committee told the Houston Chronicle that the companion legislation, House Bill 4042, is likely dead.

“That bill is probably not going to make it out of committee,” state Rep. Harold Dutton, D-Houston, told the Chronicle. “We just don’t have the votes for it … But I promised the author that I’d give him a hearing, and we did.”

Last session, Dade Phelan, the Beaumont Republican who is now House Speaker, demonstrated a lack of appetite for bills restricting rights for LGBTQ Texans.

“It’s completely unacceptable,” he said at the time. “This is 2019.”

Last week, Rep. Bryan Slaton, R-Royse City, tried to amend a bill on the House floor that would fund prescription drugs for uninsured Texans so that it would exclude hormone and puberty suppression treatments. That amendment failed after it was noted that existing bills were addressing such treatments.

Medical Associations Unite in Opposition to Anti-Transgender Healthcare Bills

In public testimony this year, transgender Texans and their parents have testified in near unanimous opposition to the bills. Several parents described their experience testifying as “terrifying,” worrying their testimony would be used against them should the bills’ penalties become law. Under Senate Bill 1646, which the Senate State Affairs Committee passed Tuesday night, they could be labeled child abusers for allowing their children to receive gender affirming treatment.

Click here to listen to a short Texas Tribune podcast featuring Maya Stanton talking about her experience as a transgender 10-year-old. 

That bill comes after Jeff Younger attracted the attention of Gov. Greg Abbott and other top Texas Republicans in 2019 after a dispute between him and his ex-wife turned into a court battle over whether he could oppose his child’s transition. Younger, among others testifying in support of these bills, emphasized young children’s lack of brain development and claimed parents and social media pressure children into identifying as transgender.

But experts say social media and social pressure have nothing to do with it.

“There’s literally zero evidence or research to suggest that that’s true,” said Megan Mooney, past president of the Texas Psychological Association.

According to Mooney, children as young as 2 or 3 can develop ideas about gender identity. By 6 or 7, she said, their sense of gender identity is relatively stable.

For LGBTQ mental health support, call the Trevor Project’s 24/7 toll-free support line at 866-488-7386. You can also call the National Suicide Prevention Lifeline at 800-273-8255 or text 741741 from anywhere in the country to text with a trained crisis counselor. Read our mental health resource guide for more information.

School Districts Present TX Town With Duelling Mask Policies

School Districts Present TX Town With Duelling Mask Policies

The two school districts in this Central Texas town headed in opposite directions after Gov. Greg Abbott ended the statewide mask mandate, sparking heated debates over safety and government responsibility.

For locals and tourists, it’s hard to overstate the charm of New Braunfels, a place of spring-fed rivers, dance halls and German festivals.

Yet against this idyllic backdrop, the nation’s ongoing fight over mask-wearing has pitted neighbor against neighbor and put the region’s schoolchildren squarely in the middle of an overheated argument.

In what quickly became a conversation about science, personal liberty and the role of government, the town’s two school boards, New Braunfels Independent School District and Comal Independent School District, landed on opposite sides of the face-covering debate earlier this month after Gov. Greg Abbott announced the statewide mask mandate would end March 10.

In New Braunfels ISD, which serves more low-income and Latino students, the school board opted to survey parents, resulting in a vote to keep the school mask mandate. The Comal ISD board, representing whiter, more rural parts of Comal county, voted 5-2 in an eleventh-hour meeting to make masks voluntary after members touted personal responsibility and parental choice. One Comal ISD board member, Marty Bartlett, cited the arguments of well-known conspiracy theorists and vaccine skeptics who say masks are government overreach, not sound science.

The mask battle in New Braunfels clearly has political overtones, but this isn’t your typical liberal versus conservative fight. New Braunfels sits on the southeastern edge of Comal County, whose residents gave former President Donald Trump 70% of the vote in November.

In this case the fight is more about moderate conservatives versus those on the far right.

And Comal ISD’s political leanings are already affecting students and teachers in a big way as masks disappear from classrooms, Comal ISD parents and teachers say.

Students are facing peer pressure to abandon masks. Teachers don’t know whose parents prefer for them to wear the masks. Parents who don’t want their children in class or crowded hallways with unmasked people must decide whether to go back to remote learning.

“Teachers had no time to prepare,” said Comal ISD middle school teacher and parent Kate Fraser, adding that students showed up without masks the day after the board meeting. “You feel as a teacher you can’t do what you need to do to protect the kids.”

The fast-growing suburbs and exurbs of San Antonio and rural areas of the Texas Hill Country where children attend Comal ISD schools have pulled the county further to the right, while more moderate conservatives struggle to hold on to the city of New Braunfels.

“I’ve always been a conservative, still am, still vote the Republican party. But the shift has been further and further and further to the right,” said Doug Miller, who represented Comal County in the Texas Legislature before losing his seat to state Rep. Kyle Biedermann, a far-right conservative who attended the Trump rally in Washington, D.C., on the day of the Jan. 6 insurrection.

Trump won all but one precinct in Comal County in 2020, capturing up to 79% of the vote in some precincts. His margins were widest in the rural areas in Comal ISD and smaller in New Braunfels ISD.

The two districts, both headquartered in New Braunfels, the largest city in the county, have subtle but important differences: New Braunfels ISD is majority students of color (54%) to Comal ISD’s 48%; 38% of New Braunfels ISD students qualify for free and reduced lunch, while 30% qualify in Comal ISD.

The demographic differences between the two districts may seem small, but parents say Trumpism has had an impact on the county, and the way the two boards settled the mask debate is the perfect example. Anti-mask beliefs have become synonymous with far-right conservatism.

“I really think it was ideology and not anything else,” Valerie Garza Estes, a Comal ISD parent, said of the board vote. “Listening to the board meeting, that’s perfectly clear.”

After Trump, Comal parents and students with “privilege,” Estes said, “are willing to be louder and meaner and push their ideas or views without even feeling there would be consequences.”

Board members who voted to remove the mandate cited parental choice, while the two dissenting votes argued masks were critical for safe in-person learning.

“What the data shows is that after every break from school we have a lot of kids who come back who get exposed outside the school,” said trustee Russell Garner. The number goes down once kids are in school. With masks, the transmission rate is “almost zero,” he said.

During the board meeting, trustee Jason York argued it should be up to parents to decide how best to keep their children safe and voted to lift the mandate.

His daughter, York said, would be wearing one. If other parents want their children attending prom, graduation and other activities, he said, “then they’re going to continue to send their children with a mask.”

That may not be true.

Sandy Mathis, a parent of three elementary school students in Comal ISD, said her family respectfully complied with the mask requirement, even though they believed that wearing masks all day had a negative effect on their children’s health and distracted them from learning.

“Now that we have been given the gift of parental choice, my kids will no longer be wearing a mask to school,” Mathis wrote in a message to The 74. Some at her children’s school have kept the masks; others have not. Some children are wearing them for a few weeks out of caution as spring-breakers return.

Removing the mask mandate gives parents a choice, but not teachers who may now have to spend entire days with maskless students, trustee Tim Hennessee argued during the board meeting. He voted to keep the mask mandate. “I think this shows a total lack of respect to the teachers.”

Of the schools he represents — in a suburban part of the district with the highest population of people of color — three quarters wanted to keep the mask mandate, he said. York countered by saying three quarters of the campuses he represents — which are in the most rural part of the district with the highest white population — wanted to be able to choose.

A Facebook group called Open Comal County Schools Safely conducted its own survey and plans to present the results to the board at its Thursday meeting.

When asked about the overall preferences of the district, Superintendent Andrew Kim said most teachers and principals indicated they would continue to wear masks.

“It varies by certain areas of our school district, I will say that,” Kim said.

His comment — and the feedback from Hennessee’s and York’s districts — suggests the tension between conservative and ultraconservative viewpoints exists not just between New Braunfels ISD and Comal ISD, but within Comal ISD as well.

Estes said that Trump’s racist and xenophobic rhetoric immediately showed up in Comal ISD schools in 2016, when classmates began to taunt her son about his Latina mother. During the pandemic, some students echoed Trump’s cavalier attitude, she said.

In August, board President David Drastata referred to COVID-19 using Trump’s racist “China virus” epithet in an athletic booster club email. He later apologized.

Miller described the new conservatism as uncompromising and domineering. “Their position is: If you disagree with me, you’re wrong.”

Kim expressed concern that emboldened parents with strong anti-mask views would become a distraction for teachers and principals if the district kept its own mandate without the state mandate backing it up.

“I think the last thing I would like to see is our administrators having a protracted philosophical conversation with our parents in the hallways,” Kim said.

The answer, the board decided, was simply to let those parents have their way.

School Nurses are Key to Reopening Classrooms. Some TX Districts Have a Problem.

School Nurses are Key to Reopening Classrooms. Some TX Districts Have a Problem.

Working as a school nurse is “not just ice and boo-boos.”

That’s how Marisa Thomison, a nurse at a Hutto Independent School District elementary school, explains her profession, which has become a crucial component of public health during the pandemic. At Veterans’ Hill Elementary School, she manages students’ medical histories, administers medications, provides health education and tries to keep COVID-19 from spreading widely among students and staff.

Among her tasks: keeping parents and teachers calm when she calls to tell them they were in contact with someone who tested positive for COVID-19. Thomison said she and her colleagues have been “cussed out” and even physically threatened by parents who are scared and frustrated at having to keep their children home for weeks.

“It’s the immediate, ‘Oh my God, I have a job. How can I have someone watch my kid? What am I going to do?’” Thomison said.

Unlike their peers in hospital COVID-19 units, school nurses have not had to care for dying patients. They are serving on the front lines of the pandemic in a different way: tracking who has been exposed to the virus, testing staff and students who experience symptoms and diagnosing signs of anxiety in traumatized students.

Thomison is one of 13 nurses in her school district, which makes her lucky. Texas law doesn’t require public schools to have full-time nurses, and many don’t. In 2019-2020, more than 8,000 Texas public schools employed about 6,100 full-time school nurses, according to state data.

State Rep. Shawn Thierry, D-Houston, has filed a bill this legislative session to require all districts to employ at least one full-time nurse per school and keep a ratio of at least one full-time nurse for every 750 students enrolled. Hiring more nurses would cost districts or the state money, and Thierry said she wasn’t yet sure exactly how much.

“These are essential workers, so it is a cost that we can’t afford to cut any longer. Even one child’s life lost would be tragic,” she said.

Similar bills have failed in previous sessions, but the coronavirus pandemic has shown the scope and importance of school nurses’ jobs. Without a trained health professional to track how the virus has spread on campuses, schools are less able to avoid major outbreaks, said Becca Harkleroad, advocacy chair for the Texas School Nurses Organization and a nurse in Lake Travis ISD.

“I can’t imagine what it’s like during this time to not have a nurse. A lot of times it falls to the front office staff to take care of the kids and send kids home who may be sick,” she said. The advocacy group is also asking the state to track how many schools have nurses and whether they are covering more than one campus, a current hole in available state data. And it is championing a bill filed by state Sen. Beverly Powell, D-Burleson, which would allow schools to use money previously allocated for school safety to pay for additional nurses.

The sole school nurse for 320-student Marfa ISD, Beverly Dutchover, springs into action after a parent or teacher reports a positive COVID-19 case. She asks who they ate lunch with, tracks down class schedules and calls dozens of parents. Sometimes, if more than one person in a small classroom tests positive, she closes down the entire room and demands everyone stay home and quarantine for two weeks.

In the fall and early winter, tourists flocking to Marfa and Big Bend National Park fueled a surge in COVID-19 cases and overwhelmed local hospital capacity. Cases among Marfa ISD students and teachers spiked to about 15 in October before dropping again. Now that Gov. Greg Abbott has repealed the state’s mask mandate, Dutchover worries cases will spike again.

“It upset me. It made me sad to think that especially with all these nurses and doctors who work so hard to keep people alive in the hospitals, and then he went and did this,” Dutchover said of the governor’s decision.This spring, the state gave school boards the power to opt out of requiring masks on their campuses, which could make some school nurses’ jobs even more challenging.

Debates over which safety policies are necessary for in-person learning have fractured some school communities, with 56% of students learning in person as of January. Marfa ISD will continue to require masks, but some school districts have already opted out. Dutchover knows that even if students and teachers wear masks on campus, they may not wear them while hanging out with friends or running errands, heightening the risk of transmission.

Masks indoors are crucial in preventing the virus from spreading, experts say, and school nurses know from experience. Tracy Ayers, district nurse in rural Caldwell ISD, recalled the time about five players on the girls soccer team tested positive for COVID-19. Upon contact tracing, she learned the outbreak stemmed from close contact on a school bus: The girls were eating with no masks. By contrast, the football coaches were adamant about having their players wear masks and sit far apart on the bus, and the season netted few cases.

“When I see lax behavior in mask wearing in particular is where I tend to see cases that will rise,” she said.

At the beginning of the school year, about half of Caldwell ISD’s students were learning in person. Now, nearly all are. The district’s school board will likely hear public comments after spring break from community members advocating to drop the mask order.

“Even taking a trip to one of the local grocery stores, some will wear masks and others don’t,” Ayers said. “I understand where parents are coming from in that they want normalcy for their kids. From where I’m coming from as a health provider and seeing how much masks are working, I want their kids in school and I want them healthy.”

The symptoms of the pandemic go beyond the purely physical. Thomison has noticed an increase in anxiety among staff members and students. Recently a student came into her office for the second day in a row, concerned about their symptoms. Before the pandemic, Thomison would have sat on the cot next to the student, met them at eye level and convinced them to open up. Now, she had to sit six feet away in a chair, fully outfitted in goggles and a mask. The student eventually confessed to being terrified of getting COVID-19 because a relative had it, and Thomison calmed them down.

She felt the strain of the distance between her and the student. “We can’t do for our students like we normally would. Our work can only provide so much comfort but it’s not going to allay anybody’s true fears,” she said. “I can’t nurse the way I’m used to because we do have safety restrictions. …It takes a big toll. We’re trying, but we’re also feeling the effects.”

Texas Hospitals Resort to Jury Rigging to Treat Post-Holiday Covid Cases

Texas Hospitals Resort to Jury Rigging to Treat Post-Holiday Covid Cases

Health officials in Austin are considering opening a makeshift hospital as its intensive care units fill up. Patients in North Texas are being treated in lobbies or in hallways. And hospitals around Laredo, Abilene, and College Station have three or fewer intensive care unit beds open, according to state data.

A week into the new year, hospitalizations in Texas have well-surpassed a deadly summer wave that overwhelmed health care workers in the Rio Grande Valley. Health experts have long warned of a dark winter — with a public tired of following safety precautions, a raging pandemic, and cold weather drawing people indoors where the virus can more easily spread. Add to that holiday gatherings and increased levels of travel, which health officials say are already being reflected in the growing numbers of hospitalized coronavirus patients.

The dire figures come as two vaccines, produced in record time, have rolled out to health care workers in a massive undertaking so far beset by confusion and mishaps. The state has reported at least 28,545 fatalities tied to the virus, available intensive care unit beds are at a low and health experts say Texans can’t vaccinate their way out of the current surge. On January 14, the first known case of a new and more contagious coronavirus strain was reported in Texas.

“There’s Physically No Space.”

On April 6, the state started reporting the number of patients with positive tests who are hospitalized. The average number of hospitalizations reported over the past seven days shows how the situation has changed over time by de-emphasizing daily swings.

“Right now, probably half the patients I see never make it out of the waiting room… just because there’s physically no space, and when we do have space it’s limited — nurse staffing also is an issue,” said Dr. Robert Hancock, who works at hospitals in North Texas, Amarillo and Oklahoma. “We’re doing the best we can, but it’s to a point where we’re not providing the care we’d like to.”

In Central Texas, Austin-area health officials forecast the region might run out of intensive care unit beds in the coming days and could start to set up a pop-up hospital as soon as this week. They erected a health facility in the Austin Convention Center as infections soared this summer, and a solicitation obtained by The Texas Tribune in June showed health officials were recruiting volunteers to “provide hands-on care to COVID + patients.” It never took in patients.

Now, “the state is in surge. The state is in crisis,” said Dr. Mark Escott, interim health authority for Austin and Travis County. “It seems very clear to us that we are going to run out of hospital beds, and that we are going to have to stretch resources in order to meet the needs of our community,” he added.

“We’re Admitting Patients Into Areas That Don’t Typically Hold Patients”

Some hospitals in North Texas are holding patients in emergency rooms that are not designed for long-term care because there’s no space in the intensive care units, said Hancock, who is president of the Texas College of Emergency Physicians. It’s nearly impossible to transfer a patient that needs more advanced or specialized care elsewhere — for those patients: “you’re out of luck. There’s nobody that’s going to accept you,” he said.

Hospitalizations lurched upward after Thanksgiving, worsened after Christmas and Hancock expects the situation will continue to deteriorate for the next month.

The hospitals are so crowded he is sometimes treating patients in the lobby and then discharging them because there are no available beds.

Around Fort Worth, some hospitals are running out of both intensive care unit beds and regular beds, said Dr. Justin Fairless, an emergency room doctor and an assistant professor of emergency medicine at a medical school in Fort Worth established by Texas Christian University and the University of North Texas Health Science Center.

At the two hospitals where he works, there are coronavirus patients in the hallway “because there’s nowhere else to put them,” and nursing staff who typically do administrative work are helping see patients, he said. Some health care workers who have the virus have returned to work because there’s not enough staff, he said. They are approved to do so under Centers for Disease Control and Prevention guidance that permit it after symptoms have improved and a certain number of days have elapsed.

During Fairless’ shift Tuesday, patients were being treated in pockets of the hospital not normally used for patient care, like a pre-operation area used by health care workers performing an endoscopy. He sent several patients home that ordinarily would have been admitted to the hospital because of the possible risk that they’d be exposed to the coronavirus.

“We’re admitting patients into areas that don’t typically hold patients and on top of that,” he said, adding that some are being held in the emergency room for up to 48 hours because they “have nowhere else to go.”

The president of the Dallas-Fort Worth Hospital Council said hospitals in the area “have capacity issues, staffing issues and are anticipating another COVID-19 surge in late January.” Elsewhere, in Lubbock, hospitals are full, but the numbers have lessened since the area saw a crush of patients this fall.

Statewide, more than a dozen regions called Trauma Service Areas have surpassed a “high hospitalizations” marker that Gov. Greg Abbott set out and that requires businesses there to scale back capacity to let fewer patrons in. Under Abbott’s order, the business limitations kick in in regions where hospitals are more than 15% full with coronavirus patients for seven-days. The number of people allowed into businesses is reduced from 75% occupancy to 50%, and open bars must close — though many have begun to sell more food to qualify as restaurants.

A Texas Tribune analysis found those remedies set out by Abbott have done little to quash the virus in areas already seeing hospitals fill up.

Policy Complications

In Harris County, which had to ratchet back business capacity under Abbott’s order earlier this week, Judge Lina Hidalgo said she was concerned the “threshold has not yielded the necessary change in other areas.”

“Reaching the threshold — activating the rollbacks — doesn’t in and of itself change the trajectory. That’s something that’s in all of our hands,” Hidalgo said.

In the Austin and Travis County area, where there’s been a 160% increase in new hospital admissions since December, Escott said he doesn’t think that “rollback to 50% occupancy at retail and restaurants is doing the trick.”

“I think it was forward-thinking to set those benchmarks, but I think we have to assess the situation and identify whether or not the strategy is working or not — it’s clearly not working,” he said.

Local officials there, he added, have “reached the limits of what we can do under state law, and under the executive orders.”

Abbott’s mandates have barred local officials from taking more aggressive actions, and over the holidays he took aim at an Austin-area curfew that tried to ban late-night dine-in and beverage service for a few days to lessen the virus’ spread.

A spokesperson for Abbott said local officials have “abdicated their authority and refused to enforce existing protocols” by leaving violations unpunished, “further endangering the health and well-being of Texans.”

“Increased restrictions will do nothing to mitigate COVID-19 and protect communities without enforcement,” said spokesperson Renae Eze. “And even states with increased restrictions and lockdowns throughout the pandemic have done little to mitigate the virus, such as California and Rhode Island, which have the highest COVID-19 infection rates per capita in the world, and New York, which is leading the nation in COVID-19 deaths.”

In the meantime, hospitals in parts of the state are full with patients, and vaccine doses are being gradually doled out to health care workers and other vulnerable groups.

Fairless, the emergency room doctor, said the hospital was becoming a more and more “unsafe environment” and was excited to get a second dose of a Pfizer vaccine Wednesday. Driving to the hospital, he said: “I can guarantee I’m going to see the parking lot totally full of people.”

“I’ve gone through H1N1 and all the other flu pandemics,” he added. “I’ve never really seen it this busy — especially at these smaller hospitals.”

Published courtesy of the Texas Tribune.

Listen to the Chapter Podcasts for Jonas and Kovner's Health Care Delivery in the United States

Gain a better understanding of the current state of the US health care system and how it might impact your work and life.

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