SUN INVESTIGATES Emergency certificates show surge planning

Behind the scenes at state’s healthcare commission

When the coronavirus crept into Maryland, hospital staffs and administrators began bracing for a potential surge in patients, racing to prevent a situation in which those seeking care outnumbered available beds.

Since then, the state’s health department has reported that more than 4,500 Marylanders have been hospitalized for complications related to COVID-19 since March. And that figure doesn’t include the number of patients seeking care for other urgent matters, such as birthing mothers or those experiencing heart attacks or strokes.

About 1,700 intensive and acute care beds are currently occupied by COVID-19 patients, according to state health officials, a more than five-fold increase since the end of March.

To accommodate patients over the course of the pandemic, Gov. Larry Hogan called for the addition of 6,000 beds throughout the state, plans that included opening a field hospital at the Baltimore Convention Center and reopening Laurel Regional Hospital. But those represent just a fraction of the 6,000 beds. For hospitals of all sizes, but especially smaller ones, a spike in contagious COVID-19 patients can overwhelm a finite supply of beds and crucial, life-saving medical supplies, such as protective gear and ventilators.

Under state law, the Maryland Health Care Commission calculates how many beds should be available each year based on an average daily acute care inpatient census. Hospitals typically are not authorized to add beds at their own discretion. Rather, they must apply for permission to add beds by submitting certificates of need that describe medical need and recommend how facility additions could make a difference.

Since Hogan’s order, hospitals and healthcare networks have worked to find space to add beds, repurposing existing space or building from scratch. Many hospitals have documented their expansion plans via public emergency certificates of need, which outline how they could repurpose existing space to fill the void and how much it will cost.

Here’s a look at the emergency requests in the Baltimore area that have been approved by the state’s healthcare commission.

Mercy hospital building a new unit: Last month, Baltimore’s Mercy Medical Center made the first bid for a physical expansion, outlining the need for a 32-bed unit on its 17th floor in an emergency certificate of need. The hospital estimated the build-out to cost about $12.5 million and determined it could be completed within three months.

Northwest Hospital to add temporary beds in recently closed unit: Through two separate emergency certificates of need, LifeBridge Health’s Northwest Hospital sought approval from the commission to renovate and refurbish existing space within the facility’s previously closed sub-acute unit. The proposals called for the addition of 105 temporary beds, with a portion to be set up immediately and others “to be operationalized as needed, within three to seven days.”

The hospital also asked to add a fully outfitted tent with 10 beds. It estimated its costs at about $217,000.

Anne Arundel Medical Center converts cafeteria, offices: Seeking 162 additional beds, Anne Arundel Medical Center in Annapolis proposed expanding capacity by temporarily converting ambulatory offices, an unused cafeteria and conference rooms into inpatient rooms. In all, the medical center calculated these ventures to cost about $1.5 million.

Kaiser turns patient care centers into bed spaces: Kaiser Permanente, an integrated medical insurance and care provider, requested 172 beds to be dispersed among its patient care centers in South Baltimore, Gaithersburg, Largo and Kensington.

These spaces typically serve as primary care clinics but would be altered “to accommodate patients who require an inpatient stay but do not require the more intensive care that will become increasingly necessary at other hospitals,” according to its application.

Kaiser would use these added beds to treat COVID-19 patients as well as those dealing with other medical needs. It estimated its costs at about $150,000.

Carroll Hospital outfits auditorium, conference rooms: Carroll Hospital, operated by LifeBridge Health, request approval to convert an auditorium into a negative pressure room with space for 30 beds. It also looked to outfit six conference rooms with as many as 14 beds.

Overall, the hospital was on track to add 108 temporary beds to accommodate the surge, but needed licensure for 52 of them. The others were added in existing space with existing supplies, such as in the peri-operative unit, the post-anesthesia unit and the cardiac catheterization unit. The costs were estimated at $237,000.

Harford Memorial Hospital plans for surge in behavioral health treatment: University of Maryland Harford Memorial Hospital sought to address a potential surge in those seeking acute psychiatric services by converting 13 beds at Klein Family Harford Crisis Center on Belair Road.

“The Klein Family Harford Crisis Center may also be used as an off campus dedicated emergency room for behavioral health patients if the hospital’s ED cannot meet the demand for emergency room care,” according to a letter sent by the Maryland Department of Health’s Office of Health Care Quality. With approval, the Klein center can add five urgent care beds and convert eight other existing beds.

Frederick Hospital takes over empty office building: Frederick Health Hospital first sought approval from the commission to add 100 beds to unused space inside the medical facility. Then, it asked for permission to transform a vacant business center across the street from the campus into a 72-bed facility for restorative care and for “lower acuity patients.”

The neighboring building once served as a nursing facility that then transitioned into office space. Hospital administrators said once they finished clearing out office furniture, the building “will need various equipment, including portable gases, suction, and sinks.” The renovation project was expected to cost $2.5 million.

Salisbury hospital turns conference room, offices into ICUs: Peninsula Regional Medical Center in Salisbury requested 48 beds, asking to turn existing conference room and office space into a temporary intensive care unit for COVID-19 patients. It also sought to turn an existing 8-bed pediatric unit into an isolation unit.

The new unit would be known as the “Delmarva/Eastern Shore Regional Critical Care/Pandemic Unit,” according to the application. It involves the modification of about 19,800 square feet.

The medical center also broke down its $3.82 million project budget, seeking $1.6 million for equipment, such as ventilators; approximately $550,000 for construction costs; $1.3 million for construction and relocation costs for the information systems department that currently occupies the conference space; and $375,000 for the isolation unit.

Atlantic General annexes beds next door: In its application, Atlantic General Hospital first petitioned healthcare commission to increase its emergency capacity from 40 beds to 67. Then, the Ocean City medical facility requested permission to rent space at Berlin Nursing Rehabilitation Center and place 16 beds there. The rehabilitation center is located next to the hospital. Rent, equipment and other operating costs were estimated at about $229,000.

Holy Cross adds 84 beds — and converts 120 others: Holy Cross Hospital in Silver Spring requested 84 more beds for its expected patient surge. But in a footnote, it noted 120 other beds were available for conversion purposes.

The 120 beds came from its post anesthesia care unit, medical and surgical units and other existing beds throughout the hospital. These beds can be converted without emergency certificate of need approval, since they are already licensed.

The hospital estimated its expenses, which includes facilities work and equipment, would amount to about $11 million in all.