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December 16, 2021 - Community Engagement Virtual Meeting


    1. Positive COVID-19 cases currently in Kaweah Health:
      As of this morning, we had 41 COVID-positive patients in inpatient beds.
    2. How many are in ICU and do we have empty beds in our ICU?
      9 of the admitted COVID inpatients were in the ICU with six using mechanical ventilation. As of this morning, five of our 21 beds in our medical ICU were available for admission or transfer and two of our 20 cardiac ICU beds were open.
    3. Positive Employees at Kaweah Delta:
      Since the beginning of the pandemic 1,629 of our employees and 39 of our providers (physicians, physician assistants and nurse practitioners) have contracted COVID; as of this past Monday, 22 (7 from 2020) of our employees and none of our providers are out on a COVID-related leave of absence; over the course of the pandemic, we have lost four employees and one provider to a COVID-related death.
    4. Hospital Census:
      As of this morning, 318 of our 344 adult inpatient beds were occupied, representing an occupancy rate of 92.4%; in addition, we had another 25 patients waiting in the Emergency Department for an inpatient bed to open up (what we call an “admit hold” patient); including these admit hold patients, our real adjusted occupancy rate was 99.7%.
    5. Vaccinated employee percentage:
      Our employee vaccination rate for those employees that are subject to the Governor’s vaccination mandate is approximately 82%; for our Medical Staff providers, it is approximately 98%.
  1. Visitor Policy Changes.
    While the acute medical center continues to be incredibly busy, running at full capacity almost every day, our COVID numbers do continue to fall which causes us to once again consider making changes to our visitation policy. We know how important visitation is to both healing and communication—for both patients and families; we are also heartbroken at the passing of a patient and want to make sure that there is a loved one at the bedside when this time comes.

Our current visitor policy for non-COVID patients allows one unique visitor throughout the patient’s entire stay. Effective December 21st, we are changing this to allow one unique visitor per day rather than per entire stay. The visitor will also be allowed to follow the patient when the patient changes level of care (higher or lower).

With respect to COVID-positive patients, routine visitation is still not permitted. However, if the patient is changing their level of care (higher or lower), a visitor will be allowed to be with the patient as they move through this level of care change. Those patients who have reached an end-of-life stage are allowed up to four total visitors with two allowed at the bedside at one time.

  1. Was November a better month financially for Kaweah Health?
    November was a miracle month for us. Bolstered by a very high inpatient census at the acute medical center (13.2% over budget), November’s Net Patient Service Revenue came in at $54.8 million, $2.0 million, or 3.9%, over budget. And, while total operating expenses of $70.1 million were $2.9 million, or 4.3%, over budget--largely due to high-than-budgeted labor, supplies, drug and physician costs—our other operating revenue of $22.2 million came in $6.9 million higher than budget and we received $6.5 million in federal COVID-relief funds in the month of December. The increase in other operating revenue pertained to higher-than-expected Medi-Cal supplemental funding revenue that we also receive through the federal government because of the disproportionately-high number of Medi-Cal patients cared for by Kaweah Health.

As a result of a very positive November, our year-to-date operating margin (the five- month period July 1, 2021 through November 30, 2021) now stands at a negative $2.8 million before considering any stimulus funds but at $4.3 million after stimulus funds. The after-stimulus-funds operating margin is $173,000 above the year-to-date budgeted operating margin.

  1. Was the flood in the Emergency Department in the new area or the old area? What was the cause of the flooding?
    The flood occurred in Zone 2 of the ED but also spread to Zone 3. Both of these zones are part of the original ED and not the new Zones 4, 5 and 6 which were constructed within the past two years. A fire suppression sprinkler located in the ceiling over Zone 2’s main hallway simply detached on a Sunday evening causing thousands of gallons of water to gush from the opening until the fire department could shut off all water valves. The damaged area has now been fully restored and opened back up Tuesday night.
  1. Where can a community member get an antigen test and how much do they cost? Antigen-based COVID-19 tests can be obtained at any of our five rural health clinics (Exeter, Lindsay, Woodlake, Hanford and Dinuba) and at our urgent care centers located on Court Street and on Demaree. Simply go on to the Kaweah Health website and click the link to Clockwise to schedule an appointment. If you require a PCR test, obtain a laboratory order from your physician and present it in person to our outpatient laboratory draw station located just inside the Mineral King Wing entrance of the Kaweah Health Medical Center. Come early in the morning if you need test results that day as specimens are batched and run on the Perkin Elmer platform at different times throughout the day. If you are insured by Medicare, Medi-Cal or private insurance, Kaweah Health will bill your insurance company for both the visit and the test; there may or may not be a small co-payment payable by the patient depending on the structure of your health plan benefits.
  1. What is the current standard of care for patients in the ICU and how long have we used this protocol?
    According to Dr. Joseph Malli, the Medical Director of our Critical Care Services and a critical care intensivist and pulmonologist, that’s a very difficult question to answer in a written statement because there are so many different factors and variables involved. If he had to generalize, he would have to say that we adhere to Acute Respiratory Distress Syndrome mechanical ventilation strategies (e.g., high-flow nasal cannulization, bilevel positive airway pressure (BiPAP) ventilation, continuous positive airway pressure (CPAP) ventilation, or full intubation with a tube in your windpipe connected to a mechanical ventilator) to maintain safe levels of oxygenation; we also employ steroids as anti-inflammatory treatment of a systemic inflammatory response brought about by COVID, possibly in combination with medications such as Remdesivir and/or Baricitinab depending on patient factors.
  1. Do we anticipate an increase of COVID-19 patients after the holiday season?
    We sure hope not but only time will tell. Yesterday morning we were down to only 44 COVID-positive inpatients in the acute medical center (43 adults and one child) and that number has been steadily trending down throughout December. That said, the number of new COVID-positive cases per 100,000 population has ticked back up at both the County and State level over the past couple of weeks. It is possible that we may see COVID hospitalizations rise after Christmas and New Year’s but we do not expect a repeat of last years’ experience due to the availability of vaccines, monoclonal antibodies and soon-to-be-released antiviral oral medications from Pfizer and Merck.
  1. The indoor masking starts all across the state today. How does this impact the hospital? How does this impact Lifestyles Center?
    California hospitals have been subject to mandatory masking, irrespective of vaccination status, since July. This applies to employees, providers and visitors. As such, the new, one-month mandate imposed Wednesday doesn’t really affect us, except for the Lifestyle Center. We will now require that TLC members and other people entering the Center must wear a mask and keep the mask on at all times except when performing aerobic exercises (e.g., running, brisk-walking on the treadmill, etc.) or eating/drinking in the café.