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In an often-overlooked corner of the country just east of the California border, Yuma Regional Medical Center is all by itself.

The nearest acute care facility is some 150 miles away, whether west to San Diego or northeast to Phoenix.

This hospital sits 30 miles north of Mexico's border. It serves a county population of 200,000 but also receives thousands of immigrants from Mexico as well as "snow-birds" who descend from Canada for warmer weather and, in some cases, healthcare.

And that means for most of the last 2 years of the pandemic, Yuma Regional has been slammed.

Since on hospital capacity in the age of COVID began in late July 2020, this independent, non-profit hospital has been operating at 100% capacity or higher perhaps more often than any other facility of its kind, filling all of the beds it can staff for 72 of those 77 weeks.

Only 1 week found the hospital operating at less than 90% of capacity.

Lack of staffing has been the primary problem, said Deb Aders, RN, the hospital's chief nursing officer and vice president of patient care services, in a telephone interview affirming that the federal data are accurate.

So each week, she adjusts the number of available beds that it can staff, dropping down from its licensed capacity of 406 to as low as 170. In recent months, the hospital has hovered around 250 to 270 beds that it could service on a daily basis, with every one of them occupied and some 10 patients waiting in a holding pattern in the emergency room until a bed becomes free, Aders said.

Sending ambulances elsewhere is out of the question.

"We cannot shut the ED and go on diversion," Aders said in a phone interview last week. That strategy of sending ambulances or walk-in patients to other hospitals where there are more acute care resources doesn't work for Yuma the way it does for more populated areas. The distance is just too far.

"Today, I have no beds," she said during the interview late last week. "I have no med surg beds because of staffing. And I have no ICU beds. So I'm holding patients in the ED. This is the problem we've run into and have been running into for some time. I just don't have the nursing staff."

Nurses Quit

After the so-called second surge -- they're now in what is considered the fourth -- a lot of her nursing staff just up and quit, Aders said.

"They were basically PTSD [post traumatic stress syndrome]; they just couldn't do it anymore. They had to get away," she said matter-of-factly.

Some nurses turned to agency work as travelers, and there was no way Yuma Regional could match those $250-an-hour pay rates, she said.

Yuma Regional has done everything it can, she continued. Regional physicians called off all elective procedures and pulled in staff from ambulatory units. Directors of departments stepped down to become charge nurses to free up registered nursing staff. Patients were urged to get care directly from their ambulatory providers, if possible.

And the hospital has called in federal help, with teams from National Disaster Emergency Medical Assistance (personnel who usually work for the Veterans Administration) and even from the National Guard.

"You name it. I've had them here. We were just extended another 4 weeks for the Department of Defense teams," Aders said.

During lulls between surges, Yuma Regional has tried to keep up with regular patient care needs. It still struggles with what Aders called a "huge backlog" of non-COVID patients who have not seen their regular providers for 2 years. Those patients are now coming into the hospital -- many through the emergency department -- because their chronic conditions were poorly managed for so long.

For example, people with uncontrolled diabetes are having heart attacks and strokes at rates far above what's considered normal in a non-pandemic year.

"It's a huge acuity," she said, "and we're still seeing it now because of the delays in care."

Still, COVID-19-related respiratory illness accounts for nearly half of the hospital's patient population, about 148 of the some 300 patients requiring hospitalization in the last week, she said.

Regionally, physicians have done their best, she added, discharging patients who can be appropriately cared for at home and utilizing home health workers. That has relieved some of the load, but those patients still have to be watched carefully for the first week or 2 post discharge to make sure they don't have to come back.

Too Late for Vaccination

Yuma's vaccination rate remains suboptimal, leaving the region classified as having an "extremely high" risk level for infection. Some of Yuma County's population has received at least one dose; 66% have had two doses or a single Johnson & Johnson shot. But only 21% have received a booster.

Of all the COVID-19 patients in the hospital one day last week, only four were fully vaccinated and boosted, Aders said.

As of Saturday, more than 1,000 people in Yuma County died of COVID-19, including five who were reported that day.

The hospital has sponsored campaigns to convince people to receive their full course of immunizations.

"But you know," Aders said, "it is their choice."

Often, when patients realize how sick they are, that's when they ask for a nurse to give them the vaccine.

"One of the saddest things I have had to say is 'No. It's not going to help you with your illness now. We're going to the ICU to get intubated,'" Aders said. "And you know, I wish there was more I could do for you, but I can't. You know, it's too late."

Benjamin Renton contributed to this report.

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