Normally, the Rotary Club of San Marino earmarks a hard 30-minute time allotment for its guest speakers, but last Thursday afternoon’s presentation by Huntington Hospital president and CEO Dr. Lori Morgan made many meeting attendees actually thankful that the Zoom format allowed for more than twice that duration.
Morgan has been in her position since 2017, and her more than three decades of experience in health care and health care management were on display as she handled questions that were submitted by club members on a wide variety of topics and presented to her by San Marinan Barbara Bice, who has worked at Huntington Hospital and has been a patient and visited others there.
Though she has known Morgan since her arrival at the hospital, Bice acknowledged that she actually learned something knew about the keynote speaker while researching her bio, which stated Morgan is an “intensivist.”
“I know she has an intensive schedule, but I didn’t know until recently that an intensivist is a doctor who specializes in the treatment of patients in intensive care,” Bice said.
That interesting fact, not to mention the ambiguity of its nature, seemed to serve as the perfect segue for the introduction of Morgan and directly into the deep waters of the obvious subject on everyone’s mind: the impact of COVID-19 on the hospital specifically and the health care profession in general.
“Had we really had all of our heads up, I suppose it probably would have been predictable,” said Morgan, who mentioned outbreaks of Ebola and other infections as a possible precursor. “As the months started to go on, we really began to understand the seriousness of it. From a health care perspective, it changed our lives forever. All of us have never seen anything like this and quite frankly hope to never see this again.”
Morgan said that Huntington Hospital was “quite challenged by the volume and severity of illness that we have seen with COVID patients,” mentioning that 36,000 patients came to the facility believing they had COVID-19. The hospital’s doctors have diagnosed over 5,000 patients who actually contracted the potentially deadly disease, admitted over 2,300 COVID-19 patients to the hospital with over 500 eventually going to the intensive care unit.
“It has been quite a burden and we have had to be very flexible in terms of what we have had to do,” said Morgan, who stated that Huntington Hospital added 162 beds since the onset of the pandemic — many in units at the hospital that had been closed — while repurposing other areas of the facility to handle the influx of patients. “On Jan. 11, we had 206 COVID patients in the hospital in addition to all of our other patients in the hospital.”
Bice mentioned that the hospital had even erected tents to handle the overflow of patients.
“We put up some tents where we could manage moderately ill patients,” Morgan said. She also said staff even surmised that more bed space could be gained by using the Braun Auditorium, a lecture hall on campus.
“Braun Auditorium is not a place where we have ever anticipated caring for patients, but when the community need was great we did a lot of out-of-the-box thinking,” Morgan said.
As of last Thursday, Morgan reported that Huntington Hospital had open beds in the ICU, which has a normal capacity of 30, a total that at one point reached 76.
She said the COVID-19 surge “had a pretty significant impact, some in indirect ways and some directly.”
“Directly, there was a period in March, April and May and actually again in December and January where the California Department of Health quite frankly said you may not do any elective surgery,” Morgan said. “You can still do emergency and urgent surgery, but not elective surgery. So when the state agency says you can’t, you can’t. So that was a pretty direct impact. I will say, indirectly, a lot of people have chosen to defer care that they might otherwise have sought because they didn’t want to get COVID or didn’t want to be at risk. Some of those things I think are things that are easily enough deferred. An elective knee replacement that you can manage with some pain medication and some physical therapy, you can defer until later.”
Morgan then mentioned other treatments and procedures she felt should not be deferred.
“Our Randall Breast Center, typically we would diagnose 50 women a month there with breast cancer,” Morgan said. “By state order that site was closed for March, April and May. I will tell you from my perspective, there are 150 women out there who have breast cancer who I don’t know how to find because I don’t know who didn’t come in. It’s the null set. We have a lot of concern around deferred health care maintenance. I feel very strongly we are going to see the end result of that and not necessarily in a happy way in the future due to all of the deferred care.”
Bice asked if Morgan and her staff were considering a public relations campaign to counter the perception and Morgan said one was currently underway.
“It’s safe to come to the hospital and it’s not safe to defer care,” Morgan said.
Morgan confirmed Bice’s assessment that the Pasadena Convention Center had been considered as a site to handle an overflow of patients.
“We had worked with the City of Pasadena especially during the surge in the summer,” said Morgan, mentioning that cots had been placed in the facility on a precautionary basis. “We never opened the site. We left it up for two extra months and then agreed with the City of Pasadena department of health that we didn’t need it.”
Morgan then added, “I didn’t think we could staff it, but if they were going to be relatively tight on staff my preference was to put the tents up at the hospital.”
Another challenge at Huntington Hospital is staff fatigue as a result of long work hours and the constant use of personal protective equipment (PPE), that is needed to shield workers from the virus but is typically hot and uncomfortable for the wearer.
“Our staff members live in the community and they have been getting COVID and their family members have been getting COVID and needing to take care of them so it has been quite a burden,” Morgan said. She mentioned that the hospital has worked with Los Angeles County to secure additional funds that employees can use for child care, and Huntington Hospital has created an in-house grocery store where employees can shop for staples.
The mood of the virtual meeting assumed a perceptible and notably dour disposition when Morgan broached the next subject: increases in alcoholism, suicides, use of narcotics and domestic abuse.
“I would say as a society I think we have all really suffered from the effects of COVID, the effects of quarantine, the economic effects, and we believe pretty strictly that from a psychological perspective both as a society and certainly as a medical staff who are beginning to have some pretty PTSD-like symptoms, we will be dealing with the post-COVID epidemic much longer than we’ve been dealing with the COVID epidemic,” Morgan said.
She said the hospital has given out more than 10,000 COVID-19 vaccinations but made a point that the institution is “a receiver of vaccines, not a distributor” of the vaccine.
“The first thing we did was vaccinate as many of our own health-care workers as possible and those on their own health care plan, all at the direction of the Pasadena Department of Health,” Morgan said.
When Morgan was asked about the challenge of maintaining an independent hospital and Huntington’s affiliation with Cedars-Sinai, she said, “If we take COVID out of the picture, this year and next year and the year after is going to be absolutely fine.”
“When I came here, one of the conversations I had with our board is that they very rightly so were extremely proud that we have been a very strong, high-quality community hospital for 125 years and we need you to do whatever is going to keep us that for the next 125 years. I started looking at the long term 10-15 years,” she said. “What it would take for us to maintain state-of-the-art equipment, beautiful campus, the best of clinicians, all of those things that for our community that Huntington Hospital Hospital is all about. I will tell you that for it is increasingly difficult because many physicians want to be employed by the hospitals they are working for.”
Morgan also shared that “technology gets increasingly expensive” and that “the kinds of economies of scale that are available to larger systems are not available to independent hospitals.”
She then mentioned a conversation she had with a consulting firm, which asked Morgan how many hospitals of similar size to Huntington are independent. The answer still surprises her, she noted.
“Really, when you think about that fact, that there are only 15 similar hospitals across the United States that were still independent out of about 3,500 accredited hospitals, it starts to identify the difficulties that stand-alone hospitals have particularly when they are those strong tertiary hospitals that we are,” Morgan said. “That when you are a Level 2 trauma center, when you are a stroke center, when you are a heart attack center, when you have all those specialty services, maintaining that technology, maintaining those high-quality physicians, becomes increasingly difficult as an independent hospital.”
When asked about Huntington’s capital needs over the next decade, Morgan said acquiring and maintaining state-of-the-art technology, upgrades to operating rooms, and shoring up clinical buildings to meet California’s earthquake requirements were most important.
“As one of my former bosses used to say, I’ve never met a dollar that I couldn’t figure out how to spend,” Morgan quipped.
She lauded the hiring of Pamela Weatherspoon, who joined the hospital’s executive management team as vice president, enterprise diversity, equity and inclusion, a new role within the organization.
When asked what she believed would eventually be successful in ending the pandemic, Morgan alluded to a phone conversation she had with Rary Simmons, a former mayor of San Marino who has a long association with Huntington Hospital.
“Rary asked me how many people were in the hospital because of the flu,” Morgan said. “I found out. It was December and we had none. Normally in December that is our biggest month. There will be some degree of evolution in our social behavior. I don’t know about you guys, I just so want to go to a concert. I so want to go to a movie. We really do thrive on that interaction and physical contact and it’s going to be very interesting to me to see where we land.”