Healthcare professionals have been sounding the alarm for weeks about staffing shortages at Rhode Island hospitals, but Gov. Dan McKee has yet to deploy the National Guard to help.

“The staffing crisis is at critical levels in all areas,” Dr. Nadine Himelfarb, president of the Rhode Island Chapter of the American College of Emergency Physicians (ACEP), said Friday. “Everything from secretaries to CNAs and medical assistants, to transport people in the hospital who will move patients from one area to another, or take labs down to the actual lab to be run.”



Rhode Island reported 46.7% of its hospitals had critical staffing shortages as of Jan. 9, the third-highest in the country, according to an analysis of federal hospital data by The Public’s Radio. By next week, the data shows, the critical staffing shortages are expected to encompass more than half  – 53.3% – of all Rhode Island hospitals.

“It's no longer just the emergency rooms’’ that are in trouble, Lynn Blais, president of the United Nurses and Allied Professionals (UNAP), said last week. The staffing crisis, she said, is impacting the intensive care units, medical floors and areas “throughout the healthcare system.’’  UNAP represents nearly 7,000 nurses and other health care workers in Rhode Island, Connecticut and Vermont.

“We need every licensed clinician to come and take some shifts” to help out in the hospitals, said Dr. Michael Fine, a former state health director. He said the state needs to consider bringing in scribes to help enter information into medical records, for example, so clinicians can spend more time with patients.

Fine, who is now chief health strategist for Central Falls, the Rhode Island community  hit hardest by the virus, was watching last week as hundreds of people stood in lines at a Covid testing site that stretched down the block. Many people waited hours in the cold for tests. McKee visited the site on Dec. 29.

Three days later, McKee had mobilized about 180 National Guard members to help with COVID-19 testing and vaccination in Central Falls.  

But so far, there has been no indication of when the National Guard might help in the state’s hospitals.

A mounting crisis

Hospitals began raising concerns publicly about the short-staffing shortly before Thanksgiving. Doctors from the state’s largest hospital group, Lifespan, and state Health Director Dr. Nicole Alexander-Scott, stood outside Rhode Island Hospital and warned of long wait times and overcrowded hospital emergency departments.

By mid-December, physicians groups described “nightmare scenarios” of patients with a treatable illness leaving the hospital or dying while waiting to be seen by a doctor, according to a Dec. 14 letter to McKee and Alexander-Scott from the Rhode Island Chapter of the American College of Emergency Physicians.

Lifespan “worked with the Hospital Association of Rhode Island and their Healthcare Emergency Management  Director to request National Guard support,’’ Kathleen Hart, a Lifespan spokeswoman, said in an email Thursday. “The request was submitted on 12/30/21.”

But Alana O’Hare, the governor’s press secretary, said in an email Friday that “this was not a formal request from Rhode Island Hospital, or any facility, for National Guard Support.”  O’Hare said that the Rhode Island Department of Health, “working in coordination with HARI [the Hospital Association of Rhode Island], sent out a form to hospitals requesting information about their needs when it comes to non-medical, wrap-around services. Rhode Island Hospital (like other facilities) replied to this survey. RIDOH made clear in the message that this was part of a needs assessment, not a formal request for support.’’ 

None of the parties involved have responded to requests by The Public’s Radio for a copy of the Dec. 30 correspondence from Lifespan. The state health department has not responded to a request by The Public’s Radio for the information under the Rhode Island Access to Public Records Act.

National Guard troops supporting hospitals

Whether or not Lifespan’s communication with the state amounted to a formal request for help, one thing is clear: when states have deployed their National Guards to assist hospitals during the pandemic, the order has come from the office of the governor.

In Massachusetts, Gov. Charlie Baker last month deployed hundreds of National Guard troops to 55 hospitals in the Bay State. The troops – including those sent to Southcoast Health hospitals in Charlton, New Bedford and Wareham – transport patients, provide hospital security and other non-clinical support.

Governors in Ohio, Oregon, Maryland this month also directed Guard troops to support hospitals in their states.

“The idea that we could have a mobilization analogous to Massachusetts comes up every day’’ in discussions with the state, Capt. Mark Incze, a Rhode Island National Guard spokesman, said in an interview. “But no formal request has been generated.”

McKee said in a Twitter post on Jan. 4 that he had toured Rhode Island Hospital’s emergency department and met with frontline healthcare workers. “Our team is finalizing operational plans for @RINationalGuard to provide support to hospitals in cooperation with their facility leadership,’’ he tweeted. 



Before the National Guard is deployed, the request generally must be approved by the state Emergency Management Agency (EMA), which then seeks federal approval for funding, said Maj. Jarred Rickey, a Rhode Island National Guard spokesman. 

The quick turnaround for deploying National Guard troops to Central Falls was possible because the support fell within a previously approved request, Maj. Rickey said in an email. The request was approved by the Federal Emergency Management Agency on Dec. 31, he said. That’s two days after McKee’s visit to Central Falls. The National Guard members, he said, arrived on Jan. 1. “Once the [Central Falls] mayor requested testing support,’’ Rickey said in the email,  “our Guardsman were already on active duty at that point.”

The state EMA has been working on a request to the FEMA for “additional personnel as medical support,” O’Hare, the governor’s spokeswoman, said Friday. The governor’s office has declined to provide any timeline for when that help might arrive.

Himelfarb, the Rhode Island ACEP Chapter president and author of the Dec.14 letter, said Friday that she remains uncertain as to what help the state will provide hospitals. “It's disappointing,’’ she said, “that there isn't any sort of direct communication right now coming from upper areas of leadership through the governor's office or through the Department of Health to say, ‘Help is on the way. This is what we're doing. These are the barriers that we're knocking down so that we can do this and offer some relief.’”

The Public’s Radio’s Sofie Rudin contributed to this story, which has been updated with additional analysis of federal data.

Health reporter Lynn Arditi can be reached at larditi@thepublicsradio.org. Follow her on Twitter @LynnArditi