Advocacy group CASA held a rally Thursday to push for greater access to care for the immigrant community. CASA says many wait until their medical issue has progressed, then go to the ER, instead of getting preventative care at a primary doctor.

“It’s thousands and thousands of our families who face this situation, and that is the reason why we have this crisis,” CASA Executive Director Gustavo Torres said.

A hearing in July brought hospital officials together to figure out what can be done. Staff shortages and a lack of bed space are among the issues.

The Prince George’s County Council will vote later this month on setting up a task force to address long wait times and come up with recommendations on how to shorten those visits.

There won’t be a quick fix, said Council Vice Chair Wala Blegay, who spearheaded the effort.

“This task force is supposed to take a holistic look at this whole issue, and the biggest thing I learned from that is there’s no simple resolution,” she said.

Blegay said the task force will involve ER staff, clinics, nonprofits and others to make recommendations within one year.

There are complaints that patients are waiting for many hours to be seen in the ER. Those complaints are largely from University of Maryland Capital Region Medical Center in Largo.

“I am gravely concerned about this issue, and one of the reasons why is because of Capital Region,” Councilwoman Wala Blegay said. “We have received many, many complaints.”

Health leaders shared stories of a complicated health care landscape.

“I think it is real, and we always need to be sensitive and acknowledge the community’s concerns,” said Deneen Richmond of Luminis Health. “We’re here to serve the community.”

Health care providers said some of the drivers of the long waits are:

• Staffing shortages,
• Not enough specialty care doctors,
• Patients with complex physical and mental health issues,
• Limited space to meet the community’s needs,
• And the need for more people to go to urgent care or primary care doctors.

“When you don’t have enough providers, this is what happens,” said Eunmee Shim of Adventist HealthCare Fort Washington. “People will use hospitals to take care of their health issues.”

Tami Douglas said her husband spent 15 hours waiting to be treated at Capital Region last month.

“We were just sitting there listening to the other people complain,” she said. “They said they had been there, some say they had been there 18 hours.”

Two leaders from the hospital gave a presentation that included graphs showing patients are usually seen within an hour and the time spent from ER arrival to discharge is trending downward.

“Speaking not specific case but in general around long wait times – 10, 12, 14 even – those are typically inpatients which we expect to have a longer time period, but there are things needed to bring that time down,” said Dr. Tom-meka Archinard of Capital Region.

The hearing intended to collect information to get a big picture idea of what’s causing the challenges and to see if the council can develop policies to help bring it under control.

According to the Centers for Medicare & Medicaid Services, Maryland has the worst hospital ER wait times in the nation at an average of almost four hours.

The documents, obtained by the I-Team from a nursing union, lay bare how many nurses say they’ve struggled to care for their patients and themselves as their ranks fell during the pandemic.

The I-Team reviewed nearly three years’ worth of complaints filed by unionized nurses in assignment despite objection (ADO) forms, which many unions use to document safety concerns on the job.

In one report, a nurse wrote, “Every nurse has an unsafe assignment. All but one RN has three babies, each with at least 1 ICU status.”

In another, a person described five nurses managing five patients each, noting, “We can’t provide adequate care.”

One nurse reported being left to manage six patients alone, calling the shift “grossly unbalanced” and “a safety risk to self and patients.”

The forms also show the lengths to which nurses have gone to help their peers and patients, documenting how one nurse worked 17 hours.

The I-Team is not naming the hospital where these nurses work because News4 asked unions representing nurses at several hospitals for the forms, but only one provided them. Further, experts say the scenes depicted in the documents are just a snapshot of what’s happening across the country.

“A nurse’s role is patient advocate, and when they’re filling out one of these forms, they’re doing it because they are worried about their patient,” said Jessica Brown, a union nurse familiar with the ADO reporting process. 

An I-Team analysis of the union data shows nurses filed nearly three times as many of the ADO forms in 2022 as they did in 2020, with 79% citing “RN shortage” as a factor last year.

At the same time, data show the number of registered nurses at this hospital was steadily falling, from more than 2,000 at the start of 2021 to just above 1,700 last summer.

“When hospitals are not staffed appropriately, patients suffer,” Brown said.

Brown said the nurse staffing crisis, which worsened for hospitals across the country during the pandemic, is preventing nurses from delivering the standard of care patients need while also leading to burnout and driving many of her colleagues from the profession.

Asked if lives have been lost as a result of the staffing crisis, she paused before replying, “I think they have been. Yes.”

Experts say the pandemic exposed and then accelerated an already brewing staffing problem in the industry, with an aging boomer population driving increased demand.

The crisis was then worsened as nurses retired or left the industry, exhausted or demoralized by the COVID-19 crisis. Some of those who remained followed the lure of higher paying temporary travel nursing jobs, worsening the shortage in places they left behind.

Silver Spring, Maryland, resident Katie Sheketoff has felt the toll of the staffing shortage. The married mom of two was diagnosed with breast cancer in 2022 and suffered complications that landed her in the emergency room multiple times.

In one instance, Sheketoff said she needed an emergency blood transfusion and waited six hours for a bed. She said she later learned the hospital couldn’t locate a nurse who knew how to administer the transfusion through her mediport – something she said would’ve been far more comfortable than directly in her veins as they had shrunken during chemotherapy.

“It was incredibly painful. I was screaming. I mean, I’ve had two kids. It was as bad or worse than the worst of the labor pain,” she said.

While there, she said, a nurse confided her frustrations.

“She told me that they were so understaffed; she wasn’t supposed to be there. She didn’t have a background in ER nursing,” Sheketoff said, later adding: “It’s a broken system, and the reality is that there just aren’t enough nurses. They don’t get the support that they need.”

According to a report on NBCNews.com, there were nearly 100,000 open registered nurse positions nationwide before the pandemic began. By September 2022, that number jumped to 203,000.

What’s more, a May 2022 report from the consulting firm McKinsey & Company predicts the U.S. could see a shortage of up to 450,000 registered nurses by 2025.

Deborah Burger, the president of the labor union National Nurses United, blamed hospital corporations for why so many nurses are dropping out of the profession, saying cost-cutting measures have cut too deeply into their ability to provide their standard of patient care.

“They’re not willing to put their license on the line. They’re not willing to cause harm to patients, so they remove themselves from the workforce,” she said.

She contends the country has enough qualified nurses to meet the demand, with data from the National Council of State Boards of Nursing showing more than 4.5 million registered nurses have active licenses as of March 1. But Burger said not enough are willing to work in hospitals.

“Hospital corporations have cut staff so badly that we just cannot humanly do it,” she said.

Like Brown, Burger also blamed the lack of widespread law mandating the minimum number of patients a nurse can care for at once. Her state, California, is the only one that has such a legal requirement.

“When we improved the staffing ratios in California, there was no longer a nursing shortage,” Burger said.

Those who have remained on the job are speaking out.

Last year, nurses at Howard University Hospital in D.C. held a one-day strike to demand better pay and more nurses. In January, 7,000 nurses walked off the job in New York, calling for increased staffing, too. And in February, nurses at George Washington University Hospital announced a push to unionize, citing a desire for “safer patient care” and “adequate staffing.”

Julian Walker, spokesman for the Virginia Hospital and Healthcare Association, said there’s no doubt the shortage “has an impact on how care is rendered.” But he said Virginia has managed to maintain good care.

“Outside observers who were evaluating patient safety, patient quality, clinical excellence in Virginia continue to rate the Virginia hospital community and Virginia hospitals as among the best in the nation,” he said.

But it hasn’t been easy. He said his organization worked to bring retired nurses back to hospitals during the pandemic and is now behind a campaign called “On Board Virginia” to attract new healthcare workers to the commonwealth. As of now, the state has more than 11,000 job openings for healthcare workers, he said.

“We’re trying to get to people at a young age; trying to appeal to them and say there are real values and benefits to careers in health care,” he said.

In statements, other hospital associations described their efforts to recruit and retain workers.

The Maryland Hospital Association said its members are raising nursing wages by 25% on average. The DC Hospital Association said it’s working to recruit nurses through higher wages, referral and retention bonuses, as well as childcare and elder-care help.

The American Hospital Association said in a statement it’s urging Congress “to enact federal protections for health care workers against violence and intimidation, to invest in nursing schools, nursing faculty and hospital training time, and to reauthorize, expand, and fully fund nursing workforce development programs.”

News4 photographer Carlos Olazagasti contributed to this report. 

CORRECTION (5:31 p.m., March 2, 2023): An earlier version of this story overstated the number of registered nurses with active licenses in the U.S.

It will take years for people to realize some of the most significant savings promised in the climate and health care bill that President Joe Biden signed this month.

The bill mostly helps the roughly 49 million people who sign up for Medicare’s drug coverage. But many will be left out from direct savings after lawmakers stripped cost-savings measures for a majority of those covered by private health insurance.

A look at how some might benefit from the drug savings provisions in the “Inflation Reduction Act” and how drugmakers might push back on those efforts.

DRUG NEGOTIATIONS

For the first time, Medicare can negotiate the price of its costliest drugs.

In the U.S., “we’ve never had any entity that was negotiating on behalf of such a large group of people before,” said Leigh Purvis, the director of AARP’s health care costs and access.

That new bargaining power won’t kick in until 2025, when Medicare is able to haggle over the price of 10 drugs covered by its prescription plan. By 2029, Medicare will be able to negotiate the cost of as many as 60 drugs.

It will take some time because the Health and Human Services Department will need to develop a plan for selecting which drugs will be negotiated. The complicated rule-making process will take years to devise and face intense lobbying and scrutiny from the pharmaceutical industry, which is eager to carve out loopholes in the new rules.

“The biggest lift is definitely going to be negotiations because the secretary is establishing a whole new program, and they’re going to do a lot of hiring,” Purvis added.

The savings are expected to be huge. The nonpartisan Congressional Budget Office estimates costs could fall by as much as $100 billion over the next decade.

Which drugs Medicare and patients will save on, however, remains a bit of a mystery.

In the first year, Medicare will be allowed to negotiate the cost of 10 drugs it spends the most money on, as long as those drugs have been approved by the Food and Drug Administration for at least nine years and don’t have any rival generics on the market.

Right now, for example, the blood thinner Eliquis, used by 2.6 million Medicare recipients at a yearly cost of nearly $10 billion, would likely be at the top of that list.

That might spur pharmaceutical companies to launch new drugs at a higher price, knowing that the product’s cost will be negotiated down for Medicare, cautioned Arthur Wong, an analyst for S&P Global, a financial research firm.

PhRMA, the trade organization that represents pharmaceutical companies, acknowledged it intends to push back against the law.

“We are exploring every opportunity – including legislative, regulatory and legal — to make sure patients have access to the medicines they need and our industry can continue to develop lifesaving cures and treatments,” PhRMA spokesperson Brian Newell said in an emailed statement to The Associated Press.

___

A CAP ON OUT-OF-POCKET DRUG PRICES

The bill limits how much money Medicare recipients must use for medications but, again, it will take some time for those rules to take hold.

In 2024, Medicare will get rid of a 5% coinsurance required of patients who have met the catastrophic threshold, which is currently set at $7,050 for out-of-pocket costs for drugs. Nearly 3 million Medicare patients met that threshold at some point from 2015 to 2019, according to a study by the Kaiser Family Foundation.

The following year, out-of-pocket drug costs will be capped at $2,000 for Medicare Part D, which typically covers at-home prescription medications.

___

HOW WILL THE PRICE OF DRUGS BE CONTROLLED UNTIL THEN?

The Inflation Reduction Act has a series of controls aimed at immediately blunting the rising cost of drugs for Medicare. The bill caps copayments for insulin at $35 per month beginning in January, but for Medicare beneficiaries only. A $35-per-month limit on out-of-pocket costs for those on private health insurance was cut.

Starting next year, drug companies will also have to pay a rebate to Medicare if they raise the cost of a drug higher than the rate of inflation. The industry regularly raises the price of drugs above inflation yearly.

A similar rule exists in Medicaid, so the Centers for Medicare and Medicaid has experience running this program, said Rachel Sachs, a professor of law at Washington University in St. Louis.

“They’ve been helpful at controlling the rate of increase,” she said of the rebates.

Only Medicare patients will benefit directly from this. A move to include people on private insurance who are sold overpriced drugs in the calculation was scrubbed from the legislation.

Some health policy experts hope this provision, along with the others in the package, will help insurance companies negotiate the price of drugs for its customers, potentially extending cost-savings to millions of people.

But others are waiting to see if the bill has the opposite effect. Medicare makes up about one-third of the pharmaceutical industry’s market, meaning companies could try to draw more profits from elsewhere.

“That could be a threat that non-Medicare payers may end up having to pay more or at least face harder negotiations with the pharma industry,” said analyst Wong.