The top official at Whidbey’s public hospital describes a “new normal” with a health care system in constant crisis mode due to ever-spreading viruses, staffing shortages and precarious financial positions.

For patients, this might mean continued long waits at the ER and walk-in clinics, delays in seeing primary care doctors and the possibility of lengthy limbo-like “boarding” periods in ER beds, but also new ways of obtaining medical services.

Mike Layfield, interim CEO of WhidbeyHealth, said hospital leaders are responding by looking into innovative and less costly methods for providing health care to the community, which may mean more of a reliance on telemedicine at clinics and even the emergency room.

He said many hospitals in the state have reduced services because of financial strains, but WhidbeyHealth officials are fighting to keep intact a public health care system that offers the island — including Navy families — a breadth of medical options and conveniences.

Layfield emphasized that the challenges facing WhidbeyHealth are the same that hospitals across the state and nation are dealing with.

“We are looking at what we can do to redesign how we provide service in a more efficient and cost effective way,” he said, adding that the hospital is working to improve patient and staff satisfaction at the same time.

Dr. Nick Perera, WhidbeyHealth chief of medicine and the head of the emergency department, has been in the thick of the triple threat of COVID, the flu and RSV. He said this is the worst flu season he’s ever seen. The 2009 H1N1 pandemic caused more serious symptoms but it wasn’t as contagious, he said. The hospital had more confirmed cases of the flu in November than in the entirety of 2021.

Wait times have increased in the ER as well as walk-in clinics, but it could be worse. The hospital administration reports that ER wait times nationally average more than six hours while WhidbeyHealth has been averaging four to six hours. Last week a family in Mount Vernon was “shopping ERs” and drove more than 90 minutes to WhidbeyHealth to wait three hours in the ER, which was still quicker than waiting at Skagit Regional, according to Marketing Manager Conor O’Brien.

Layfield said medical professionals expect that new and resurgent viruses will continue stressing the nation’s health care system.

Just as significant, Perera said, are the boarding times. ER patients who need to be admitted into a hospital for treatment are often “boarded” in the ER until hospital beds can be found at WhidbeyHealth or elsewhere. The ER has 13 beds and at least three of those are often used for boarding.

Perera said in the pre-COVID world it would take about an hour for ER patients to be admitted to a hospital, but nowadays the wait can be three to five days as staff calls around the region to find an open bed. A child suffering from RSV recently had to be airlifted all the way to Tacoma.

The problem is especially bad in Washington, Layfield said, because the state has the lowest number of ER, acute patient, long-term and behavioral health beds per capita in the nation. Providence Medical Center in Everett was boarding as many as 80 patients at a time.

To make matters worse, the hospital doesn’t always get reimbursed by insurance companies for boarding patients.

“The whole system is strained,” Perera said. “The root problem is staff shortages, especially in nursing care.”

Perera said a national nurse shortage pre-dates COVID, which only exaggerated the problem. It’s a difficult and under-appreciated job and a lot of nurses burned out during the hectic days of the pandemic. Recent increases in nurse pay may help, he said, but hospitals “can’t pull nurses out of the air.”

Layfield said WhidbeyHealth is offering signing bonuses, but essentially hospitals are competing to attract the same small pool of nurses. It is projected that more than 1,500 new nurses will be needed in the greater Seattle area next year. Without an adequate number of nurses at hospitals, fewer beds will be available and boarding waits will likely increase.

“At some point you have to worry about safe staffing,” Perera said, adding that the federal government needs to step in and offer resources to help with the problem.

Layfield said the staffing problem isn’t confined to nurses. The hospital is having trouble filling a broad range of positions in the hospital, from housekeeping to the CEO. He was supposed to be replaced by a permanent CEO by now, but has agreed to stay on months more.

An increase in telemedicine systemwide, Layfield said, is one solution that the hospital is exploring for staffing problems. He said a team of providers and administrators are looking into bringing online medical help to the ER for non-emergency cases, like pink eye or earaches. Rooms near the ER may be set up with computers for patients to talk to a physician online.

Insurance reimbursements for telemedicine are less than normal visits, but still “relatively good,” Layfield said. O’Brien said telemedicine has been around for a while but that the pandemic really shined a light on the benefits.

WhidbeyHealth also shares the financial challenges that hospitals across the nation are facing.

The Washington State Hospital Association recently reported that hospitals and health systems in the state lost $2.57 billion in the first nine months of 2022, with almost $1.66 billion in losses from operations and continued massive losses are forecast into the future. Layfield said 10% of hospitals in the state may face bankruptcy.

WhidbeyHealth started out the year in controversy as the elected board members realized that the hospital’s financial troubles were far worse than they previously realized. They fired the CEO and hired a management firm, HealthTechS3, to provide management, an interim CEO and help finding a permanent CEO.

WhidbeyHealth is expected to end the year in the red by $980,000, even with the addition of $6 million in tax dollars from a levy increase that passed in 2021. Layfield said the projected loss for next year is just $400,000 as the hospital has trimmed costs and improved financial management.

Nevertheless, hospital officials have contacted legislators and are hoping for financial help from the government.

The state hospital association reports that Gov. Jay Inslee’s recently released budget includes substantial investments in hospital priority areas, especially difficult-to-discharge patients and behavioral health. It includes some investments in health care workforce, but not increased Medicaid payments to hospitals through the Safety Net Assessment Program.