Nurse Cassandra Pateneaude treats a patient in the hallway of the Maine Medical Center emergency department. The Portland hospital and its affiliates have been pushed to the brink by a recent surge of COVID-19 patients, most of whom are unvaccinated. Credit: Courtesy of MaineHealth

Maine’s two largest hospital systems are canceling non-emergency procedures amid a spike in coronavirus hospitalizations, and say they would have difficulty staffing outside facilities if the pandemic got far worse and they needed to expand patient capacity.

Officials from Portland-based MaineHealth and Brewer-based Northern Light Health made something of a plea to Mainers on Wednesday to get vaccinated, get booster shots if eligible and refrain from behaviors that could further the coronavirus’ spread.

The plea came as they said their hospitals were buckling under the pressure of record coronavirus hospitalizations, chiefly among unvaccinated patients. MaineHealth said its seven Maine hospitals had been pushed to the brink.

The hospital systems are not yet at the point of employing crisis standards of care like those employed in some U.S. states under which the hospitals would prioritize certain care due to limited resources. The systems said they would still be able to treat patients from a mass-casualty event at this time.

Yet as coronavirus cases continue to rise after Thanksgiving and Maine continues to break its record for COVID-19 hospitalizations, they fear the situation could get much worse. A conversation about crisis standards of care could come if MaineHealth continues to see significant demand for high-acuity care, said Dr. Andrew Mueller, the system’s CEO.

“We’re running out of straws. There are not a lot of great options left,” Mueller said.

Maine Medical Center has been postponing about half of its scheduled non-emergency procedures. The hospital, Maine’s largest, also plans to close half a dozen of its operating rooms so it can create and staff more ICU beds.

All of MaineHealth’s hospitals are at full capacity, said Joel Botler, Maine Medical’s chief medical officer.

“There’s really no more room at this point,” Botler said. “We are doing everything possible to increase that capacity.”

MaineHealth leaders made a point of noting that the procedures being postponed were non-emergency, but not cosmetic. They include hip and knee replacements as well as spine surgeries.

At Northern Light, Eastern Maine Medical Center in Bangor will start on Friday looking at postponing some procedures, especially those that would require that the patient be admitted to the hospital and take up scarce bed space, said Dr. James Jarvis, senior physician executive of Northern Light Health’s COVID-19 response.

“We’re prepared to take additional steps if needed to ensure that our sickest and most vulnerable patients get the critical care they need,” Jarvis said.

At the root of the capacity struggle is staffing. Gov. Janet Mills on Wednesday said she’s deploying 75 National Guard members to supplement staffing at hospitals and nursing homes. She’s also requesting federal aid for Maine Medical Center and Central Maine Medical Center in Lewiston, which would provide teams of federal doctors and other health professionals to supplement staffing

Both MaineHealth and Northern Light said their employees were struggling to treat the present load of patients and would have great difficulty handling many more. Northern Light is in a better position than MaineHealth, but not by much, Jarvis said.

“It would not take many more patients needing to access care for us to talk about similar stresses that MaineHealth is experiencing right now,” Jarvis said.

Also at issue is the lack of long-term care beds across Maine in nursing homes that are struggling with their own staff shortages. That means that many patients who would have been discharged from the hospital have to remain there as workers search for beds in long-term care facilities.

While nurses have been in high demand, Mueller said the MaineHealth system needs new applicants in a variety of positions, including respiratory therapists and physicians.  

Early in the pandemic, the state and health care providers planned to use the Cross Insurance Arena in Portland and the Cross Insurance Center in Bangor as care sites if hospitals exceeded their capacity. The state didn’t have to use them at the time.

Now, the state’s two largest hospital systems say they would have difficulty staffing those alternative care sites if they were needed, and Jarvis said it was unlikely that a care site would be set up at the Bangor arena.

The regions of southern, western and coastal Maine that MaineHealth’s hospitals primarily serve have seen lower coronavirus infection rates than the mainly northern and eastern territory Northern Light serves since the day after Thanksgiving. But the absolute number of cases in MaineHealth territory has been larger, according to Maine Center for Disease Control and Prevention data.

Jarvis said Maine’s four largest hospitals — Maine Medical Center, EMMC, Central Maine Medical Center and MaineGeneral Medical Center in Augusta — were coordinating closely.

“Maine’s statewide health care system is certainly fragile,” Jarvis said. “Any one area that sees stress puts stress on the rest of those areas.”