Tennessee prepares to send National Guard to hospitals for COVID-19 surge

Brett Kelman
Nashville Tennessean

As the surging coronavirus outbreak threatens to overwhelm Tennessee’s health care infrastructure, Gov. Bill Lee invoked emergency authority allowing National Guard members to be sent to hospitals as nurses, COVID-19 testers or ambulance drivers.

According to Executive Order 68, issued Friday, guardsmembers will only be given  these duties if they have “appropriate training or skills” and the assignment is approved by Guard Adjutant General Jeff Holmes and state Health Commissioner Lisa Piercey.

Dr. Morgan McDonald, a deputy health commissioner, said the state would not assign guardsmembers who are currently working in civilian medical jobs, which would effectively “rob Peter to pay Paul.” Instead, the executive order will only be used to assign a “relatively small number” of "trained medics" who are actively on duty with the Guard. Some are currently staffing state-run test centers.

McDonald said some hospitals have already expressed interest in Guard help but declined to identify them. She said the need for additional hospital manpower was statewide.

“Staffing shortages are increasingly problematic for capacity," McDonald said. "So our first priority is really to staff hospitals knowing that they have facility space but their bed capacity is really limited by staffing."

Tennessee National Guard members assess people as they wait in line to be tested for the coronavirus Saturday, April 18, 2020, at the Williamson County Health Department in Franklin, Tenn.

The guardsmembers will wear military uniforms but won't carry firearms, said Laine Arnold, a spokeswoman for the governor's office.

While the number of guardsmembers sent to hospitals may be small, this order is among the most aggressive steps yet taken by the Tennessee government to prevent the virus from overwhelming hospitals. In addition to activating the National Guard, the order suspends some health care regulation laws to allow health care facilities more flexibility to treat the coming surge.

The possibility of guard reinforcements is welcome news in northeast Tennessee, where several Ballad Health hospitals have struggled to keep up with a flood of patients. Johnson City Medical Center recently made headlines when it acquired a refrigerated truck to supplement the capacity of its morgue.

Ballad CEO Alan Levine said a group of guardsmembers began performing COVID-19 testing at one the company’s hospital about a week ago.

“We were able to use the national guard to free up some of our clinical team to come back into the hospital,” Levine said. “Already it’s been helpful.”

Ballad Health is stationing mobile morgue trucks outside two of its Northeast Tennessee medical centers in response to dire projections of more than 500 hospitalizations following the Thanksgiving holiday.

Vanderbilt University Medical Center, the largest hospital in Nashville, also praised the governor's action. In an email statement, Vanderbilt Deputy CEO C. Wright Pinson said the Guard help and staffing flexibility “could significantly help hospitals across the state, including ours.”

The Trump Administration first floated the idea of governors deploying the National Guard to hospitals with COVID-19 in July, and the strategy has since been used to some degree in a few states. While Lee has now embraced this recommendation, he rejects far-more-common defenses like a statewide mask mandate or requiring businesses take precautions. Lee as repeatedly refused to combat COVID-19 by restricting individuals, businesses or gatherings despite the increasingly desperate pleas of medical professionals and much of the public.

"Our national guard shouldn't have to be sent into harm’s way to address a surge Governor Lee could have prevented had he not abandoned his own post and responsibility to act earlier,” said Dr. Amy Gordon Bono, a Nashville-area physician, in a statement responding to the executive order.

“We have since seen that patchwork, 'fend for yourself' approaches to global pandemics don't work. So we have one simple question: now what?”

INVESTIGATION:COVID-19 crept from cluster to cluster, weaving a web over Nashville

Medical assistants can now perform nursing duties

While Lee rebuffs their pleas for a mask mandate, the governor has given medical professionals more flexibility in how they treat coronavirus.

The executive order signed on Friday suspends some state laws "in order to relieve the capacity strain" on hospital manpower and emergency services. 

For example, the order allows hospitals to delegate nursing tasks to certified medical assistants – who have a lower level of training – if they are supervised by a nurse.

Levine, the Ballad CEO, said he'd recently urged the governor's office to lift this restrictions and was "grateful they acted on it."

“We do intend to take advantage of this. I hope and pray we can minimize the use of it, but if we need to make use of it, we will. The goal being to provide relief for our nurses," Levine said.

The order also allows medical professionals who are treating COVID-19 to perform tasks outside of the normal licensed duties anywhere in a hospital. Previously, under another executive order, this flexibility was only permitted in an emergency room or an “acute care setting.”

VACCINE:Tennessee expects 56,000 Pfizer doses this month, but that won't reach far

Beyond hospitals, the order lifts regulations limiting the expansion of nursing homes and home health agencies. Normally, before these businesses are permitted to expand, they must prove to a government board their expansion is necessary to fill a public need. This is no longer required if their expansion is related to the treatment of COVID-19. (Lee already suspended this requirement for hospitals in May.)

Ambulances are also permitted to operate with lower levels of staffing.

COVID-19:Why Tennessee schoolchildren won't be required to get a vaccine

The new order comes as Tennessee once again sets new records for COVID-19 infections, hospitalizations and test positivity. The average number of new infections per day exceeded 5,000 for the first time ever this week, and this statistic is expected to continue to rise next week in a widely feared post-Thanksgiving surge.

Tennessean reporter Natalie Allison contributed to this story.

Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at brett.kelman@tennessean.com. Follow him on Twitter at @brettkelman.