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Fans of Athens Pizza in Brimfield, Mass., learned the restaurant's beloved owner was sick via Facebook. 

"The [pizzeria] will be closed for the rest of the week," reads the post from Nov. 30, 2021. "Unfortunately we have been exposed to Covid."

Get-well wishes poured in, but Athens Pizza will not reopen. Tony Tsantinis, 68, died at Harrington Hospital, in nearby Southbridge, on Dec. 10. 

His daughter, Rona Tsantinis-Roy, is haunted by many moments from her father's brief battle with COVID-19. Here's one: As a doctor delivered the news that Tsantinis was dead, he "literally looked me in the eyes and said this didn't have to happen," Tsantinis-Roy recounted.

Her notes from the conversation show that this meant her father might have survived if he'd been transferred to a larger hospital. Typically, that's what happens when a patient who arrives at a community hospital needs more specialized care. But with hospitals full — or close to it — across Massachusetts, transfers are harder and harder to arrange. And some patients are dying while they wait.

For Tsantinis, the community hospital in south-central Massachusetts made two transfer attempts. According to Tsantinis-Roy, the first was on Day 4 in the hospital as her father grew worse and needed intensive care. The intensive care unit at Harrington was full, so doctors and nurses searched for an available bed at another facility. Tsantinis-Roy says they called 17 hospitals but couldn't find an ICU that would take her father. 

Within a few days, Tsantinis-Roy learned that a bed had opened in Harrington's ICU and her father had been moved. But then his kidneys started to fail, and Harrington wasn't able to provide dialysis. Hospitals say nurses who specialize in dialysis are in particularly short supply right now. 

Harrington Hospital tried to transfer Tsantinis again, but it was too late. A few hours before Tsantinis died, his daughter heard that Hartford Hospital in neighboring Connecticut would put him on its waiting list. By then, Tsantinis was too unstable to make the journey. 

Harrington Hospital says it won't discuss the details of Tsantinis' case. The hospital is part of UMass Memorial Health, which also declined to answer specific questions about Tsantinis. But the network's president and CEO, Dr. Eric Dickson, says there are problems at every level of care right now.

"Everybody wants to believe that the system is holding up just fine, but it isn't," Dickson says. "It's breaking down. And when it breaks down, patients are harmed."

Like the majority of people who have died in this phase of the coronavirus pandemic, Tsantinis was not vaccinated. Tsantinis-Roy says she begged her father to get the shots, but "he was old-school and didn't believe in vaccines."

Dickson, while not commenting on Tsantinis, says whether or not a patient is vaccinated does not affect efforts to transfer or accept the person. 

Massachusetts hospitals — as well as hospitals nationwide — are also crowded with patients who do not have COVID-19, but who are coming in with a range of illnesses and injuries, including heart problems, strokes, diabetes complications, drug overdoses and mental trauma.  Doctors say many of these patients with chronic illnesses got sicker during the pandemic because isolation or closures meant delayed medical care or missed medications.  

The sheer number of patients is colliding with staff shortages. Many nurses and other health care workers have quit during the course of the pandemic, and others have tested positive in this current surge and have to isolate at home before returning to work. 

Massachusetts College of Emergency Physicians

, says moving any patient who needs higher-level care is difficult right now if not nearly impossible.

"It's very unfortunate when we can't transfer patients," she says. "It means that our system is broken somewhere in the process."

Massachusetts Gov. Charlie Baker's office responded to a request for an interview with an email containing bullet points about activating National Guard members to help staff health care facilities and helping to organize daily 

 calls with hospitals. The calls are supposed to promote collaboration among hospitals, help balance the patient load and flag urgent cases. 

Some hospital staff members say it's time to impose the crisis standards of care, a set of guidelines that help determine who receives care when the medical system is so overwhelmed by a crisis that doctors and nurses can't care for everyone. Some states, 

, were forced to enact their guidelines last year. Massachusetts' standards were drafted by state hospital leaders early in the pandemic. If access to ICU beds or dialysis is limited, for example, the guidelines would help hospitals determine who gets that care based on who is most likely to survive. 

There are some concerns about using the guidelines now. Despite revisions, they may still give white patients with no physical challenges easier access to limited medical resources. And they were drafted when the focus was on too few ICU beds and ventilators. Now there are many more shortages throughout hospitals, including staff shortages. 

"It's not as simple as not enough ventilators or ICU beds. It's now a much more complicated environment compared to two years ago," says Michael Wagner, the chief physician executive at 

, the hospital chain anchored by Tufts Medical Center in Boston. Wagner co-chaired the state's Crisis Standards of Care Advisory Committee.

Wagner says the guidelines may need to be amended to address this surge. Even if they are, Dickson, of UMass Memorial Health, says asking hospitals to start using the crisis standards right now would impose more stress on exhausted staff. 

"We have to have a conversation among health care leaders and the state about what that would mean and how we would implement it," he says. "But at some level, care is already being rationed because we don't have enough care for all of the patients who are coming in with COVID."

Dickson says it's almost like a lottery for care. Tsantinis wasn't the only patient affected. At hospitals in the greater Boston area, doctors describe patients who've died while waiting to be transferred for more specialized care: A gunshot victim and a man with heart failure are among them. A woman who needed surgery to stop a stroke waited eight hours before she was transferred to a stroke center; the emergency room staff that sent her doesn't know if she survived. Hospital employees did not have permission to discuss the details of these cases. 

It's not clear when the omicron surge will subside for hospitals in Massachusetts.

Kerrigan says the challenge of transferring patients is getting worse. Hospitals in neighboring states are so full they are closing to out-of-state transfers. 

"This was the pandemic we were afraid of when the governor shut down the state back in March of 2020," Kerrigan says.

This translates to fear that more families like Rona Tsantinis-Roy and her children will lose beloved parents and grandparents. Tony Tsantinis was able to call once, from the hospital. His daughter says she put him on speaker so he could talk to her kids. He assured them he'd be home soon.

"He said, 'I'm good. I'm great. I love you guys,' " Tsantinis-Roy says. "He hung up with them, and obviously, they were over the moon."

But to Tsantinis-Roy, her dad's optimism seemed too good to be true.

"We never heard from him again after that," she says. "It felt like a good-bye."

Tsantinis-Roy is still struggling to understand how her dad's death could have happened in a state with health care that is supposed to be among the finest in the world. Dr. Melisa Lai-Becker, who runs a hospital ER just north of Boston, CHA Everett, shares that sense of dismay.

"This feels completely surreal," she says. "I'm practicing within spitting distance of at least five world-class medical centers in Boston, Massachusetts, which is considered one of the world's medical meccas ... and yet they've often had to refuse to accept these patients."

For Kerrigan, it is not too late to ask again for everyone to get vaccinated. If more people made that decision, she says, "we'd be in a better situation — we'd have fewer critically ill patients."

This story is from NPR's reporting partnership with 

Health

COVID-19

Martha Bebinger

Author

A beloved pizzeria owner in Brimfield, Mass., had COVID-19 and needed dialysis, but it wasn't available at the hospital where he died. The health system is "breaking down," a hospital CEO says.

17 hospitals had no room for this COVID patient. He later died waiting for dialysis

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