Despite Controversial Leader, Charity’s COVID Field Hospitals Prove Helpful

Days before Christmas, a hospital in the North Carolina foothills of the Blue Ridge Mountains maxed out its resources.

Caldwell UNC Health Care, a 137-bed hospital in Lenoir, had planned for a surge of COVID-19 cases for months. But the facility went from treating 19 infected patients to 49 in just one week, its president and CEO Laura Easton told MedPage Today. The hospital’s average daily census rose from between 60 and 80 patients to between 110 and 120.

Community spread was high, and a number of employees were also out of work, Easton said. Three out of five neighboring hospitals were similarly stretched.

The outlook was bleak, but Easton and her colleagues thought of an organization nearby.

Samaritan’s Purse — an evangelical Christian charity known for treating Ebola patients and victims of war abroad — is based in the mountain town of Boone, just 25 miles from Caldwell UNC Health Care. Easton knew the organization had previously deployed COVID field hospitals in New York City’s Central Park, Italy, and the Bahamas, and thought perhaps it could do the same for them.

The chief medical officer at Caldwell UNC Health Care made a call, and it turned out the charity had been closely watching the rising number of cases in its own backyard, Easton said.

It took just a week to stand up a 30-bed field hospital adjacent to Caldwell UNC Health Care, Easton noted. Once the charity decides to deploy a field hospital, it moves fast because it knows the need is immediate and may not be the same in just a short period of time.

“This is what they do,” Easton said. “They go into crisis situations, and they execute rapidly.”

The field hospital at Caldwell UNC Health Care opened Jan. 7, and has been supporting that facility as well as five other hospitals in Western North Carolina. Nine days later, Samaritan’s Purse also stood up a 54-bed unit in Los Angeles County, California, next to Antelope Valley Hospital.

Both non-state-run facilities — funded by donations and staffed with volunteers, including its doctors and nurses — are uniquely positioned to help ease the strain on hard-hit hospitals. But they haven’t evaded scrutiny.

LGBTQ activists last year opposed the COVID field hospital set up by Samaritan’s Purse in New York. And as the North Carolina and California facilities opened, the charity’s CEO, Franklin Graham — son of the late evangelist Billy Graham — found himself in hot water over his support for former President Donald Trump after the Jan. 6 attack on the U.S. Capitol.

All the while, hospitals say the charity’s resources have filled a void and been critical to managing a surge of COVID cases.

Field Experience

Samaritan’s Purse — founded more than 50 years ago — has experience transporting, setting up, and running field hospitals. It has responded to natural disasters, war, and famine, with a mission of providing humanitarian aid and promoting the Gospel of Jesus Christ in doing so.

In recent years, it has increased its focus on the treatment of infectious diseases.

In 2014, Samaritan’s Purse deployed staff to care for Ebola patients in West Africa, and in 2016, the organization first flew its own field hospital in response to the massive earthquake that hit Ecuador. Less than a year later, it transported a facility to treat civilians injured during the conflict between Iraqi security forces and ISIS in Mosul.

Though the pandemic presented a new challenge, it was relatively simple to adapt the charity’s existing field hospital model to one with a primary focus on respiratory support, Ken Isaacs, vice president of international programs and international relations at Samaritan’s Purse, told MedPage Today.

“We need to be next to a hospital … that allows for the easy passage of patients,” Isaacs said. “We’re not a receiving center. We’re an extension of a co-located hospital.”

COVID patients who need care, such as supplemental oxygen or treatment with medications, are transferred to the field hospital to free up beds in the co-located facility, he said. Doing so eases the burden on space and staff, and allows the primary hospital to focus on caring for COVID patients who need ventilators as well as non-COVID patients with other health concerns.

Field hospitals are primarily funded through donations, Isaacs said. The cost of setting up and running the facilities ranges from about $700,000 to $3 million. Most are in operation at a site for between six weeks and three months.

Though flying portable hospitals around the world on a moment’s notice is a heavy lift, Samaritan’s Purse has the resources to do so.

Samaritan’s Purse reported $734 million in revenue in 2019, of which ($720 million) was from contributions and grants, according to its most recently available financial filing. Total revenue was up nearly 5% from the year prior.

Expenses were $689 million in 2019, with the majority (86%) going to program services. Just shy of 8% of expenses were for fundraising, and about 5% were administrative. The organization’s top paid employee was its CEO, Graham, who made $722,403 in 2019.

Charity Navigator, a nonprofit that evaluates organizations’ finances and transparency, gives Samaritan’s Purse its highest rating of four stars.

No Shortage of Staff

In 2019, Samaritan’s Purse employed 3,305 people, and enlisted the services of 197,000 volunteers, according to its financial filing.

That is what differentiates the organization’s swift ability to set up field hospitals, said Easton of Caldwell UNC Health Care.

“Their field workers are prepared to go anywhere in the world, several times a year,” Easton said of Samaritan’s Purse. “They had that advantage over a state government-run hospital.”

The team can put out a call on Monday night, and by Tuesday afternoon feel confident that it has enough people to staff a unit, Easton said.

“These folks are very mission-motivated … and they do this on a regular basis,” she said. “When the team came in, they knew each other. They were in Italy together. They were in the Congo together. It’s really a unique set of circumstances.”

The state of North Carolina has been very supportive, Easton noted. However, one challenge it faces is that, if it needs to call in members of the National Guard who are medically trained, it may have to pull individuals out of the very hospitals it is intending to help.

With Samaritan’s Purse, volunteers are coming from all parts of the country.

“It didn’t harm the COVID effort of any one single institution like it might have if [North Carolina] pulled some of the resources that they could have within the state,” Easton said.

Keith Acree, a spokesman for North Carolina Emergency Management and the Department of Public Safety, told MedPage Today in an email that the state has not set up any field hospitals during the pandemic. He said that the state does have one recently closed hospital equipped and on standby in case it is needed for overflow. However, that facility would indeed require staffing, he added.

Easing the Strain

Last year Samaritan’s Purse treated more than 680 COVID patients at its field hospitals in Italy, New York City, and the Bahamas.

At Antelope Valley Hospital in California, Samaritan’s Purse has already admitted 83 COVID patients to its new field hospital, according to Cynthia Frausto, director of marketing and public relations at the hospital.

Within two-and-a half days of the charity’s assessment team making an initial on-site visit, the field hospital was up and running, Frausto told MedPage Today.

“We did experience the patient surge from the holidays, especially around Halloween and Thanksgiving,” Frausto said. “We’re in the middle of waiting to see [what] the last of the holiday patient surge is going to bring.”

That’s where Samaritan’s Purse has been able to alleviate stress.

“They have been incredibly helpful in terms of picking up COVID patients who otherwise would have been waiting for beds in our hospital,” Frausto said. “It’s not only the space,” she added. “The biggest help is having the staff and the resources that come with Samaritan’s Purse. They provide all of their supplies, nurses, doctors, techs. They come well-equipped to help these patients and the hospital.”

Easton of Caldwell UNC Health Care concurred.

Co-located hospitals provide other support, such as patient medical records, connections to oxygen tanks, pharmaceuticals, and even malpractice insurance, Easton said.

Though it is not a profitable endeavor for Caldwell UNC Health Care, billing insurers for patient care should cover the cost, she said.

Facing Opposition

Both Easton and Frausto said that their respective communities have been supportive of Samaritan’s Purse setting up field hospitals.

However, that hasn’t always been the case.

After Samaritan’s Purse set up a 68-bed field hospital in New York City’s Central Park last April, the charity’s CEO and Christian minister Franklin Graham said in a statement that it had faced backlash from eight democratic members of New York’s Congressional delegation, the New York City Commission on Human Rights, and the Reclaim Pride Coalition.

Their objections focused on a statement of faith the charity asks its employees to sign and its volunteers to support. The statement notes the organization’s belief that marriage is between a man and a woman.

Graham said at the time that the organization didn’t believe it was the time or place to wage the debate.

“It’s true, for 50 years, we have asked our paid staff to subscribe to a statement of faith — but we have never asked any of the millions of people we have served to subscribe to anything,” Graham said. “In other words, as a religious charity, while we lawfully hire staff who share our Christian beliefs, we do not discriminate in who we serve.”

“We have provided billions of dollars of medical care and supplies, food and water, and emergency shelter without any conditions whatsoever,” he added.

New York’s Mount Sinai Health System, with which Samaritan’s Purse partnered on the Central Park field hospital, declined a request for comment for this story.

Though Samaritan’s Purse said that its other field hospitals have not faced similar opposition, Graham has come under fire for an unrelated reason during the most recent openings.

Following the siege on the nation’s Capitol Jan. 6., Graham — a supporter of former President Donald Trump — made public comments against a second impeachment of Trump for inciting an insurrection.

“Shame, shame on the ten Republicans who joined with @SpeakerPelosi & the House Democrats in impeaching President Trump yesterday,” Graham tweeted Jan. 14. “After all that he has done for our country, you would turn your back & betray him so quickly? What was done yesterday only further divides our nation.”

In response, the nonprofit Faithful America — which describes itself as a community of Christians committed to social justice — launched a petition calling for Graham to be removed from his leadership positions at Samaritan’s Purse and the Billy Graham Evangelistic Association. It has garnered more than 25,000 signatures.

“By appearing to legitimize Franklin Graham’s hateful politics and his lies about the 2020 election results — which were part of the disinformation campaign that provoked the deadly attack on the U.S. Capitol — the board of Samaritan’s Purse is detracting from its vital medical mission and undermining its intended message of Christian love,” Nathan Empsall, an Episcopal priest and campaigns director at Faithful America, said in an emailed statement.

Empsall said that enabling conspiracy theories can also lead to a fractured news environment, misinformation, and the additional spread of COVID.

“The work of Samaritan’s Purse staff members can be incredibly beneficial in spite of Franklin Graham, including in COVID-19 field hospitals from Italy to North Carolina — yet those professionals could do even more under different, reasonable leadership,” he said. “How much more love and healing would Samaritan’s Purse achieve if it welcomed all qualified health-care workers?” he questioned. “And how many patients have chosen to stay away in fear of receiving biased, substandard care?”

Committed to the Cause

Paul Saber, who serves on the boards of both Samaritan’s Purse and the Billy Graham Evangelistic Association, provided a statement in response to the petition, saying that Faithful America fabricated a lie that Franklin Graham incited violence at the Capitol.

“Mr. Graham was not in Washington, D.C., he didn’t encourage people to go to the Capitol on January 6, and he condemned the violence at the Capitol,” Saber said. “The Boards of Directors for Samaritan’s Purse and the Billy Graham Evangelistic Association have expressed that they fully support Franklin Graham and are more than satisfied with the job he has done and is doing in leading these ministries to bless people in over 100 countries around the world.”

Isaacs of Samaritan’s Purse said that, at the current stage of the pandemic, there continues to be international interest in its COVID field hospitals.

Its resources — though substantial — can only stretch so far.

“We consider each situation and request on a case-by-case basis,” Isaacs said. “We don’t want to say no, but we can’t say yes everywhere either.”

He said that he expects and hopes infections will continue on a downward trajectory this year, especially with vaccinations.

“I hope that we’re not needed,” Isaacs said. “What we have to offer is just a small thing when you look at the magnitude of the disease,” he added. “But if it’s a service we can provide, we want to do that.”

Easton of Caldwell UNC Health Care also said that she hopes COVID cases will continue to decline.

To date, about 80 patients have been treated at the field hospital in Lenoir, she said.

That included a husband and wife who celebrated their 49th wedding anniversary under its tents, Easton said. Most of the field hospital’s patients — including the couple — have been successfully discharged.