‘Net is gone’: All of Idaho put in crisis standards of care amid ‘unabated’ COVID spread

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In a stark indication of the severity of Idaho’s COVID-19 crisis, state health officials activated a last-resort measure on Thursday that allows hospitals across the state to ration care as needed because of an unmanageable influx of patients.

The implications of the decision are bleak, allowing medical professionals to prioritize patients most likely to recover and withhold what could be lifesaving treatments from patients deemed unlikely to survive — all because the spread of the virus in a poorly vaccinated state means there are not enough resources to provide adequate care for all.

Although the Department of Health and Welfare on Thursday approved the change, called crisis standards of care, not all health care systems will implement the standards immediately, because those decisions are made on an individual basis.

St. Luke’s Health System, which requested Wednesday that the crisis standards be enacted, has begun activating the measures at its hospitals, while Saint Alphonsus is operating “at the most extreme contingency standards,” which is the level of care below the crisis level, according to Dr. Steven Nemerson, chief medical officer for Saint Al’s.

West Valley Medical Center in Caldwell did not respond to an inquiry Thursday afternoon about its situation, but in a statement that morning, the hospital said, “We will not be making immediate changes to our hospital operations as a result of this announcement.”

Portneuf Medical Center, the large hospital in Pocatello, also has not declared the crisis standards yet, and is operating at the same level as Saint Al’s, according to Health and Welfare.

The standards were created in June 2020 as a plan to strategically ration health care should the need arise for hospitals that became overwhelmed. The state’s guidelines for rationing care emphasize that hospitals must shift the priority from offering the best care to each individual patient to saving the most lives.

“The situation is dire — we don’t have enough resources to adequately treat the patients in our hospitals, whether you are there for COVID-19 or a heart attack or because of a car accident,” Department of Health and Welfare Director Dave Jeppesen said in a news release Thursday.

On Sept. 6, crisis standards were activated in two North Idaho health districts. A day after the announcement, Dr. Robert Scoggins, a doctor at Kootenai Health in Coeur d’Alene, told reporters that patients were being triaged outside of the ER, and those coming to the hospital should expect longer waits in emergency rooms.

What are Idaho hospitals facing?

At a press conference on Thursday, hospital leaders in the Treasure Valley described their challenges and said conditions would only get worse in the coming weeks.

At St. Luke’s facilities, surgeries for certain types of severe conditions — like some tumors and cancers — have been stopped because of a lack of resources. “Primitive” ventilation devices are being used on some patients in non-monitored settings, and the hospital has had to reduce its supervision of patients’ vital signs, according to Dr. Jim Souza, chief physician executive of St. Luke’s Health System.

Under normal circumstances, he said that an abundance of resources and high-quality care are the net that allows doctors to perform “high-wire” procedures with high reliability.

“The reason we made this case for (crisis standards of care) is because the net is gone,” Souza said. “And people will fall from the wire.”

As of Wednesday, the hospital had 245 COVID-19 patients and 608 total patients, according to the hospital dashboard.

There were a record 678 patients hospitalized with COVID-19 in Idaho on Monday, including a record-tying 173 in intensive care, according to data from Health and Welfare. Those numbers are likely underreported, as only 45 facilities provided data on Monday. Health and Welfare shows data on other days from as many as 52 facilities.

The hospitalization high last year was 496 on Dec. 1.

“If we continue on this course over the next several weeks, St. Luke’s Health System will become a COVID health system,” said Chris Roth, president and CEO of St. Luke’s, who added that nearly every COVID-19 patient in the hospital is unvaccinated. “We will consume every single bed and every single resource we have with COVID patients in our hospital.”

Nurses who normally operate on a 1:1 or 1:2 nurse-to-patient ratio are now treating at least three patients at St. Luke’s according to Sandee Gehrke, chief operating officer. An additional 93 beds at facilities in the Treasure and Magic valleys have been added, and any additional patients will need to be treated on stretchers, she said.

At St. Luke’s Nampa Medical Center, some patients are now receiving care in the hospital’s imaging suite, where X-rays and other scans would normally be conducted. And at the hospital in Boise, St. Luke’s is opening an additional morgue this week.

“We have new space that has come online as a result of our new central plant (in Boise); otherwise we would not have the location to provide for these deceased bodies,” Gehrke said.

At Saint Alphonsus, a record 35% of the hospital’s inpatients — 135 total patients — are COVID-19-positive. Nemerson said that the hospital’s modeling expects that number could exceed 210 patients within the next month, as COVID-19 infections “continue on unabated.”

What do hospitals’ crisis standards plans entail?

Though each hospital’s crisis plan is slightly different, the state’s guidelines indicate that hospitals may begin ranking patients based on the severity of their conditions, the likelihood of their survival and the the number of years they have left to live.

One strategy for when ventilator supplies are scarce even includes implementing a universal do-not-resuscitate order on adults who experience cardiac arrest in a hospital, because of the low chance of survival and risk of aerosol spread to health care workers, according to the state guidelines.

“Unfortunately, you’ll die, but you’ll free up the ventilator for somebody else,” said Dr. David Pate, the former CEO of St. Luke’s, in an interview with the Idaho Statesman. “That seems very harsh to say it, but these are the harsh realities we’re dealing with right now.”

While many hospitals ordered extra ventilators at the start of the year, Pate said, the high number of patients could cause a shortage.

“It could be that it would be a ventilator shortage, it could be that we just don’t have an (intensive care unit) bed available, it could be that we don’t have the staff,” Pate said.

Despite hospital crisis, mandates are scarce

Idaho has no statewide mask mandates, limits on gathering sizes or vaccine requirements in place. Last Friday, Gov. Brad Little’s office announced that he was “exploring” a lawsuit against President Joe Biden’s proposed expansion of vaccine requirements for employees of large businesses.

On Thursday, Boise Mayor Lauren McLean released a statement saying that Boise residents are having to sacrifice their health care because of a lack of state action.

“We as Boiseans are asking the state to step in because this virus knows no city borders and we are seeing the devastating impacts of this surge in our local medical centers,” she said. “Our hospitals have asked for regional and state action, without response.”

In an emailed statement, Little said that the state has “taken many steps to alleviate the pressure on our health care system.” He added that “the activation of statewide Crisis Standards of Care signals the need for more Idahoans to do their part to slow the spread of COVID-19 and to choose to receive the vaccine.”

Little has opposed vaccine and mask mandates while encouraging Idahoans to do both. Barely 50% of eligible people in the state are vaccinated, ranking Idaho near the bottom of the nation.

In an interview with the Statesman, Dr. Ted Epperly, the CEO of Family Medicine Residency of Idaho, called for more state action to help hospitals and health care professionals.

“We cannot continue to pretend this is not happening,” he said. “We must take it seriously, and we must take efforts that will help immediately decrease the stress on the systems, which are primarily going to be the public health initiatives of mask wearing, social distancing and approved size limitations” on gatherings.

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