• Tue. Oct 26th, 2021

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Idaho Allows Overwhelmed Hospitals to Ration Care If Needed

With its hospitals struggling to cope with a flood of patients, Idaho officials activated “crisis standards of care” across the state on Thursday, allowing overwhelmed facilities to ration treatment if needed.

“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,” Dave Jeppesen, the director of the Idaho Department of Health and Welfare, said in a statement.

Crisis standards of care lay out guidelines for hospitals to follow when they cannot meet demand and must ration services. Idaho officials noted that patients may find themselves being treated in repurposed rooms, or that needed equipment is not available. Some patients may have to wait for beds to become available.

If the situation worsens, rationing could get more drastic, with hospitals having to decide which patients will get priority for limited supplies of oxygen or ventilators, potentially sending some patients with a low likelihood of survival to palliative care.

Though states around the country have prepared plans for how to allocate critical resources in a crisis during the pandemic, few have formally implemented such plans even when hospitalizations have soared. Alaska’s largest hospital said this week that it was operating under crisis standards, and that some emergency-room patients had to wait in their vehicles for hours to be seen by a physician.

Nationwide, new coronavirus cases and hospitalizations have declined slightly in recent weeks, but much of the progress seen in hard-hit Southern states is being offset by growing outbreaks in the Upper Midwest and Mountain West, including Idaho.

One in four hospitals across the country reports that more than 95 percent of its intensive care beds were occupied as of the week ending Sept. 9, up from one in five hospitals last month. Experts say hospitals may have difficulty maintaining standards of care for the sickest patients when all or nearly all I.C.U. beds are occupied.

Idaho adopted crisis standards for hospitals in the northern part of the state earlier this month. Nurses there are caring for higher patient loads than usual and are authorized not to check vital signs as often as they otherwise would.

“We are being absolutely crushed by Covid,” Chris Roth, the president and CEO for St. Luke’s Health System, which has a network of hospitals across the state, said at a Thursday afternoon presser.

Mr. Roth warned that if this continues, “we will consume every single bed, and every single resource we have, with Covid patients in our hospitals.”

Dr. Jim Souza, the chief physician executive at St. Luke’s Health System, described the worsening conditions of hospitals during the presser. Many are resorting to treating patients in waiting rooms, and even sending some Covid patients that they would normally hospitalize back home, with oxygen prescriptions and instructions for their caregivers.

Hospitalizations for Covid-19 have continued to surge across Idaho, and are now running nearly 40 percent above the previous peak of the pandemic, according to federal data.

“We are out of actual hospital beds,” Sandee Gehrke, the chief operating officer for St. Luke’s Health System, said at the presser, detailing that patients are now being treated on stretchers.

Despite the spreading crisis, Gov. Brad Little has resisted imposing new coronavirus restrictions or mandating mask-wearing and vaccinations. That has led to growing frustration in neighboring Washington State, which has an indoor mask mandate and other safety protocols, and where hospitals have been strained by numerous patient transfers from Idaho.

Idaho has one of the lowest vaccination rates in the country. Mr. Jeppesen said the best way to end the use of crisis standards of care is for more people to get vaccinated.

“And I am scared, I am scared for all of us,” Dr. Steven F. Nemerson, the chief clinical officer for Saint Alphonsus Health System, in Boise, Idaho, said on Thursday, adding that hospitals are just “able to tread water” at the moment.

“It’s going to decline simply because a caregiver can’t get to a patient fast enough,” he said.

Mitch Smith and Charlie Smart contributed reporting.