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September 13, 2021

'A last resort': How Idaho hospitals are rationing care amid the delta surge

Daily Briefing

    Over the past two weeks, Covid-19 cases in Idaho have increased by more than 40%, and hospitalizations are up 25%, leading the state's Department of Health and Welfare (DHW) on Tuesday to activate "crisis standards of care" that permit 10 hospitals to ration health services.

    How much worse will the 'delta surge' get? Watch these 7 factors.

    Idaho hospitals overwhelmed with patients

    According to Brad Whitlock, CEO of the Idaho Hospital Association, hospitals "have reached the point where we are almost on overload and have an inability to transfer patients to other areas of the state or even the region because of the lack of capacity around the state."

    For example, the main Kootenai Health hospital in Coeur d'Alene is licensed for 200 regular medical beds, but on Wednesday, it had 218 "med surge" patients, according to Jeremy Evans, the hospital's Covid-19 incident commander.

    On top of that, around 500 of its clinical and staff positions are empty, Evans said, meaning administrative staff and others have been asked to do extra work, such as cleaning hospital rooms.

    Robert Scoggins, chief of staff at the hospital, said the surge of patients has forced the hospital to "[do] things that were not normal—way outside of normal—at times."

    "Almost every day at this point we are having cardiac arrest from patients when their oxygen levels dip too low and we can't supply them with enough oxygen," he added.

    Meanwhile, Peter Mundt, spokesperson for Gritman Medical Center in Moscow, Idaho, said the hospital is having difficulties finding places to transfer patients with heart problems and other non-Covid conditions.

    "Our ability to accommodate non-Covid patients [is] very strained at this point," he said. "Even though we're all different hospitals, we normally work together as collaborative colleagues and peers. We need it to work as a giant system and that system is just under severe strain right now."

    Gov. Brad Little (R) announced earlier this month he is reactivating the National Guard to help hospitals as they face capacity limits.

    Up to 370 National Guard members will be dispatched to assist hospitals, with up to 150 helping short-staffed health care facilities with procedures such as lab work and screenings.

    In addition, the U.S. General Services Administration is sending 200 medical and administrative personnel to help hospitals in the state, and the Department of Defense is sending a 20-person medical response team to northern Idaho, an area with low vaccination rates.

    Some hospitals to start ration care

    At the 10 hospitals in which crisis standards of care are in effect, DHW announced that "patients admitted to the hospital may find that hospital beds are not available or are in repurposed rooms (such as a conference room) or that needed equipment is not available."

    "Crisis standards of care is a last resort. It means we have exhausted our resources to the point that our health care systems are unable to provide the treatment and care we expect," DHW Director Dave Jeppesen, said.

    In the announcement, Little said the state has "reached an unprecedented and unwanted point in [its] history."

    Under crisis standards of care, patients are given priority scores based on factors that impact their likelihood of survival, which, according to Whitlock, means some hospitals will be having "difficult conversations" about ventilator use.

    "If you have somebody in an ICU that's been on a ventilator for a couple of weeks and is not showing any sign of improvement, and you do have somebody who it might be younger whose conditions may not be as acute as that person that's been in the ICU for a couple of weeks, those are conversations that are taking place about moving that one patient into comfort care and freeing up the ventilator in order to hopefully save the life of another patient," he said.

    And while many of northern Idaho’s smaller, rural hospitals have not yet been forced to take these emergency measures, Jeppesen said, "For the rest of the state, we remain dangerously close to crisis standards of care." And according to the Associated Press, public health officials are warning that health care rationing may soon spread statewide.

    According to the DHW release, the standards will remain until there are "sufficient resources to provide the usual standard of care to all patients." (Saric, Axios, 9/8; Idaho Department of Health and Welfare release, 9/7; PBS News Hour, 9/8; Boone, Associated Press, 9/9; Gonzalez, Axios, 9/1)

    How much worse will the 'delta surge' get? Watch these 7 factors.

    looking aheadJust how worried should you be about the delta variant? Advisory Board's Yulan Egan takes a deep dive into this question, detailing seven factors you should watch closely (and two to ignore) to determine just how deadly and disruptive the variant will prove to be.

    Read the latest take

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