October 5, 2021

'Choices we never wanted to make': How overwhelmed Alaska hospitals are rationing care

Daily Briefing

    Overwhelmed by a recent surge in Covid-19 cases, Alaska has activated crisis standards of care for 20 hospitals in the state, allowing them to ration care as they struggle with limited staff and resources and an inability to transfer patients.

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    Hospitals in Alaska struggle amid Covid-19 surge

    Over the past few weeks, Covid-19 cases in Alaska have increased by 72%, the highest increase in the country, NBC News reports. From Sept. 22 to Sept. 29, one in 84 people were diagnosed with Covid-19, according to data Johns Hopkins University Center for Systems Science and Engineering. The state with the next highest Covid-19 case rate was West Virginia with one in 164 people.

    "If Alaska were a country, it would be the nation with the world's highest per-capita case rate," Alaska Sen. Lisa Murkowski (R) said last week.

    This surge in Covid-19 cases has put further strain on Alaska's already sparse health care system, NBC News reports. According to the Kaiser Family Foundation, the state only has 1.8 ICU beds per 10,000 people, making it the third lowest in the nation behind Hawaii and Vermont.

    In addition, Anne Zink, CMO of the Alaska Department of Health and Social Services, said the sheer geographic size of Alaska makes it difficult to transfer patients for care—a problem hospitals faced even before the pandemic.

    "It's not just about driving down the street or even driving two or three hours to an [ED] hospital," Zink said. "This is multiple flights and sometimes takes days to be able to get to any hospitals."

    Some hospitals activate crisis standards of care

    On Saturday, the Alaska Department of Health and Social Services activated crisis standards of care for 20 health care facilities, including those that had already implemented crisis protocols, Axios reports—a similar move employed by Idaho last month.

    According to a statement from the state health department, several factors led the state to activate crisis standards of care, including limited medical supplies, a lack of adequate staff, and difficulty transferring patients due to a limited number of available beds.

    Providence Alaska Medical Center, the state's largest hospital, has had to limit the number of transfer patients it can accept from rural hospitals due to a lack of ICU beds and has begun using a triage team to make decisions about rationing care, the Wall Street Journal reports.

    According to Michael Bernstein, Providence's CMO, the triage team has had to make decisions about how to ration care in at least eight cases so far.

    "We have the most highly sophisticated medicine and advanced training in the world, and we're having to ration care," Javid Kamali, an intensive-care doctor at Providence, said.

    According to the Journal, in one situation the triage team had to decide between two critically ill Covid-19 patients for the use of a single specialized dialysis machine. The patient who had to wait for the machine later died.

    "We're making choices we never wanted to make," Bernstein said.

    Fairbanks Memorial Hospital also activated its own crisis protocols last week due to a shortage of beds, workers, and monoclonal antibody treatments, along with an inability to transfer patients.

    "The move to crisis standards of care is not something we take lightly," Angelique Ramirez, Fairbanks' CMO, said. "This is in response to a very serious surge of Covid in our community."

    "This impacts all patient care, those with broken bones, traumas, heart attacks, strokes, Covid, anyone needing medical care," Ramirez added. "The care we are able to provide is highly fluid and can change day by day and even hour by hour depending on the availability of resources within our system and stateside."

    "Today's action recognizes that Alaska has an interconnected and interdependent health care system, requiring the need for activation of the state's decision-making framework," the state health department said. "That framework includes a progression of conventional, contingency and crisis standards."

    Heidi Hedberg, director of Alaska's Division of Public Health, said health officials are working to provide state and federal resources to health care facilities across the state and encouraged people to take measures to prevent coronavirus infection.

    "Please get vaccinated if you have not done so already, wear a mask when needed and keep your social circles small," Hedberg said. "Every action you take helps prevent COVID-19 from spreading and protects you, your family, other Alaskans and our health care system. No one wants to use crisis standards of care guidelines." (Lee/Kesslen, NBC News, 9/29; Saric, Axios, 10/3; Frosch/Evans, Wall Street Journal, 10/3; AP/Modern Healthcare, 10/3; Alaska Department of Health and Social Services release, 10/2)

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