Officials: Health care rationing could spread across Idaho

Hospitals during the Pandemic. Photo: Irwan Iwe

BOISE, Idaho — Idaho’s move to “crisis standards of care” is allowing some hospitals to ration health care as they struggle with an onslaught of coronavirus patients, and officials are warning the procedures could spread statewide. But the main hospital affected by the designation was already operating under extreme conditions, officials said.

“Unfortunately we haven’t been really at our normal standards for some time,” said Dr. Robert Scoggins, the chief of staff for Kootenai Health, the largest hospital system in the northern half of the state and located in the city of Coeur d’Alene.

The hospital has had to move patients into a conference center, “doing things that were not normal — way outside of normal — at times,” Scoggins said.

State public health officials warn that the rest of the state is teetering on the edge of health care rationing. Newly confimed coronavirus infection cases are surging and Idaho has one of the lowest vaccination rates in the U.S.

“For the rest of the state, we remain dangerously close to crisis standards of care,” Idaho Department of Health and Welfare Director Dave Jeppesen warned Tuesday.

At Kootenai Health, some patients are being treated in converted lobbies and hallways. Urgent surgeries are on hold and critical care patients must often wait long periods of time for intensive care unit beds, said Scoggins said.

“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,” Scoggins said.

An entire floor of the hospital has been turned into a COVID-19 ward — meaning medical staffers must put on full protective gear before they enter the floor — and the hospital’s conference center has also been converted into a field hospital of sorts.

In one hospital conference center classroom, COVID-19 patients in beds separated by temporary partitions are receiving oxygen. In another classroom, coronavirus patients who aren’t hospitalized are getting monoclonal antibody treatment in hopes of preventing their symptoms from worsening.

While many of the region’s smaller, rural hospitals have not yet had to ration health care, they frequently have no place to send their critically ill patients who would normally be transferred to Kootenai Health.

Hospitals in neighboring Washington state would normally help with the overflow, but they are also full, Jeppesen said.

Peter Mundt, the spokesman for Gritman Medical Center in the Idaho city of Moscow said the institution is struggling to find hospital destinations to transfer patients with serious heart problems and other conditions unrelated to COVID-19.

“Our ability to accommodate non-COVID patients are very strained at this point,” Mundt 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.”

In the city of Lewiston, St. Joseph Regional Medical Center is also operating “at the very edge of our capacity,” spokeswoman Sam Skinner said Tuesday evening.

“Our current situation is worse than it’s ever been,” Skinner said. “As we continue to see the COVID-19 surge in our community, the impact on one hospital can quickly have this rippling effect. Our low community vaccination rates are putting an incredible burden on our community.”

The Idaho Department of Health and Welfare moved northern and north-central Idaho into the crisis designation Monday evening, giving hospitals a legal and ethical template to use while rationing care.

The designation will remain in effect until there are enough resources — including staffing, hospital beds and equipment or a drop in the number of patients — to provide normal levels of treatment to all patients.

Under the guidelines, patients are given priority scores based on a number of factors that impact their likelihood of surviving a health crisis.

Those deemed in most in need of care and most likely to benefit from it are put on priority lists for scarce resources like ICU beds.

Others in dire need but with lower chances of surviving will be given “comfort care” to help keep them pain-free whether they succumb to their illnesses or recover.

Other patients with serious but not life-threatening medical problems will face delays in receiving care until resources are available.

Jeppesen stressed Tuesday that vaccines are the best way to reduce the demand on hospitals. Data from the U.S. Centers for Disease Control and Prevention shows that full vaccination with any of the currently available coronavirus vaccines dramatically reduces the risk of requiring hospitalization for a coronavirus infection.

State health officials have also asked people should not go to emergency rooms for asymptomatic coronavirus tests or other matters that can be handled in doctor’s offices, but said no one should hold off emergency room visits for potentially serious conditions. They warned people people to be prepared to wait for care.

Idaho’s hospitals have struggled to fill empty nursing, housekeeping and other health care positions, in part because some staffers have left because they are burned out by the strain of the pandemic and because others have been quarantined because they were exposed to COVID-19.

Late last month, Little called in 220 medical workers available through federal programs and mobilized 150 Idaho National Guard soldiers to help hospitals cope with the surge.