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Idaho hospitals begin rationing health care amid COVID surge

Jack Kingsley R.N. attended to a COVID-19 patient in the medical intensive care unit at St. Luke's Boise Medical Center on Aug. 31 in Boise, Idaho. Idaho public health leaders have activated "crisis standards of care" for the state's northern hospitals because there are more coronavirus patients than the institutions can handle. The Idaho Department of Health and Welfare made the announcement Tuesday, Sept. 7.
Jack Kingsley R.N. attended to a COVID-19 patient in the medical intensive care unit at St. Luke's Boise Medical Center on Aug. 31 in Boise, Idaho. Idaho public health leaders have activated "crisis standards of care" for the state's northern hospitals because there are more coronavirus patients than the institutions can handle. The Idaho Department of Health and Welfare made the announcement Tuesday, Sept. 7.Kyle Green/Associated Press

BOISE — Idaho public health leaders revealed Tuesday that they activated “crisis standards of care” allowing health care rationing for the state’s northern hospitals because there are more coronavirus patients than the institutions can handle.

The Idaho Department of Health and Welfare quietly enacted the move Monday and publicly announced it in a statement Tuesday morning — warning residents that they may not get the care they would normally expect if they need to be hospitalized.

The move came as the state’s confirmed coronavirus cases skyrocketed in recent weeks. Idaho has one of the lowest vaccination rates in the nation.

The state health agency cited “a severe shortage of staffing and available beds in the northern area of the state caused by a massive increase in patients with COVID-19 who require hospitalization.”

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The designation includes 10 hospitals and health care systems in the Idaho panhandle and in north-central Idaho. The agency said its goal is to extend care to as many patients as possible and to save as many lives as possible.

The move allows hospitals to allot scarce resources, including intensive care units, to patients most likely to survive.

Other patients will still receive care, but they may be placed in hospital classrooms or conference rooms rather than traditional hospital rooms or go without some life-saving medical equipment.

Other states are preparing to take similar measures if needed. Hawaii Governor David Ige quietly signed an order last week releasing hospitals and health care workers from liability if they have to ration health care.

Idaho Department of Health and Welfare Director Dave Jeppesen made the decision to enact the crisis standards about 5 p.m. Monday after the state's Crisis Standards of Care Activation Advisory Committee determined that all other measures taken to help relieve staffing and bed shortages had been exhausted.

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The department waited until Tuesday morning to make the public announcement “out of respect to the hospitals,” department spokeswoman Niki Forbing-Orr said in an e-mail. She did not elaborate or immediately respond to questions seeking more details.

The unfolding crush of patients to Idaho hospitals has been anticipated with dread by the state's heath care providers. Medical experts have said that Idaho could have as many as 30,000 new coronavirus cases a week by mid-September if the current rate of infections lasts.

“This is a decision I was fervently hoping to avoid,” said Jeppesen. “The best tools we have to turn this around is for more people to get vaccinated and to wear masks indoors and in outdoor crowded public places.”

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.

More than 500 people were hospitalized statewide with COVID-19 on Sept. 1 — the most recent data available on the Department of Health and Welfare's website — and more than a third of them were in intensive care unit beds.

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 others have been quarantined because they were exposed to COVID-19.

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

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Two hundred of the federal workers are medical and administrative staffers available through a contract with the US General Services Administration. The US Department of Defense agreed to send a 20-person medical response team to northern Idaho. The Idaho National Guard soldiers will help with logistical support such as screenings and lab work.

On Tuesday, the governor called the move to limit care “an unprecedented and unwanted point in the history of our state.”

Data from the Centers for Disease Control and Prevention show that full vaccination with any of the currently available coronavirus vaccines dramatically reduces the risk of requiring hospitalization for a coronavirus infection.

“More Idahoans need to choose to receive the vaccine so we can minimize the spread of the disease and reduce the number of COVID-19 hospitalizations, many of which involve younger Idahoans and are preventable with safe and effective vaccines,” said Little, who is a Republican.

The state’s crisis guidelines are complex and give hospitals a legal and ethical template to use while rationing care.

Under the guidelines, patients are given priority scores based on a number of factors that affect 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 including 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.

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