Copyright © 2021 Albuquerque Journal
SANTA FE – New Mexico activated crisis standards of care for its hospital system – a step intended to aid the rationing of care amid a shortage of intensive care beds and nurses.
The state Department of Health issued the order Monday, expanding certain legal protections for doctors asked to work outside their normal area of practice.
The declaration also will help standardize the decision-making for who gets an ICU bed or similar medical resource when the demand outstrips the supply, state officials said.
The order leaves it up to each hospital system to decide when to engage crisis standards.
But some intensive care units in New Mexico are operating at 117% to 150% of normal capacity, according to the Department of Health.
“Health care workers, especially nurses, are just getting crushed in this environment,” Jennifer Vosburgh, associate chief nursing officer at the University of New Mexico Hospital, said in a public briefing.
Activation of the crisis standards comes after health officials and hospital leaders have repeatedly warned of high patient volumes at hospitals in New Mexico, exacerbated by the number of COVID-19 patients.
But coronavirus patients are just one factor in the full hospitals, they said. Health care providers say they are treating more patients for all kinds of conditions – partly because many delayed seeking health care earlier in the pandemic and they are now showing up sicker, requiring emergency care or hospitalization.
“We are in a crisis right now in the state of New Mexico,” Vosburgh said. “We need to get control of our COVID cases immediately.”
Acting state Health Secretary David Scrase, a geriatrician, said New Mexico has hit a six-week plateau in cases after a late-summer surge driven by the highly contagious delta variant.
“Unfortunately,” he said, “we are stuck at a level of a disease in New Mexico … that is more than our hospital system can currently handle.”
The state on Monday reported 1,895 new cases of COVID-19 for the past three days and 12 deaths. The statewide COVID-19 death toll is now 4,942.
The number of COVID-19 patients hospitalized for the disease – about 300 on Monday – is far less than during the wintertime peak last year, Scrase said, but hospitals are as crowded as ever because of an increase in people seeking care for other conditions.
“We’re in tough shape right now in New Mexico,” Scrase said.
The declaration of crisis standards, he said, is intended to standardize and ensure equity as health care providers face a scarcity of resources.
An analytical tool that evaluates a patient’s chance of survival, for example, will be used to guide the rationing of care, Scrase said, not any consideration of a patient’s age or ethnic background.
New Mexico has had a long-standing shortage of doctors and a limited supply of hospital beds. But the pandemic, health officials say, has made it even harder to recruit traveling nurses and contributed to burnout among local health care providers, some of whom have left the profession.
Republican legislators have also assailed Democratic Gov. Michelle Lujan Grisham’s decision to impose a vaccine mandate on hospital workers, describing it as a factor further stressing the health care workforce.
The governor contends the mandate helps protect patients and makes hospitals safer.
The five-page order issued Monday outlines a number of steps intended to bolster legal protections for doctors and other practitioners called on to work outside their normal area of practice to help address the crush of patients. The state can extend its own legal liability coverage to providers who move to higher levels of care.
Before a hospital engages crisis standards of care, it must temporarily suspend procedures that aren’t medically necessary. But Scrase said hospitals have flexibility to determine what is or isn’t necessary.
The state last invoked crisis standards of care in December.
This time, Vosburgh said, health care providers are already making tough calls as the demand for beds sometimes outstrips the supply.
“As nursing leaders,” she said, “we are struggling, we are frustrated, and we often find ourselves in the position of trying to make the least-bad decision we can.”
In some cases, Vosburgh said, hospitals share ventilators and take other steps to level out the workload, but in others, the state’s “hub hospitals” have to report that no beds are available when another hospital calls.
Sometimes, she said, by the time a bed is available, the patient has already died.