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Patient Care

Hospitals at Capacity, New Mexico Eyes Rationing Care

The Santa Fe New Mexican

As officials of New Mexico's largest hospitals await guidance on whether to implement "crisis care" standards — an action that could lead to a rationing of care as COVID-19 continues to overwhelm the health care system — they reiterated their facilities are at capacity and staffing remains a challenge.

They may learn more Tuesday, when state Human Services Department Secretary David Scrase  gives an update on the proposed standards of care. Crisis care refers to a set of standards that help determine which patients receive medical resources, based on likelihood of survival.

Gov. Michelle Lujan Grisham on Friday issued an executive order that, among other measures, asks the state's Medical Advisory Team to make a recommendation on whether and when crisis care standards should be implemented. In an interview last week, she suggested the state may have to implement the plan to deal with an explosion of cases that have put more than 900 New Mexicans in the hospital in recent weeks.

On Monday, the state said 935 people were hospitalized with COVID-19.

Alleviating the stress on the state's health care system now falls on New Mexico residents, officials said at a Monday news conference, during which they beseeched people to follow COVID-19 safe practices.

"Please, please don't put us in that position to have to ration care," said Dr. Irene Agostini, chief medical officer for University of New Mexico Hospital. "Those decisions are awful."

Hospital leaders have been working to define procedures for the possible implementation of prioritizing care since the crisis slammed the state in March, said Dr. Jeff Salvon-Harman, medical director of infection control at Presbyterian Healthcare Services.

Those procedures are still being worked out, Agostinia said, as each facility develops its own triage care oversight board to discuss, "If we have to get there, how do we do that?"

In the interim, the state's health care system is working to find more beds for COVID-19 patients and maintain necessary staffing levels to deal with the pandemic — the likes of which has not been experienced in over a century, since the so-called Spanish flu epidemic of 1918-20.

According to the state Department of Health, 88 percent of the state's intensive care unit beds are full. But other challenges exist that make controlling the virus a challenge, said Lovelace Chief Medical Officer Vesta Sandoval.

"It may not just be beds," she said. "It may be staffing constraints or additional equipment or whatever it may be."

The hospitals are working to expand patient capacity by putting beds in clinical areas not normally set up for patients and by moving some patients well enough to recover at home into an outpatient program.

The officials said they are hiring traveling nurses, who work short-term jobs at hospitals around the country, to fill those gaps. Lovelace hired 130 of those professionals, Presbyterian 200 and UNM Hospital 300.

Salvon-Harman said one source of hope is the news that New Mexico expects a shipment of 17,550 doses of Pfizer's coronavirus vaccine by the end of the calendar year. Assuming the U.S. Food and Drug Administration authorizes the emergency use of that vaccine, those doses will first go to health care workers dealing with COVID-19 patients, he said.

"It's an added layer of defense, an added layer of body armor, if you will," for those workers, he said.

As it is, he said, Presbyterian has experienced "a couple of losses" of health care workers to the virus. He said contact tracing procedures indicate "community acquired infections are a big driver of workforce infections."

Dr. Gurdeep Singh, interim chief medical officer for UNM's Sandoval Regional Medical Center, said while his facility has not reported any worker deaths from COVID-19 "the vast amount of transmission [to health care workers] is from the community."

He and Salvon-Harman said personal protection gear is helping to keep those workers safe on the job.

The hospital leaders say New Mexicans should stay home for the holidays.

Salvon-Harman said while it is "heartbreaking" to not be able to spend time with your loved ones, it is also safer.

The bottom line, he said, is "it's better to speak with them on the phone or speak to them via FaceTime or any online chat platform rather than to attend their funeral."

 

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