In a sleek, modern building on Albuquerque’s north side, hospital executives and top state officials hunker down in situation rooms.
Directors are on the phone, calling dozens of regional medical providers to devise game plans for a rapid spike in cases. Meanwhile, other officials assemble a massive coronavirus call center that will allow them to get information and give it in real time.
It’s all being done with utmost urgency, because this isn’t a drill.
Welcome to the command center for the Medical Advisory Team, a group of more than 100 officials and experts set up by the New Mexico Department of Health to stretch the capacity of the state’s health care system as far as it can go during the COVID-19 crisis.
The members of this team, many the most important players in New Mexico medicine, in normal times would be competing with one another, often looking for any edge they could find in a sometimes contentious industry.
But the pandemic has forced a different approach. The people in this group must hastily work to knit together a cohesive medical system — and in some cases, a framework to govern the most difficult decisions a doctor can make — that can withstand the coming waves of COVID-19 patients.
Their work touches on almost all parts of the crisis, including the most pressing and sensitive. Who lives and who dies in a triage situation? How does the state find enough hospital beds when it’s still projected to be more than 1,000 short?
In a series of interviews with The New Mexican last week, key members of the team laid out exactly how they’re going about these huge tasks — and what they hope to accomplish.
“All hands on deck,” said Clay Holderman, a Medical Advisory Team member and the executive vice president and chief operating officer at Presbyterian Healthcare Services.
A few weeks ago, after some 2,000 care managers, financial analysts and other employees vacated Presbyterian’s Cooper Center near Balloon Fiesta Park to work from home, the state’s largest health care provider converted the empty administrative building into mission control for the newly formed advisory team.
Soon, top officials, including state Human Services Secretary David Scrase and directors of major New Mexico hospitals, were invited to “embed” there, Holderman said — while keeping 6 feet of distance from one another, of course.
Joining them was Dr. Michael Richards, vice chancellor for clinical affairs at the University of New Mexico Health System, who was tapped to lead the effort.
One of the effort’s main subgroups, the health system advisory group led by Holderman, is in charge of adapting the state’s existing emergency health care plan to the COVID-19 crisis. That includes organizing the state’s 42 hospitals into a “hub-and-spoke” model.
The goal, Holderman said, is to reduce the number of patients who will need to be transported to Albuquerque during the surge. To do that, the team is expanding intensive care capacity at regional hospitals so severe COVID-19 patients can be treated there instead.
For instance, Memorial Medical Center in Las Cruces has become the “hub” for the south-central part of the state, and it will receive critical COVID-19 patients from “spoke” hospitals in Alamogordo, Truth or Consequences, Silver City and Deming.
“I spent a lot of time calling hospital CEOs throughout the state to see what they were experiencing in terms of patient flow but also in terms of their preparation for this event,” said Troy Greer, chief executive officer of Lovelace Medical Center in Albuquerque.
Albuquerque’s major hospitals also are planning to transform certain parts of their facilities into new intensive care units and retrain staff from other areas so they can work in intensive care.
Yet these efforts alone won’t be enough. According to state officials’ most recent projections, New Mexico could still need an additional 687 general hospital beds, 1,232 ICU beds and 732 ventilators during the peak of the surge, expected sometime in May.
Some help is on the way. The group is working with the New Mexico National Guard and U.S. Army Corps of Engineers to assemble temporary hospitals: a new, 200-bed facility at the former Lovelace hospital site in Albuquerque, 50-bed field medical stations in Gallup and Farmington, plus a U.S. Army field hospital promised by the federal government.
“That’s a big part of making more ICU beds available,” Holderman said.
Additionally, Albuquerque’s three major hospitals are combining their respective call centers into one to better coordinate patient care during the surge.
But what happens if the state still doesn’t have enough ICU beds and ventilators during the peak?
The answer falls into a subgroup called the ethics team — perhaps the least understood and potentially most controversial part of the mission.
Led by Robert Schwartz, an emeritus professor of law at UNM, a subgroup of medical ethicists has been having deep, philosophical discussions for hours about what to do if doctors face a terrible choice: which patients get those lifesaving resources if there aren’t enough to go around.
“Those are the kinds of decisions that it’s important to make, I think, really thoughtfully and from some distance of the actual case,” said Schwartz, a nationally recognized scholar in bioethics.
Such determinations — who lives, who doesn’t — are difficult to make, even in theory.
One way of solving the dilemma could be to allocate scarce resources based on age — giving them to the young over the elderly. But the ethics group, which also includes a psychiatrist, a critical care doctor and a health consultant, has mostly tossed out that option.
“Really, that is a distinction that ends up in many cases hiding straight age discrimination,” Schwartz said. “We decided we couldn’t use that criterion.”
Another possibility might be to look at dependents — perhaps prioritizing those who have children over those who don’t. But the group also thought it unfair to discriminate in a life-and-death decision against people who made a personal choice not to have kids or were unable to.
So what’s left? While the group has yet to make a definitive decision, the most likely conclusion at the moment would be to use medical criteria. In other words, people who are most likely to have their life saved by a ventilator would get one, Schwartz said.
Schwartz said a complicating factor for ethicists is timing: There’s no precedent similar to the current crisis that has occurred during their lifetimes.
“It’s really interesting we have nothing within our own experience that we can look to,” he said, noting ethicists are reading about the most obvious parallel, the Spanish flu of 1918.
Once the group finalizes its recommendations, they’ll likely be added to the state’s emergency medical document, known as the New Mexico Crisis Standards of Care Plan.
They also could be adopted into regulations by a state agency at some point, but no decision has been made about that yet, Schwartz said.
For now, and likely through the peak of the crisis in New Mexico, Schwartz’s group and the rest of the advisory team continue to work around the clock on the emergency planning, and in some cases are already putting those plans into practice.
Meanwhile, the members of the team still have their workload from their regular jobs — in many cases also heightened by the crisis. Trying to balance both can mean people barely see their families.
“We do have to meet this challenge, we do have to give the extra time and we do have to make some sacrifices,” Greer of Lovelace said. “Our caregivers who are heroes every day — they’re willing to make sacrifices and risk their own health to care for our own community. So, to complain about an administrative function is just not acceptable.”