The state Department of Health announced a new public health order that allows its beleaguered health care facilities to transition to crisis standards of care, which provide for the rationing of treatment amid a double-whammy of COVID-19 cases and an ongoing shortage of hospital staff.
The order announced Monday creates what officials called a “standardized and equitable” process for determining patient priority for treatment when beds are limited.
“At the core of this is the lack of nurses to provide direct nursing care to patients in ICUs and general medical surge floors,” Dr. David Scrase, acting health secretary, said during a virtual news briefing.
But other factors are also at play, including a large number of patients flooding hospitals with non-COVID-related illnesses, he said
“We could talk for a long time about whether this very large number of very sick people who don’t have COVID is related to the pandemic or not,” Scrase said. “Most of us think it is. Most of us think that this unprecedented increase in how sick just the non-COVID patients are is related to delays in care.”
The state’s decision to enact crisis standards of care, the second time since the start of the pandemic, doesn’t mean every hospital will make the move.
“It isn’t every facility in the state [that] all at once goes into this,” Scrase said. “But a single hospital may invoke crisis standards of care for a period of time because they’re not able to handle the volume of patients or the complexity of patients.”
Dr. David Gonzales, chief medical officer at Christus St. Vincent Regional Medical Center, said the hospital is not at that point.
“Fortunately, we’ve been able to meet the needs of the community, both COVID and non-COVID, being very efficient in the care that we’ve given,” he said. “But we do realize that what the state has offered today is a tool for other institutions who are in a different situation than we are.”
Jennifer Vosburgh, associate chief nursing officer at the University of New Mexico Hospital, said while the number of COVID-19 cases and hospitalizations isn’t as high as they were in winter “thanks to the mask mandate and vaccines,” most hospitals never got a reprieve from previous spikes.
“During the winter surge … [the state call and transfer center] was always able to place the ICU-level patient,” she said. “Sometimes it took a little longer than others, but we always were able to say, ‘Yes, we will find you a bed.’ This surge is not like that. We are often finding ourselves saying, ‘No, we don’t have a bed. I’m so sorry. Please call back tomorrow.’ “
Sometimes, it’s too late.
Vosburgh said nurses at the call center try to follow up every 24 hours on calls they receive.
“Oftentimes, when they call and say, ‘Hey, were you ever able to find a bed?’ The answer is, ‘No.’ And often it is, ‘And the patient died,’ “ she said. “This is very, very distressing for our staff and for all of the health care workers in the facilities that can’t provide the care that they were trained to do.”
Vosburgh said New Mexico is in a “crisis.”
“We need to get control of our COVID cases immediately,” she said.
The Department of Health said the pandemic has placed an enormous and unsustainable strain on the state’s health care system.
“In particular, the volume of COVID-19 patients — almost all of whom are unvaccinated — have exacerbated existing staffing and other resource shortages,” the department said in a news release.
“Hospitals and providers are already faced with difficult choices about who gets care. Now, under [crisis standards of care], facilities statewide will use a more standardized and equitable procedure for making those decisions,” the department said, adding the state “will extend limited legal liability coverage to providers” using crisis standards of care.
Before a health care facility invokes crisis standards of care, it must temporarily suspend procedures that aren’t considered medically necessary.
Laura Parajón, deputy secretary for the Department of Health, said more than 81 percent of the state’s residents 18 and over and 62 percent of young people between the ages of 12 and 17 have received at least one dose of the vaccine.
“We continue to slowly but surely increase the number of New Mexicans fully vaccinated,” she said, adding 71.6 percent of adults and 53.5 percent of 12- to 17-year-olds are fully vaccinated and 5.3 percent of residents have received a booster dose.
“I think the next part of this pandemic is up to us as a community, as a state, as to how much we all decide to get vaccinated and try to end this pandemic,” she said. “We have the science now. We know how to fight this with the vaccine. So to me, it’s about how we think about as a community coming together and getting vaccinated to prevent more hospitalizations, more deaths, more difficulties in the hospitals.”
The state on Monday reported 1,895 new cases since Saturday and 12 additional deaths, for a total death toll of 4,942 residents.
“Sadly,” Scrase said, “this week we will in all likelihood surpass 5,000 deaths.”