Idaho crisis impacts Washington hospitals’ ability to care for patients

As the state of Idaho goes fully into crisis standards of care, Washington hospitals are feeling the impact.

Crisis standards of care is a medical designation given typically during a disaster event, when there are not enough resources to care for everyone with serious medical needs. Lifesaving treatment must be rationed, given to those with the greatest chance of survival.

How would crisis standards of care be enacted in Washington — and at what point?

North Idaho went into crisis standards of care last week, with the entire state following on Thursday. Alaska’s largest hospital has also started to implement those crisis measures.

Washington itself has not made that decision, but it is getting close. It’s not a decision that is days away, but perhaps weeks, said Cassie Sauer, CEO of the Washington State Hospital Association. She said people may not realize how fragile the situation is in Washington, thinking the problems are confined just to those other states. In reality though, Washington is the next state over for hospitals in Idaho and Alaska with no room for their own patients.

“We’re now surrounded by states that are in this space, so we don’t want to be there … because it’s terrible,” Sauer said. “It means that you choose who has the best chance of survival. And those who don’t have as great a chance of survival do not receive treatment.”

At the moment, Washington hospitals aren’t accepting as many Idaho patients as previously due to a lack of room. Dr. Dan Getz, chief medical officer of Providence Holy Family and Sacred Heart Medical Centers in Spokane, said Eastern Washington hospitals are used to taking transfers from nearby Idaho in normal times.

“Historically, we’re roughly able to accept 90% of the requests from our areas for transfer of patients into our facility,” Getz said at a briefing earlier this week. “And now we’re struggling to accept half of those patients.”

Still, it is not possible for Washington hospitals to shut their doors to Idaho and prioritize the state’s own residents. Federal law requires the hospitals to take a transfer from out of state if they do have space.

“Hospitals are obligated to take transfers if they can, and so it really depends on what the capacity looks like in Washington state,” Sauer said. “You can’t reserve space for your own patients if you can take a patient who’s in critical need from another state.”

That means an additional burden as Washington is already having trouble finding places for its own transfers from small, rural hospitals to large, urban ones. Dr. Steve Mitchell, founder of the Washington Medical Coordination Center, said earlier this week at the Washington State Department of Health’s briefing that the center had received 1,000 transfer requests since July from small hospitals that haven’t been able to find a place for people needing to go to bigger, more specialized facilities.

As a result, people with strokes, appendicitis, and other fatal conditions are being forced to wait for care — sometimes at the expense of their health.

“We in this country are so accustomed to, you have a stroke, you have a heart attack, you fall off a ladder, you go to the ER, you get treated fast, you get really good care — anybody who walks in the door,” Sauer said.

However, she warned that at the moment that is not the case. She advised that just as important as taking COVID precautions like masking up, getting vaccinated, and avoiding large gatherings is also steering clear of extreme sports or other activities that could put you at risk of an injury.

“If you break your leg and you’re in pain, you may be sitting in the ER for a long time, … and you’re going to be in pretty serious misery while you’re waiting for care,” she said.

Sauer finds it unfair when Washington has done so much against COVID that the state’s own health system has to suffer as a result of overflow from a state that has not put similar COVID precautions into place.

“It’s really challenging to be a state that’s doing so much to prevent COVID and to be neighboring a state that’s not, and then having to essentially bear the brunt of it,” she said.

She begged Idaho’s leadership and residents to rethink their approach to the pandemic.

“We want Idaho to do more. They should have a mask mandate, they should be canceling large events,” Sauer said. “They are not doing what they need to do to prevent the spread of the disease in their state, and it spills over into our state.”

For now, Washington hospitals hold on, trying desperately not to go into crisis standards of care.

Getz said that they are OK on the ventilators for now, but it is other resources he worries about.

“Things like dialysis are becoming exceedingly tight, just traditional ICU space is becoming more difficult,” he said. “I think those would be some of the resources that we could see tipping us into crisis standards.”

Follow @NicoleKIROFM