Alaska’s largest hospital is now implementing crisis standards and rationing medical care and treatments amid a crush of COVID-19 patients that’s forced providers to prioritize patients most likely to recover.
Providence Alaska Medical Center’s chief of staff announced the decision in a two-page letter Tuesday that urges Alaskans to wear masks regardless of their vaccination status, get tested, get vaccinated if eligible and avoid potentially dangerous activities or situations that could result in hospitalization.
“We’re out of beds. Life saving measures are not going to be possible in every case,” said Dr. Leslie Gonsette, an internal medicine hospitalist and member of Providence’s executive committee board who helped draft the letter. “And that’s what we’re trying to emphasize.”
The letter describes an emergency room overflowing with patients who must wait in their cars for hours and heart attack patients sometimes denied timely care that can save lives. Providence now often declines transfer requests from outlying rural hospitals trying to move accident or stroke victims and has instituted a strict no-visitor policy except for non-COVID patients who are dying.
Some elective procedures, a category that can include tumor removals or heart valve replacements, have been delayed for months and be continue to be postponed.
“People from around Alaska depend on Providence to provide medical care for people statewide. Unfortunately we are unable to continue to meet this need; we no longer have the staff, the space, or the beds,” Providence chief of staff Dr. Kristen Solana Walkinshaw wrote on behalf of the hospital’s medical executive committee, about 1,000 doctors, nurse practitioners and physician assistants.
If people need specialty care at Providence — a cardiologist, trauma surgeon or neurosurgeon — “we sadly may not have room now. There are no more staffed beds left.”
Gov. Mike Dunleavy on Tuesday urged more Alaskans to get vaccinated against COVID-19. The state reported seven more deaths linked to the virus, near-record hospitalizations and nearly 700 new cases.
Dunleavy allowed the state’s COVID-19 emergency declaration to expire in April and last week declined to declare another, instead submitting bills to restore lost telehealth options and streamline health-care worker background checks. The legislation died in the Alaska House after it lost support when a Sunday-night vote added an amendment that could have prevented hospitals from limiting patient visits.
Anchorage Mayor Dave Bronson last week said he will not ask residents to get vaccinated, issue a mask mandate or order other COVID-19 restrictions. Bronson also said hospital capacity issues weren’t caused by COVID-19 patients but nurses leaving their jobs over vaccination requirements.
“Nurses here are not leaving because of the vaccine mandates. They’re leaving because they’re overwhelmed by the emotional toll it’s taking,” Gonsette, the Providence hospitalist, said in an interview Tuesday. “Part of it, we all feel it, is because we are not heard. The public either wants to bury their head in the sand or maybe some of them really don’t know what’s going on. Those are the ones we’re trying to reach.”
Rising case rates mean it’s likely COVID-19 hospitalizations will escalate in the next two to four weeks, the letter says. “What is already a stressful situation could rapidly progress to a catastrophe.”
The hospital is “no longer able to provide the standard of care to each and every patient who needs our help,” it continues. “The acuity and number of patients now exceeds our resources and our ability to staff beds with skilled caregivers, like nurses and respiratory therapists. We have been forced within our hospital to implement crisis standards of care.”
More than 30% of the adults hospitalized at Providence were COVID-positive as of Tuesday. Patients with the virus demand more time-consuming care than most others, providers say.
The shift to crisis standards means the hospital must “prioritize scarce resources and treatments to those patients who have the potential to benefit most,” the letter states. That means enacting policies and procedures to ration care and treatments including dialysis and specialized ventilatory support.
The hospital developed its crisis standards of care at the start of the pandemic in March 2020, according to Gonsette. Last week, Providence stood up a triage ethics committee to help physicians facing “difficult decisions”, she said. The executive committee board decided to issue the letter during an emergency meeting Sunday.
Rationing care does not mean denying care for unvaccinated people, Gonsette said. Rather, it involves decisions based on where limited resources go and who benefits the most.
[Read the letter: How you can keep stress off of Alaska’s overburdened hospitals]
Providence issued a statement Tuesday after the letter surfaced saying “the current demands on acute care in our hospital and in the state of Alaska are exceeding available capacity and are requiring difficult choices regarding allocation of specific life-sustaining treatments or resources and regarding patient transfers to higher levels of care. As a result of this situation, providers and health care facilities are currently experiencing limitations in their ability to provide the standard of care that we wish to provide to our community and normally expect to provide. This situation may persist for some time, which has required us to use processes developed to ensure the most equitable allocation of limited resources.”
It wasn’t immediately clear if Anchorage’s other two main hospitals planned to follow suit.
Idaho public health leaders announced last week that they activated crisis standards of care allowing health care rationing for the state’s northern hospitals because there are more coronavirus patients than the institutions can handle.
State health officials last week said they were talking with hospitals about what resources they needed as well as other states, including Idaho.