As Hawaii heads into what’s anticipated to be the worst months of the delta surge, health officials said they hope state and local health care systems do not have to enact “crisis standards of care,” a last-resort plan for rationing medical care during catastrophes that was made possible last week by a state executive order.
In New York, for example, ambulances were so overwhelmed at the start of the pandemic that they couldn’t pick up every patient, forcing staff to decide who would get help and who would be left to possibly die at home, Hilton Raethel, president and CEO of the nonprofit Healthcare Association of Hawaii, said Tuesday.
Gov. David Ige’s executive order signed Sept. 1 gives immunity to health care facilities — barring misconduct, gross negligence or recklessness — during the COVID-19 pandemic. It is similar to the sixth supplementary proclamation signed by Ige in March 2020 and sets the framework for health care rationing.
Maui Health System CEO Mike Rembis said Tuesday that employees at Maui’s only acute care hospital are stretched — but “it’s not at an emergency situation yet.”
Rembis added that he hopes Maui Memorial Medical Center and other facilities that Maui Health oversees will not reach the point of enacting crisis standards.
“The governor is following what a lot of other states have done to put something in place so that if we do go there, we’re prepared for it and we can appropriately take care of our patients,” Rembis said. “We’ve never had to do that on Maui and we don’t want to ever be in the place where we have to do it.”
Maui Memorial Medical Center is licensed for 219 beds and is able to move to 300 beds if needed, hospital officials have said. On Tuesday, there were 198 patients at Maui Memorial. Of those, 32 were hospitalized for COVID-19 — 27 unvaccinated, five vaccinated, two in the ICU and one on a ventilator.
“We have capacity,” Rembis said. “We have never been in a situation where we can’t take care of any patient that presents themselves. We’ve never been in that situation.”
Rembis also reassured residents that there has never been a full cancellation of elective surgeries and most of them continue. At times, some physicians are asked to postpone a procedure a day or two.
Idaho leaders announced Tuesday that severe staffing shortages, lack of available beds and massive hospitalizations have led to health care rationing at 10 hospitals and health care systems, the Associated Press reported. Under “crisis standards of care” designations, their new goal is to extend care to as many patients as possible and to save as many lives as possible.
Raethel said that within Hawaii, acute care hospital leaders and industry officials have been working for more than a year on contingency plans in the event of a catastrophe during the ongoing crisis of the pandemic.
He leads a trade association that represents more than 170 health care organizations, including most of the state’s hospitals, skilled nursing facilities, assisted living facilities, home care agencies and hospices.
“As part of our planning, which is what all emergency planners do is look at worst-case scenarios, we decided to develop these crisis standards of care, and it was done with a huge amount of thought and consideration,” Raethel said.
Once developed, the guidelines were approved by acute care leadership, and shared with the Hawaii Emergency Management Agency, the state Department of Health and the Governor’s Office, who signed off.
“Crisis standards of care” refers specifically to what happens if resources run out in Hawaii, Raethel noted.
Thankfully, the crisis standards were not enacted last year, Raethel said.
Now Hawaii’s infection rate is many times higher than it was last year, however.
Health officials have said they anticipate September and October to see the highest volume of COVID-19 cases, driven by the highly transmissible delta variant. Further complicating health systems are oxygen supply shortages, nationwide and statewide health care staffing shortages and available bed capacities.
ICU capacity this fall will be under “extreme stress” in Hawaii, Tennessee, Kentucky, Indiana, Georgia, Delaware and Wisconsin, according to the latest modeling from the Institute for Health Metrics and Evaluation at the University of Washington. “Extreme stress” means that 60 percent or more of ICU beds will be occupied by COVID-19 patients.
The move to “crisis standards of care” was considered but evaded during the H1N1 pandemic, Dr. Sarah Kemble, state epidemiologist, said on Tuesday.
“I think what you’re raising is exactly the reason why we’re still not out of the woods,” she said during a news conference Tuesday. “We’re still facing a situation — a dire situation in the state — where many of our health systems are overwhelmed or overtaxed and saying they can’t keep this up for much longer.”
* Kehaulani Cerizo can be reached at [email protected]