By Phil McCausland - NBC News
Idaho hospitals are so overwhelmed by rising coronavirus cases that doctors and nurses have to contact dozens of regional hospitals across the West in hopes of finding places to transfer critically ill patients.
Kootenai Health, a hospital in Coeur d'Alene, Idaho, has already converted a conference room into a COVID-19 unit because of the overflow, started paying freelance nurses $ 250 an hour, brought in a military medical unit and has received permission from the state to ration care.
All of this in response to the wave of coronavirus that in recent weeks has gripped much of Idaho, a state with one of the lowest vaccination rates in the country.
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"It's non-stop trying to find a location for these patients and the care they need," said Brian Whitlock, president and CEO of the Idaho Hospital Association, noting that hospitals across the state are struggling with the same problem. .
"We are evaluating minute by minute where there are beds available, and the hospitals do not know where they are going to put the next one."
The need for beds in the ICU is affecting a number of patients: those with coronavirus, as well as people who have suffered heart attacks or strokes or have been involved in accidents, for example.
Before the pandemic, experts said the borders between states in the region were blurred when it came to patient care.
Although many of the states are known for their beautiful landscapes and vast grounds, access to critical healthcare can be difficult for the small rural towns that dot their landscape.
The easiest access to medical treatment may be across a border, rather than within the boundaries of a state.
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However, those state borders have gotten a bit tougher as hospitals struggle to keep beds open for patients within their own state.
Washington state health officials say they are trying to help their neighboring states, but are closely monitoring their own inventory of available beds.
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"We have had to set up patient placement committees with physicians from our various hospitals to really evaluate and prioritize - in conversation with these centers that want to relocate - to really identify who is most at risk of receiving a higher level of care and what. can be managed where they are and what can't be managed where they are, "said Peg Currie, director of operations for Providence Health Care in Spokane, Wash., which is a 40-minute drive from Coeur d ' Alene and Kootenai Health.
It has become an ethical challenge, as Washington has been aggressive in its sanitation measures, while Idaho state leaders have done little to address the latest increase.
Dr. Doug White, director of the Critical Illness Ethics and Decision Making Program at the University of Pittsburgh, said that while Washington health services may feel a moral obligation to help, the need to act rests with the Idaho state government.
"Medical practice is regulated at the state level, public health interventions occur at the state level and, therefore, in an emergency like this, I believe that state lines acquire great importance because what we are seeing are these very marked differences between how Washington state has responded to the pandemic and how Idaho has responded to the pandemic, "he said, noting that Washington's aggressive security measures had some cost to the state.
But the relationships between these hospitals run deep.
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Dr. David Pate, a member of the Idaho coronavirus task force and former president and CEO of Boise's St. Luke's Health System, said that because of the remoteness of Idaho cities from metropolitan areas, Before the pandemic, it was common for doctors to send their patients to cities such as Spokane, Salt Lake City, Seattle, Portland, Oregon, and other distant cities in the region.
It was often necessary to take patients by plane or helicopter and to closely coordinate medical centers.
Now doctors are forced to call 30 or more hospitals in various states to find a single-patient bed in hospitals with which they have little or no relationship.
Some Idaho doctors have called as far south as Texas and as far east as Georgia.
Corrine Brown, an intensive care nurse, administers antiviral medication to a COVID-19 positive patient at the regional medical center in Coeur d'Alene, Idaho, on September 6, 2021. Michael H. Lehman / DVIDS US Navy / via AP
"It takes seven to eight hours to call a bunch of hospitals to see if one accepts your patient who might be facing an urgent emergency. Seven to eight hours can mean that that patient doesn't survive," Pate said.
The relocation challenge has also pressured Idaho to allow its hospitals to set standards of care in the event of a crisis, which means that doctors can classify patients based on bed availability and workers can be recruited. health workers without specific training to work in the ICU.
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For Idaho health leaders, the number of hospital transfers that Kootenai Health had to reject due to the increase in coronavirus cases crystallized the need to change the standards of care.
Kootenai Health, which is a regional transfer center for patients in urgent need of care (typically traffic accidents, heart attacks and strokes), had to reject 392 patient transfer requests in August due to the number of patients of COVID-19.
From July to the end of September last year, they rejected 18 patient transfers.
Kootenai Health is not the only hospital setting these new standards of care, and Northern Idaho is not the only part of the state that could enforce them.
When Idaho declared it would ration care in its northern region last week, the state's director of health and wellness, Dave Jeppesen, called it a "last resort."
He said crisis care regulations are "imminent" for hospitals in the rest of the state as Idaho continues to set new records for hospitalizations and patients in the intensive care unit and on ventilators due to the coronavirus.
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"The numbers are increasing at an alarming rate and we don't see a peak in sight," he said at a briefing on Tuesday.
Under critical care standards, the state allows healthcare providers to make difficult decisions about how to allocate and use scarce medical resources, allowing them to classify patients if necessary.
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Idaho is not alone in pursuing this kind of care.
The Billings Clinic, a 300-bed hospital in Montana, is considering adopting standards of crisis care as its ICU reaches 150% capacity.
Alaska's largest hospital, the Providence Alaska Medical Center in Anchorage, said Tuesday that due to its number of patients, they had been "forced to enforce standards of care in the event of a crisis."
Meanwhile, Wyoming hospitals are rarely equipped with pediatric beds.
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Eric Boley, the president of the state hospital association, said they typically rely on neighboring states to take in critically ill children.
"We don't really have pediatric beds in our state, so we depend on neighboring states to help us with them," he said.
"And we are seeing a huge increase in pediatric cases right now."
It's a frustration for healthcare leaders across the West as they struggle to control this latest increase.
With little indication that it will subside soon, the region's healthcare systems could be on edge in a region of the country that remains highly skeptical of COVID-19 vaccines and mask mandates.
"It doesn't matter what is being believed about the coronavirus right now. What matters is that our healthcare system is at capacity," said Pate of the Idaho coronavirus task force. "I just ask people who collaborate with us for a month, six weeks, to go along with us. Be careful, don't get in a big crowd, wear a mask and please consider getting vaccinated."