Overwhelmed Hospitals In New Mexico Consider Rationing Care
NOEL KING, HOST:
OK, now we're going to get a look at what's going on inside of hospitals in New Mexico. Jason Mitchell is a doctor and the chief medical officer for Presbyterian Healthcare Services, which includes New Mexico's largest critical care hospital. Dr. Mitchell is in Albuquerque this morning. He's on Skype. Good morning, sir.
JASON MITCHELL: Good morning. Thanks for having me.
KING: How bad is it in your hospital system? You heard Will Stone there talking about New Mexico. What does it look like?
MITCHELL: I did. You know, we have all pulled together as a community, but our hospitals are awful. We really are pulling out all the stops to make sure people continue to get the excellent care that they deserve.
KING: Do you have enough beds at this point? Do you have enough doctors, enough staff?
MITCHELL: You know, we started planning in March. We started planning before the first case came to New Mexico. We did that because we have some of the fewest beds per capita of any state in the nation. And so we had to plan ahead. And so we've brought in agency nurses. We trained up ambulatory doctors and anesthesiologists on all the systems they need to come in. We set up volunteer lists of people that are willing to come into the hospital. And so we began pulling levers, and we pulled those levers. In one of our hospitals, we have increased our ICU by 50% in size without sacrificing the care in there. That said, we have pulled every lever we can, and now we truly are full at this point.
KING: Would you say this is worse, Dr. Mitchell, than what New Mexico saw over the summer?
MITCHELL: Yeah, it really was. If you look at what our state did is - we pulled together. We did the right things, and we missed the spring surge. We prevented that summer surge. But this fall and winter, we really began to spike, and that's led to this. Fortunately, if you look at those numbers, the most recent governor's orders, we've seen the growth rate become negative, meaning it's actually getting better. Unfortunately, hospitalizations tail that by two to three weeks.
MITCHELL: So we anticipate our spike of patients coming in around December 17 and then hanging on for a few weeks before it begins to drop down to a tolerable level.
KING: All right, so we know that health authorities in New Mexico are talking about rationing care. Can you explain to us what that means? What are doctors considering? What kind of decisions will have to be made?
MITCHELL: Yeah, you know, it's really important to know that each doctor doesn't do that alone, and each system doesn't do it alone. But as a state, we came together - the health care system, ethicists, public health folks, community folks came together - and we actually put together scoring systems, rules and philosophies around making sure that it's equitable if we have to ration. So we've got a unified approach of the state. The other thing that allowed us to do is to plan ahead with regards to other levers to pull - so bringing in people from different specialties into the hospital that maybe don't practice there, changing nursing staffing ratios, having patients in tents or hall stretchers or two patients in one ICU room even.
So we begin to work through these scarce resources with the goal of never having to decline care. But it can come to the point where you truly are out of resources and the rationing occurs. Everyone thinks of the most dramatic thing, of running out of ventilators, but it really may be that we just don't have enough staff, and you're not getting cared for by the normal clinicians that would care for you.
KING: And then what happens? Do you at some point say to people - again, this is the worst-case scenario - but do you at some point say to people, do not come in to the hospital? Do you have them waiting in hallways? What does this look like?
MITCHELL: What happens is, as you go into those stages and there's a specific resource that you need, then you begin scoring all the patients in a very objective way. So everyone gets the same scoring. And it's really looking at how can you save as many lives as possible with that resource. And based on that scoring, it goes to a triage group and a triage officer that follows that statewide scoring, and then you decide who gets the resource and who does not get the resource. But it's not based on things like age or gender or anything like that. It really is based on survivability, and it's done in a very equitable way.
KING: OK. This week, some good news - the U.S. could approve its first COVID vaccine. Do you have any sense of how many doses are coming to your hospital system?
MITCHELL: You know, the vaccines will come to New Mexico, and I believe the first lots in New Mexico is about 17,500, and we'll get a portion of that.
MITCHELL: But then you'll see additional doses rolling in. And so I am very excited about beginning to vaccinate our workforce, vaccinate everyone in New Mexico. I mean, that's really how we get past this, is vaccination.
KING: OK. Dr. Jason Mitchell is the chief medical officer for Presbyterian Healthcare Services, which operates nine hospitals in New Mexico. Dr. Mitchell, thank you so much for taking the time. We appreciate it.
MITCHELL: Thanks for having me. Take care.
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