ALBUQUERQUE, N.M. (KRQE) – Leaders from Presbyterian Healthcare Services and the University of New Mexico Hospital are addressing a newly enacted “crisis standards of care” (CSC) status for their Albuquerque hospital facilities, as New Mexico continues to deal with a high number of new COVID-19 cases. The new status beginning Thursday in part means “non-medically necessary” procedures are expected to be delayed at the beleaguered facilities for anywhere between 30 to 90 days.
“This (COVID-19 pandemic) has left a very long time and the scale of this has gotten to the point where we’re now having to go to the next step of our overall statewide response,” said Dr. Michael Richards of UNM Health System. “Currently at UNM today, we’re operating at about 140% of our normal operating capacity and we’ve had moments where we’ve approached 150%.”
The new CSC status for the two Albuquerque hospitals comes nearly a month after New Mexico’s Department of Health opened up the option for any hospital in the state to make the declaration in mid-October. The status allow for several changes in terms of patient care.
The hospitals will be allow to use a “standardized, equitable procedure for making decisions on who receives medical care.” That means in certain situations, some patients could be delayed immediate, non-life threatening medical treatment because staff may not be able to assist a patient.
Describing what it means to make a “CSC”-decision, Presbyterian’s Chief Medical Officer Dr. Jason Mitchell emphasized Thursday the hospital systems would not be “deallocating care,” or “triaging and denying care.” Dr. Mitchell says right now, the CSC-status is in part more about shuffling patients in Albuquerque to other hospitals in rural New Mexico or around the southwest region.
“So the decision is not going to be to take someone off a ventilator, that’s not what we’re doing,” Dr. Mitchell said. “The decision may be, ‘we don’t have beds in our hospitals, who else can take this patient?’ And it may mean that a patient goes into a regional hospital that has capacity, and they go to different Albuquerque hospitals, so the decision is how can we get the patient to the best spot where there’s an available bed.”
Presbyterian’s Dr. Mitchell says CSC-decisions may mean patients have to go out of New Mexico to surrounding states like Texas, Arizona or Colorado. Meanwhile, the hospitals say they’re now in the process of scanning through their schedules to see which patients with non-medically necessary procedures may be able to have delayed medical care.
“It’s not large numbers anymore, people have already put off their surgeries for a long time and they’ve become medically necessary,” Dr. Mitchell said. “It is unfortunate though, so many have already had to wait for surgeries that now the vast majority now are medically necessary.”
Dr. Mitchell said while the delay on medically necessary procedures will give some relief to Presbyterian’s facilities, the hospital system will likely have to look at other measures. “It’s not as big of a lever, which is why we have to start focusing on other levers, like how do we stand-up beds maybe at other hospitals, for us we have our Kaseman Hospital where we may be able to add some additional beds.”
UNMH says the delays to non-medically necessary procedures will start at 90 days, but could be reduced based on need. “It really is a matter of deciding whether or not it has to be done today or whether it can be postponed,” Dr. Richards of UNMH said.
Fueling the capacity at hospitals is not just COVID-19 patients. The hospital systems said Wednesday they’re seeing an increase in the average length of stay at their facilities. Dr. Mitchell of Presbyterian said Thursday the biggest challenge for intensive care units has recently getting patients out of the hospital.
“Our (Emergency Departments) are packed because patients can’t get up to the hospital because patients are so sick, and then we don’t have a place to put them,” Dr. Mitchell said. “At this point it’s not necessarily that we don’t have enough ventilators, it’s that the overall demand in hospitals is exceeding the capacity.”
At UNMH, Dr. Michael Richards emphasized while COVID-19 cases are a driver, there’s also a high degree of non-COVID patients staying in hospitals. “It not whether or not we create the ICU capacity for the COVID patient, but its that we need the ICUs for other kinds of patients also, so the community needs that we have for trauma patients, or patients that have a heart attack or a stroke that need an ICU, we need to ensure that capacity is there for them too.”
As of Thursday, UNMH had about 70 COVID-19 patients, representing about 17% of its capacity. Presbyterian said Thursday about 20% of its patients were COVID-19 patients, while the hospital runs about 120% of normal capacity.
“The people that don’t have COVID are much sicker, and so they’re staying longer,” Dr. Mitchell of Presbyterian said. “So even at 120% capacity, things are worse because people need to stay longer because they’re much sicker and that backs the whole system up.”
UNMH and Presbyterian join the San Juan Regional Medical Center in Farmington as the second and third hospital systems to have made a CSC-declaration in the last month.