In a California hospital, patients who could barely breathe were crowded in a hallway because there was no room for them anywhere else. This was in a TV news report in mid-December. That’s what it looks like, I thought.
Around the same time, New Mexico’s healthcare system went over the line into crisis mode. It has swung back. It will probably go back and forth again, especially if we have the anticipated surge resulting from people who did not take the holiday warning seriously.
New Mexico does not have enough hospital beds to cope with a surge of COVID-19. We’ve known that since the beginning.
We don’t have enough doctors or nurses to serve those patients, if the case numbers continue to rise.
Panels of experts have been organized, to make the decisions about who gets the ventilator and who doesn’t, if those decisions have to be made.
The governor cautioned, last spring, that New Mexico’s healthcare system is not robust enough to respond to an explosive spread of the virus. She warned New Mexicans to follow the guidelines, including wearing masks and staying out of large gatherings.
We heard from health care leaders. A few of these discussions were online and public. The CEOs of the major hospital systems described their plans for cooperation and sharing of resources. They talked about medical ethics issues and how New Mexico could be forced to ration health care. They did not want physicians to bear the burden of life or death decisions – who does not get the hospital bed or the ventilator — while standing in the hallway of the emergency room.
There was talk of a statewide panel of medical ethicists who would create guidelines that doctors could follow.
The science has progressed in the last several months. Ventilators are no longer quite as critical as they were back then. Treatments now exist that were not known in the spring. Those treatments are available only if there are doctors, nurses, therapists and hospital beds.
New Mexico has been over the line. Though I cannot predict our status on the day you read this, we have spent some days in crisis mode.
The governor’s executive order 2020-083 orders a new COVID-19 credential for physicians, nurse practitioners and other advanced health care providers treating patients with the virus or believed to have the virus. With this credential, they are considered public employees for the purposes of the state’s Tort Claims Act. That ensures doctors treating COVID-19 patients have some of their liability exposure absorbed by the state.
This order takes effect when the state reaches the point where “crisis care” is necessary because there aren’t enough resources for every patient. At that point, the health care system switches from the standard of the best interest of every individual patient to the best interest of the state’s public health.
The governor didn’t get us here. People who ignored the public health guidelines did.
The executive order is on the governor’s website. It’s worth reading in detail.
I also recommend a longer document titled “New Mexico Triage Protocol for the Allocation of Scarce Resources Under COVID-19 Crisis Standards of Care.” I especially recommend this document to you if you think your individual judgment is smarter than the science and you don’t have to social distance or wear a mask.
The protocol document is on the Health Department website. With almost mathematical specificity, it explains the statewide and local advisory boards and the standards for decisions that have to be made under crisis standards of care.
As the policy documents explain, if someone in your family is the one denied a ventilator, it will not be the governor but a member of your community who will make that tragic decision.
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