'We are struggling, we are frustrated.' New Mexico again declares crisis standards of care
Health officials, hospital leaders reiterate pleas to take COVID-19 vaccinations
Algernon D'AmmassaNew Mexico has, for the second time since the arrival of the COVID-19 pandemic, formally enacted crisis standards of care for the state's hospital network, owing to a lack of resources sufficient to meet the demand for care.
The announcement from the state Department of Health Monday came in the midst of a six-week plateau in cases, following a increase in cases over the summer driven by the highly contagious delta variant. Officials said hospitals have been struggling at times to find beds in the statewide network for patients in need of higher levels of care.
The latest surge has fallen hardest on unvaccinated individuals, but health officials said the current load on hospitals is exacerbated by a larger population of non-COVID patients.
Under crisis standards of care, medical facilities may use a standardized procedure for deciding how to allocate resources that have been stretched beyond their capacity to care for everyone — particularly the costliest decisions about how to allocate what is available and to whom.
The protocol guides decisions on which patients are prioritized for scarce resources based on an assessment of their medical conditions and chances of survival, while providing a check against personal biases by the provider.
State Deputy Health Secretary Dr. Laura Parajón emphasized that it also provides guidance for heading off the necessity of such choices.
Facilities must suspend non-medically-necessary procedures prior to moving to the crisis standard of care. The declaration by the state unlocks regulatory protections for acute care providers making the hardest choices about how to use scarce medical resources, in the midst of a long-running nursing shortage and staffing gaps statewide.
It also extends legal liability allowing those providers to recruit medical providers on an emergency basis to provide higher levels of care, or care outside their normal scope of practice. Providers credentialed under these circumstance may assist with COVID-19 patients or with non-COVID patients needing care. The tort liability protections are similar to those afforded to state employees.
Acting state Health Secretary Dr. David Scrase said that the number of COVID-19 hospital admissions may be lower in the current wave compared to the dead surge of last winter, before vaccines were available against COVID-19, but he said the current spike is different.
Residual effects of previous surge
"People in the hospital are as sick as they've ever been — sicker, actually," he said, adding: "We have a lot more people in the hospital right now with non-COVID-related illnesses."
The larger load of non-COVID patients was attributed in part to patients delaying care earlier in the pandemic, as well as the impacts of an exhausted healthcare workforce facing a public health crisis that Scrase said was largely preventable.
"Most hospitals never saw a reprieve from the prior surges," UNMH Associate Chief Nursing Officer Jennifer Vosburgh said during Monday afternoon's news conference.
Scrase said only 11 ICU beds were available in the state as of Monday morning, and guessed that those had likely been filled by afternoon.
The health department had signaled that New Mexico was skirting the threshold of crisis standards of care for several weeks, but Scrase said the state had held off from making the formal declaration based on modeling suggesting that the surge would drop off.
Instead, average daily cases have remained largely flat for several weeks as several hospitals in the state provided treatment for various illnesses in hallways and other converted treatment areas.
Most healthcare workers vaccinated
The health department reported that 88.4 percent of hospital employees in the state had completed their primary course of a COVID-19 vaccine, with an additional 3.37 percent having received at least an initial dose.
Meanwhile, over 7.5 percent of that workforce had been approved for an exemption from vaccine mandates on religious or medical grounds.
While vaccines are affording hospital staff better protections from infection and severe illness from COVID-19, officials said the workload and the emotional stress continue to tax the front line of the state's medical response.
"We are struggling, we are frustrated, and we often find ourselves in a position to make the least bad decision we can," Vosburgh said.
The announcement echoed the earlier enactment of crisis standards of care in New Mexico last December.
That decision followed weeks of urgent pleas to the general public to help curb community spread by complying with public health guidance to stay home as much as possible, wear masks in public, wash hands frequently and keep at least six feet of distance from non-household members.
During the current surge, vaccination rates around the state slowed, test positivity rates crept up and the Centers for Disease Control and Prevention rated most of the state at a high level of transmission. New Mexico reinstated a mask mandate for indoor public spaces in August and campaigned for more residents to take one of the three vaccines available to them for free.
On Monday, Parajón reported that 71.6 percent of the state's adults had completed a primary course of vaccine — either the single dose Johnson & Johnson vaccine or the two-dose products from Moderna and Pfizer-BioNTech. Among minors age 12 through 17, 53.5 percent had completed their vaccination.
The state has also begun rolling out booster doses to eligible residents based on medical vulnerability while awaiting action from Washington on making Moderna and Johnson & Johnson vaccines available for minors, and vaccinations for minors age 5 an up.
Parajón said the priority, however, was increasing primary vaccinations — getting more individuals who can be vaccinated to take the shots.
Without slowing spread down, the department warned that hospitals may continue to function beyond their limits for an extended time.
"We owe it to our healthcare workers," Scrase said. "In all honesty, if we want to have a viable, effective healthcare system for us ... we really do need to do everything we can to support them."
'They're still working through it'
The Gerald Champion Regional Medical Center in Alamogordo has restricted visitation, suspended in-patient elective surgeries and converted areas such as its Outpatient Care Unit for staging patients.
In Otero County, cases have increased while vaccination intake has slowed. As of Tuesday, 51.2 percent of its residents had completed a course of vaccine and less than 61 percent had taken at least one dose.
Spokesperson Lillie Lewis said the hospital was taking every step it could to avert moving to crisis standards of care and having to ration resources, but she said it had become more difficult to find beds for patients needing higher levels of care in time to help them.
"We are in our own state of crisis, it just may not be to that level," she told the Las Cruces Sun-News.
On Tuesday, the center was treating 21 admitted COVID-19 patients in addition to non-COVID patients. The hospital had a single ICU bed available in the morning.
"We are in the same nursing and staffing crunch that every other hospital is," she said. "Our staff is tired but they're still working through it."
At Memorial Medical Center in Las Cruces, the designated hub hospital for the state's south-central region, spokesperson Andrew Cummins emphasized that individuals in need of medical care should still seek it.
"We want to remind our community to not delay their healthcare needs and to seek care early," he said. "We currently have adequate staffing and resources to care for our patients and our community. We also strongly encourage our community to get the COVID-19 vaccine and a flu shot. Vaccinated individuals are significantly less likely to become severely ill or require hospitalization if they do contract COVID-19."
Algernon D'Ammassa can be reached at 575-541-5451, adammassa@lcsun-news.com or @AlgernonWrites on Twitter.
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