(TNS) - Michelle Lujan Grisham is expected to allow hospitals to begin rationing care based on how likely a patient will survive, a move many physicians had hoped to avoid but say is necessary given New Mexico's spiraling number of hospitalizations amid the COVID-19 outbreak.
A declaration permitting hospitals to implement crisis standards of care, which the Lujan Grisham administration is expected to announce in the coming days, is the latest sign the state's hospital system has reached its breaking point under the strain of the coronavirus pandemic.
The news was first reported by the Washington Post on Saturday.
Tripp Stelnicki, a spokesman for the Governor's Office, said Lujan Grisham hasn't authorized or enacted the crisis standards of care, but on Friday signed an executive order that will make it easier for hospitals to implement such standards.
"In the simplest possible terms, it provides for the temporary facilitation of that assistance that may become necessary outside providers' regular scope of practice and support. So, if and when the Department of Health deems it necessary, they can," Stelnicki wrote in an email.
In the executive order, Lujan Grisham asked the secretary of health to request the state's Medical Advisory Team make a recommendation on when crisis care standards should be implemented.
Public health officials are scheduled to hold a virtual news conference early this week to explain the move in greater detail, Stelnicki said.
Some in the medical community applauded the move.
In a statement, Dr. Jason Mitchell, chief medical officer at Presbyterian Healthcare Services, one of the state's largest health care providers, said such a declaration "provides another lever for hospitals to meet the demand during this surge."
"This is an incredibly concerning time for our entire community, and especially for our clinicians and staff," Mitchell said Saturday. "We will care for our patients as safely and effectively as possible. We urge our fellow New Mexicans to prevent further spread of COVID-19 by limiting gatherings, practicing social distancing, masking up and staying home whenever possible."
In a separate statement, Dr. David Gonzales, chief medical officer for Christus St. Vincent Regional Medical Center in Santa Fe, said the hospital has seen "a significant increase" in COVID-19 patients in recent weeks.
"In the event that we have a strain on hospital capacity and resources we, like other New Mexico hospitals, will utilize the established crisis standards of care as a consistent guide for triaging patients when health care resources become inadequate," Gonzales said Saturday.
Over the past couple of months, the virus has spread exponentially across the state, leading to an alarming number of COVID-19 deaths and hospitalizations. The state Department of Health on Saturday reported 1,925 new cases and 32 more deaths, including three in Santa Fe. The state said 925 people were hospitalized with COVID-19 on Saturday.
While New Mexico has seen a drop in its daily case count in recent weeks, which many attribute to Lujan Grisham's decision in November to enact a two-week shutdown of nonessential businesses, the numbers are still far higher than they were before the latest surge began in early fall.
The state on Wednesday released its first color-coded map of New Mexico's 33 counties as part of an initiative that would loosen business restrictions in counties where the virus is less prevalent. No county had earned "green" status, and only one county, San Miguel, was in the yellow. The rest of the state was awash in red.
For weeks, health officials have warned what will happen if the state's hospitals continue to be inundated with COVID-19 patients.
"When we go crisis of care, it means we may have to share equipment like ventilators," Mitchell said in late October. "It may mean people are in tents outside in the parking lot in hospital-type MASH units. It may mean that health care providers who have not practiced in a hospital for many years ... may have to come in and relearn how to run ventilators and take care of patients. It is a time when if you have other health care needs like the birth of a child, a car accident or any other emergency, you may not have a place to go.
"This is a place where nobody wants to be," he added.
Each major hospital has its own individual surge plan it has activated to help manage resources during the outbreak.
The scenario that confronts New Mexico hospitals is precisely the one Lujan Grisham said the state was trying to avoid as it imposed restrictive health orders both in the spring and later in the year. In March, she warned the state's health care system, relatively small and understaffed compared to those of neighboring states, could not handle an endless wave of patients — and care for patients who would be coming to the hospital for non-COVID-19 issues.
For the first nine months of the pandemic, the state's hospital system has avoided going into a crisis of care mode by finding ways to increase capacity, such as converting operating rooms into patient rooms. But as the spread rate continued to spike, hospital beds filled up.
"We are out of ICU beds," Mitchell said last week. "We really are totally full."
The state's Medical Advisory Team, led by Dr. Michael Richards, vice chancellor for clinical affairs at the University of New Mexico Health System, prepared a supplement to the New Mexico Crisis Standards of Care Plan in April, when the public health crisis began to unfold.
Under the plan, medical professionals would use complicated formulas in deciding who would be given priority for medical resources such as ventilators. They would consider a patient's chances of surviving as well as preexisting conditions such as lung disease, heart disease, dementia and fragility.
In some cases, patients might have to share a ventilator.
It's a physician's "worst nightmare," Mitchell said of having to ration care.
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