The next step: Hospitals in New Mexico will ration COVID-19 care, other states to follow

Hospitals across New Mexico are operating at or near capacity. Many hospitals are close to running out of ICU beds and regular beds, too. Governor Michelle Lujan Grisham announced that soon hospitals may go to “crisis standards of care” which means that COVID-19 care will be rationed depending on the likelihood of the patient’s survival.


This sounds like the horror stories of socialized medicine in countries like England. People wait long periods of time for necessary procedures and often denied lifesaving operations if the patient is deemed too high of a risk for survival. Most of those who end up needing hospitalization for COVID-19 are the elderly or those compromised with existing pre-conditions. Will the elderly, those most likely to die from the virus, be denied a hospital bed? Will those who are diabetic or overweight or have heart disease be written off? What about black and Hispanic people who are more likely to be infected with the virus? This is a really slippery slope.

Governor Grisham went so far as to shut down grocery stores and other shops just before Thanksgiving in order to mitigate the spread of the coronavirus. New Mexico is experiencing a dramatic spike in cases despite the almost draconian measures being taken. Grisham shuts down businesses over rapid test results. She issued a public health order that a business must close if four or more rapid responses of COVID-19 cases are reported within a 14-day period. The order requires the businesses to close for two weeks, even essential businesses like grocery stores. Public health experts sing her praises for taking such strong actions. Nonetheless, positive cases continue to climb and hospitalizations continue to increase.

A medical dam-break had been part of repeated warnings by state officials for weeks as COVID-19 counts surged in October and November. The human toll includes health care workers — at least 18 have died since the crisis began earlier this year, state Human Services Department Secretary David Scrase said during a separate news conference with Gov. Michelle Lujan Grisham later in the day.

“Every death is a tragedy,” he said. “But when we lose a health care worker, we lose the opportunity to care for hundreds of other New Mexicans.”

Scrase also said the state has experienced an alarming increase — almost 90 percent — in hospitalizations tied to the virus over the past 14 days.

The crisis is so severe that Mitchell said small rural hospitals can still call around to larger hub hospitals to see to try to find a bed for a seriously ill patient, but they could be placed on waiting lists.


Governor Grisham admits that there has been a drop in positivity and infection rates, yet she is expected to allow hospitals to move to “crisis standards of care” on Monday. Each hospital will be allowed to decide for itself if the move is necessary.

Jason Mitchell, Presbyterian Health Care Services’ chief medical care officer, said the company’s nine hospitals are operating at about 110 percent of capacity.

Mitchell said it’s the “worst nightmare” of any health care provider to think about rationing health care resources, such as rooms or ventilators.

“Hopefully it does not come to that,” he said.

He added it’s “scary” to think about having to prioritize certain patients over others but if that becomes the case, “teams of clinicians will make those decisions together.”

Dr. Vesta Sandoval, chief medical officer at Lovelace Health System, said “a process is being worked” on for making those determinations and “the state will be working on it and release more information.”

A document called the New Mexico Crisis Standards of Care Plan, updated in April, lays out some of the frameworks for determining how to allocate limited resources. In an email, Maez wrote each hospital is required to develop its own plan, but added the state is “operating in a medical surge model.” She did not elaborate.

Hospitals in Boise, Idaho may not be far behind New Mexico in such drastic action. Two large hospital systems report that they expect to reach crisis standards of care in a matter of weeks, maybe even by mid-December. The area is dealing with record numbers of daily cases and hospitalizations.


“I think it’s more probable than not that in the next two to four weeks, we will find ourselves” at a point of needing to ration care due to COVID-19, Souza told the board. Later, Souza and Nemerson said their models project reaching crisis standards in early January, but that’s without the expected Thanksgiving-related surge in cases.

Crisis standards of care would have to be declared by Gov. Brad Little. At that point, a scoring system would determine which patients receive life-saving care, Souza said. Souza and Nemerson said the situation also could lead to other care being delayed — such as removal of cancerous tumors.

Souza said St. Luke’s is operating under contingency care standards. Care today is not the same as it was a year ago, he said. A daily meeting is held to determine how quickly patients can be sent home.

Doctors urge residents to wear masks, stay home, and avoid contact with people who are not in their households. One called the coronavirus “a totally preventable disease.” He expressed frustration that the situation has reached this level.

“This is a totally preventable disease, and it’s dumbfounding we’re in this situation that we’re talking about limiting our ability to deliver care to patients that need us,” Nemerson said.

The Central District Health Board of Health (CDH) is considering a new public health order. A revised order was published on the CDH website Friday. A vote hasn’t been taken, likely not until Tuesday. Protesters showed up at the CDH building in opposition to the proposed order. They tried to force their way into the building. It was noted in a press report that most of the protesters were not wearing masks. Boise police stated that only 5 people at a time were allowed into the building, due to COVID-19 restrictions. The CDH meeting taking place was available for people to watch online but the protesters showed up anyway. No arrests were made.


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