At least two Long Beach-area hospitals recently took the grim step of convening teams of medical professionals who would decide which patients are given potentially lifesaving care and which are denied it if the current wave of COVID-19 cases pushes local health care providers to that point.
These “triage teams” were put together as the state mandated local hospitals to finalize and publicly post their plans for what they’ll do if the surge in coronavirus cases becomes so overwhelming that medical facilities are pushed into something called “crisis care.”
All hospitals have three levels of operational protocols: conventional, contingency and crisis. Conventional care is business as usual—normal bed counts, normal staffing levels and an abundance of supplies.
But as resources dwindle, and staff is stretched thin, medical facilities alter protocols in attempts to maintain the best patient care, and outcomes, possible.
“At this time, we’re working very hard to ensure that we don’t reach a crisis care situation,” Long Beach Health and Human Services Director Kelly Colopy said during a press conference Wednesday.
Los Angeles County hospitals, including St. Mary and the other Long Beach-area facilities, currently are all operating under contingency protocols: increased bed counts to meet demand, longer shifts and different staff configuration, and conservation of medical supplies by using substitutes and reuse. The level of care during contingency is more or less equivalent to conventional care but often includes longer wait times, as has been seen countywide since the end of November.
Now, as the number of cases, hospitalizations and deaths mount at a staggering pace, local hospitals are preparing for crisis care. At this critical level, staffed beds are full and cots are necessary, there are significant impacts on nurse and doctor ratios, and supplies and care are rationed.
Essentially, hospital personnel would evaluate each patient to determine which have the highest likelihood of survival and prioritize that patient over others. Patients with a lower chance of survival would be given palliative care, which is an effort to make the patient as comfortable as possible until their death.
The ideology behind crisis care is simple: preserve extremely limited resources for patients who can be saved, thereby preserving the health of the many over the few. As more resources become available, each patient is reevaluated to determine whether or not to alter treatment.
To make these decisions, each hospital puts together a triage team to evaluate patients. The team is made up of medical professionals not directly involved in the treatment of patients so as to remain impartial.
The triage process includes strict ethical guidelines that ensure decisions are not made based on any extraneous circumstances such as age, race, gender, disability, sexual orientation, imigration status or any other factor beyond survivability.
But some of the ethical areas get murky as crises worsen. For instance, certain disabilities require additional attention from medical staff. When staff is severely overwhelmed, the amount of time necessary to treat a patient is critical. These same cases also often require more skill and resources. Depending on the number of patients and resources, these cases may be pushed to comfort care.
Apart from immediate survivability, the patient’s subsequent quality of life may also become a factor examined by the triage team. These gray areas are often viewed with suspicion by those with disabilities, according to the state’s crisis care guidelines.
“To ensure non-discrimination against individuals with disabilities, triage protocols must … assess at most how far treatment will return the patient to their own baseline quality of life,” the guidelines read. “Decisions cannot be based on generalized assumptions about a person’s disability.”
Officials at St. Mary and MemorialCare Long Beach Medical Center confirmed they have convened their triage team and conducted preliminary meetings to discuss the facility’s crisis care guidelines.
Crisis care protocols often include counseling for patients triaged to comfort care and their families, a practice that may prove difficult at a time when visitors are not allowed inside hospitals even to visit the dying. City spokeswoman Jeniffer Epstein said hospitals would still work with families to provide counseling but added that resources would be limited.
The city is in constant communication with county and state health agencies to bring in more staffing and supplies, Colopy said. Field hospitals have been erected at multiple local hospitals to increase the number of beds in the area but health officials are bracing for the coronavirus surge to worsen following Christmas and New Year’s gatherings, placing further stress on an already-overtaxed health system.
The partial reopening of Community Hospital in East Long Beach, which added 51 beds to the area, including 11 intensive care, is going to prove helpful in stemming the need for crisis care, Colopy said. But with cases and hospitalizations trending up with no end in sight, multiple local hospitals have begun preparations for crisis care.
“No healthcare provider ever wants to be in a situation where there are more patients than available resources,” Christina Zicklin, a spokesperson for Dignity Health – St. Mary Medical Center, said in an email to the Post. “Since the start of the pandemic, we have done everything possible to expand capacity.”