Yakima hospital may have to ‘ration health care’ amid COVID patient surge

'This is kind of a slow, simmering mass casualty event'

YAKIMA, Wash. — Yakima Valley Memorial Hospital is rapidly approaching the point of needing to turn to crisis standards of care in order to keep up with the increase in COVID-19 patients.

“It could happen tomorrow,” Chief Medical Officer Dr. Marty Brueggemann said at a press conference Wednesday. “Honestly, if we get another handful of patients that require ventilators, another 10 COVID admissions, this could happen really quickly.”

Brueggemann said all it would take is for just one of the hospital’s resources to break down to put them in a position of having to ration care for patients. He said the hospital is already having to closely monitor the number of patients needing oxygen and how much they’re consuming.

On a recent visit to the hospital’s COVID unit, Brueggemann said he saw that one of the patients’ oxygen requirements had risen to a level where it was pushing the oxygen supply for the whole floor over its limit. They had to separate two family members staying in the same room and move one of them to a different floor to stay under the limit.

“What crisis standards would mean — if we get there — is that I don’t have a place to send that patient; I don’t have the oxygen,” Brueggemann said. “That means somebody somewhere is going to get taken off oxygen and given pain medicines to kind of give them a peaceful death.”

As of Tuesday, 10 hospitals and healthcare systems in northern Idaho had activated crisis standards of care due to the overwhelming number of COVID-19 patients. The move allows those health care facilities to allocate resources in short supply to patients most likely to survive.

Brueggemann said the situation in Idaho will likely begin to impact hospitals in Washington state. Just a few hours’ drive from Yakima, Kootenai Health — the largest hospital in northern Idaho, located in Coeur d’Alene — has been hit particularly hard.

“If you live in Coeur d’Alene or maybe right at the border or in some of those surrounding communities, you know that if you go to your hospital, you may not get the care you need,” Brueggemann said.

Brueggemann said the patients who are not able to receive care there and have the means and ability to go elsewhere, will get in the car and drive for less than an hour to get to Spokane. He said hospitals in those areas will start to see more and more patients coming from Idaho.

“As they get maxed out, it’s not a hard stretch to see them being the first ones that have to go into crisis standards,” Brueggemann said.

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Brueggemann said that would likely create a ripple effect across the state, where overflow patients would start heading further west to health care facilities in Wenatchee, Yakima and the Tri-Cities. He said those additional patients could be what pushes the hospitals over the edge.

“This is kind of a slow, simmering mass casualty event,” Brueggemann said. 

In a statement released Wednesday, the state Department of Health said their goal is to never have to use crisis standards of care anywhere in the state and are working to stretch resources and figure out solutions to the current challenges to prevent that from happening.

“DOH is working with state, federal, and private partners to mitigate Washington’s health care surge by accessing additional volunteer and contracted resources, coordinating information sharing, and supporting efforts to shift patients to healthcare facilities that can best support their care,” the statement said.

The state Department of Health plans to use a framework developed by the National Academy of Medicine, “which stresses the importance of an ethically grounded system to guide decision-making in a crisis standards of care situation.”

A state Department of Health representative told KAPP-KVEW on Wednesday that the decision will not be made at the state level, but at the “point of care” — meaning it will be up to each hospital to decide if and when to transition to crisis standards of care.

Brueggemann said while Yakima Valley Memorial Hospital isn’t quite at the point where they need to make that decision, they’re still preparing for the worst as the demand for care increases and their resources decrease.

The hospital has been at capacity for several weeks and has had to take drastic measures to make room for more patients, including housing patients in emergency department exam rooms. The overflow of patients into the ER has pushed initial exams out into the hallways, with patients being seen on stretchers and in chairs.

YVMH had 54 patients hospitalized with COVID-19 on Wednesday, accounting for more than 25% of the hospital’s total patient volume. Brueggemann said 46 of those COVID patients are unvaccinated and six are currently on ventilators.

The emergency department at YVMH is the second busiest in the state and saw more than 300 patients on Monday alone. Brueggemann said they had 30 to 40 people in the waiting room through most of the day and about 10% of those patients left without ever seeing a provider.

“That’s a dangerous situation, because those patients may have medical problems that require emergency attention that we can’t get to because of the volumes,” Brueggemann said.

Brueggemann said many of the people in the ER waiting room were there for COVID testing — some because they were unable to quickly get an appointment at another testing site and others because the community-based testing site at Yakima Valley College was temporarily closed due to poor air quality.

“We’re also aware that some urgent care clinics and doctor’s offices are sending patients to the ER to be tested because they think that we can do better tests or a quicker test,” Brueggemann said. “Our ER cannot sustain these volumes.”

Brueggemann asked that people not come to the ER for a COVID test unless they also need to be evaluated or receive medical care for their symptoms.

“Please don’t send people in just to be tested; that goes for employers, doctors, clinics, urgent cares,” Brueggemann said. “We simply do not have the capacity for that at this time.”

In a news release Wednesday, the Yakima Health District said COVID-19 transmission, hospitalizations and deaths have been increasing at a “disturbing rate” over the past few months.

Yakima County reported a COVID-19 case rate Tuesday of 1,093 per 100,000, which is approaching the highest reported case rate of 1,167 per 100,000 from the end of 2020 to early 2021.

“Given recent trends, the community is on track to surpass this case rate over the next few days,” health district officials said in the release.

The county is also experiencing the highest positivity rate for COVID-19 testing throughout the pandemic; three out of every 10 people tested at community-based testing sites in Yakima County are positive for the virus.

The Yakima Health District has also received a letter signed by 140 health care workers in Yakima County urging community members to help them in the fight against COVID-19 by getting vaccinated and wearing face masks.

“It is now too late to rely solely on vaccines,” health district officials said in the release. “All individuals must also implement public health preventative measures in their everyday lives to protect themselves and those around them.”

Those preventative measures include masking, physical distancing, increased handwashing and sanitization of frequently touched surfaces.

***Note: KAPP-KVEW spoke with the state Department of Health on Wednesday. In the video broadcast aired Wednesday, the reporter misstated that the conversation with state health officials took place on Tuesday.


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