County looks for clarity on ICU edict
Marin County’s public health officer said he is trying to get more details on a state order that counties with adequate intensive care unit capacity accept coronavirus patients from overwhelmed regions.
“We’re seeking clarification on where the authority lies to require us to accommodate patients from outside the region and what ICU capacity would be used to determine our ability,” Dr. Matt Willis said Friday.
The California Department of Public Health did not respond to a request for comment.
Under the order, an overwhelmed hospital may seek a mandatory transfer if it has “reached crisis care and does not have the ability to examine and treat patients.”
The order states that crisis care occurs “when resources are scarce and the focus changes from delivering individual patient care to delivering the best care for the patient population.”
In a released statement, Tomás Aragon, California’s public health director, said, “When hospitals are overwhelmed and overflowing, they are no longer able to provide the traditional standards of care we expect, but if health care resources are available elsewhere, we should ensure Californians can receive appropriate care.”
On Friday, both the San Joaquin Valley and Southern California regions were reporting 0% intensive care
unit bed capacity. The Bay Area’s IUC bed capacity stood at 3%. The Sacramento region’s ICU capacity was at 6.4%, and the Northern California region had the highest capacity at 27.5%.
Marin reported ICU bed capacity of 5% on Friday; 20 of the county’s 21 ICU beds that were deemed to be functionally staffed that day were occupied.
Coronavirus intensive care unit hospitalizations in California have increased more than sixfold over the last two months. Health officials are bracing for an acceleration following increased travel over the holidays.
And while a new mutation of the virus believed to be more easily transmissible has been detected in the state, its effect has not yet been seen.
Until now, state health officials would issue alerts
to Medical Health Operational Area Coordinators, who oversee distribution of patients at the county level, and Regional Health Operational Area Coordinators when hospitals in a region became overwhelmed with coronavirus patients.
Willis said recently hospitals in Southern California have been seeking to transfer dozens of patients daily.
“We haven’t had the internal capacity to accept patients from that far away,” Willis said.
Prior to the new order by the state health department, counties were asked to volunteer to accept transfers. There was no requirement that they do so.
Willis says he is seeking clarification as to what criteria will be used now “if no one raises their hand.”
“We’re eager to get the answer to that question,” he said. “I assume it will be related to reported ICU capacity for a given region.”
The order issued Tuesday also requires hospitals to postpone non- essential surgeries if they are located in a region that has 0% ICU availability and a county where the ICU availability is 10% or less.
Willis said he has already begun discussing with Marin hospitals how difficult decisions might be made if rationing were to become necessary. He said the aim would be to ensure that patients are treated fairly in that situation “and there is no bias from an ethical standpoint.”
“We’re not near that point now,” Willis said, “but it is really important to think through those things before you get to that situation so there is not a lot of subjectivity to those decisions.”