Los Angeles Times

Some critically ill patients wait days for ICU

Hospitals in Fresno may be forced to turn to ‘crisis standards of care,’ official says.


Some hospitals in Central California are so overwhelme­d with COVID-19 patients that critically ill people are waiting days to be transferre­d to the intensive care unit from the emergency room, officials said.

One Fresno-area hospital had nine critically ill patients who were unable to get into the ICU for more than three days, Fresno County interim health officer Dr. Rais Vohra said at a news conference last week.

The backlog forces workers in the emergency room to treat patients needing ICU care, thereby disrupting the care of patients with less severe conditions.

“We’re basically really straining what the emergency department has to do,” Vohra said. “We still anticipate at least a few more weeks of thoroughly impacted operations.”

Hospitals in Fresno County are teetering on the need to ration healthcare and implement “crisis standards of care,” Vohra said. In those situations, hospitals conclude that they can no longer provide the same standard of healthcare to everyone and must choose whose lives to prioritize, in an effort to keep as many patients alive as possible.

“We’re still just right there, where we’re looking at things on a day-by-day — and even hour-by-hour — basis to see how we can match the resources with the needs,” Vohra said.

Similar or worse conditions are evident in other states. Idaho recently declared that its hospitals statewide can provide only crisis standards of healthcare because of what officials called a “massive increase of COVID-19 patients requiring hospitaliz­ation in all areas of the state.”

“The situation is dire — we don’t have enough resources to adequately treat the patients in our hospitals, whether you are there for COVID-19 or a heart attack or because of a car accident,” Dave Jeppesen, director of the Idaho Department of Health and Welfare, said in a statement. “The best way to end crisis standards of care is for more people to get vaccinated. It dramatical­ly reduces your chances of having to go to the hospital if you do get sick from COVID-19.”

In Fresno County and the greater San Joaquin Valley, hospitals remain overtaxed, according to Dan Lynch, director of the Central California Emergency Medical Services Agency. Most of Fresno County’s hospitals are running at 108% to 110% of standard capacity, while Clovis Community Medical Center near Fresno has been running at 130% capacity.

“It just means that they’ve got patients in nooks and crannies throughout that hospital. And they’re taking advantage of every, every place they can to place patients safely,” Lynch said of the Clovis hospital. “We’re providing them with as much staff, and they’re finding staff from outside the state and other areas of the state of California to help them staff those beds.”

Officials have been forced to extend the policy by which not all patients calling 911 are transporte­d to emergency rooms if they don’t meet certain criteria. Many had been hoping to relax that policy but cannot while emergency rooms remain overwhelme­d.

Lynch said he’s been pleading with federal officials to bring in additional staffing to support the hospitals.

Some help has arrived in the region in the form of National Guard teams, comprising nurses and emergency medical technician­s who can provide aid in emergency rooms.

But Lynch is still seeking federal medical teams that can provide the kind of care needed in ICUs. That, he said, “is really what’s needed so we can expand our ICU surge beds. We have the capability of adding ICU beds to some of our hospitals — we just don’t have a staffing to do it. And that’s what those federal teams would do.”

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