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Los Angeles Hospitals Plan to Ration COVID-19 Care Amid Surge

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File: Check-in tents at the Martin Luther King Jr. Outpatient Center. Hospitals are making plans to start triaging patients if infections continue to increase. (Chava Sanchez/LAist)
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Hospitals across Los Angeles County are preparing to ration care and prioritize treating patients who are most likely to survive — a dire but necessary step as coronavirus continues to spread widely in Southern California.

To make those decisions, hospitals are designating teams made up of people not directly involved in patient care.

Those steps are needed because the number of COVID-19 patients in hospitals has been exploding, with more than 7,100 people now being treated. ICU bed availability also has plummeted.

Huntington Hospital in Pasadena is among the facilities preparing for a continuously worsening situation. The hospital has released a plan that describes how the process would work.

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“It's a committee that's formed by a bioethicist, a clinician, a nurse, a community member, and sometimes an administrator or a fourth person," said Dr. Kimberly Shriner, speaking Wednesday on KPCC's public affairs show, AirTalk. "It's not anybody who's actually taking care of any of the patients.”

Shriner, who is an infectious disease specialist at Huntington Hospital, said her facility has so far been able to manage the surge, but she cautioned that more COVID-19 infections could soon force hospitals to the tipping point.

And that’s what the decision-making team is preparing to handle. Here's Shriner again:

“If we get to a point where we have a very big shortage of, let's say, oxygen tubing or oxygen tanks or ventilators, they examine patients from a clinical basis in terms of whether or not that person would benefit from that intervention. They don't know the patient's ethnicity, they don't know anything about their insurance status or anything. The only thing they know is their clinical status and their age.”

L.A. County is in the midst of a historic medical crisis, with a hospital system that Shriner says is on the brink of collapse. Like many hospitals, Huntington has already set up a surge tent in its parking lot. In some cases, patients are being forced to wait hours in ambulances before they can be admitted. Some hospitals are so short on space that they are using conference rooms and gift shops to treat patients.

"No healthcare worker ever wants to have to be put in the position to make this decision," Shriner said. "Our job is to save lives and provide the very best care for everybody we can, but sometimes there's just a limit to how many resources we have."

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According to the latest statistics, L.A. County has 7,415 people hospitalized with coronavirus, the most at any one time since the start of the pandemic. One in every five of those patients are in intensive care units.

The 11 counties making up the state-designated Southern California region have been maxed out for days on ICU capacity, with a bed availability of 0% for COVID patients. Beds are available for non-Covid patients requiring ICU care.

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