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Local Hospitals Prepare To Ration Care As COVID Cases Surge

Tents set up outside UC Irvine Medical Center's emergency room. (Chava Sanchez/LAist)
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As coronavirus cases surge in Southern California, local hospitals are bracing for an overwhelming number of patients and the possibility of rationing care.

The 11 counties that make 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.

Now, some hospitals are having to expand beds into nontraditional spaces.

One is Riverside Community Hospital, where some patients are being moved into the cafeteria. The facility is in the process of setting up a tent outside the emergency department to treat people arriving in ambulances. Even the National Guard came to provide assistance to the overwhelmed staff

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Annette Greenwood, Chief Nursing Officer of the hospital, said it's all taking an emotional toll on the healthcare teams.

"I've not seen anything that's like it in my lifetime," Greenwood said. "At the end of the shift there's a lot of tears being shed because of exhaustion, but also because of the emotional toll of being the last person to help someone into eternity."

As soon as next week, she said, staff may soon have to make difficult decisions about prioritizing certain patients for care -- such as determining who gets a ventilator.

Greenwood cited predictions that COVID-19 cases could double in the next week, after infections spread at Christmas gatherings take hold. That would send new people looking for treatment into an already overloaded facility.

"That would be when everybody would be at the tipping point," Greenwood said.

With the help of a task force, including bioethicists, physicians and nursing experts, the hospital is drafting crisis plans for those situations. They plan to consider the likelihood of survival between patients, but specific instructions haven't been finalized.

Greenwood says her hospital is borrowing from similar protocols recently released by Huntington Hospital in Pasadena.

Dr. Kimberly Shriner, an infectious disease specialist at Huntington, spoke on KPCC's public affairs show AirTalk on Wednesday about its plan for a designated team to determine care.

"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," Shriner told KPCC. "It's not anybody who's actually taking care of any of the patients."

Kaiser Permanente of Southern California is also making plans for rationing care. From an emailed statement to LAist:

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"We are taking necessary actions to ensure that we have the capacity and staffing needed, such as postponing elective surgeries and procedures.

We are staying closely aligned with state and local public health officials and other health care systems, as we trend closer to activating crisis standards. If the number of new infections doesn't slow, it's only a matter of time. We hope not to get to the place where we have to start making extraordinarily difficult decisions that most of us have never had to face before."

According to news reports, some local Kaiser hospitals have been among those hard-hit by the pandemic and the growing number of COVID patients.

Dr. Christina Ghaly, director of the L.A. County Department of Health Services, said all acute care facilities statewide must publish their crisis protocols by next week, at the direction of the state health department.

At this point, L.A. Department of Public Health Director Barbara Ferrer says no hospitals in the county are dealing with crisis care situations. But if rationing conditions do begin, hospitals must alert the state and county.

This post has been updated.


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