COVID-19 Surge Forces Alaska's Largest Hospital To Ration Care
On Sept. 14, doctors who work at Providence Alaska Medical Center said that they’ve begun to ration care as Alaska endures one of the worst surges of COVID-19 in the country.
“While we are doing our utmost, we are no longer able to provide the standard of care to each and every patient who needs our help,” said a two-page letter from the Medical Executive Committee of Providence, representing the independent physicians who practice at the hospital. “The acuity and number of patients now exceeds our resources and our ability to staff beds with skilled caregivers, like nurses and respiratory therapists.”
The letter is signed by Dr. Kristen Solana Walkinshaw, chief of staff of the Medical Executive Committee. The hospital administration is distributing the letter on the committee’s behalf, a hospital spokesman said.
The letter said that the medical staff has had to “prioritize scarce resources and treatments to those patients who have the potential to benefit the most.”
The doctors said that they’ve enacted procedures to ration care “including dialysis and specialized ventilatory support.”
Hospitals have warned that the COVID-19 surge could reach this crisis point for weeks, as the number of patients hospitalized with the virus continued to climb, setting new records daily. On Sept. 14, Alaska reported another seven deaths from COVID-19.
‘We are in crisis at the hospital’
Dozens of health care workers, including Walkinshaw, also took their concerns to the Anchorage Assembly on the evening of Sept. 14. They told Assembly members that Providence is overloaded with patients suffering from COVID-19.
“We are in a crisis at the hospital,” Walkinshaw said. “When we have four patients and two machines, two patients are not getting that care.”
Unlike earlier in the pandemic, the city has not implemented any mask mandates or capacity restrictions to try to limit the spread of the virus.
Mayor Dave Bronson reiterated his position after the Assembly passed a resolution asking him to require face masks in municipal buildings.
“If someone wants to wear a mask or get a vaccination, that’s their personal choice,” Bronson wrote in a statement. “But we will not violate the privacy and independent health care decisions of our citizens in the process. The personal choice to wear a mask or vaccinate is up to the individual person.”
“Oftentimes, we have to decide who comes up from the emergency room first to an intensive care unit bed. And so that’s a normal part of the triage process in a hospital or an emergency room,” said Hospitalist Dr. Ryan Webb in an interview. “Over the past week, I would say we have been making more of those decisions, and those decisions have been growing more and more challenging to make.”
Providence staff decided to write the letter because they wanted to be transparent with the public, said Webb.
Among those most affected are patients at hospitals outside of Anchorage who would normally be transferred to Providence. Webb said that emergency room wait times have also increased dramatically.
“And so someone who simply has a bad urinary infection, or a heart attack, or a car accident here in Anchorage is also facing unexpected delays that we think are outside of the norm, and really outside the standard of care,” he said.
Webb said that it’s a demoralizing time for the doctors, nurses, and therapists at Providence.
“You get into this job to provide great care for anybody that needs it,” Webb said. “It is both very shocking and really tragic to be where we are at this point where we’re unable to do that.”
Caregivers now have to choose which patients get care first “or perhaps at all,” he said. “And that’s also not something that we really ever want to be doing.”
In the letter, Walkinshaw wrote that the worst is not over.
“As we watch the case rates rise in our community, we anticipate an escalation in COVID-19 hospitalizations in the coming two to four weeks,” said the letter. “What is already a stressful situation could rapidly progress to a catastrophe.”
Already, the letter said, Providence’s ER is overflowing.
“Patients wait in their cars for hours to see a physician for emergency care,” it said. “On a daily basis, our transfer center is unable to accept patients who sit in emergency rooms and hospitals across the state, people who need care their current facility is unable to provide. If you or your loved one need specialty care at Providence, such as a cardiologist, trauma surgeon, or a neurosurgeon, we sadly may not have room now. There are no more staffed beds left.”
Webb and state health officials say that the public can help reduce the surge by getting vaccinated and wearing masks when in public indoors, regardless of vaccination status.
State Epidemiologist Dr. Joe McLaughlin said that Alaska is experiencing one of the sharpest surges of COVID-19 in the country.
“Alaska currently has more people hospitalized with COVID-19 compared to any other time during the pandemic,” he said. “And Alaska is second only to North Dakota for the percent increase in hospitalizations due to COVID-19 over the past two weeks.”