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YKHC CEO explains why YKHC activated crisis standards, and what could cause it to ration care

YKHC classifies the entire Y-K Delta under high transmission of COVID-19.
YKHC classifies the entire Y-K Delta under high transmission of COVID-19.

The Yukon-Kuskokwim Health Corporation continues to operate under crisis standards of care. On Oct. 5, President and CEO Dan Winkelman explained what precipitated that decision. He spoke during a public meeting over Zoom.

YKHC activated the crisis care standards on Sept. 29. The prior weekend had seen 24 beds at the hospital full, with six of those patients being treated for COVID-19.

“We are a 26-bed hospital, so for YKHC we were at capacity due to the nature of the COVID patients and their very high acuity," Winkelman said.

In an email last week, YKHC said that its hospitalized COVID-19 patients were requiring stays of two weeks or longer. Each needed significant resources, like staffing.

Winkelman said that activating the crisis standards allowed YKHC to increase the number of patients that nurses can be responsible for at a time, and it gives more support to providers if they have to make “difficult decisions” if patient numbers increase. Under the crisis standards, YKHC has a committee of physicians to help providers decide how to prioritize care in crisis situations.

“Fortunately, that did not happen. YKHC’s implementation of crisis standards of care did not mean that YKHC was rationing care in any way,” Winkelman said.

Rationing care would refer to deciding which patients get care to the exclusion of others. Care is often given to patients who providers consider most likely to recover. However, Winkelman listed a series of situations that could force YKHC to ration care: “If our in-patient census continues to increase beyond our capacity, or we stay at capacity for a long period of time. Or our patient mix substantially increases with more COVID patients and we continue to be unable to medevac the high levels of care, or medevacs continue to be delayed.”

YKHC, along with other rural hospitals, has experienced delays in medevacing patients to urban hospitals for advanced care since early September. The urban hospitals have often been at capacity. Winkelman said that the number of patients hospitalized at YKHC changes rapidly. On Oct. 4, YKHC had 21 patients hospitalized, nine of them with COVID-19. YKHC has gained some staffing support, however. Under a federal contract with the state, most of an expected 14 nurses and five nursing assistants arrived this week.

YKHC Chief of Staff Dr. Ellen Hodges gave more COVID-19 numbers during the public Zoom meeting. She said that there are 355 active COVID-19 cases in the region across 33 villages, including Bethel. Many of those communities have widespread community transmission of the virus. Over 1,000 people in the region are in quarantine after being exposed to COVID-19, and 74.4% of the region’s eligible population over the age of 12 has been vaccinated against the virus. Hodges wants that number higher.

“I really want that number to be 100%. One hundred percent of those age 12 and older. That’s what’s going to keep our kids the safest until we can vaccinate everyone,” Hodges said.

Winkelman is encouraging employers and schools to create programs to incentivize vaccinations, and he’s encouraging cities and tribes to provide financial incentives to encourage vaccinations.

COVID-19 vaccinations and testing are available at the Bethel hospital and village clinics.

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