Could COVID force rural Kansas hospitals to ration care? Doctor warns of what patient surge could mean.

Jason Tidd
Topeka Capital-Journal
A medical director in Abilene is concerned about the potential for rationing medical care. This comes weeks after a doctor in Abilene spent hours trying to find a critical care bed for one of her patients.

A rural Kansas doctor is warning that further surges in the coronavirus pandemic could overwhelm hospitals and result in health care rationing.

Brian Holmes, the medical director of the ER and lab at Memorial Health System in Abilene, said the potential for rationing is what concerns him with the COVID-19 situation.

"We're going to see more rationing of care in the U.S.," Holmes said last week during a media briefing hosted by The University of Kansas Health System. "We've been spoiled to this point where we really haven't had to deal with that. But COVID and the pandemic, these patients that come in, they don't just stay two or three days.

"They're here for a week or longer, and you've seen people in the ICU even for over a month."

Holmes said the ICU normally has "people come and go pretty quickly."

"When you lose that cushion and you don't have the volume to move people in and out for other normal time-critical diagnoses like trauma, heart attacks, strokes, etc., it puts a severe strain on our system," he said.

In Idaho, some of the state's northern hospitals are rationing care because of a massive increase in coronavirus patients. Public health officials activated the "crisis standards of care" last week.

"We don't want to get to that point," Holmes said. "But in our facility, we're a 26-bed critical access, we have two BiPaps and three Vapotherm machines. At one time, we had two Vapotherms and one BiPap being used by COVID patients.

"It would only take two or three more patients to come in and overwhelm us, with COVID that need oxygen at a high flow, that all of a sudden you're picking and choosing who gets to be on these machines and who doesn't. We don't want to be in that position, we want to be able to treat everybody the same and give them the best care we possibly can. That's my biggest fear when I think about trying to take care of our community."

The Abilene hospital gained widespread attention amid a glut of options for patient transfers. Last month, medical staff spent 3.5 hours calling hospitals farther and farther away, trying to find an ICU bed for a gravely ill patient. The patient was transferred via air ambulance to a hospital in Wisconsin.

More:An Abilene man had COVID-19 and needed ICU care. His doctor searched until she found a bed — 570 miles away.

Finding beds for transfers of sicker patients remains difficult. Doctors said Monday that KU hospitals would have had even more COVID-19 patients if they hadn't been rejecting transfer requests to the "really full" hospital over the weekend.

Dana Hawkinson, an infectious disease specialist, said KU hospitals currently have enough ventilators and drugs to keep patients comfortable while on the ventilators.

"Right now, we haven't had to make those decisions on rationing care," Hawkinson said Thursday.

In Abilene, it wouldn't take much to get to such a situation. It is at the point where additional surging of COVID-19 patients could affect non-COVID patients.

"I preach to my folks, whoever will listen: don't get in an accident, be careful, don't do anything silly, don't put yourself at risk with your activities or driving and even your own job," Holmes said. "We have a lot of farmers around here, and accidents happen ... but there may not be a bed for you."

The bed crisis has less to do with the literal number of beds than with staffing challenges. Holmes said there are fewer nurses in the profession now than a year ago because "people are burned out, they've left, they just can't do it anymore."

More:‘We need you in Kansas’: Officials finally approve rules for $50 million nurse bonus program

"We don't want people dying in the hallways and dying trying to get into the emergency room and dying at home because they can't get treatment," Holmes said.

Public health officials have warned against using hydroxychloroquine or ivermectin for treatment or prevention of COVID-19. Nevertheless, Holmes said he has been "threatened" in the clinic by patients who demand treatment with the drugs.

Health care systems have finite resources on staff, equipment and bed space. Decisions on how to ration care would put a "tremendous amount of pressure" on providers.

"You may get pulled into a situation where you've got 10 people that need five pieces of equipment," Holmes said. "How are you going to choose who gets what? Do you base that on age? Do you base it on comorbidities? Do you base it on it's your friend or your friend's family member?"

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He called on people to get vaccinated, because it is primarily unvaccinated people who get seriously sick, hospitalized and die. He also called for schools to follow mitigation measures, including mask requirements.

Still, Holmes said he doesn't want to make triage decisions based on vaccination status.

"It is frustrating to see these people come in and tie up resources that didn't necessarily have to happen because they chose not to get vaccinated," he said. "But it doesn't mean we're going to treat them any differently. We're still going to try to give them the best care that we can."