In a Thursday meeting marked by desperate hospital capacity reports, a leading eastern Idaho doctor told regional health officials that the state is "getting very close to initiating" an extreme resource-conservation plan meant to divvy up care to patients based on who is likely to survive.
"There is a breaking point," Dr. Kenneth Krell, ICU director for Eastern Idaho Regional Medical Center, told the health board. "And ... we are at it. We all grow numb to the numbers … but to those of us on the frontlines, the patients and the deaths are real. And the toll on health care workers is personal."
The comments came during a tense Eastern Idaho Public Health board meeting. Hospital representatives told the board that the swarm of COVID-19 patients is inhibiting their ability to provide normal levels of health care.
Krell said the committee that developed Idaho's Crisis Standards of Care plans to meet next week; he serves on that committee. Krell urged the board to enforce existing and new public health restrictions, including by instructing law enforcement to enforce mask mandates and event restrictions in place for most of the region.
The health board members doubted they had any power to issue additional restrictions. Members again signaled that enforcement should fall to local governments, which can issue lesser fines and penalties than the health district's orders that carry misdemeanors.
EIRMC, the region's largest hospital, is rationing care informally because ICU staff are limited, Krell said. Patients at risk for a crash are not being preemptively admitted to EIRMC's ICU as soon as they would be normally, Krell said. He relayed those concerns to the Post Register earlier this week.
"Make no mistake," Krell told the health board Thursday. "We are already rationing care."
Regularly, Krell said EIRMC has 20 virus patients on ventilators. Administrator David Hoffenberg said the hospital EIRMC was treating 44 total COVID-19 patients on Thursday morning, with 14 of its 29 ICU beds filled by virus patients.
Hoffenberg said Bingham Memorial Hospital in Blackfoot was recently told the University of Utah could not accept the small, rural hospital's patients who need more advanced care. Anticipating a wave of more hospitalizations over the coming weekend, he said EIRMC is "planning to have overflow units."
"We're not seeing the trend go in the direction anyone is hoping for," Hoffenberg said. "In fact, I fear this weekend that we'll continue to see more and more admissions because we haven't seen the impacts of Thanksgiving."
At Idaho Falls Community Hospital, administrator Casey Jackman said seven of its 10 ventilators were being used by COVID-19 patients in the ICU Thursday morning, with 20 more patients occupying other beds.
The hospital is at a critically high level of resource strain, Jackman said, and "we have begun limiting elective surgeries as much as possible to outpatient surgeries." That move is meant to free up nurses, who are in short supply, he said.
Rachel Gonzalez at Madison Memorial Hospital in Rexburg said the hospital's four-bed ICU has "hit capacity I think at least three times this week. Again last night." Half of the demand was from COVID-19, but overdoses and a rise in mental health emergencies has utilized more resources, she said.
On potential enforcement of restrictions, Krell told the board it could require people with the virus to quarantine, close "non-essential businesses" such as bars and restaurants, and instruct local law enforcement to enforce mandates.
He argued the board could, too, utilize its regulatory health powers over restaurants that skirt public health orders. Health district Director Geri Rackow said the board's powers over restaurants are limited, only including health violations outlined in Idaho's legal rules that the Legislature sets.
Rackow and board members were skeptical that they could enforce the regional mandates. They organized plans to meet next week and have their attorney advise them on their powers.
Madison County representative Brent Mendenhall and board Chairman Bryon Reed both said the board has done all it can to educate the public. The rest falls to local cities, Mendenhall and Reed argued. But Mendenall seemed to leave the door open to more action, if possible.
"What authorities are we not utilizing? What do we have, because we've had this discussion, Dr. Krell, many, many times," Mendenhall said. "Our enforcement — we can put out the mandate, which we did and we took criticism for early on. … But it goes to … local law enforcement to enforce that. What you are indicating and suggesting we do, we would love to have that happen. But it takes a city council."
Rackow agreed that enforcement "does go to the local and state law enforcement." She later said: "It is incredibly challenging and I think it would behoove us to have our legal" counsel advise the board. "We have not come up with any way that we, as a public health (board), could absolutely enforce the orders that are in place."
Local health orders can carry lesser penalties than the health district's orders, which are misdemeanors that could result in up to six months in jail and $300 in fines, as outlined in Idaho law. Reed said prosecutors have told him that enforcing the stringent orders would be "quite problematic."
Reed added that personally, he does not want to see people arrested for violating the mask mandate, but he supports enforcement decisions by cities such as Idaho Falls, which recently said it could issue infractions to some event organizers that violate gathering restrictions.
In COVID-19 spread updates, two counties, Lemhi and Teton, have seen their caseloads gradually decline over the past few weeks, bringing them down from the critical-risk level to the high-risk level. Seven of eight counties here are under mask mandates while at the moderate-risk level or higher. Custer County is at moderate-risk; Fremont, Jefferson, Lemhi and Teton counties are at high-risk; and Bonneville and Madison counties are at critical-risk.
No additional restrictions necessarily come at the higher risk levels, but the board's plan says it could consider a stay-home order at the critical-risk level; the board hasn't clarified when it would issue such a tight restriction.