Idaho hospitals have needed crisis standards during COVID. How would a new bill change that?
For the first two times in its history, Idaho’s Department of Health and Welfare activated crisis standards of care in parts of the state last September and in January as hospitals battled two deadly waves of the coronavirus.
A bill in the Idaho Legislature would require Health and Welfare to limit the scope of its crisis activations, to develop long-term health care capacity strategies, to define patients’ rights and to put in place an ombudsman to oversee crisis-related patient complaints.
The bill passed the Senate on Thursday and now heads to the governor’s desk. It was passed by the House earlier this month.
Individual hospitals develop crisis standards plans, which are implemented when a hospital does not have enough resources to treat all patients with the usual levels of care. In extreme circumstances, a crisis standards activation could mean that health care is triaged based on who is most likely to survive.
In an interview with the Idaho Statesman, Republican Majority Caucus Chair Megan Blanksma, R-Hammett, and the bill’s floor sponsor in the House, said the bill is intended to provide greater clarity on how the crisis standards process works, while also helping the state learn from the process every time crisis standards are activated.
“The model of Idaho hospitals was excellent,” Blanksma said. “They did their best with what they had. … This is just a way to kind of firm up what procedures were used so that we have better guidelines should we ever have to deal with something like this again.”
House Republican leadership met with the Idaho Hospital Association earlier this session to discuss how new legislation could be passed “without jeopardizing our ability to provide adequate care in our facilities during a crisis,” Brian Whitlock, CEO of the Idaho Hospital Association, told the Statesman in an interview.
The new legislation would require a report from the director of Health and Welfare to state leaders within a week of any crisis activation, and it would also require health care facilities operating under crisis standards to send daily reports to Health and Welfare about their circumstances.
During the COVID-19 surges, hospital leaders met daily with officials at Health and Welfare to share resources and coordinate needs in an effort to avoid the worst outcomes. While the first iteration of crisis standards was caused by insufficient hospital staff and available beds to treat COVID-19 patients, this year’s activation was caused in large part by a blood shortage supply, Whitlock said.
Whitlock said he does not think the bill is necessary, saying its intent “may be a solution in search of a problem.”
“If you look at other states that had crisis standards of care activated, they did get to that point where they had to ration care,” Whitlock said. “We never did. And so what Idaho did during crisis standards of care worked, and it became a model for other states to look to.”
A provision of the bill would prohibit hospitals from withholding food and water from patients in a crisis, which Whitlock, who testified at Tuesday’s Senate hearing, said does not happen anyway.
Sen. Melissa Wintrow, D-Boise, was the lone vote against the bill in committee, saying it felt punitive and unnecessary. While she said she liked the ombudsman idea, the larger bill was a misguided attempt to legislate for a specific circumstance, which could then cause problems in different situations down the road.
“The hospitals have been beat up for two years when we should actually be applauding and lifting them up,” she said. “I think this is basically icing on a cake we don’t need.”
‘Essential caregivers’
The bill would require that a patient has the right to visitation from “essential caregivers,” even if other visitors are being excluded from the hospital.
“We want to make sure that people have access to their loved ones,” Blanksma told the Statesman. “But we also want to make sure that the hospital can still do their job.”
She added that legislators have been concerned about how Health and Welfare made its decisions to activate and deactivate crisis standards of care, and said the legislation was meant to provide more clarity.
“We’re just looking at more transparency … so that the public understands what’s happening and there isn’t misinformation being bandied about that might sway public opinion one way or another that may or may not be accurate,” she said.
Whitlock noted that there are some “legitimate concerns about visitations and patients’ rights during the pandemic,” and that the bill aimed to balance patient rights with a hospital’s needs.
“The sponsors of the legislation were willing to take input from us and modify the language to make it as workable as possible,” he said.
Onus on hospitals: ‘That’s not going to work’
In the bill’s legislative intent section, it charges Health and Welfare with “limiting the duration and scope of operating in crisis standards of care by using all measures that are available and within its authority.”
So far this year, Idaho lawmakers have banned businesses from mandating COVID-19 vaccines while attempting to ban mask requirements aimed at stopping disease transmission and preemptively end the governor’s declared public health emergency, which allowed the state to access Federal Emergency Management Agency funds. Gov. Brad Little announced the end of the emergency declaration on April 15.
During the delta and omicron coronavirus variant waves of infections that overwhelmed hospitals and caused parts of Idaho to enter crisis standards, hospital leaders have consistently said that a large majority of those filling up hospital beds and intensive care units were unvaccinated. Hospital leaders have also noted that masks and social distancing are also effective at reducing case numbers.
To stave off future crises by building capacity, Whitlock said the state will need to begin viewing health care as infrastructure, particularly given Idaho’s rapid population growth.
“Just relying on the private sector alone to build capacity coming out of a pandemic, to meet future needs and surges in health care demand — that’s not going to work,” he said.
Whitlock said that another bill this session to reduce the state’s allocation of general Medicaid funds by around $66 million starting in 2024 will mean hospitals have to pick up the slack.
“If legislators’ intent is for hospitals to be able to build their capacity, why did you just tax them $66 million to pay for other costs?” he said.
Whitlock added that he hopes the current bill will be sufficient to handle future issues for years to come, and that his association hopes to work with state leaders on adopting specific rules around crisis standards if the legislation is passed.
“We survived 131 years as a state without having this kind of specificity for crisis standards of care,” he said. “I hope this language is sufficient to get us through the next 130 years.”
Editor’s note: This story was updated 11:32 a.m. on March 25 to include the Senate vote on Thursday.
This story was originally published March 23, 2022 at 8:18 PM.
