With one in 49 Coloradans contagious for COVID-19 and several areas of the state now out of ICU beds, Gov. Jared Polis on Monday issued an executive order authorizing the Colorado Department of Public Health and Environment to prepare for surges in hospital capacity that are beginning to overwhelm local hospitals.
The order's biggest takeaway: it protects consumers from out-of-network charges when a patient has to be diverted from an in-network hospital that has no capacity to an out-of-network one.
Polis' executive order Monday said that "unfortunately, given the increase in infections, the number of persons seeking medical treatment at hospitals may far exceed the capacity of any given hospital. Hospitals who have reached capacity may need to cease admitting patients and may also need to transfer such patients to a separate facility without first obtaining the individual’s written or informed consent for such transfer. The transfer of patients from hospitals that have reached capacity to other specified care facilities will combat the current public health emergency due to COVID-19 and promote public health."
Julie Lonborg, senior vice president for the Colorado Hospital Association, said the state is trying to support what's already been worked on, known as the Combined Hospital Transfer Center. The executive order attempts to clarify the role of a federal law around transfers, which dictates when a hospital can and can't transfer patients.
The transfer plan, announced on Nov. 4, "allows for the bi-directional transfer of patients between hospitals throughout Colorado as they manage their surge capacity," according to a statement Monday from the hospital association. Lonborg told Colorado Politics that they talked with Scott Bookman, the COVID-19 Incident Commander for CDPHE after the order was issued, who explained that following the creation of the transfer plan, "the state recognized the benefit of empowering and supporting the plan with an Executive Order. Importantly, by issuing the Executive Order, Gov. Polis is ensuring that providers have the tools at their disposal necessary to function collaboratively as one health care system."
Transfers will be completed through "a data-driven process that ensures patients can access the level of care needed while making the most efficient use of the health care system and protecting the system for future capacity challenges," the hospital association said on Nov. 13. The first tier of the plan was activated Nov. 13 due to capacity and staffing concerns.
Two regions of the state — southwestern Colorado and the San Luis Valley — report Monday their ICU bed capacity has been exhausted, although Lonborg said that capacity fluctuates, especially over the weekends. The Southwest Regional Emergency Medical & Trauma Services Advisory Council (RETAC) reported Monday the 25 ICU beds in the region are all full. Southwest RETAC includes Archuleta, Dolores, La Plata, San Juan and the Ute Mountain Ute reservation. The region has two hospitals: Mercy Regional in Durango and Southwestern Memorial in Cortez. A third hospital, in Pagosa Springs, transfers its patients in need of ICUs to the other facilities. The southwest RETAC provides services to about 130,000 Coloradans.
The San Luis Valley RETAC has a total of 16 ICU beds, including three added in the last week, and all are in use. The Valley RETAC serves 47,000 residents in Alamosa, Conejos, Costilla, Mineral Rio Grande, and Saguache counties. The website for San Luis Valley Health, which operates a hospital in Alamosa with some of the region's 16 beds, advises that some of its staff are in isolation or quarantine and that COVID-19 is increasing "at a rapid rate" in the Valley.
The news is only slightly better for those who don't need intensive care. The percentage of acute care beds ranges from a low of 12% available in northeastern Colorado — including Weld County — to 58% available in the southeastern RETAC.
Statewide, and as of Monday, 81% of acute care beds are in use.
But the state has taken away two of the tools that could have helped stem the surge — alternate care centers — that were closed in October in Mesa and Larimer counties. Mesa County is one of the counties where there are no more ICU beds; in Weld County, adjacent to Larimer, as of Friday there were only three ICU beds left at the county's two major hospitals.
A spokesperson for CDPHE told Colorado Politics on Friday that the two facilities — Western Slope Memory Care in Grand Junction and the Ranch at Loveland — have been turned over to the property owners and the state has no plans to reopen them.
Western Slope was expected to provide 50 beds; the Ranch would have had up to 200 beds available. Western Slope was classified as a Tier 2.5 facility, meaning it would be available for COVID-19 positive patients from senior long-term care facilities to provide isolation from the rest of the facility. The Ranch, a Tier 3 facility, would be used for recovering COVID-19 patients who are no longer in need of critical or acute care.
Weld County, in particular, has turned into a special problem for Polis and state public health officials. The county was one of 22 put on "red level" status in the past week by the CDPHE, meaning indoor dining would close and capacity at other establishments, such as gyms, would also be severely restricted. The Weld County public health website claims it has 43 ICU beds available, however, 40 of the 43 ICU beds listed are located at hospitals in Adams, Denver, Larimer and Boulder counties, not Weld County.
But county commissioners have made it clear they have no intention of following state public health orders and instead will encourage residents to follow the guidelines if it isn't too much trouble. Weld County's two-week positivity rate is 16.5%; it has reported 1,260 new cases in that same time period.
In a statement Friday, the commissioners said the state's decision to move the county into red "does not change the stance of the Weld County Board of Commissioners with regard to enforcement of the state’s mandates. Instead, county government continues to do what it has done since March, which is promote and encourage residents and business owners to take individual responsibility and make decisions to protect themselves, their families, their community and their businesses. The county will not enforce a rule confining individuals to their homes for an undetermined length of time; the county will not enforce a rule that states residents cannot have personal gatherings; the county will not tell the school districts how to provide education to their students; the county will not enforce a rule requiring a reduction of attendees in places of worship; the county will not enforce a rule demanding restaurants close their indoor dining areas; the county will not enforce any rule that forces a business to shut down or impedes their ability to operate...The county will continue to encourage individuals to evaluate their personal situation and make decisions that protect them as best as possible."