How Republicans in Montana hijacked public health and brought a hospital to the brink
During the Delta surge
The doctor wanted to transfer the patient to the ICU. But the unit was full.
Harkins quickly convened a video meeting of the Scarce Resources Committee. As doctors began to weigh in, the committee realized the crisis ran deeper. There were an additional four critically ill patients in other parts of the hospital who also should be transferred to the ICU.
The math was brutal: Five patients and zero beds.
The committee began the process spelled out by an allocation algorithm in Montana’s crisis standards of care guidelines. Factors like age and preexisting conditions were fair to consider, but vaccination status was not.
Harkins quarterbacked as the committee deliberated: How old? Other serious health conditions? How long in the hospital? What is the latest status?
One critically ill non-COVID-19 patient had a serious heart condition. “I feel the heart patient will not survive. How do you feel?” one doctor asked. Everyone agreed that the heart patient would not get an ICU bed and could be treated in another unit.
After about 20 minutes, the committee decided the woman in the emergency room had the most urgent need and should go to the ICU. They could make a bed available by moving a dying patient too ill to survive to another unit. But they had promised the patient’s family they would wait until everyone arrived to say their goodbyes before removing life support. One family member was not there yet. The hospital was running out of time.
Suddenly, a piercing code blue alarm sounded in the emergency room. “Wait a minute, guys,” an attending physician told the committee. “The patient is coding.”
Then, “the patient has died.”
The committee took a moment to absorb the news. Then it began deliberating again. The call lasted an hour. In the end, the terminal ICU patient’s family members were able to gather to say their goodbyes. When that bed was free, another patient discussed during the call was moved into the ICU but died a few days later.
Of the five patients who had been vying for a bed, four ultimately died.
“Under normal circumstances we would have moved all five into the ICU,” Harkins later told ProPublica. “But we just couldn’t.”
Being forced to make such profound decisions changed Harkins and others on the call.
Kimberly Pepper, the hospital chaplain who served on the committee, described seeking solace in the “thin places,” a Celtic belief that there are spots where the distance between heaven and Earth is at its slimmest. Hers was in the Montana mountains. She noticed her hikes had become longer and longer.
Harkins said hospital staff had found their “cry spots” to deal with the anguish. Hers was in an empty office. “The human psyche,” she said, ”was not built for this.”
The virus was forcing cracks in the hospital’s usual care.
Nurses at St. Peter’s had to bathe patients and clean rooms to make up for the large number of nursing assistants who had quit. Kari Koehler, who was serving as the acting chief of nursing during the surge, told ProPublica that the exodus had left the hospital with two assistants per shift instead of the desired 10.
