By Andy Rose, CNN
(CNN) -- Idaho officials announced Thursday they're preparing to ration hospital care due to the Covid-19 surge, and it was the last thing next-door Washington state's top hospital advocate wanted to hear.
"It's terrible. I don't know if people understand the gravity of the situation," Cassie Sauer, chief executive of the Washington State Hospital Association, told CNN Thursday evening. "This is not something that should be happening in America at this point."
Sauer says hospitals in Washington are getting more requests to take patients from overwhelmed facilities in Idaho. In some cases, sick Idahoans are simply driving themselves across the border seeking treatment.
"The fact that it's not causing severe alarm in Idaho is shocking to me," Sauer said. "In a normal time, our hospitals would accept almost every transfer request. They're accepting some, but they're declining more now."
Although hospitals as far west as Seattle have been getting transfer requests, according to Sauer, most are coming to Spokane. That city is just across the border from Coeur d'Alene, the largest city in Idaho's narrow northern region.
"While we have been able to accept some of those patients, we have also had to decline more than half," said Marce Edwards Olson with MultiCare, which operates Deaconess Hospital in Spokane. "All of our hospitals are very busy taking care of Covid patients and we have been near capacity for some time."
Under the Crisis Standards of Care declaration announced Thursday, the Idaho Department of Health and Welfare said, "The massive surge of Covid-19 patients has exhausted the supply of staff, available beds and necessary resources to adequately address the increased demand for healthcare services."
The declaration is a decision of "last resort," Idaho's health department director, Dave Jeppesen, said earlier this month. It moved Idaho Gov. Brad Little to plead for eligible Idahoans to get vaccinated.
"We have reached an unprecedented and unwanted point in the history of our state," the governor, a Republican, said earlier this month.
'We're in a situation of limited resources'
Throughout the pandemic, Covid-19 has strained the US health care system. Hospitals continue to face difficult decisions on which patient takes priority when staffing is low and beds are full.
"We're already making those choices, and they're very difficult choices," Dr. Steven Brown, a critical care pulmonologist at Mercy Virtual Care Center in St. Louis, told CNN's Ana Cabrera earlier this week. "I work in the intensive care unit. Many people have serious illnesses but not illnesses where they're going to die immediately, but serious illnesses where they need an operation and some of these operations are so serious that after surgery, they need to be in the intensive care unit for a day or two -- replacement of a heart valve, surgery for serious cancers like pancreatic cancer.
"If the intensive care unit beds are all filled up with patients who are on ventilators because of their pneumonia, surgeries have to be postponed," Brown said. "We have situations where people may come into the hospital with a heart attack, and they have to stay in the emergency room for extended periods of time while waiting for a bed to open up."
In some cases, that means a patient has died.
"It's a sad situation that we really haven't seen in American history in a very, very long time." Brown said. "We're in a situation of limited resources now, and when you have limited resources, we are in triage situations -- and some people may die as a consequence of this."
Generally, hospitals and health systems say they have plans to address an overflow of patients.
"All hospitals and health systems have plans in place to deal with a surge in patients. These plans can include actions like adding beds, including in non-traditional areas of care in a hospital like a cafeteria or parking lot, shifting patients between hospitals, and working with their local and state health departments to find other sites of care," Akin Demehin, director of policy at the American Hospital Association (AHA), wrote in an email to CNN earlier this month.
"Sometimes this includes sending patients to hospitals in nearby states that may have the capacity to treat them," Demehin wrote. "One other option that some hospitals have taken is to scale back, or put a pause on, so-called elective procedures that are non-emergent and can be safely delayed."
Yet for the most part, hospital capacity is not only about how many beds are filled. A hospital can usually add beds. But many facilities are more concerned about enough staffing to care for patients, according to Demehin.
"Hospitals and health systems entered the COVID-19 pandemic already facing a shortage of skilled caregivers, and the last 18 months have exacerbated that," Demehin wrote, adding that AHA has called on the Biden administration to work as a partner in developing strategies to address the shortage of health care staff.
Hospitals making tough choices
Under federal law, an ER must accept any patient who seeks care, Art Caplan, professor of bioethics at NYU Langone Health in New York, told CNN earlier this month.
"You have to accept anybody, even if they have no money, and stabilize them. It's called EMTALA, and it's been around for a while," Caplan said.
The Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals with emergency departments to provide a medical screening exam to any person who comes to the emergency department and requests care. The law also prohibits hospitals with emergency departments from refusing to examine or treat people with emergency medical conditions.
Now, during the pandemic, many of the Covid-19 patients filling hospital beds are unvaccinated. EMTALA obligations remain in place.
Back in Washington, Sauer is frustrated that the state's neighbor to the east is not taking the kind of extensive steps Washington has to stem the tide.
"Idaho's not doing what it should. They don't have a [statewide] mask mandate. They need to do their part," said Sauer. "They cannot rely on Washington as their stopgap."