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With Hospitals In Crisis, Primary Care Clinics Expect Sicker Patients: "We Can Only See So Many"

The Exterior of a Primary Health Clinic Location in Boise.
Photo Courtesy Primary Health

Overwhelmed hospitals asked Idaho to declare crisis standards of care this week, allowing facilities already short on resources to ration care. At Idaho's Primary Health Clinics, the crush of patients has forced CEO Dr. David Peterman to close all locations an hour earlier each day - 7 p.m. - and in some cases, close locations during normal business hours.

Peterman spoke with Boise State Public Radio's Troy Oppie on Thursday, Sept. 16, following the state's crisis declaration. Listen to the interview or read the transcript below.

TROY OPPIE: Dr. David Peterman is CEO of Primary Health, and he joins us on the telephone line now to discuss the impact of today's declaration of crisis standards of care across the state of Idaho on the more than two dozen clinics, I believe, across southern Idaho. Dr. Peterman, thanks for being here. You've been concerned about capacity issues for for several weeks. How have your clinics been dealing with the influx of patients of all kinds? Certainly the overabundance of COVID patients.

DR. DAVID PETERMAN: So first of all, thank you very much, Troy, for calling me and giving me an opportunity to share our experience with the community. I think we all believe as health care workers - the more we can educate the public about the crisis we're in, the better it is for our community throughout this pandemic. Primary Health has literally seen hundreds of thousands of patients that we have evaluated for COVID, possibly tested for COVID, and then we've given over 160,000 vaccinations for COVID. So we've been very involved.

We keep very detailed data about who we're seeing diagnosing COVID and share it with the state. And we began approximately four or five weeks ago sharing information with the hospitals and the state that all our numbers are rising and they were rising in a very scary way in terms of demand for services, and for testing with COVID and positivity rates. And our concern was as this continued to go out of control, it might lead to the crisis of standard of care where we are today.

I would say approximately three weeks ago, the demand for our service was just incredibly high, such that it was impacting our ability to really give care. Normally we would get maybe 1,000-to-1,100 visits to our urgent care on a daily basis. The last few weeks we've had multiple days where we've seen over 2,000. Normally, we would get about 40,000 phone calls to our urgent care clinics on a monthly basis. In August, we had 80,000. With that in mind, what started to happen as we were seeing this large volume of patients and the majority of them being evaluated for coronavirus? The staff, normally we close our doors at 8 p.m. and we were we were staying in the clinics until 11 p.m.-12 a.m., and then we have to turn right around with the staff and be there the next day to see patients again. And we literally couldn't keep up. We just couldn't see enough of the patients. Coupled with that is our own impact of of COVID on our own staff. That is, while 91% of our staff are vaccinated, there have been breakthroughs in terms of getting COVID.

As we all know, the consistency with masks in schools has been variable in our valley, some doing it, some not. And so many of our employees have children. Even though they're vaccinated, they've been exposed to COVID and any given day, we may have 30 of our employees out because they're waiting for results are actually they have a positive COVID test. All that taken together, we couldn't keep up. So I made a decision which frankly, I've never done in the whole history of Primary Health. We started closing our clinics early at 7 p.m. and in a sense, basically saying to the public, we can only see so many. This enabled our staff to get things done, do their charting and be ready for the next day. The next step was approximately two weeks ago. We had to close clinics on weekends. We just didn't have enough staff. Then finally, this week we actually closed a clinic during a weekday. So from our perspective, this surge, this demand in a sense, unfortunately, was predictable.

OPPIE: Your clinics are usually the first stop for people who are feeling ill or they've hurt themselves somewhere along the way. Are you having to attempt to treat patients that you would otherwise be referring to local emergency rooms for for advanced care?

PETERMAN: Yes. Just let me answer in two parts.
The first part is as soon as I became aware of the standards of care being declared by [Dave Jeppesen] the director of [Idaho] Health and Welfare, we immediately put the team together so that we could prepare our staff for that. In any given day at Primary Health, we take care of about 80,000 patients that are our patients. It is our expectation many of them (patients leaving hospital care) will be discharged early. So we have set up a system just to address exactly what you said, Troy, which is to be prepared to have patients come out of the hospital early, sicker. And we, as primary care doctors, need to be aware of it and we need to contact them and make sure they're okay.
On the other side, I sent out a memo or we sent out a memo to all our staff that it's very possible we will be seeing sicker patients in our urgent care. And frankly, we have because they can't be seen in the emergency room. And the other aspect of that with these crisis standards of care, our urgent care has to try to do as much as we possibly can without sending the patients to the hospital.

OPPIE: The effect of having to close clinics early and on weekdays is essentially the denial of care to somebody who needs it. How have your staff been dealing with shutting the doors on people?

PETERMAN: It is heart wrenching that we would have to close our doors early when you get 80,000 a month. I have to say to the patients, I'm not sure I can get to all the phone calls; you may have call three or four times. That's not the care we're used to giving, and it is absolutely heart wrenching to all of us who are health care providers in our staff.

What you're not seeing because this is radio is, is I'm shaking my head. This is incredibly sad because all of us in health care know there are some simple steps that that we could help this situation and quite frankly, avoided it. And and we know what those are: They are all of us wearing masks when we're indoors, vaccinated or not vaccinated. Wearing masks, [when] we're going to all be [in] close contact and most importantly:those that are eligible being vaccinated. That's what's so sad about this today, is that there are such simple steps we could do to avoid this.

OPPIE: My wife just texted me as we're talking: our girls just got their flu shots and she says, 'Hey, make an appointment next day or two to go get yours.' A lot of folks come to primary health for flu shots every year. How are you going to manage that necessity along with what you're already doing with this influx of COVID 19?

PETERMAN: She's absolutely 100% right. So we've got a lot of balls in the air here. So normally Primary Health vaccinates 40,000 people every fall for influenza, and it's absolutely [critical] we vaccinate them. So we are right now as we speak, setting up outside sheds outside our clinics. We're starting to get all the influenza vaccine out to the clinics, and we will do a combination of appointments and walk ups for influenza for all ages while we continue to vaccinate people for COVID. And we're also preparing for the possibility of doing boosters for COVID. So your wife is is is absolutely 100% because, oh my goodness, what if we are dealing with a surge in influenza and COVID? It's unimaginable.

OPPIE: We have to leave it here. Dr. David Peterman is CEO of Primary Health. Doctor, thank you for your time. Continued good luck to you and your staff.

PETERMAN: And Troy, thank you very much and to the listeners. I'm going to make one last plea. Those who that are not vaccinated, please get vaccinated and please wear your mask when you're indoors and close to other people.