Central District Health Posts Draft Health Order For Public Comment, Vote Tuesday

Dec 4, 2020

Central District Health board Friday punted a vote on new, more restrictive health orders for its four-county area to a meeting Tuesday. The board will accept public comment on the proposed order through Monday. If approved, the order would take effect Friday, Dec. 11.

Credit Central District Health

The board issued an advisory in mid-November, calling for mask use outside the home, ten-person limits for most pubic and private gatherings, an emphasis on take-out service for restuarants and bars and capacity limits on businesses like gyms. The advisory had no enforcement aspect and appears to have largely been ignored by many businesses. The draft order is similar, with exceptions for education activities including athletics (without spectators), but board members have expressed concerns about enforcement language. The draft order does not require any businesses to close, but limits capacity to 50% in many cases and requires patrons to be able to keep distance.

Doctors Jim Souza and Steven Nemerson, chief medical and clinical officers at St. Lukes and St. Alphonsus Hospitals respectively, presented a dire outlook for patient care as numbers of new and critical COVID patients continue upward. Tuesday, St. Lukes was nearly forced to divert patients away from its Treasure Valley hospitals, normally where smaller hospitals across the region send patients requiring critical or specific levels of care. Divert status was only avoided, Souza said, because several existing patients died.

St. Alphonsus reported approximately twice as many staff absenses due to COVID as they had COVID patients across southern Idaho.

Both hospital systems are already at 'contingency' standards of care, meaning certain normal procedures or treatments may not be available for patients due to staffing shortages. Nurse-to-patient ratios have also increased, and hospitals are already limiting many elective procedure - and St. Lukes may limit more, Dr. Souza said. All patients needing care now can receive it, but that may not be possible if hospitals reach crisis standards.

"We're making sure we're still meeting the needs of our patients, but not the way we'd like to be doing," Nemerson told the board.

The existing advisory would automatically have become an enforceable order if hospitals were forced to implement crisis standards of care. Friday, both doctors told the board of health they are very close to those standards and could reach that point in two-to-four weeks based on current modeling. Because hospitalizations lag new cases, the model does not yet include the expected increase in patients following the Thanksgiving holiday.

"Our staff are beginning to fall to the side," Nemerson said. "They've exhausted their endurance." Souza, of St Luke's, said reaching crisis standards would crush the spirits of healthcare workers placed in impossible positions of triaging patients for care.

"The mayhem when that happens," Souza said, "I think we'll get a full-on shutdown of our economy then."

Several board members reacted to feedback they've received, much of it against mask mandates or limitations. "I understand it's frustrating and not fun for anybody," commented Boise County member Ryan Stirm. "But can you legitimately look your neighbor in the eye and say 'I don't care if you get your tumor pulled out tomorrow or you die from it.'"

In advance of Friday's meeting, Lieutenant Governor Janice McGeachin sent a letter to the CDH Board posted online by St Lukes Hospital spokeswoman Anita Kissee. The letter, co-signed by eight state representatives and one senator - some from outside the Central Health District - called proposed restrictions burdensome and likely unconstitutional. 

A crowd of people protesting Friday outside the Central District Health building attempted to force their way into the facility. Yelling could be heard at several points during the meeting. Boise Police posted on social media that they were at the building to keep order and that criminal behavior would lead to arrest, though it was not clear if any protestors who attempted to push past officers were cited or detained.

The only board member present at the CDH building appeared to be state representative Megan Blanksma, who represents Elmore County on the board of health. She was likely already in town for representative duties at the state capitol earlier in the day. All other board members attended the meeting remotely.

Follow Troy Oppie on Twitter @GoodBadOppie for more local news.

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