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Beleaguered Texas Hospital to Ration Treatment of COVID Patients

A second county in the Rio Grande Valley has issued an unenforceable stay-at-home order to reduce transmission of the coronavirus. Its one overwhelmed hospital will implement a triage system to determine which patients to treat and whom to reject.
July 27, 2020, 10am PDT | Irvin Dawid
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Starr County, Texas

Planetizen readers may recall the recent warning made by public health expert, William Haseltine, about Arizona activating the "Crisis Standards of Care" in late June to deal with the onslaught of COVID-19 patients at some hospitals in the state. The standards provide hospitals a framework for deciding who to treat and who to turn away.

"It means that if you're old, you get sent home without care, and you die..., Haseltine, chair and president of ACCESS Health International and a former Harvard Medical School and Harvard School of Public Health professor, told CNN on July 8. "We are on the brink of not treating people. There's a whole equation they are going to put into effect which says, "Are you worth treating or not?"

As he predicted, it would appear that another state, Texas, will soon activate the crisis standards of care to allow the one rural hospital that serves Starr County to refuse COVID-19 patients in order to preserve resources for those that show the best chance of survival.

"Unfortunately, Starr County Memorial Hospital has limited resources and our doctors are going to have to decide who receives treatment, and who is sent home to die by their loved ones," Starr County Judge Eloy Vera wrote on the county's Facebook page on Thursday morning, reports Li Cohen for CBS News on July 24 (source article).

Dr. Jose Vasquez of the Starr County Health Authority announced during a press conference on Tuesday that the local hospital is establishing an ethics committee that will set up a triage program to decide how to best allocate limited resources. 

"The reality is that science and statistics are against those people with multiple medical conditions," he said. "We have to start making a triage evaluation and realizing who has a better chance. For all of those patients who most certainly do not have any hope of improving, we believe that they are going to be better taken care of within their own family in the love of their own home, rather than thousands of miles away dying alone in a hospital room." 

Vasquez told The Monitor on July 19 that the ethics committees, to include "a patient’s primary care physician, the emergency room doctor or the hospital doctor taking care of the patient, a social worker, and one of the hospital administrators... are expected to be set by end-of-day Monday."

The agenda [pdf] for the Starr County Hospital District's meeting on July 23 included, "Adoption of North Texas Mass Critical Care Guidelines."

“We have a very difficult situation here,” Dr. Vazquez told Texas Standard host David Brown on July 21. “We do not have specialty services, we are just […] a rural health hospital.”

The COVID unit only has 49 beds, but the nearest facility with a higher level of care is about 45 miles away in McAllen, Texas. 

McAllen is the largest city in neighboring Hidalgo County. On July 22, the county's shelter-at-home order took effect to suppress community spread of the virus, the first time in the pandemic a county has issued a second such order. However, the order is unenforceable under Gov. Greg Abbott's current statewide orders.

Starr County became the second county to re-issue it's stay-at-home order on July 23 despite being unenforceable with the exception of the mask mandate due to the statewide mandate on facial coverings.

Like Hidalgo County, Starr is also overwhelmingly Latino. "According to the Census Bureau, Starr County had the highest percentage of Hispanic residents of any county in the United States, and the lowest percentage of non-Hispanic white residents," per Wikipedia.

Reopening blamed

"Vasquez said that when the pandemic began, the county was able to keep the situation under control," adds Cohen. "But after the state started to reopen, Vasquez said, cases increased 'in an exponential and alarming way.'"

As if the pandemic wasn't enough, both Hldalgo and Starr counties lie in the path of the Atlantic's first hurricane, Hanna, which made landfall just south of Corpus Christi, Texas, on Padre Island on Saturday night.

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