The day before Idaho activated “crisis standards of care” statewide, St. Luke’s Health System made a request for that last-resort declaration. It had no other choice.
The state’s crisis standards activation committee was called to meet on Wednesday, Sept. 15, to consider the request. The process had to move quickly. St. Luke’s CEO Chris Roth presented to the committee by videoconference, from his daughter’s bedroom.
“It was a memorable place to be, during a really sobering call,” Roth told the Idaho Capital Sun.
That day, St. Luke’s had a record 281 COVID-19 patients in its hospitals — occupying more than half of its 475 staffed adult hospital beds.
The hospital system had already opened 93 beds in overflow areas. It ran out of physical beds “and would be treating patients on stretchers until the additional beds they have ordered arrive,” the Idaho Department of Health and Welfare’s declaration said. St. Luke’s told the state’s crisis standards committee that 58 of its 71 ICU patients had COVID-19, that it was starting to use pediatric ventilators for adult patients, and that it had to cancel surgeries such as “removal of low risk cancers, fractures with pain and hernia repairs,” the declaration said.
Even then, St. Luke’s couldn’t keep up with the influx of patients, and its projections for the coming weeks were dire — reaching a point where it would have to choose between patients.
Roth talked with the Sun in a video interview Friday, the day after crisis standards were activated statewide. He talked about the health system’s vaccine requirement, the disinformation that fuels the surge of COVID-19, and more.
This interview is edited for length and clarity.
Idaho Capital Sun: How are you feeling about this surge, and the move to crisis standards?
Chris Roth: It’s been a surreal 20 months. I stepped into this role in February of 2020. Lots of ups and downs, for sure. But I’m very proud of our organization. We’re focused. I know we will get through this. We have an amazing team. I have a great support system — my kids, wife, a board that’s behind me.
I’m sad, and I’m concerned for the people who are actually doing the work. I have a job, and I’m doing everything I can. But I’m not on the front lines. There’s a helpless feeling — and our leaders feel this, and our board feels this — like, what more can we do to help the people who are providing care? There’s a helplessness there. But there’s also optimism, and there are a lot of bright spots, every day, just got to look for them.
Idaho Capital Sun: What do you think it’s going to take for more Idahoans to take the risk of COVID-19 seriously?
Roth: What we’re seeing in our community, in our society, is that too many are putting the individual before the community. I think one of two things is going to have to happen: The suffering is going to have to get more personal and closer to individuals — which is the worst case scenario — or, you know, I was talking with (Idaho House Speaker Scott Bedke, R-Oakley) last week, and he toured our ICU. And after that, he said he was able to convince, I think he said, five people to get vaccinated, which is awesome. It’s incredible. So the other opportunity we have is that — individual communications to convince the people who are hesitant or skeptical, for whatever reason, to get vaccinated.
If people weren’t scared to hear the news yesterday (about the move into crisis standards), they should be. At the same time, we don’t want to communicate to the public that they shouldn’t come in to receive care if they need it.
We need people to come in if they’re sick, and we’ll take care of them. Care may be delayed, probably will be delayed, but we can care for people today, and we will continue to do that.
Idaho Capital Sun: How are your employees doing, with the move to crisis standards and possibly making live-or-death choices for patients?
Roth: We’re deeply concerned about our frontline caregivers, and they are just going through hell. Every day. And then they go out to the community, and it’s business as usual — rodeos, fairs, football games, debates in the school boards.
I made the mistake, a couple weeks ago, of listening to all six and a half hours of the West Ada School District school board meeting, and (two St. Luke’s chief physicians) were kind of sharing a perspective, and they literally got laughed at by some of the audience when they were talking about what’s going on in the hospitals.
It’s like we’re seeing the de-evolution of humanity, right in front of our eyes.
Idaho Capital Sun: Where are you right now, on the vaccine requirement for staff?
Roth: We had a deadline of Sept. 1 for the first vaccination. That didn’t mean that we were firing a bunch of people on Sept. 2. There’s a whole process that plays out. We’ve been very, very pleased with compliance with our policy. Now, when I say “compliance,” that’s either getting the vaccine or having a valid exemption. And as of this morning, we are just above 97%.
We’ve hired 802 individuals over the past 60 days. And when we hire those people, they need to be compliant with the vaccine as well. Maybe some were vaccinated at St. Luke’s but many (were vaccinated elsewhere), so we have to get those records. It takes time. We think that 97% is probably closer to 99%, a little higher than 99%.
We made the decision yesterday, and we’re communicating it today to our employees, that we are going to extend our timeline. We’ve always said we’re going to put safety first. And when we announced the vaccine requirement, that was July 8, I believe. Delta was starting, but nothing like what we’ve seen (since then), and we did not anticipate we would be in crisis standards at this time.
We will take extra precautions to protect that (unvaccinated) staff. We’re going to test them. We’ve got all the masking and (other precautions), but we’re not going to initiate terminations of individuals, while we’re in crisis standards. It’s just not the responsible thing to do. But we are not backing off of the vaccine requirement, we’re just extending the timeline.
It’s difficult to say, “Look, we’re not going to do surgeries for low-grade cancer and tumor removal,” and at the same time, asking people to leave our organization. And not everybody’s a frontline caregiver (who isn’t yet vaccinated), we get that, but we want to treat everybody the same.
So that’s where we are right now. Our progress has been phenomenal, and the support (within) the organization has been incredible.
Idaho Capital Sun: Did St. Luke’s request crisis standards of care to keep from having to enforce the vaccine rule?
Roth: Absolutely not. But it’s a fair question. I’ve thought about that myself, like, ‘Oh, isn’t that convenient.’
The driver for crisis standards was … our standard of care is eroding, and crisis standards enable our clinicians to make real time decisions (in an ethical framework). We have been seeing increasing levels of anxiety and concern with our frontline licensed caregivers. Their license is on the line, and they need to practice according to that license, and they have been on the edge, doing things that are not typical of their license and are not typical of our normal policies and practices.
So that’s why we implemented crisis standards. The fact that we have a fraction of people who are still not compliant … we made the decision (to give an extension on compliance) because we need the people right now. But it’s a fair question, and I’m sure the conspiracy theorists will say, “Well, there you go.”
Sadly, we’ve had individuals who have been used by other groups, or other causes, like the ‘health freedom’ group. We’ve had some of our own people who have been put in front of the camera, and frankly they’re just getting used for somebody else’s cause, and that’s unfortunate.
Idaho Capital Sun: Are the unvaccinated employees in areas where you have critical staffing shortages, like ICU nurses?
Roth: Our physicians are at 100%. Then you get to nurses and respiratory therapists and pharmacists, it’s (also very high). Then you get to areas where we’ve struggled — environmental services, laundry, security, people who are answering the phone, scheduling, registration. Many of those are in contact with the public, and patients, but we see less compliance in those areas.
I’ve been asked, “Well, can you treat the two groups differently?” And what we’ve said from the beginning is that, you know, our frontline health care workers already feel like they’ve been carrying the burden of the pandemic for 20 months. And we don’t want to send a message to them that, “Oh, this group of people are not part of the same team, or don’t have the obligation.” It’s critically important that we say: we are a team. We either provide direct patient care, or we support those who do, and we’re not going to bifurcate our organization that way.
Idaho Capital Sun: Do you think state and local government could do anything to help?
Roth: If we could rewind the clock, and rewind time, and make different decisions, I’m sure a lot of us would — maybe the governor, local leaders, others. I’ve been critical of state and public health district leadership, particularly in 2020.
But we’re here where we are today. We can’t ignore the politics that are going on in the community.
I’ll start with the governor. I think he’s doing a really good job, given the circumstances, and he has stood behind the employer’s right to make decisions for their workforce. He stood behind government not intervening in things that are more local. Now, that cuts both ways, I get it. But if you look at who’s in line to run against him … I think he needs to stay the course, in that way. It’s almost like, what’s the worst potential outcome?
I wish the health districts would go back to where we were last year. They had criteria, they had community spread criteria, they counseled people on group sizes and masks. I think that health districts have so many levers they can pull that they’re not pulling, and I think that if anything’s going to change, it’s going to be at that level, not at the state level.
I also believe that the state and the Idaho State Board of Education could lean in further with the universities and high schools. I think the university presidents in particular are on an island, making big decisions about things like masking in schools and football games. I’m really concerned about the weight on principals, superintendents, university presidents, and I think they need more cover from the state. I don’t know exactly what that looks like, but they need more support, because they’re being left on an island right now.
Idaho Capital Sun: It seems like many Idahoans don’t know whom to trust right now. Some of them are, unfortunately, looking to ideological groups and even some health care providers who are misleading them. What are your thoughts?
Roth: I think that the people who are intentionally spreading misinformation, for their own personal gain, are going to be held accountable. It’s a matter of time. And that’s probably all I have to say about those types of individuals.
I also think that we’re reminded that elections matter. They matter a lot, and local elections matter.
Everything’s political right now. But these health districts, particularly Central District Health, it’s all about politics and not about public health. And, you know, we’ll see what happens in the next election. People are going to have to choose whether and how that changes.
But I do believe that people spreading misinformation, particularly those who are licensed medical professionals who have taken an oath, will be held accountable.
Idaho Capital Sun: Do you know they will be held accountable? Or do you just hope so?
Roth: I hope they will be. But I would put money on it that they will be at some point. And it’s a national problem, it’s just not an Idaho problem. We have a very fragmented national system of boards of medicine and boards of nursing and others. That’s been a problem for years. But I think that those individuals are going to get rooted out somehow, I hope.
