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Starr County hospital, facing 'ethical dilemma,' receives federal help

4 months 1 week 1 day ago Monday, July 20 2020 Jul 20, 2020 July 20, 2020 5:58 AM July 20, 2020 in News - Coronavirus Pandemic

STARR COUNTY — Help from the military is on its way to Starr County, the county health authority announced on Sunday.

It'll arrive as COVID-19 cases are deceptively on a decline, yet health officials are struggling with an "ethical dilemma" at the county's only hospital. 

Dr. Jose Vazquez, the Starr County health authority, said he met with members of the U.S. Army and U.S. Navy on Sunday afternoon. They will be deploying two teams to help Starr County Memorial Hospital. 

The teams will each consist of one intensive care doctor, five nurses and a respiratory therapist. The teams will stay in Starr County for about a month. 

The military teams will be in addition to the 15 nurses sent by the state on July 5. Originally, they were only staying for two weeks, but Vazquez said the county needed them to stay longer. Hospital nurses have fallen ill and others have left, concerned about the risks associated with COVID-19 care.

Starr County officials submitted a request to the state, asking that the nurses stay for additional time. A response is pending.

Lately, the county has been reporting COVID-19 cases in the double digits when surrounding counties are reporting in the hundreds or thousands daily. The numbers may be going down, but Vazquez says the metric measuring the severity of the situation in Starr County is flawed. 

Uninsured residents in Starr County were getting tests at the mobile site free of charge, but it was a mounting financial responsibility for the county. The county stopped free testing on July 8. Since then, the number of daily cases reported is no longer a reliable measure of the pandemic's effect on the community.  

Up to 200 tests were performed a day when they were free at the county's mobile site. Now, Vazquez said it's only about 20 to 30 people getting tested there.

The number of people going to the hospital is a better gauge of the county's growing crisis. 

"We are getting more and more cases in our hospital, and sicker and sicker patients on a daily basis," Vazquez said. 

The influx of people with coronavirus symptoms at Starr County Memorial Hospital is creating what Vazquez called an ethical dilemma for the county.

During a meeting on Sunday, Vazquez said they began discussing the reactivation of the hospital's ethics committee — a group that hadn't made any decisions in years.

The committee will consist of the patient's primary care and emergency room doctors, a social worker and a hospital administration representative. Their task will be to present the patient's family with a difficult choice like whether or not to transfer the patient hundreds of miles away.

"If it's sensible decision to transfer an 85- or a 90 year-old with multiple comorbidities, intubated and with ventilatory support, to transfer him or her to Oklahoma, rather than perhaps taking a decision about hospice services and comfort care and sending that patient home perhaps to die peacefully with family members," Vazquez said as he spoke of a hypothetical situation. 

Resources are limited for the hospital that has about nine ventilators and about 37 beds. Vazquez said they're receiving elderly patients in severe condition with multiple comorbidities at the hospital.

"Science tells us that those patients do not do well, that most of those patients will never make it out of a ventilator," Vazquez said.

Some of those resources could be used on patients with a higher chance of survival.

"The ethical dilemma that the next patient may be a 25-year-old patient who has a lot more chances, but we will basically not have enough resources to take care of them," Vazquez said. 

Vazquez renewed his call for a temporary shutdown in Starr County.

"We need to have at least a two- to three-week seclusion at home. We need to restrict mobilization, traveling outside the home, social interaction to necessary outings," Vazquez said. "It's now or never."

The ethics committee could be created as soon as Monday.

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