Oxygen crunch exposes potential 'crisis'

Two patients consuming unsustainable amounts of oxygen at Cabinet Peaks Medical Center last week underscored the strains the pandemic has placed on rural hospitals and the local health care system.

Both patients were treated with what is known as high flow oxygen, meaning they receive 60 or more liters of the gas a minute. The high rate both helps get oxygen into the patient’s system and helps them to breathe by forcing their lungs to expand slightly.

But it also takes up a lot of oxygen, which is a finite resource at Cabinet Peaks. For reference, most patients requiring oxygen receive between two and 10 liters of the gas per minute.

“It’s standard treatment for COVID-19 patients and it uses quite a bit of supplemental oxygen,” said Dr. Kelli Jarrett, a physician at the Northwest Community Health Center who serves as a hospitalist for Cabinet Peaks, at the Dec. 9 Lincoln County Health Board meeting.

Jarrett first sounded the alarm about the situation at a Lincoln County Board of Commissioners meeting earlier that same day. Hospital officials confirmed that the two patients were using a high rate of oxygen. The facility was in danger of running out of the gas had the patients not been transferred, confirmed Kate Stephens, public information officer for the medical center.

But the proper procedures were in place, meaning officials knew the oxygen use was unsustainable, and staff members arranged for their transport to a facility with a higher level of care, Stephens said.

“Without getting into the medical specifics, these patients were on an extremely high volume of oxygen 24 hours a day,” she said. “We don’t get our tanks refilled every day. … We have what we have. When we have a lot of patients running at high flow oxygen, it eats up oxygen quickly.”

Because the two individuals were transferred out of Lincoln County, the medical center has enough oxygen for any current or incoming patients, Stephens said.

“Our systems responded appropriately and we were able to deal with the situation,” she said. “If someone came in right now and needed oxygen, we could provide it.”

Still, the situation was a first for Lincoln County, Jarrett said.

Hospital officials declined to discuss the medical circumstances surrounding the patients, other than to say that their health care providers deemed hospitalization necessary, citing privacy laws. Jarrett said they both suffered from COVID-19.

“I think this is an important thing to know, as a community, that two COVID-19 patients were transferred out of the hospital on [Dec. 8] and it was because the hospital was running out of oxygen,” she told the county health board.

Jarrett said the incident highlighted one of the possible consequences of the pandemic that local health workers have warned about since the summer: shortages.

“This is one of those real implications [of the pandemic],” she said. “We ran out of resources and had to transfer those patients out.”

Patients suffering from COVID-19 are routinely transferred out of Cabinet Peaks, often going to medical facilities in Kalispell or Idaho. But health care systems in those areas have been hard hit by the coronavirus and may not boast the capacity to take in patients from Lincoln County. In Idaho, Gov. Brad Little warned last week that the state might have to ration health care if efforts to slow the spread fail.

Had the medical center run through its supply of oxygen, not only would it have been temporarily unable to treat COVID-19 patients, but also individuals suffering from a variety of ailments that require the gas, said Jarrett.

Laura Crismore, a member of the Lincoln County Health Board and quality manager for the medical center, deemed it a potential crisis while noting that officials were working on a fix.

“It wasn’t a crisis, but it has the potential to be a crisis,” she said. “We’re not alone in the nation. We continue to worry about resources on a day-to-day basis.”

Commissioner Josh Letcher (D-3), who attended his first health board meeting Dec. 9 as a voting member, offered whatever help county leadership could provide, up to securing a way to produce oxygen locally.

“I’m just trying to be proactive about that,” Letcher said.

In the days since Jarrett made public the situation, hospital officials have said they taken short-term steps to avoid similar circumstances while working on a long-range plan. Stephens said the center’s plant operation manager was working on a solution. It likely will be in place in early January, she said.

While Stephens did not go into detail, she said the proposal involved working with the center’s oxygen distributor and required the center to have special equipment shipped to Libby.

In the meantime, center staff secured regulators for “H” oxygen cylinders, the green tanks often seen inside medical facilities. The devices give health workers the ability to offer high flow oxygen to patients as needed, Stephens said.

“These tanks can go directly into a patient’s room with them to supply high flow oxygen when needed,” Stephens wrote in a statement. “The tanks will last several hours and can be changed out by staff. This will allow patients to have access to high-flow oxygen until our long-term solution is in place.”