Health orders allow Colorado hospitals to refuse new admissions, transfer patients as COVID-19 numbers rise

Gov. Jared Polis signed two executive orders on Sunday in response to the high level of COVID-19 hospitalizations and limited health care resources after suggesting last week that increased action could be necessary. 

One order authorizes the state health department to direct hospitals to stop admitting patients and to transfer patients to other facilities. The other order clarifies when so-called crisis standards of care can be activated and lets the state’s insurance division create emergency rules to streamline processes during a staffing shortage. 

“Because of the rise of COVID-19 cases and this shortage, we must undertake targeted efforts to respond and mitigate the effects of the pandemic, prevent further spread, preserve our health care resources, and provide needed flexibility to address the collateral consequences of the pandemic,” the order relating to crisis standards of care reads.

Both orders expire in a month but could be extended. 

“Our capacity is stretched to a level it hasn’t been during the pandemic. Our COVID levels are very high. They aren’t as high as what we saw last year, but we are seeing other types of patients now too. That’s what is stretching our capacity, and then the other issue layered on top of that is the staffing issues we have right now,” said Cara Welch, the senior director of communications for the Colorado Hospital Association, which represents more than 100 hospitals throughout the state.

There are no crisis standards of care plans currently activated, but this new executive order paves the way for that to happen. Those plans provide guidance to hospitals over how they should allocate resources like ventilators, beds and other assets should the need overwhelm normal capacity. 

As for the patient transfer executive order, hospitals will still need to stabilize the patient before transferring them to another facility but don’t need that patient’s consent, nor do they need to consider insurance status or ability to pay before making the transfer.

“We are stretched. We are maximizing all of our resources. So if that means we need to transfer a patient who is about to be discharged out to a rural hospital to finish their stay, we might do that,” Welch said. T

The new executive order creates a framework for statewide collaboration for transfers.

“The transfer of patients from hospitals that have reached capacity or are reasonably anticipated to reach capacity to other specified care facilities will help to ensure that Coloradans have adequate care as we continue to combat COVID-19 and promote public health and protect the ability of hospitals to serve those with COVID-19 and other conditions,” that order reads.

A tough holiday season

There were nearly 1,200 people hospitalized with COVID-19 as of Oct. 29, according to state data, the vast majority being unvaccinated. That is the most since last December’s enormous wave of infection that saw a peak of almost 2,000 people hospitalized.

Just about 7% of the state’s ICU beds are currently available and 38% of the state’s hospitals say they expect to be short-staffed within the next week. 

The two executive orders could foreshadow a tough holiday season as pandemic numbers once again inch towards crisis level, even with the vaccine widely available. 

The Colorado Department of Public Health and Environment also issued or amended three public health orders Sunday also aimed at easing the strain on hospitals. 

A new order requires health care facilities to delay cosmetic procedures by up to six months, so long as the delay wouldn’t be life-threatening.

Additionally, CDPHE extended a public order related to mask wearing in settings like hospitals, homeless shelters and prisons, and it reemphasizes hospital reporting requirements. Finally, another public order was amended so that vaccine providers are required to administer second doses or booster doses regardless of where a person got their initial shots and requires providers to submit their data to the state within 48 hours.