Governor Janet Mills speaks at a news conference in the State House, Wednesday, Feb. 6, 2019, in Augusta, accompanied by administration officials including and Health and Human Services Commissioner Jeanne Lambrew, at right. Credit: Robert F. Bukaty / AP

Many of Maine’s hospitals have been making hard decisions for weeks about what kind of care they can provide. If the COVID-19 pandemic gets worse, they could be deciding who gets life-saving care and who does not.

States including Idaho, Montana and Alaska have already activated their crisis standards of care, a last-resort blueprint that states use in emergency circumstances to allow hospitals and other health providers to prioritize care for people who are likeliest to live. 

Those standards have never been used in Maine, where officials are trying to stave off a capacity crisis amid a record number of COVID-19 cases and hospitalizations. Gov. Janet Mills on Wednesday said she will deploy up to 75 National Guard members to hospitals and nursing homes and ask for federal staffing help at hospitals in Portland and Lewiston.

State officials and the hospital trade group said Maine is not yet at the point where it would need to ration care. But the question of whether it will become necessary is on hospital leaders’ minds as they plead for the public to get vaccinated to alleviate the pressure heading into the winter.

There is no definite line for when the crisis care plan would be activated as officials closely monitor the status of Maine’s health care system, said Department of Health and Human Services Commissioner Jeanne Lambrew.

“Our job is to provide quality health care to all Maine residents and we’ll move heaven and earth to try to make sure we can continue to do that,” she said at a Wednesday news conference.

The crisis plan would allow providers to allocate life-saving care based on a patients’ likelihood of survival. It would require a declaration from Gov. Janet Mills and institute a scoring system to help hospitals make their decisions. In New York, hospitals were advised to judge who should get ventilators early on in the pandemic as the state’s system struggled to adapt to the virus.

Nearly 80 percent of intensive care units were full in Maine as of Wednesday, according to federal data. A record 379 people were hospitalized with COVID-19 that same day. MaineHealth, the state’s largest provider based in Portland, said all its hospitals were at capacity with roughly half of scheduled non-emergency procedures postponed.

At the same time, a wide health care worker shortage has led to early-pandemic surge plans being effectively thrown out, including arena COVID-19 treatment centers that Maine never had to use in 2020. Officials at Northern Light Health said they would not have enough staff. That is why Mills, a Democrat, is now emptying the drawers for solutions. 

In hospitals, guardsmen will administer monoclonal antibodies, a therapy for those with serious cases of COVID-19, while they will perform chores and other duties in nursing homes with the goal of opening rehabilitation beds for non-COVID-19 patients who may be languishing in hospitals. A state budget passed earlier this year provided $146 million more to hospitals, nursing homes and other providers.

Such measures may be enough to prevent rationing care, said Steven Michaud, the president of the Maine Hospital Association. But with cases continuing to climb and new COVID-19 hospitalization records set again this week, he said Maine may not be far away.

“Have we discussed it? Yes,” he said. “Do we think if things don’t turn around pretty quickly, we’re going to have to have active discussions about it? Yes.”