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dr vin gupta is a critical care pulmonologist who you have seen before on this show and on other shows here on msnbc he's generally based in washington state but tonight he's going to join us from ohio where he is on duty with the u.s air force reserves in his capacity as an icu doctor for their critical care air transport team for covid response now these critical care air transport teams are highly specialized essentially they create and operate a portable intensive care unit for use on airplanes so they can deliver icu level care at 30 000 feet while transporting critically ill patients from point a to point b these critical care air transport teams are an amazing thing that the u.s military does and they were created what they're meant for is to transfer critically wounded soldiers from places like bagram in afghanistan to germany to u.s military hospitals elsewhere and then of course onto walter reed at home in the united states covet has changed that focus and now those skills and that equipment and those teams are being used to move critically critically ill coveted patients around the country earlier today dr gupta posted this photo of himself and his colleagues in front of one of the military planes that's being used to transport patients under these circumstances he said quote best job in the world working with some of the most talented icu respiratory therapists and nurses in service to our beautiful country joining us now is major vin gupta critical care pulmonologist affiliate assistant professor at the institute for health metrics and evaluation part of the university of washington uh dr gupta thank you for taking time to join us tonight especially in the middle of all your all you're involved in rachel thank you for the privilege of being here let me ask if i adequately explained um what this deployment is like for you this activation is like for you in terms of your air force reserve service you know rachel uh first of all let me say thank you for highlighting this because there's a lot of our members in the ccat community ccap for sword critical care transport team um that are active duty that are deployed across the world right now and and there are some of us as reservists who've been deployed i've been deployed at arizona for covert response we're actually training up here in southern ohio but the threats that lie ahead because i think all your viewers out there conceive of an icu as static on the ground complex care but now it's no longer stationary we have mobile icu care for the reasons that you mentioned cobit had stretched hospitals then so we're tr we're transiting patients from alaska down to seattle from boise down to spokane and that's part of our the fact that yes we have a decentralized healthcare system that at the end of the day the most advanced therapies are in some of our biggest health systems across the country and you need to be able to move people i can't imagine that anybody involved in this program ever thought that it would have to be deployed domestically in any considerable size well and that's why i think it's great that we're talking about this because tens of millions of dollars of taxpayer money are used to sustain this incredibly agile capability from the air force and and what what a team consists of an icu doc like me an icu nurse and a respiratory therapist we can manage a 10 bed icu in the field or we can transport a critically ill patient from covid or an injured soldier from downrange all the way back to the united states there's a lot that we can do because we have specialized equipment and we can be safe at 30 000 feet so expect to hear more about this type of team and this capability moving forward rachel because that threat has changed we are following breaking news tonight out of the great state of alaska where alaska's republican governor mike dunleavy has just announced that alaska has now become the second state in the country to declare that all its hospitals statewide will now be shifting to crisis standards of care what that means in english is that hospital care is now being rationed at hospitals in alaska in practical terms that means that people who are less likely to survive get moved down the priority list in terms of whether or not they get an icu bed whether or not they get certain intensive forms of treatment and care people less likely to survive will not get those resources they will be moved down the line instead in an effort to try to save as many human lives as possible these hospitals now have permission and guidance to prioritize giving treatment to people who are more likely to live and that is as bad as it sounds it means that some people will just not be admitted to the hospital even though they need to be hospitalized other people who might previously have been given curative treatment treatment to cure them and and save them instead we'll just be given comfort care to try to make things easier for them and it's a sort of anodyne phrase crisis standards of care but it is a terrible thing and it is a thing that we really haven't confronted before as a country now we've got it in place though in one of montana's major medical centers they moved to crisis standards of care this week we've also got it in every hospital in the state uh in idaho as of last week and in every hospital in the state in alaska as of tonight and it's not just coveted patients who are going to suffer from this rationing in these hospitals it means everybody who needs to go to the hospital for any reason has reason to worry the idaho statesman newspaper recently described this critic this this crisis standards of care system for idaho as being like the whole state was being put on a dnr the whole state was being given a do not resuscitate order whether you wanted one or not the anchorage daily news yesterday described what's been happening at alaska's largest hospital in anchorage where they actually as an individual hospital started crisis standards of care before the whole state did tonight anchorage daily news reporting quote a triage team using a specific formula to prioritize patients most likely to recover has been asked to help with patient care decisions in one decision there were four patients who required a special kind of dialysis called continuous renal replacement therapy four patients required that but only two of the four could get it of the two patients who did not receive the therapy one of them died the other one survived but remains hospitalized now in a palliative care setting in a comfort care setting another decision at the hospital involved deciding which patient got intubated because there were not enough beds in the icu another patient died at a rural alaska hospital because they needed cardiac catheterization they were quote waiting for a bed to free up so we could transfer them said the hospital chief of staff again that patient died providence alaska the hospital that previously set up crisis standards of care they set up a three-person wellness team at the hospital to help their own doctors and nurses who are struggling with these kinds of decisions because imagine if you are a doctor or nurse trained to provide extreme going to ex trained to go to the the the most extreme end of the range possible to save the lives of your patients and you're now in a situation where you're triaging people you're not likely to make it you're less likely to make it than these other people so we're going to treat them not you i mean the psychological effect that that has on doctors and nurses in this circumstance cannot be um overstated forgive me for just putting this in personal terms for a second but you know people say getting vaccinated or not is a personal decision as if it only affects you i hear that a lot explicitly partic in particular on conservative media and from conservative politicians it's a personal decision it only affects you well these dire circumstances we are now seeing in multiple states unprecedented crisis standards of care statewide in two states in the country and in additional hospitals in other states rationing of care so that people who would live with normal hospital standards are dying instead i mean these circumstances in multiple states now show that your personal decision whether or not to get vaccinated it has really tangible consequences for a whole lot of other people who aren't you i mean to put it in blunt terms the personal decision by someone in alaska to not get vaccinated right now ultimately results in someone else dying in anchorage because that person can't get the dialysis treatment that would save their life and that they'd otherwise be able to get if it weren't for the hospitals being overwhelmed by people who are sick specifically and only because they chose not to get the shot to protect them from covid i mean they they keep saying you keep hearing it is this mantra on the right even from people who ought to know better in the conservative media that it's a personal decision that it only affects you that it doesn't affect people who aren't vaccinated well tell that to the family of the person who just died in anchorage because they couldn't get that form of dialysis they would otherwise be able to get because that hospital is overrun and the standards that allowed that death to happen are now in place statewide in every hospital in alaska and in every hospital in idaho and they're going into effect in other individual hospitals in other states now too that is because people are not getting vaccinated your decision whether or not to get vaccinated can be a life or death determining factor for somebody else who did get vaccinated but gets in a car wreck or needs dialysis or needs a heart catheterization procedure something that they won't be able to get because of all the unvaccinated people filling up the hospitals this is not complicated math and it is not a yeah it may be a personal decision but a decision that has consequences way beyond your personal corporeal self yeah forgive me i'm sorry but the situation in idaho and alaska is a story of national significance it needs a lot more attention than it's getting and it should affect all of our thinking about how we are taking care of ourselves and our loved ones when it comes to keeping ourselves from getting covered but as ridiculous as it is this whole mishigas about the election being stolen and there being grounds to be suspicious of the election results and we need to change all the rules around voting to make sure that this can never happen again because it was stolen and trump really should be present this whole mishigas as stupid as it is is going to go nuclear the day after tomorrow it is going to go nuclear for these folks when they say in arizona whatever it is they're going to say about bamboo fibers and uv lights and anomalies and alien fingerprints and secret coven cures they discover that you can make at home out of flaming hot cheetos and mothballs or whatever it is they say it is going to set this stuff on fire on the trumpest right and in the republican party and among the conservative base the day after tomorrow and this all should have collapsed in on itself by now because it is all created out of out of whole cloth but instead it really is still coming to a head for republicans and for conservative media and to that end importantly reuters today has an investigative report into how this myth this fantasy as ridiculous as it is is going to shape who actually gets to run the real next elections in our swing states who gets to administer the elections who gets to count the vote who gets to decide if there's a meaningful dispute about the vote that ought to be adjudicated by maybe themselves here's their report today quote reuters special report backers of trump's false fraud claims seek to control next elections quote reuters interviewed nine of the 15 declared republican candidates for secretary of state in five battleground states arizona georgia wisconsin michigan and nevada and we reviewed public statements by all of those candidates 10 of the 15 candidates have either declared outright that the 2020 election was stolen from donald trump or they have called for their state's results to be invalidated or further investigated 10 of the 15. only two of the candidates interviewed by reuters said outright that joe biden won the election the team at reuters goes on to show how huge amounts of money are pouring into these secretary of state races in battleground states secretary of state races do not usually get this kind of attention but this year for some reason these secretary of state races which again these are the people who run elections at the state level they have somehow become the the top priority elections for the republican party and specifically for donald trump's political operation so how does that play out in a state like arizona where republicans there are now just two days away from proclaiming that the presidential election was all wrong and definitely stolen and really it looks to them like trump should have won well here's reuters today quote in arizona democratic secretary of state katie hobbs is running for governor leaving her secretary of state seat open in an open race she won by a single percentage point in 2018. both parties expect another extremely close race for secretary of state next year trump last week endor endorsed mark fincham for arizona secretary of state praising his quote powerful stance on the massive voter fraud the state lawmaker is now seen as a favorite in the republican primary for the secretary of state's race quote in addition to promoting voter fraud claims and calling for arizona to decertify biden's win fincham has also expressed views linked to the q anon conspiracy theory which casts trump as a savior figure and elite democrats as a cabal of satan worshiping pedophiles and cannibals one of fincham's competitors for the republican nomination for secretary of state in arizona is a state representative named shawna bolick she has proposed a law that would empower the republican-controlled arizona legislature to overrule the secretary of state's certification of popular vote results in the state of arizona the republican-controlled legislature could overrule the certification of who won the election and just declare who they themselves thought won the election reuters somewhat dryly calls this quote a drastic change in how america chooses presidents yeah yeah you think the whole conspiracy theory about the election being stolen really is just made up we are getting more and more detailed information about that all the time with more to come but it is growing and growing and growing in importance on the right on friday of this week it really is about to go nuclear and they meanwhile are using it to literally try to take over the actual administration of real elections by putting in charge of elections republicans that not only buy into the big lie at least some of them are pledged basically to concretely do the work to undo election results in the future if those election results don't go republicans way it is really happening it is underway joining us now is one of the reporters on that remarkable piece for reuters tim reed national political response correspondent at reuters talk to us about um what kinds of powers these secretary of state candidates would have if they were successful in their election efforts and how close those powers get to the sorts of doubts that they're expressing about election results that have already happened in their states right so generally speaking the secretary of state in an individual state is the top election official in that state so they're in charge of running elections and they're in charge of how votes are tallied um and it's important also to remember that in a presidential election it's basically the the totals from each county in each state that are then tallied up and sent to the secretary of state for certification so if the secretary of state can maybe uh cast out on the vote total in an individual county or the entire states vote total they have um potentially an enormous amount of power to delay the certification of an election results or even potentially overturn that result given those powers it seems like it would be not just disqualifying it would be a scandal in normal terms for somebody competing for one of those jobs to say that they do not believe in the integrity of their state's electoral process they believe that previous elections were falsely decided that they should be investigated or overthrown the results should be thrown out it seems like the sort of thing that would be either you'd want to keep quiet or you would expect to cause a huge furor if you opened up about them but it seems like in this case with these 15 candidates who you and your colleagues um looked at and talked to in many instances this is in fact the grounds on which they are con they are running for these for these jobs this is essentially the platform they're taking to the voters that is correct um if you look at their campaign websites for example pretty much every single candidate their top issue their number one issue is voter integrity or election integrity and actually it's not just these candidates the secretary of state i mean nearly the entire republican party on capitol hill are now running or talking about uh voter fraud or voter integrity so it's an issue that's really got a firm grip on the party um candidates obviously believe that without talking about voter fraud or election integrity they probably won't win a primary and already former president trump he's endorsed three of the secretary of state candidates which is an extremely rare thing for a former president to be endorsing candidates for secretary of state at a state level you and your colleagues also discovered that people tied to the former president are providing considerable funding to some of these candidates who are again pledging that previous election results should be overthrown and implicitly thereby promising that they would overthrow future election results if they felt they were similarly uh compromised there is a there's a there's a money story here as well as just an endorsement story is there not very much so um there are several um conservative groups that are that are involved in either the funding of these secretary of state candidates or the funding of republicans generally who are espousing the lie that the last election was stolen um and there's already record amounts of money being raised in some of these secretary of state races in in georgia for example uh where um brad raffensberger the current uh secretary of state stood up to uh president trump and and refused to um overturn the election result there he's facing an extremely strong challenge from a georgia congressman named jody heiss um price has already raised about 580 000 so his secretary of state race it's an extraordinary sum of money for a secretary of state race um and uh already uh candidates generally in georgia have raised over a million dollars which again is unprecedented amounts of money for for a secretary of state race and former president trump heading back to georgia this this weekend to raise more money for that candidate um and others alive with this same message [Music] you

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Length: 20min 26sec (1226 seconds)

Published: Thu Sep 23 2021