Roger Severino, civil rights office director at the Department of Health and Human Services, has posted a bulletin warning “entities” receiving HHS funds against deciding which patients can receive treatment on the basis of discrimination, including age and disability.
The director issued the bulletin in response to fears of health care shortages at hospitals in areas strongly affected by the coronavirus epidemic, a crisis that has allegedly led some hospitals in Italy to ration care away from the elderly.
“Our civil rights laws protect the equal dignity of every human life from ruthless utilitarianism,” said Severino in a press release Saturday evening. “[The Department of Health and Human Services] is committed to leaving no one behind during an emergency, and helping health care providers meet that goal.”
While hospitals across the country have not been forced to ration care, the fear of such a situation has resulted in health care providers developing contingency plans.
Medical leaders in Washington state began developing a triage document last week to create state-wide policies that would establish criteria for who would, and would not, receive treatment in the event of a health care rationing, reports The New York Times.
“They look at the criteria — in this case it would likely be age and underlying disease conditions — and then determine that this person, though this person has a chance of survival with a ventilator, does not get one,” said Cassie Sauer, chief executive of the Washington State Hospital Association.
“It’s protecting the clinicians so you don’t have one person who’s kind of playing God,” Sauer told the news agency. “It is chilling, and it should not happen in America.”
After posting the discrimination bulletin, Severino told The New York Times that the warning wasn’t intended to prohibit states from developing triage contingency plans.
Rather, Severino says his goal is to make sure “entities” begin “considering the civil rights implications of any crisis standards of care plans they may be putting into effect if it were to come to that.”
Last Thursday, a draft of a Henry Ford Health System contingency plan leaked online and revealed how the Detroit health system tentatively plans to approach patients in the event of a health care shortage.
“We currently have a public health emergency that is making our supply of some medical resources hard to find,” reads the leaked draft. “Patients who have the best chance of getting better are our first priority. Patients will be evaluated for the best plan for care and dying patients will be provided comfort care.”
The document emphasizes that the decision to remove a ventilator and provide comfort care instead will be based on the patient’s “medical condition and likelihood of getting better.” It also states the decision can be appealed by asking your individual doctor to request an evaluation from a clinical review committee.
A spokesperson for the healthcare system told The Wall Street Journal that the draft “is part of a ‘worst-case scenario’ planning document, and we are not in the worst case scenario.”
The Journal notes that states such as Oklahoma and Utah have given more leeway to individual doctors to decide on treatment plans for patients.