Disparities in healthcare are not new in our state, but the pandemic has intensified the unfairness. The aged, people with disabilities, and communities of color have been especially hard hit by the virus and the recession.
Unfortunately, a striking example of that increased unfairness is reflected in Connecticut hospitals’ policies for rationing scarce resources during the pandemic. Rationing is not a theoretical problem. Early in the pandemic, hospitals in New York City had to ration access to ventilators and medications.
Right now, overwhelmed Los Angeles area hospitals are rationing critical care. Connecticut has suffered over 7,000 COVID deaths so far and hospitals’ intensive care units are near or over 90% of capacity.
Starting ten months ago, advocates reached out to the governor and the Department of Public Health with multiple letters and meetings outlining the growing urgency to create a uniform rationing policy as cases and deaths rise, but we still don’t have an updated state policy. Responding to guidance issued by the U.S. Dept. of Health and Human Services on March 28 about federal anti-discrimination law and regulations, other states updated their policies early in the pandemic. But Connecticut is dragging its feet.
To their credit, some hospitals have stepped up when the state wouldn’t and drafted policies to avoid discretionary case-by-case decisions by doctors and hospital administrators. Not all hospitals have drafted policies and the ones that exist are not uniform, meaning that the same patient may get different care in different hospitals. DPH needs to immediately fix their outdated policy as other states have done.
Rationing policies at all but one Connecticut hospital system do not meet minimum anti-discrimination standards. Responding to the community, Hartford HealthCare crafted its policy to fully protect patients and comply with nondiscrimination laws and regulations. Unfortunately, ten Connecticut hospitals and health systems still have no rationing policies.
All Connecticut hospitals consider a standardized clinical metric to determine the likelihood that a patient will not recover from COVID-19, even with treatment. Advocates agree that limited resources should be prioritized for patients who can benefit from the treatment and survive COVID-19.
But some hospital policies went beyond coronavirus survivability to include one- to five-year life expectancy requirements. One expressly deducted points for a patient’s age.
Meanwhile, we know that people with disabilities are at three times higher risk for co-morbid conditions such as heart disease, stroke, diabetes and cancer that statistically lower life expectancy. There is overwhelming evidence that people of color in Connecticut are statistically at higher risk for premature death.
Studies have found implicit biases are common among healthcare providers based on race, age, gender, sexual orientation, and other characteristics not relevant to their care, and that the biases are likely to influence diagnosis and treatment decisions.
Other studies found good evidence that decisions about life expectancy made during triage are usually wrong, underestimating life expectancy 64% of the time. Lawmakers have taken note: a bill has been introduced at the state Capitol to outlaw discrimination in rationing medical care.
These policies and the secrecy surrounding them add to mistrust of the health care system, especially among communities of color. In a community meeting, we heard about a woman from a community of color in Connecticut who lost her mother to COVID-19 in a hospital. She wasn’t able to see her mother before her death nor talk about care options with her doctor. She is now suspicious that her mother was denied life-saving care.
It’s likely the vast majority of Connecticut residents are unaware of these policies. The state has not taken responsibility.
Decisions about who gets life-saving care and who doesn’t shouldn’t be made at the bedside by overwhelmed providers, nor should they be made in closed rooms by hospital administrators. Decisions should be made in the open by people accountable to the public. And policies should comply with federal and state law.
Transparency is the best antidote to mistrust.
Ellen Andrews, PhD, is the executive director of the CT Health Policy Project. Follow her on Twitter @CTHealthNotes.
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