Advocates representing a combination of vulnerable populations have been trying coax guidance from a reluctant Public Health Department to ensure they will have fair access to health care in the event that hospitals have to ration their resources.
Since March, a coalition of groups has tried unsuccessfully to pressure the agency to issue statewide guidance streamlining hospital response should care rationing become necessary. The department’s acting commissioner, Dr. Deidre Gifford, said Thursday it was up to individual hospitals to develop and implement guidelines for making those calls.
“We’ve been working with them and we’ve been looking at what the hospitals have put out and providing some technical assistance to the hospitals around that, but they’re the ones that actually promulgate the guidelines,” she said.
Although hospitalizations related to the virus have been on the decline here in Connecticut, health care officials in COVID-19 hotspots have been forced to adopt policies to decide things like which patients receive intensive care beds or who gets placed on ventilators. Last month, emergency medical officials in Los Angeles County, where hospitals were overwhelmed, told responders not to transport cardiac arrest patients to hospitals if the EMT could not resuscitate the patient after 20 minutes of trying, according to NPR.
The advocacy groups, who represent populations including underserved racial groups, older people, and people with disabilities, say Connecticut has not done enough to protect them from discrimination if a similar situation unfolds here. That’s because some hospitals have developed problematic guidelines in the absence of a statewide policy, the groups said.
Many hospitals reported having no written rationing policies and some included considerations the groups considered to be discriminatory. For instance, some hospitals will consider a patient’s chances of survival in the years following their discharge when deciding whether to treat them in a care-rationing situation. The advocacy groups claim these types of policies permit discrimination against older people.
Clear guidance from the state agency overseeing the hospitals would help alleviate the concerns of folks who worry that their age, race, or disability could see them edged out of adequate care. The advocacy groups point to uniform policies enacted by health departments in other states.
“It’s not like they need to reinvent the wheel,” Debbie Dorfman, executive director of Disability Rights Connecticut, said Friday. “They could look to other states and they could try to use that as a model.”
The Connecticut Department of Public Health does have some guidance on the matter in the form of a white paper, drafted in 2010 when the idea of a prolonged pandemic was a theoretical exercise. The members of the working group who wrote the paper acknowledged the possibility that health officials could be forced to set priorities and ration care. “Such decisions will literally consist of life and death decisions, and will impinge on closely held values,” they wrote.
On Thursday, Gifford said her agency was planning to reevaluate those decade-old guidelines as a matter of course.“It was on the books to revisit that process this year actually and so that’s what we’ll be doing,” she said.
Advocates said they saw little reason to delay the process any longer.
“Eleven months ago, they said they were going to do something and here we are. It’s February almost a year later and they still are now saying they’re going to do it this year,” Dorfman said.
In a statement last week, a spokeswoman for the Connecticut Hospital Association said hospitals were committed to ensuring the fair and appropriate treatment of all patients.
“Hospitals across the state have gone to extraordinary lengths, collaborating during the pandemic to be sure that space, staffing and supplies are adequate to provide care to all of our patients. As a result, Connecticut’s hospitals have met and continue to meet demand during this challenging time. It is highly unlikely that crisis standards will be utilized in Connecticut during the COVID-19 public health emergency,” wrote Jill McDonald Halsey, the association’s vice president of communications.
The immediacy of the issue has fluctuated throughout the COVID-19 pandemic. As of Friday, Connecticut hospitals had been enjoying a steady two-week decline in admitted coronavirus patients. Statewide, 827 people were hospitalized with the virus but that number had been elevated above 1,000 patients for most of the two months prior.
The issue seemed especially dire in March when the advocacy groups first started raising alarms at the outset of the pandemic. By late April the virus was testing hospital capacities across the state and, at its peak, almost 2,000 patients were admitted with the virus.
But even now during the current decline in hospitalizations, the occupancy of intensive care units is high at some hospitals. While ICU beds were about 62% occupied statewide as of a week ago, the percentage was much higher in certain areas. For instance, the ICU unit at St. Francis Hospital was 93.5% occupied, according to DPH statistics.
With the agency planning to revisit care rationing, the question becomes one of urgency. Advocates argue it is better to hash out clear guidance on the matter while there is room at the state’s hospitals. A lawyer for the Public Health Department, meanwhile, told disability rights advocates that the agency was not looking to rush adoption of a statewide crisis standard.
However, the state legislature seems likely to consider the issue in the meantime. Sen. Matt Lesser, D-Middletown, and Rep. Gary Turco, D-Newington, have raised a bill to ban discrimination in care rationing when it comes to a patient’s disability status.
“This is an important public health issue that merits our attention, sooner rather than later,” Turco said in a press release.
