TOPLINE
At least a dozen states adopted emergency medical plans that would allow life-saving care to be withheld from disabled patients and patients with illnesses common to people of color, according to a coalition of disability and civil rights groups that this month filed federal civil rights complaints against Arizona and North Texas, two Covid-19 hotspots.
Health workers monitor a Covid-19 patient in Colombia, near Bogota, on July 24, 2020. (Photo by Raul ... [+]
KEY FACTS
Groups including The Arc, which advocates on behalf of people with intellectual and developmental disabilities, and the Autistic Self Advocacy Network, filed complaints with the U.S. Department of Health and Human Services, Office for Civil Rights about emergency care plans in a dozen states so far; including three (Alabama, Tennessee and Pennsylvania) that have agreed to rewrite their plans following the complaints.
The question of who gets care as coronavirus cases soar and swamp local health care resources has come into sharp relief in South Texas, where a small hospital, overwhelmed with Covid-19 patients, said last week it was setting up an “ethics” and “triage” committee to screen coronavirus patients for survival potential, and plans to talk with families about sending home those deemed to have low prospects, even if it means probable death.
The coalition’s concern centers on states’ official “crisis standards of care” policies, guidelines put in place usually at the state level and “activated” or “triggered” during a crisis to give guidance to healthcare professionals in the trenches as their ability to care for patients is stretched thin.
The groups charge, in part, that the North Texas and Arizona crisis plans “categorically exclude people with certain disabilities from life-saving treatment” and allow the use of “discriminatory assumptions [on] future medical resources the patient may require,” allegations that the Texas agency in charge of drafting its plan, the North Central Texas Trauma Regional Advisory Council, said it is working to resolve.
The coalition already has some successes: Tennessee became the first state to prohibit medical workers from considering “long-term survivability” in treatment decisions, while Alabama changed past guidance that said staff shouldn’t provide ventilator support to patients with “severe or profound mental retardation,” dementia, or traumatic brain injury.
Pennsylvania and Tennessee were blocked from taking a patient’s own ventilator and using it on a different patient, said Alison Barkoff, director of advocacy for the Center for Public Representation, which is part of the coalition.
crucial quote
“People with disabilities ... by no means should be left behind during a life or death public health crisis. These complaints and the resolutions that have followed have been critical in educating states and hospitals nationwide that disability rights laws apply to the provision of medical care during this pandemic.”
big number
5,416: That’s the number of new cases in Arizona on June 29, as caseloads were peaking, according to the Arizona Department of Health Services. The state reported 1,973 new coronavirus cases and 19 additional deaths on Sunday morning, according to KTAR News. As of Monday afternoon the state had 163,827 confirmed cases and 3,304 deaths since the pandemic began.
key background
With more than 4 million cases in the U.S., the coronavirus has spread rapidly, leaving some hospitals scrambling, with scarce equipment and not enough trained personnel. “Crisis standards of care” plans help medical personnel know how the state feels scarce resources should be allocated. But the rights groups argue that at least of a dozen of the plans were written in a way that discriminates against the disabled and people of color, for example by giving lower priority to patients with certain diseases or if physicians feel it would take them longer to recover. The North Texas guideline, for example, includes criteria like comorbidity (the presence of one or more additional conditions) and projected longevity, according to the complaint, both factors that would lower the priority given to Blacks and Latinos, who, due largely to inadequate health care, have more underlying health conditions and shorter lifespans than whites.
tangent
At least 15 states, including Alaska, Illinois and Minnesota, had crisis standards of care plans written before the pandemic, according to Valerie Gutmann Koch with the University of Houston Law Center who has researched the different approaches to plans in the U.S. An additional 13 plans were drafted or updated in response to the pandemic, including Alabama, California and New Jersey, she said. Other states don’t have a plan but are working on one, or have not made the plan’s status public, according to Koch.
further reading
‘Ethics’ Panel In Covid Cases Will Help Pick Who Gets Aggressive Care, Texas Hospital Says (Forbes)
