A lack of resources is making medical staff deal with difficult choices in treating their patients, and decision-making guidelines are inconsistent from state to state
By Christopher Weaver, Melanie Evans and Tom McGinty Updated March 27, 2020 3:30 pm ET As Jerry Ed Roth prepared for heart surgery this month, doctors told the former theater director that the procedure might buy him a couple extra years for his life.
Now, states and hospitals are dusting off pandemic guidelines about who gets treated—basically, who lives and who dies. But what is critical is having a plan, “so there is some fairness or transparency,” Dr. Khouli said. He noted that some states haven’t done so and face the prospect of justifying their decisions in the midst of a crisis.
Ethical guidelines for rationing ventilators, devised by New York State and adopted or referenced by other states including Indiana, Connecticut, Mississippi, Kansas, Minnesota, Louisiana and Arizona.Balance saving the most lives against caring for each patient.Plans must be public, and evaluate feedback from the public.That would leave more than 15,000 “blues,” “reds” and “yellows” without needed care at the peak of the crisis.
Joneigh Khaldun, the top state doctor guiding Michigan’s pandemic response, said she couldn’t give an exact number of ventilators available at hospitals in her state. “I know it is not enough,” she said. “The letter is part of a ‘worst case scenario’ planning document, and we are not in a worst case scenario,” said Henry Ford spokeswoman Brenda Craig. The system hadn’t run out of ventilators nor intentionally shared the document with any patients, she said.
The New York task force, for instance, rejected the idea of giving health-care workers top priority for ventilators in their 2015 plan, arguing they likely wouldn’t be able to return to work soon enough to help fight the pandemic. On the other hand, some states like Oklahoma and Utah offer little more than checklists and flow charts that rate patients’ odds of survival, leaving the decision-making mostly to individual doctors.
Such decision-making has taken a toll on doctors in Italy, where a coronavirus epidemic has overwhelmed hospitals in some areas. In Bergamo, one of the hardest-hit areas, intensive care units have been taking almost no patients older than 70, doctors have said. “We have approved the technology that allows one ventilator to serve two patients—what they call splitting,” said New York’s Gov. Cuomo during a Thursday news conference, referring to a MacGyver-style approach that involves retrofitting tubing to connect multiple patients to the same ventilator. “It’s not ideal, but we believe it’s workable.”
Sarah Nafziger, emergency medicine doctor at the University of Alabama Birmingham, said her hospital is “planning for the worst,” with doctors mapping out how to handle potential ventilator shortages, as well as moving to free up resources. Gallbladder patient Pamela Parquette, in Toledo, Ohio, vomited daily for months before finally getting a test at her local hospital on March 2 showing she needed surgery.
Dr. Kaminski said that isn’t consistent with ProMedica’s policies, which “is to see, evaluate and treat everyone who is coming in” to any of the system’s emergency rooms. Scheduling the procedure took some time, Mr. Roth’s daughter said, and by February the family finally had a date on the books: March 19. That improved Mr. Roth’s spirits, his daughter, an education-services executive, said.
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