Guidance Laid Out For Life-Saving Care Decisions

BOSTON (State House News Service) — In preparation for the potential that hospitals may run out of life-saving supplies to treat every COVID-19 patient that shows up at their door, state public health officials released guidance Tuesday to help providers make the grim choice about which patients to prioritize, advising the doctors treat the young and most likely to survive first.

The recommendations were published by an advisory committee of medical experts and ethicists from Massachusetts convened by Public Health Commissioner Monica Bharel, who herself is suffering with COVID-19.

"This guidance is intended to provide a unified, transparent framework that supports consistent hospital and provider decision-making aimed at maximizing the number of life years saved," the report states.

While it's unknown whether hospitals will ever need to implement such a triage system, Gov. Charlie Baker has made no secret about the difficulties he has encountered in securing critical life saving supplies, including ventilators.

The state has requested 1,700 ventilators from the national stockpile, but to date has only received about 100 as the federal government has prioritized sending its own limited resources to other states, and places where cases are surging now.

The Department of Public Health and other agencies are also working to set up field hospitals in Worcester and South Boston to deal with patient overflow, free up nursing homes for the treatment of coronavirus patients and boost the state's intensive care bed inventory by at least 500.

Still, the prospects of hospitals at some point needing to triage critical care has been an ongoing concern, particularly for people considered to be at a high-risk.

"This virus it's clearly deadly. It's pervasive. It's fast moving, So we naturally we'd worried about our constituents because a higher percentage of people with disabilities have medical comorbitities," Leo Sarkissian, executive director of the Arc Of Massachusetts, told the News Service this week.

Sarkissian represents patients and families living with intellectual and development disabilities in group homes or at home with caregivers.

"We're worried about the criteria for treatment and aggressive treatment, and especially worried about people who can't communicate well because of their disability and need exceptions for people being with them in the hospital," Sarkissian said.

The guidance, while voluntary, is intended to give hospitals a road map in the event the number of coronavirus cases in Massachusetts surge in the coming weeks to the point that health care facilities are overwhelmed and encounter shortages of equipment, staff or beds to accommodate the need.

Baker has said he expects the surge to hit Massachusetts between April 10 and April 20.

"The overwhelming need for care created by a disaster would necessitate a shift of focus from the absolute care of each individual to promoting the conscientious stewardship of limited resources intended to result in the best possible health outcomes for the population as a whole," the advisory panel concluded.

If it becomes a crisis, the state is recommending that providers focus on maximizing the number of life years saved, not simply trying to save the most lives. Race, gender, ethnicity, disability or incarceration status are among the qualifiers that should have no bearing on the determination.

"Patients who are more likely to survive with intensive care are prioritized over patients who are less likely to survive with intensive care. Patients who do not have serious comorbid illness are given priority over those who have illnesses that limit their life expectancy," the guidance recommends.

Under such a system, patients would be given a score of one to four points based on their prognosis for hospital survival, with an additional two to four points added for major to severe underlying health conditions in addition to COVID-19 that would limit life expectancy.

Priority for equipment like ventilators and other life-saving equipment would be given to patients with lower scores on the eight-point scale. Pregnant women could have up to two points deducted from their scores and "heightened priority" should be given to health care workers needed to care for other coronavirus-infected patients, the guidance recommends.

Treatment of pediatric patients should be approached differently, the experts recommended, with consideration for short-term survival given consideration.

The doctors and ethicists further recommended that each hospital set up a triage team to perform the assessments, and not leave the decision to a patient's treating physician.

By Matt Murphy, State House News Service

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