New York hospitals would use LOTTERIES for ventilators in shortage

New York hospitals could use LOTTERIES for ventilators in an extreme shortage during coronavirus emergency – and other states plan to DENY access to those with cancer or a mental disability

  • There is no national protocol for rationing ventilators and each state has its own
  • In New York, ethical guidance calls for lottery if there’s equal chance of recovery
  • In Alabama, protocol says those with mental disabilities may be poor candidates 
  • That policy applies even to children, outraging disability rights group
  • Washington state’s emergency protocol drew similar complaints
  • Coronavirus symptoms: what are they and should you see a doctor?

State emergency plans to ration ventilators if the coronavirus pandemic worsens are raising thorny ethical questions, as New York considers lotteries for access to the machines and other states contemplate denying them to those with mental disabilities.

The White House says that as yet, no one has been denied a ventilator who needed one. But as the crisis deepens, several states are putting grim plans in place to ration the vital machines.

In New York, the state’s ethical guidelines for allocating ventilators in a pandemic call for devoting scarce resources to the patients who are most likely to be saved.

However, the New York report concluded that in the rare case when multiple patients are equally likely to recover, but there are limited resources to help them, hospitals should ‘utilize “random selection” (e.g., lottery) methods.’

A coronavirus patient is transferred from Elmhurst General Hospital in Queens on Thursday. New York state’s ethical guidelines call for ventilator lotteries in a crisis shortage

The panel concluded that a lottery was more equitable than treating people on a first-come, first-serve basis, which could disadvantage ‘those who are of lower socio-economic means who may not have access to information about the pandemic or to reliable transportation, or minority populations who might initially avoid going to a hospital because of distrust of the health care system.’

The New York guidelines are not binding, and hospitals there are already forming their own ethics panels to determine how to ration care in the event of a critical shortage — a scene that has already played out tragically in Italy.

Meanwhile, in the absence of national protocols, states around the country have been devising their own, some of which have drawn outrage from disability rights advocates.  

On Tuesday, Alabama’s Emergency Operations Plan for mechanical ventilator triage was the subject of a complaint to the U.S. Department of Health and Human Services’ Office for Civil Rights.

A ventilator is pictured in a file photo. Health officials fear that a shortage of the machines in the pandemic could lead to rationing, and heartbreaking decisions about who gets care

Part of Alabama’s Emergency Operations Plan for mechanical ventilator triage is seen above

In the event of a crisis shortage, the Alabama protocol lists several health conditions for which providers should ‘not offer mechanical ventilator support,’ including heart failure, respiratory failure and metastatic cancer. 

It also says ‘persons with severe mental retardation, advanced dementia or severe traumatic brain injury may be poor candidates for ventilator support.’

Those categories could include people with Alzheimer’s, as well as people of any age with disabilities such as Down syndrome, outraging disability rights advocates.

Alabama ‘is poised to make life-and-death decisions that will deny needed medical treatment to countless individuals based entirely on their underlying disabilities,’ the complaint says. 

‘The mere fact that a person has an intellectual or cognitive disability cannot be a basis for denying care or making that person a lower priority to receive treatment.’ 

‘In this time of crisis, we cannot devalue the lives of others in our community based on their disabilities. It’s morally wrong, and it violates the law,’ said James Tucker, Director of the Alabama Disabilities Advocacy Program, in a statement.

Medical personnel screen a patient for coronavirus symptoms in Alabama. The state’s emergency protocol for ventilator triage has drawn a complaint from disability groups

The group pointed to 37-year-old Matthew Foster, a resident of Vestavia Hills, Alabama, as an example of someone with Down syndrome who could be affected by the state’s emergency plan. 

‘When Matthew was told about this policy, he responded: ‘I have Down Syndrome. It’s not going away. But I have a right to live. I’m worth it,” the group said in a statement. 

Down syndrome advocate Matthew Foster says ‘I have a right to live’ of Alabama’s ventilator triage protocols

Matthew, who has held a job for the past twenty years, has ‘enormous gifts and talents because of his disability, not in spite of it,’ said his mother, Susan Ellis, according to the group. 

‘He’s had a positive impact on our family and community. The idea that his life is not worthy because of his intellectual disability is devastating and wrong,’ she said. 

Disability rights groups also filed a complaint with the Office for Civil Rights on Monday in regard to Washington state’s emergency protocol.

The complain says guidance distributed by the Washington State Department of Health last week recommends that triage teams consider transferring hospital patients with ‘loss of reserves in energy, physical ability, cognition and general health’ to outpatient or palliative care. 

President Donald Trump said Friday that he is using wartime federal authority to force production of up to 100,000 ventilators. 

Trump made the comment just hours after announcing he was invoking the Defense Production Act to force General Motors to to produce ventilators under government contracts.

‘We are prepared for things that nobody has any idea that we’d be prepared,’ Trump said at the White House. 

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