Through the garbled word soup of fancy buzzwords and bureaucratic newspeak, officials in Washington state are basically saying they are preparing to ration health services, with those whom the state seems as less desirable to receive less attention and care. In the age of what’s pretty much Bernie Sanders’s wet dream of socialized healthcare, there simply aren’t enough resources to care for everyone.
Washington state and hospital officials have been meeting to consider what once was almost unthinkable — how to decide who lives and dies if, as feared, the coronavirus pandemic overwhelms the state’s health care system.
“We don’t want to do it. We don’t think we should have to do it,” said Cassie Sauer, chief executive of the Washington State Hospital Association, which along with state and local health officials has been involved in refining what Sauer called a “crisis standard of care” — essentially guidelines to health care officials on who should receive treatment and who should be left to die.
Dr. Vicki Sakata, the senior medical adviser to the Northwest Health Care Response Network, said a group of medical officials and other experts have been discussing how the state would deal with a crisis that overwhelmed the medical system. She prefers to add the word “planning” to the idea of “crisis standard of care” because, in her mind, the goal is to avoid a crisis in the first place.
That said, the state is prepared to act if it has to and has developed guidelines that will be implemented across the system, from the bedside doctor to hospital systems.
“We will do it as a state under an ethical framework that is part of the state plan,” she said. “It will be overseen by an objective team who has been thoroughly briefed on the protocols and processes, and will be undertaken in a transparent and equitable manner.
“But, make no mistake, it will not be pretty,” said Sakata, who is a practicing emergency medicine physician. “That’s why we are taking the steps we are taking now, the social distancing, the hand washing, all of that, so sometime down the road nobody is left having to decide who gets resources, and who doesn’t.”
The New York Times reported on Friday that state and health care officials held a conference call to discuss the triage plan. It reported the plan will assess factors such as age, health and likelihood of survival in determining who will get access to full care and who will merely be provided comfort care, with the expectation they will die, the newspaper reported.
Of course they don’t want the public to know what is being discussed behind closed doors, as the article continues:
DOH spokeswoman Lisa Stromme said the department will release information on the triage guidelines soon, saying it is “one of our top priorities.
“However, it will not be discussed externally until we can discuss it internally in the right way,” Stromme said. “It’s too crucial.”
Sauer said the guidelines are being finalized and she hopes they are never implemented. If they are, then treatments will be allocated to “the greatest number of people who are likely to survive,” with others provided comfort care and allowed to die.
The decision will be made regionally, so no one doctor or hospital will have to make the decision, Sauer said. At that point, it is anticipated every hospital would be overcrowded and resources would be limited.
The coronavirus has proved to be particularly virulent among the aged and individuals suffering from underlying health problems. If a triage plan has to implemented, Sauer said, decisions will be mostly be based on people in those two categories.
“They will be less likely to receive care, and more likely to die” so people with a better chance of recovering can live, she said.
In this worst case scenario, providers begin to “care for a population” rather than individuals, says Sauer, who is participating in a state task force preparing for such a transition. It is a style of medicine that, except for several harrowing days during Hurricane Katrina, has not been practiced in America during living memory.
“You’re trying to give the most people the best chance of survival,” Sauer says.
If the medical system is swamped, hospital staff will be forced to choose which patients receive care and which are left to die to preserve resources, Sauer said. The standards being drawn up would guide care providers in directing resources toward patients most likely to recover, Sauer said, and it would likely require a governor’s order to implement them.
Perhaps their next step will be providing some sort of soy and lentil food that happens to be green.
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