Colorado health officials are finalizing guidelines to help doctors on the front lines of the coronavirus crisis make the excruciating choices about how to prioritize care for COVID-19 patients should the pandemic overwhelm the capacity of the state’s hospital system.
Julie Lonborg, a spokeswoman for the Colorado Hospital Association, said the state’s medical network is currently “not anywhere near capacity” but the growing numbers of coronavirus cases in the state — the latest tally Tuesday was 2,966 cases and 509 people hospitalized with COVID-19 — could quickly change that situation.
“We have to get ready for it to be a lot of patients all at once,” Lonborg said.
That kind of surge could lead to the nightmare scenarios that have most notably played out in northern Italy, where doctors have been forced to decide which critical patients get scarce equipment and staffing to keep them alive.
“There may be dire circumstances where our resources are unable or are insufficient to provide optimal care to everyone,” said Dr. Darlene Tad-y, a physician at the University of Colorado Hospital in Aurora who serves on the Governor’s Expert Emergency Epidemic Response Committee, or GEEERC. “Should we reach that moment, I hope community members will feel we have done our due diligence in using the utmost sense of fairness and ethics in what we write.”
The 19-member GEEERC is in the midst of finalizing recommendations for how to put in play the Colorado Crisis Standards of Care Plan, a set of emergency protocols meant to help caregivers manage a health crisis when “demands related to patient care and public health needs radically exceed available resources.”
“This is statewide guidance on how to do triage in the most ethically defensible way,” said Dr. Matthew Wynia, director of the Center for Bioethics and Humanities at the CU Anschutz Medical Campus.
It’s expected that the group will forward its report to the governor’s office in the next week to 10 days.
At the core of the guidelines is the acknowledgment that when things get desperate — like there’s a shortage of hospital beds, ventilators or medical staff — “there may be circumstances in which resources should be diverted from patients with a lower likelihood of benefit to those with a greater likelihood to benefit,” according to the 2018 Colorado Department of Public Health and Environment’s All Hazards Internal Emergency Response and Recovery Plan.
But how those patient care priorities are determined is critical, said Julie Reiskin, executive director of the Colorado Cross-Disability Coalition.
“We don’t want assumptions made about quality of life — that because someone has an underlying condition or a disability they have less to offer,” she said. “We don’t want them to use a disability characteristic that is not relevant to the pandemic (to deny care). It has to be scientifically based and not based on the assumption or belief about the value of someone’s life.”
According to a story published by ProPublica and the Arizona Daily Star, several disability advocacy organizations recently filed complaints with the civil rights division of the U.S. Department of Health and Human Services about wording in disaster preparedness plans for the states of Washington and Alabama.
They object to wording in Alabama’s plan, for instance, that states “persons with severe mental retardation, advanced dementia or severe traumatic brain injury may be poor candidates for ventilator support.”
Tad-y, the CU doctor who sits on GEEERC, said Colorado’s approach to critical care is not to look at categories of people but at an individual’s overall health condition and their likelihood to survive coronavirus.
“Primarily, we’re looking at the clinical status of our patients as it relates specifically to this illness,” she said.
The Seattle-based Institute for Health Metrics and Evaluation projects that Colorado will hit its peak COVID-19 cases on April 17, when it says there could be a shortage of nearly 2,000 hospital beds and nearly 500 intensive care unit beds based on the measures the state has taken so far to stem the spread of the virus. A number of efforts are underway to close that gap.
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