Hawaii State Department of Health to Use Age as Tie Breaker in Crisis

The state’s health ministry on Wednesday posted an updated version of its healthcare rationing plan on its website, which, despite recent outcry from high-level advocacy groups like the AARP, is using always age as a starting criterion when evaluating certain treatments during a crisis.

The COVID-19 outbreak in Hawaii has not become severe enough to invoke its Crisis Care Standards triage allocation framework, which is a statewide effort to plan for worst-case scenarios. where there would not be enough medical resources for everyone.

The framework, which was developed last year by 21 Hawaiian doctors representing the state’s health systems, was updated on Wednesday and posted on the state’s Department of Health website at bit.ly/398XbXB.

DOH Director Dr Elizabeth Char declined an interview with the Honolulu Star-Advertiser on Wednesday, but answered lawmakers’ questions about the plan, which she described as a “living document” during a briefing. afternoon before the House Committee on Pandemic and Disaster Preparedness.

Char’s remarks did not specify what changes had been made since the plan was last revised in August 2020. However, the updated document still states that “life cycle considerations will also be used as a tiebreaker. , if there are not enough resources to provide all patients of a priority group, younger patients will be prioritized.

“Evidence from several countries, including the United States, shows that age (over 65) is an indicator of poor prognosis in COVID-19 patients,” the executive said. “If the triage score is equal between two people, the triage worker / review board should consider that a patient (over 65) who is also COVID positive is less likely to benefit from the scarce resource. “

Keali’i Lopez, State Director of AARP in Hawaii, thanked DOH for making public the Crisis Care Standards, which “keep the public aware of the state’s plan. ration health care in emergencies ”.

Char told lawmakers that the August 2020 version of the document had already been posted on HI-EMA’s website. However, the DOH and the Healthcare Association of Hawaii told AARP Hawaii last week that the document could not be released because it was under review. The DOH told the Star-Advertiser it could not be located.

Lopez said AARP Hawaii understands the state will continue to review and update the Crisis Care Standards Framework, and strongly advocates that the DOH review recent federal and ethical guidelines on discrimination based on age.

“The problem we see with today’s standards of crisis care is that age is a factor doctors can take into account when deciding whether someone receives health care. It’s a tiebreaker. If two people have equally bad conditions, the state’s health care rationing plan allows young people to be prioritized over old people only on the basis of their age, ”she said. “We believe this is age bias and age discrimination and does not fall within these crisis standards.”

Lopez said that since August last year, when the state initially developed the plan, other states have changed their plans to end age discrimination.

The Office of Civil Rights of the Health and Human Services Administration has further ordered states that the use of age as a limiting factor in health care violates federal age discrimination laws. and the thinking of medical ethicists has evolved to recommend that states do away with age and all prejudice. their plans, ”she said.

Char told lawmakers the plan does not discriminate on the basis of age, which has been “rejected as a primary triage criterion.”

She said using the age of 65 in a tiebreaker situation is just a specific exception.

“In the case of COVID, in particular, research was showing that your prognosis for the elderly who had severe COVID was not as good as that of the younger population who had severe COVID,” Char said.

Char said the authors of the document indicated that they checked it with kupuna who said “if all other things were equal” and “it was just for a tiebreaker” that they would prefer in made give the fan to “a younger person”.

State Representative Tina Wildberger (D-South Maui) noted that vaccines were not discussed at all in the rationing care prioritization document, and said she had received many calls or comments from ‘voters’ who worry that unvaccinated people represent a disproportionate number of people. persons occupying a large part of the hospital capacity.

Wildberger asked Char to address the medical ethics behind the executive’s decision-making.

Char said: “As an emergency doctor, I treat anyone who comes to my emergency, don’t I, and if you crashed your car because you were intoxicated, I always take care. from you.

“If you walked in as a bad trauma patient because you did things that weren’t too smart and had a bad altercation or something like that, I’m still going to take good care of you. my abilities. So that’s kind of where it is. Anyone who needs care at that time, we as doctors have a duty to try to treat that person at that time. “

Char dodged a question from Rep. Gene Ward (R-Hawaii Kai, Kalama Valley) as to whether she supported using age as a tie-breaker in the frame.

“This is not my document. I didn’t write it, “she said.” It was our health practitioners in our community with input from our community ethics specialists, our kupuna community. “

Char said she hoped the document would never have to be used.

“Can you imagine what kind of hurt feelings could happen to that person having to make these kinds of decisions? We absolutely don’t want to play God, ”she said. “And that’s what this document allows us to avoid having to do, that it’s not a person who just makes that decision and has to do something arbitrarily.”

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