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Valley hospitals ask for 'crisis care' as COVID-19 cases rise

Doctor Surgeon Medical AP
Posted at 10:33 PM, Jun 27, 2020

Arizona Hospitals have asked the Department of Health Services to implement a "crisis standard of care" due to a lack of essential medical supplies.

Arizona Healthcare leaders proposed an addendum to the AZDHS COVID-19 protocols, asking for the ability to assess patients based on health needs and health history when distributing medical resources.

"[They're] deciding who gets care, and what care," said Elizabeth Wilson, D.O., an Emergency Medicine Physician for Medlink. "It’s gonna be devastating for anybody who’s going to be involved in any of this, but when we have a crucial shortage of resources, that’s why you have to do, we don’t have a choice."

Under this plan, patients would be individually assessed on a point system based on factors such as age, current health and survival chances, and whether or not the patient will die in the next 1-5 years due to non-COVID medical reasons.

"Who am I going to put on a ventilator? A 22-year-old single mom with no medical problems versus a 65, whose kids are already grown, with preexisting medical problems," said Wilson. "They're going to have to choose between those."

Individual patients will also be scored on a color chart. Red will be assigned if the patient is a high priority for critical care resources, yellow for immediate critical care, and green for low priority.

Below is an excerpt of the proposed addendum for determining a patient's priority:

If two or more patients require a single resource, additional factors may be considered as priorities, including:

  1. Pediatric patients < 18 years of age
  2. First responders or frontline healthcare workers (HCWs). This prioritization reflects the instrumental value HCWs serve in the community during a pandemic, as well as an acknowledgment of the increased risk they are assuming in caring for high-risk patients. They specifically do not receive priority because of an estimation of worth.
  3. Single caretakers for minors or dependent adults
  4. Pregnant patients

"If resources are sufficient, all patients who can potentially benefit from therapies will be offered therapies. If resources are insufficient, all patients will be individually assessed. No one will be categorically denied care based on stereotypes, assumptions about any person’s quality of life, or judgment about a person’s “worth” based on the presence or absence of disabilities," reads an excerpt from the proposed addendum.

Many medical professionals refer to the recent surge of COVID cases in Arizona not as a "second-wave," but instead a continuation of the first wave. Wilson said this extreme measure to preserve medical equipment could have been avoided by Arizona Government Leadership.

"Governor Ducey and Dr. [Cara] Christ failed miserably," said Wilson. "We had months and months of lead time. At least two months of lead time to learn, and gain knowledge, and learn how to prevent this from happening. Governor Ducey and Cara Christ had the power and the knowledge to prevent this from happening."

The proposed "crisis standard of care" plan has been sent to the State Disaster Medical Advisory Committee and is currently being review by the Arizona Department of Health Services.

In a statement about the addendum, AZDHS said the following:

"The Arizona Department of Health Services (ADHS) continues to work closely with our hospital partners to monitor capacity and resources. ADHS is currently reviewing the recommendation to the State Disaster Medical Advisory Committee (SDMAC) to activate the Crisis Standards of Care. This request was taken as a proactive step to ensure clear and consistent guidance to healthcare partners throughout the COVID-19 response. If the request is accepted, ADHS will post this update along with other guidance and recommendations made by the SDMAC on the SDMAC webpage. During a public health emergency, the SDMAC convenes to develop incident-specific priorities and guidance for the delivery of healthcare and use of scarce medical resources."

Read the full addendum here.