Civil rights lawsuit targets health care rationing in Idaho

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AP
FILE: hospital

BOISE, Idaho (AP) – An older adult advocacy group has filed a civil rights complaint against Idaho over state guidelines for “crisis care standards” for hospitals overwhelmed by patients amid the coronavirus pandemic.

Justice in Aging group Tuesday asked the U.S. Department of Health to investigate Idaho’s health care rationing plan – claiming it discriminates against older adults, and especially older black and Native American adults, by prioritizing factors like age in patients that can be used for life-saving care.

“Older adults are at serious risk of discrimination, which leads to death,” Justice for Aging’s attorneys wrote in their letter of complaint because of the crisis standards in Idaho.

Other states have faced similar complaints in the past few months. Since the pandemic began, public health officials in Arizona, Utah, and North Texas have changed their contingency plans based on complaints from Justice in Aging and other disability and civil rights organizations.

Idaho activated crisis standards for care earlier this month after a surge in COVID-19 patients depleted resources available at most Idaho hospitals.

RELATED: The entire state of Idaho is now subject to crisis management standards

Crisis care standards are designed as ethical and legal guidelines for the rationing of the health system and direct scarce resources such as beds in intensive care units or ventilators to patients with the highest probability of survival. If resources are scarce, other patients can be treated with less effective methods or, in severe cases, can receive pain-relieving or other palliative care.

Idaho Department of Health and Welfare spokesman Greg Stahl said Friday that the department was unaware of the complaint.

“The patient care strategies for resource constraints” document is based on ethical commitments that include duty of care, resource management, fairness of distribution and process, and transparency, “wrote Stahl in an email to The Associated Press. “The guiding principle is that all lives have a value and that no patients are discriminated against on the basis of disability, race, skin color, national origin, age, gender, gender or the practice of conscience or religion.”

But Justice in Aging said the standards discriminate by using patients’ remaining “years of life” to aid decision-making when two generally similar patients need the same resources.

“The Idaho language is not limited to situations where there is a large age gap between the two care recipients. According to its terms, it would be used in situations where there might be very little difference, such as Robinsue Frohboese, assistant director for civil rights.

The letter added, “If they are so clinically similar that a tie-breaker is required, it would lead to an absurd and outdated result of refusing care to the 61-year-old man just because he is only a year older. “

Idaho’s standards also include a Sequential Organ Failure Assessment, or SOFA, to help clinicians determine a patient’s likelihood of surviving an illness or injury.

RELATED: Idaho COVID-19 hospital stays continue to hit all-time highs

The score takes into account how well the patient’s most important organ systems are functioning. But Justice for Aging attorneys say recent studies by Yale University researchers suggest that this is not an accurate measure of the survival of adult black patients.

Using age as a decision criterion violates the Federal Age Discrimination Act of 1975 and the Affordable Care Act, said Regan Bailey, litigation director at Justice for Aging.

The individual patient ratings in the guidelines already take into account the effects of aging on the human body, Bailey said, and reusing it as a tie-breaker essentially means double counting age at the expense of older patients.

“We want the state not to include age as a separate factor,” and move away from SOFA scores, Bailey. “We are concerned about the continued reliance on an instrument that has been shown to disproportionately prevent black people from receiving life-saving care.”

Several entities were involved in the development of the Idaho contingency plan, including a disaster medical advisory committee, the medical panel, the Idaho State Independent Living Council, officials from the Idaho Attorney General and the Department of Health and Welfare, Stahl said. To date, the tie-breaks have not been used in Idaho, he said.

“The need for tiebreaker criteria is expected to be very rare,” wrote Stahl.

Coronavirus numbers in Idaho have continued to rise, resulting in record hospital stays. And the state’s coronavirus vaccination rates remain among the lowest in the country, with only about 51% of eligible residents fully vaccinated.

Hospitals and health care providers struggle to treat all of them, and new patients sometimes stay on stretchers for days while doctors try desperately to find enough beds and other resources.

Hospital officials have also reported that the mechanical systems their hospitals use to provide oxygen to hospital rooms are also struggling to keep up with the high demand from the massive influx of COVID-19 patients.

More than 760 coronavirus patients were hospitalized nationwide on September 20, including 202 people in intensive care beds, according to the Idaho Department of Health and Welfare.

READ: What does Crisis Management Standard mean?


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