Hospital Group Backs Guidelines For Use Of Ventilators During Coronavirus Peak

Apr 14, 2020
Originally published on April 14, 2020 5:38 am

As Florida approaches an expected peak in the number of coronavirus cases, people on the front lines are waiting and planning for one of the worst possible outcomes: a shortage of ventilators needed by patients battling COVID-19.

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While Gov. Ron DeSantis’ administration has remained relatively quiet on the topic, Florida Hospital Association leaders have decided to endorse a proposal that spells out how crucial ventilators would be used.

The most current model from the University of Washington Institute of Health Metrics and Evaluation shows that Florida’s health care resources are expected to reach their limits on April 26.

The model predicts a shortage of 1,041 ventilators that day for patients who are infected with COVID-19, the deadly respiratory disease caused by the coronavirus.

To address the shortage, the Florida Hospital Association’s Board of Trustees last week agreed to support a proposal by the Florida Bioethics Network to establish an evidence-based standard of care protocol for the COVID-19 crisis.

The board’s support has no legal binding authority, and individual hospital adoption of the guidelines is completely voluntary, Florida Hospital Association interim President Crystal Stickle said in a statement to The News Service of Florida.

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But it’s the only move to date for statewide guidance.

“We, of course, hope that a crisis, the magnitude of which would require the FBN (Florida Bioethics Network) standard of care to be implemented, does not arise,” Stickle said. “However, it is our belief that being prepared requires anticipating what might happen and taking steps to ensure that the highest standards of care are maintained and that any decisions to triage resources are not made capriciously, inconsistently or unjustly.”

The Florida Bioethics Network is made up of large hospital systems, as well as medical school faculty members and staff, among others. Its mission is to help understand and resolve ethical and legal problems arising in health care.

The network’s guidelines contain a range of recommendations stemming from when a hospital should begin to triage patients for ventilators and how to assign order of treatment to a risk-benefit analysis of physician exposure.

“The values undergirding this, I think are right in the sweet spot of ordinary people trying to do that right thing,” said Ken Goodman, director of the Florida Bioethics Network and chair of the University of Miami Hospitals and Clinics Ethics Committee.

The recommendations are culled, in part, from a 2011 draft  report compiled by a Florida Department of Health workgroup developed following an H1N1 outbreak. The report was never adopted. Goodman said the Florida Bioethics Network in January decided to use the report as a starting point for the coronavirus recommendations. 

As the coronavirus pandemic has spread across the nation, some states published guidelines health-care providers could follow if demand exceeded supply for ventilators.

“Every state in the country is either wringing its hands or wetting its pants under this right now,” Goodman said.

Alabama made national headlines when it posted a policy that said people with severe or profound intellectual disabilities, severe or moderate-to-severe dementia or catastrophic neurological complications such as being in a persistent vegetative state are unlikely candidates for ventilation support. Alabama’s policy was subsequently withdrawn.

The policy was challenged in federal court, as were policies in Kansas, Tennessee, Washington, Utah, Pennsylvania and New York.

The U.S. Department of Health and Human Services’ Office of Civil Rights on March 27 issued a memo making clear that no civil-rights protections in federal health-care laws have been waived.

Tony DePalma, director of public policy for Disability Rights Florida, sent a letter to DeSantis on April 3 asking the administration to “lead by example in ensuring that all relevant portions of  (federal law)  prohibiting discrimination in the provision of life-saving medical care are upheld and complied with during this crisis. “

DePalma said he has not heard from the administration on his request. The governor’s office did not reply to requests for comment.

Disability Rights Florida has not endorsed the Florida Bioethics Network’s guidelines.  DePalma agreed with the network, though, that statewide standards should be in effect. 

“What we are supporting is strict adherence to federal standards. But at the moment we  have taken (the network) at face value and believe they are sincere when they say the worst outcome that could happen for the state is if there were not standards articulated at all,” DePalma said.

DePalma worked with the network on massaging the guidelines before they were considered by the Florida Hospital Association board on Thursday.

As evidence of the collaboration, the introduction notes that the guidelines include a “commitment to do our best to provide respect, care and compassion to all patients without regard to race, ethnicity, citizenship status, national origin, religion, sex, disability, veteran status, age, genetic information, sexual orientation, gender identity or any other such characteristic or trait.”

Goodman said he feels good about the collaboration’s outcomes.

“To the best of my knowledge, we are the only ones in the United States that have worked as closely with the disabilities community,” Goodman said.

The Florida Department of Health announced Monday morning the state had 20,601 cases of coronavirus and that 470 residents had died.

The DeSantis administration won’t disclose how many of the deaths involve long-term care residents, such as people who live in nursing homes, assisted living facilities or group homes.

It also won’t disclose how many people with developmental or intellectual disabilities who live in group homes or intermediate care facilities are infected.

The Agency for Persons with Disabilities would not answer if the state had been in contact with hospitals to discuss the treatment of people with disabilities as the potential need for ventilators exceeds demands.

In a prepared statement to The News Service of Florida Agency for Persons with Disabilities Director Barbara Palmer said the agency is “committed to providing quality, compassionate care to customers and remains steadfast in that effort.  The agency will never allow withholding or rationing of health care by our providers.”