Several of the leading medical experts in Massachusetts who developed the state’s controversial plan to ration access to life-saving equipment like ventilators say they believe the state’s hospitals will be able to weather the surge of coronavirus infections without having to implement those protocols.
According to the Department of Public Health, the state’s hospitals still had 56 percent capacity to accept new patients as of late last week.
“A lot of the work we’re doing is to prevent the crisis standards from ever having to be activated,” said Dr. Michael Wagner, chief physician executive of Wellforce, a state health system focused on supporting clinicians and their patients. “I believe we will be able to achieve that directive.”
The committee of doctors, public health experts and medical ethicists that developed the crisis standards of care revised their guidelines last week to reflect concerns voiced by state and federal lawmakers about their impact on underserved minority communities.
U.S. Rep. Joseph Kennedy III and the Black and Latino Legislative Caucus, including Boston Medical Center emergency room physician Rep. Jon Santiago, wrote to state leaders two days after the guidelines were published to warn that the standards would penalize people of color, who disproportionately struggle with underlying health conditions that make them more vulnerable to the virus.
“Once the guidelines were released there was a lot of public feedback that was super helpful and we quickly realized that we needed to make a change,” said Dr. Robert Truog, director of the Center for Bioethics at Harvard Medical School.
Three doctors who sat on the panel that developed the standards presented the revisions Thursday to the state Public Health Council.
The revised guidelines now advise hospitals to take into account a patient’s chances of near-term survival over the next five years rather than trying to maximize life-years, which would have prioritized younger patients with COVID-19 and those without underlying health conditions.
Still, Truog and Dr. Emily Rubin, a critical care pulmonologist at Massachusetts General Hospital, said they’re cautiously optimistic that no hospital in Massachusetts will have to make these types of decisions.
“I don’t think we will need them,” Truog said of the standards.
Wagner said the Crisis Standards of Care Advisory Committee was convened by Commissioner of Public Health Monica Bharel in late March to develop a set of worst-case-scenario guidelines for how to allocate resources during the pandemic should they become scarce. The panel was looking to avoid a situation where patients were treated differently depending on which hospital they visited.
Truog said the initial set of guidelines took an approach adopted by several other states to prioritize the probability of a patient’s long-term survival, defined as life-years saved. The new standards look only at chances of survival over the next five years, thereby reducing the impact a disability or an underlying health condition might have on someone’s access to a ventilator or intensive care bed.
“We adopted what we believe to be a reasonable compromise,” Truog said.