Physicians outline ‘objective’ standards for rationing care in NM - Albuquerque Journal

Physicians outline ‘objective’ standards for rationing care in NM

University of New Mexico Hospital. (Roberto E. Rosales/Albuquerque Journal)
University of New Mexico Hospital in Albuquerque. (Roberto E. Rosales/Albuquerque Journal)

Copyright © 2020 Albuquerque Journal

SANTA FE – A patient’s chance of survival – not age, occupation or ability to pay – will guide the rationing of medical treatment as New Mexico prepares to invoke crisis standards of care in its hospitals.

In an online briefing Tuesday, hospital and health care leaders said the rationing of care isn’t yet necessary, but they are bracing for the possibility because of a dramatic increase in COVID-19 patients requiring hospitalization.

Dr. Denise Gonzales, medical director at Presbyterian Healthcare Services, said physicians will use a scoring tool that focuses on medical attributes – such as whether a person has cancer or another chronic disease – to determine who gets priority if the demand for ventilators or some other treatment exceeds the supply.

The goal, she said, was to develop an objective system so doctors and nurses don’t have to make judgment calls on which patients are most worthy. The priority will be probability of survival.

“The tool itself is as free from bias as it possibly can be,” Gonzales said in a public briefing Tuesday.

To boost capacity in the meantime, hospital leaders say their organizations are treating patients in hallways, employing out-of-state nurses and taking other steps to handle the extra patients.

The number of COVID-19 patients in state hospitals stood at 925 on Tuesday – the eighth day in a row over 900. To help them breathe, 171 of the patients were intubated.

“This public health emergency is unprecedented,” said Dr. Michael Richards, vice chancellor for clinical affairs at the University of New Mexico Health System.

The triage protocol, he and other physicians said, is intended to be objective, applied consistently across the state and employed only as a last resort if the demand for a particular treatment outstrips the supply.

New infections leveling off

Dr. David Scrase, secretary for the state Human Services Department, said the number of new COVID-19 infections detected each day is reaching a plateau, though they’re still at a historically high level.

Hospitalizations tend to follow new cases by about two weeks, he said, so New Mexico hospitals are bracing for a continuing surge in patients before the falling case numbers relieve some of the pressure.

The state Department of Health is considering issuing a public health order establishing crisis standards of care in New Mexico hospitals. That would allow hospitals to call on pediatricians to treat adults, for example, and take other steps aimed at doing what’s best for the community as a whole rather than what’s best for an individual patient.

“We believe now the level of pressure is high enough that we’re ready to move into the crisis standards of care designation,” Scrase said.

Vaccines will help at some point, Scrase said, but it may take until late summer – rather than April or May – before 60% to 70% of the state is vaccinated.

Even with crisis standards, physicians will continue to provide care in a “level-headed, thoughtful manner,” Richards said. Each patient will receive health care, though some therapies might not be available because of rationing.

No judgments on worth

Physicians, in any case, won’t be asked to make a call on whether an essential worker’s life is worth more than someone else’s. They will focus strictly on medical attributes that show how likely a patient is to respond to the treatment and their chance of survival.

Gender, social status, value to society – none of that is part of the consideration, physicians said.

“We landed on the concept of fairness being the most important driving principle,” Richards said.

Triage boards and triage officers at each hospital are to make decisions on rationing care, Scrase said, not government officials.

“The only criteria is one’s ability to survive the infection,” he said.

Citing an internet outage, New Mexico health officials didn’t issue their daily report Tuesday on the number of new COVID-19 cases and deaths.

The outage interrupted the Department of Health’s electronic laboratory reporting system, state health officials said, and affected some state websites and email accounts.

The state said it was still notifying people who test positive for the virus and investigating their cases.

Tuesday’s case and death numbers will be reported with the Wednesday batch, state officials said.


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