Hawaii Department of Health (DOH) Director Dr. Elizabeth Char admitted to Star-Advertiser reporter Allison Schaefers that the state is including a triage policy formulated earlier last year that would enable hospitals to deny care to kupuna over 65 if a bed were needed for a younger patient (“Crisis of Care,” Star-Advertiser, Sept. 12). The policy states in part, “if there are not enough resources to provide to all patients within a priority group, younger patients will be prioritized.” Simple, and profoundly wrong.
The article also pointed out that an order signed by Gov. David Ige releases health care facilities and health care workers from liability if they have to ration care. In other words, a hasty medical decision can be made and no one is responsible. It will be too easy to claim that the now-obsolete state policy requires the unfortunate decision to deny care to a kupuna who would be expected to rapidly benefit from treatment.
The policy had not been made public and apparently has not been revised in the face of game-changing factors, such as the close-to-universal vaccination of Hawaii’s elderly and the prevalence of the delta variant of the coronavirus that is sickening and killing younger people. A New York Times article published on Sept. 11 was headlined, “The CDC reports that unvaccinated Americans are 11 times more likely to die if infected.” This condemns Hawaii’s triage policy as obsolete and it should not stand. Certainly, it should not be supported by our state health director.
Faced with the need to make a difficult decision, health care providers must take into account the general health situation of both patients. An older person needing short-term support who is likely to survive and soon be discharged should not be condemned to die by a secretive policy created over a year ago and implemented by persons who bear no liability for the consequences of their decision.
The policy includes “An Appeals Process available to patients, families, or clinicians who disagree with triage decisions” — but since the policy is not publicly available, it would be impossible for patients or families to appeal. In any case, time is of the essence in making treatment decisions. A patient needing ICU treatment is not able to engage a secret appeals process if no family members are available to immediately make the case.
The policy must be immediately withdrawn and replaced by one that takes into account the changed circumstances since its publication date of August 2020. Existing triage policies that have guided medical practitioners until now are adequate and morally sound enough to replace the defective policy that DOH currently defends.
The Star-Advertiser story on Sunday also reported that Lt. Gov. Josh Green, an emergency room physician who understands triage, recommends first increasing resources and options for care; the article included several of his recommendations that the state should be implementing before choosing to ration care. Hawaii’s DOH should scrap their secret policy and pay attention to those recommendations.
Larry Geller is a board member of the senior advocacy group, Kokua Council; he wrote this in his individual capacity.