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Arizona hospitals want more power to decide who gets care as COVID-19 overwhelms facilities, staff

Rarely used 'crisis standards' would give hospitals guidelines for who gets treated when resources are scarce. Approval is up to governor and health director.


Arizona hospitals on Friday asked the state Department of Health Services to formally activate crisis standards of care, rarely used guidelines that would give health care providers more freedom to decide who should be treated for the coronavirus and how they should be treated.

The 14-page crisis standards for treating COVID-19 patients are a guide for dealing with scarce resources: 

  • Hospitals could allocate resources to patients with the best chance of survival or the longest projected lifespan. 
  • Decisions would be guided by a points scale and a color-coded triage chart to determine a patient’s priority for care. 
  • No one would be denied care “based on stereotypes, assumptions about any person’s quality of life, or judgment about a person’s ‘worth’ based on the presence or absence of disabilities."
  • The standards stress that “all efforts must be made to determine a patient’s goals of care and treatment preferences.”
  • Health care companies could also seek liability protection to allow them to make those triage decisions. 

The call for crisis standards by the State Disaster Medical Advisory Committee, which represents the state's major hospitals and other health care facilities, is the clearest sign to date that the out-of-control coronavirus infection is overwhelming the state’s health care resources.

It’s also a test of Gov. Doug Ducey’s pledge that the state will have enough hospital beds to treat sick Arizonans.

"The committee agreed that most, if not all, hospitals are currently operating under crisis standards of care," according to a member update Friday by the Arizona Hospital and Healthcare Association.

“Moving to crisis standards of care will allow consideration of regulatory waivers as well as additional liability protections. A decision on activation is expected to be made within the next few days.”

The past week saw several major hospital networks move patients, delay surgeries, and shutter clinics in attempts to free up staff and hospital beds.

Health care workers report increasing levels of stress as patients flood their units. 

A Tucson doctor described a desperate situation: “It is hard to admit that I feel vulnerable and scared when I think of the COVID-19 surge we are facing now. But I am admitting it because you need to know how close health care workers are to breaking.”

Since Memorial Day, Arizona has seen its hospitalization rate grow faster than any state in the country. A recent headline in the Washington Post told the story: How Arizona “lost control of the epidemic.”

Statewide, 86% of inpatient beds are in use and 88 percent of intensive care unit beds are occupied.

COVID-19 patients use one in every three inpatient beds and two in every five ICU beds.

The decision on activating crisis standards is now up to Health Services Director Dr. Cara Christ and Gov. Doug Ducey.

A spokesman for the governor said via text message, “The governor supports the continued partnership between the Department of Health Services and our hospitals. The agency is currently reviewing the request.”

Christ's spokesman, Chris Minnick, emails this statement: 

"The Arizona Department of Health Services (ADHS) continues to work closely with our hospital partners to monitor capacity and resources. ADHS is currently reviewing the recommendation to the State Disaster Medical Advisory Committee (SDMAC) to activate the Crisis Standards of Care. This request was taken as a proactive step to ensure clear and consistent guidance to healthcare partners throughout the COVID-19 response.

"If the request is accepted, ADHS will post this update along with other guidance and recommendations made by the SDMAC on the SDMAC webpage. During a public health emergency, the SDMAC convenes to develop incident-specific priorities and guidance for the delivery of healthcare and use of scarce medical resources."

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