death panels being set up in indiana?

[tyler34]

"INDIANAPOLIS | Some cancer patients, heart attack sufferers and burn victims would be removed from ventilators and left to die if pandemic flu patients overwhelmed Indiana's hospitals.
The goal would be to save the most lives as possible, according the Indiana State Department of Health.
But a draft copy of Indiana's "Altered Standards of Care" guidelines reveals that if faced with overwhelming demand, Indiana hospitals would establish what amount to "death panels."
A "triage review officer" would decide who gets access to hospital staff and equipment and, likely, who lives and who will die."


full story:

State guidelines set up decision process if flu outbreak overwhelms hospitals

official document: http://in.gov/isdh/files/ASC_FINAL(twb)(08_18_2008).pdf

 

[Denny347]

Not really surprising. We are talking about a medical SHTF that overwhelms medical resources. This is the same concept used in the battlefield. Why? Because the medics are a valuable resource that cannot be tied up on patients that are beyond help and are needed to assist those who can be saved. We would not be in war but the concept still holds true. Who do you help in a medical catastrophe with a finite medical resource? It's a tough choice but it will still have to be made. Better now when rational minds are available rather than come up with a plan DURING the crisis.

 

[gund]

There are only X resources available. When more than X people require those resources. Somebody has to decide who gets those resources.

There are many ways to decide. The hospital could decide based on triage. Or they could decide based on auctioning those resources to the highest bidder.

What do you suggest happen when a hospital has an overflow of patients and cannot accommodate all of them and there are no other available medical facility close enough to do any transfers?

This has nothing to do with the death panels mentioned by Sarah Palin.

In any emergency, first responders have to decide who to save first and who to save later. It's the same idea.

 

[tyler34]

well, 1- I agree with you and 2- my title sounds like I'm trying to be a fear monger, but thats not the case, I'm just passing on info and letting people decide.

 

[Phil502]

I think an illegal alien with the flu should get dibs on the ventilator over a ww2 vet.
Sound okay?

 

[misconfig]

I think an illegal alien with the flu should get dibs on the ventilator over a ww2 vet.
Sound okay?

That's already drafted in the bill.

 

[rich8483]

I think an illegal alien with the flu should get dibs on the ventilator over a ww2 vet.
Sound okay?

i hope this is sarcasm or i am missing something.

 

[jsharmon7]

i hope this is sarcasm or i am missing something.

Are you saying there is a priority for one over the other? In your case, giving priority to the WWII vet over the illegal immigrant? That's the point he's trying to make. Sometimes one takes priority over the other, i.e. the idea of a "triage officer" deciding who to help and who is beyond help.

 

[Libertarian01]

To All,

I just read most of the document.

I must say that having this in place is an extremely good idea! Should we be faced with a pandemic crisis as we were in 1917 the entire system will be overwhelmed.

It will be far better to have an understanding of what our rights and protections are going into such a scenario before it occurs. It will also be good to know that individuals are not "winging it" but rather following a protocol that applies to every citizen equally.

That said, after reading the document there are few concerns that I would have about their draft proposal.

#1) I do not like the idea of "triage review officer". Imagine the psychological trauma this would inflict on a person. Also imagine the fallout after the event passed and everyone who was taken off of a ventilator wants to go after "that guy/gal"! It would be adding pain enough to an already horrific situation. I would rather see them create in each hospital (or other care facility) a "triage review board". This would at least give some comfort to the board members that they alone were not responsible for saying "you go left, you go right" if you get my meaning.

#2) Whether or not you use a single triage review officer or board I would want the law changed such that they would receive: A) Absolute immunity from any civil action, save in the event that they acted in a criminally negligent manner; B) They receive from State funding any psychological counseling for AS LONG as they need it; C) Their identity be kept confidential.

#3) I agree with the idea that "age, social worth, and job function will not affect triage allocation decisions." However, later in the document it goes into alternative care for young children. I disagree with this. I want there to be a truly even playing field for every human being. My perspective, personally, is that a father or mother of children has more value than a single child. However, I acknowledge that others may disagree with that ethical standard. Thus, I would want the playing field equal for every human being and let the chips fall where they may. I concede that there are medical reasons to treat children differently just as there are reasons to treat the elderly differently, but I do not want to see any age group receive more or less care based upon their age. I must also acknowledge that there is some medical terminology that is beyond my current understanding. If a medical professional can explain the document better I will obviously change my opinion so long as it doesn't conflict with my "all ages getting equal access" position.

#4) In the list of Triage Criteria in Appendix #4 there are several issues that I think need review. One condition is diabetes. I know that there are several different types of diabetes along with different severity's. I think this needs to be addressed in a better way than just "diabetes." It also list "malnutrition as a condition. In this case I would modify it to "self imposed malnutrition". I don't mind the junkie going to the bottom of the list. I DO MIND the malnourished dependent of of someone being placed at the bottom of the list.

All in all I think we should have something like this and that it should be posted in every care facility and in each Board of Health for all to read and understand. One important leg of good government and a free society is the open transparency of that government.

Let us all pray to the Almighty that such a document is a total waste of our time.

Regards,

Doug

PS - If you are interested in learning about the true horror of the 1917 pandemic I would recommend the book "The Great Influenza: The Epic Story of the Greatest Plague in History" by John M. Barry. I have read this and it cover not a "what if SHTF" but rather "When the SHTF". An extremely interesting and sad read.

 

[rambone]

I think the hospitals are capable of figuring things out on their own. The Government can take a hike out of health care as far as I'm concerned.

If this is drafted in response to H1N1 Swine Flu, it is the height of folly.

 

[Timjoebillybob]

Did anyone else notice the date on the draft? August of 2008. This was written over a year ago because of the possibility of the bird flu.

That said, after reading the document there are few concerns that I would have about their draft proposal.

#1) I do not like the idea of "triage review officer". Imagine the psychological trauma this would inflict on a person. Also imagine the fallout after the event passed and everyone who was taken off of a ventilator wants to go after "that guy/gal"! It would be adding pain enough to an already horrific situation. I would rather see them create in each hospital (or other care facility) a "triage review board". This would at least give some comfort to the board members that they alone were not responsible for saying "you go left, you go right" if you get my meaning.

I agree to a point, but the one problem I see with a board is that the more people involved in a decision the less likely a decision is going to be made, or made on time, and there will still have to be a "head officer" who makes the final decision in cases of tie votes(and will bear the brunt of the guilt in all cases because he is the "boss"). Also how it is set up it makes it a bit more impersonal because its not the Dr that is careing for the patient making the decision, they just make notes on a chart and pass them up, the one who makes the decision most likely doesn't know the person or quite possible in medium to large hospitals(heck even small ones in a situation like this) have never even seen them, they are numbers on a chart to be compared to other number on another chart(yes its cold to say it but its true) I would like to see names omited off the charts that get passed up and just serialized to help avoid any chance of favoritism and to help with the reviews officers mental health by dehumanizing the process. And not to be even more callous but the Drs. have to make decisions while not exactly the same but comparable on a somewhat regular basis. Unless they are dermatologists . I have quite a few family members in the medical field (none Drs. but just about everything else) and after hearing stories from them I'm seriously wondering about my sanity(possible lack of and what may happen to the little I have left) after having decided to get into the field myself after hearing them. My sister is a nursing shift supervisor at a hospital and I've unfortunatly had to witness her breaking the news to the family that the person they brought into the ER didn't make it, then shortly afterwards sit down with her family for dinner and act like nothing had happened, and no she is not cold hearted. To work in that field you HAVE to be able to seperate what happens there with the rest of your life otherwise you will end up eating a barrel. I just hope if I make it into it, I can.

#2) Whether or not you use a single triage review officer or board I would want the law changed such that they would receive: A) Absolute immunity from any civil action, save in the event that they acted in a criminally negligent manner; B) They receive from State funding any psychological counseling for AS LONG as they need it; C) Their identity be kept confidential.

Agreed on A and C, B they should have allready from where they work for being in the medical field same as LEO's and Military and Paramedics and Firefighters and.... pretty much anyone who deals with life and death on a daily basis(see above)

#3) I agree with the idea that "age, social worth, and job function will not affect triage allocation decisions." However, later in the document it goes into alternative care for young children. I disagree with this. I want there to be a truly even playing field for every human being. I concede that there are medical reasons to treat children differently just as there are reasons to treat the elderly differently, but I do not want to see any age group receive more or less care based upon their age. I must also acknowledge that there is some medical terminology that is beyond my current understanding. If a medical professional can explain the document better I will obviously change my opinion so long as it doesn't conflict with my "all ages getting equal access" position.

From my(not medical professional) reading its not that any age group is getting more or less care based on their age, its the amount of care that is available for children, nicu(neonatal icu) picu(pediatric icu) and standard icu, all have different (sized) equipment along with in some things totally different equipment. They are not in most cases interchangeable. Along with the need to treat different age ranges differently. From page 7 of the draft " Due to the scarcity of pediatric intensive care units in Indiana, it may be necessary to explore out‐of‐state hospitalization for some pediatric cases. The process for making this decision is outlined in Appendix 7." Its not that they are being discriminated because of their age but because of the amount of equipment and training available for that age.
And some of the medical terminology is beyond my understanding also, but I'm trying to learn about it as I go.

#4) In the list of Triage Criteria in Appendix #4 there are several issues that I think need review. One condition is diabetes. I know that there are several different types of diabetes along with different severity's. I think this needs to be addressed in a better way than just "diabetes." It also list "malnutrition as a condition. In this case I would modify it to "self imposed malnutrition". I don't mind the junkie going to the bottom of the list. I DO MIND the malnourished dependent of of someone being placed at the bottom of the list.

I could be wrong but I don't think the list your referring to places anyone on the bottom of the list but almost the exact opposite. That is criteria for being moved up on the list I think. Without anything on the list they are just going to get basic care and sent home with meds, having something on that list gets you sent to further evaluation to determine if you need hospitalization.

All in all I think we should have something like this and that it should be posted in every care facility and in each Board of Health for all to read and understand. One important leg of good government and a free society is the open transparency of that government.

Let us all pray to the Almighty that such a document is a total waste of our time.

Regards,

Doug

I agree in the necessity of having something like this, and also with praying that we will never need it.

 

[fire1035]

Triage review officer sounds like exactly what it is to me. If there is a plane crash or some other mass casualty incident that is exactly what will happen. A triage officer will go through the victims, they will be assigned a color coded tag which will dictate what we will be able to do for them, the ones with the worst injuries/highest likelihood of survival will be treated first and move on down the line. If they are not savable and the person lying next to them is guess who is going to get attention? It may sound harsh but you cannot save everybody.

 

[Phil502]

I thought triage officer would be to find out who needs attention first and give it to them, not find who is gonna die first and throw him to the side.

Oh I'm sorry Mrs. Smith we need to take your husband off the ventilator because this othe man needs it more? People do make it off of the ventilator and live the rest of their lives. I say first come first serve.

 

[fire1035]

It's a little of both actually. I am speaking from an emergency point of view which is probably what the OP information is about. In an emergency situation triage is designed to mark those in most urgent need of care without spending to much time worrying about those that are going to die anyway even if we do stop to help them. For example you see patient A with a massive head injury with brain matter exposed, next to him is patient B with a spurting arterial bleed, the chances of patient A surviving are practically zero whereas if we stop patient B's bleeding they will most likely live. It's about saving as many people, who are savable, as you can.

 

[Libertarian01]

Follow Up - Got Response from Vice Chair of Board

To All,

I took some of my concerns and contacted one of the board members as I could not find a name. She forwarded my issues to the Vice Chair and I have received a very nice, detailed response.

While this does not address all potential issues it certain addressed the ones I contacted them about. I will follow up with her and continue the discussion.

Many times those in government hope for public input and receive none. They are at least receiving some input from me. Lord help them...

"Altered Standards of Care

Mr. Horner,


Thank you for your thoughtful comments to Dr. Gaffney on the draft Altered Standards of Care Guidance from the Indiana State Department of Health website. Input from people like you is very important as we develop tools to cope with a difficult situation such as a shortage of ventilators. This document was developed by a multi-disciplinary committee of physicians, nurses, attorneys, ethicists and others who looked at all the issues over a two year period. I am the co-chair of the committee that developed this document and will attempt to address your concerns.


We agree that repeatedly making the tough decision of who gets a ventilator and who does not may be difficult for one person. This guidance document is not a mandate or statute, but simply guidance and suggestions. Hospitals may certainly choose to use a “triage review board” to make these decisions if they wish.


We appreciate your concerns about provider liability. It was a topic of much discussion among the committee. The reality is that a balance must be struck between the liability concerns of providers and concerns of maintaining health care quality. During a declared disaster, health care providers providing services in response to the event are immune from liability absent gross negligence or willful misconduct. See Ind. Code § 34-30-13.5. Compared to protections offered to health care providers in other states, this is excellent protection. Also remember that the legal standard of care is generally based on the care and skill expected in the same or similar circumstances. In that respect, the circumstances around decision making would already be taken into account in any scenario that ended up in litigation.


There is no State funding allocated at this time for the psychological counseling of providers. It is something that could be pursued should the need arise. Many employers offer employee assistance type programs as well.



Though it’s not likely that disclosure of the identities of triage officers would be up to the State, the State would encourage as much transparency as possible under the circumstances. It’s likely that several individuals in each facility would have that responsibility at one time or another.



We included guidance for children in order to enable them to fit in the same scheme of decisions as the adult. Because we chose to not use age as a determining factor, we needed to “equalize” the children with the adults so the values used to assess children would not be adult values but those more applicable to children. We do not plan to evaluate and treat children or elderly people any differently than adults. Our goal is to do the greatest good for the greatest number by choosing those who have the best chance of survival, regardless of age or social position.


The Triage Criteria in Appendix #4 is used to perhaps evaluate patients at an off-site location and helps health care workers decide who should be sent on to the hospital for further evaluation. People with pre-existing medical conditions need a more thorough evaluation than just a list of symptoms and a fever. If you have diabetes or another chronic illness you should be evaluated more thoroughly by a physician before a decision is made regarding the level of care required. So the people who have the conditions listed in Appendix #4 are not placed on the bottom of a list, but evaluated more thoroughly before a decision is made.


It is our hope that each hospital in the state will adopt the guidance document, but we have no authority to make that happen. It is then up to that local hospital to educate the people in their community about the criteria and need for altered standards of care.



I hope this helps to alleviate some of your concerns.


Janet Archer, RN, MSN
Chief Nurse Consultant
Public Health Preparedness and Emergency Response"


I hope this sheds some light on the document that was linked.


Regards,


Doug