HONOLULU (KHON2) — The state’s plan on how to allocate medical care during times of a crisis was made available for the public to read on Wednesday, Sept. 15.
The Hawaii Department of Health (DOH) said its Crisis Standards of Care Triage Allocation Framework was created in 2020. It included input from healthcare providers across the state, and it was done in preparation for if the state ever found itself in a serious COVID situation.
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“It’s something that I reject out of hand, the process to discuss and think about is ok, but Hawaii should never ration care, and of course it created a lot of fear,” said Lt. Gov. Josh Green, who is also an emergency room physician.
“So I thought that someone had to speak up. It created fear amongst our kupuna because in the plan, there was consideration for rationing care under certain circumstances, severe shortages to the elderly, and that’s not anything we could accept,” he continued.
The 36-page public document laid out a scoring system that healthcare facilities would use if they were ever faced with a triage situation.
According to the document:
Advanced age was rejected as a primary triage criterion because it discriminates against the elderly. Age already factors indirectly into any criteria that assess the overall health of an individual because the likelihood of having chronic medical conditions increases with age and there are many instances where an older person could have a better clinical outlook than a younger person. Thus, clinical factors (with the exception of the COVID-19 disease-specific age criterion based upon the known poor prognosis with older age) will be used to evaluate a patient’s likelihood of survival and to determine the patient’s triage priority unless there is a case of equal priority and can be a factor in as a “tie-breaker.”Hawaii Crisis Standards of Care Triage Allocation Framework document
The document also added that age would only be used if a situation resulted in the need for a tie-breaker.
“Age is used only in a tie-breaking situation. Evidence from multiple countries including the U.S. shows that age >65 yo is an indicator for poor prognosis in COVID-19 patients. If the triage score is equal between two individuals, the Triage Officer/Review Committee should use the consideration that a patient >65 yo who is also COVID-positive is less likely to benefit from the scarce resource.”
Green said he received dozens of phone calls from kupuna after the document was released.
“When a 75-year-old woman reaches out to you, and she’s afraid that if she gets sick, she won’t be able to go to the hospital for life-saving care, that’s when you know you’ve made a mistake,” Green said of the document’s release.
Two weeks ago, Oahu hospitals were at a critical state when there were nearly 450 COVID-patients hospitalized, and triage tents were set up at most major hospitals to handle any overflow.
Hospitalizations have dropped 30% since then.
“I think that it’s important that everyone realizes we will not need to ration care, I will fight against it,” Green said. “It was terrible, it’s a terrible idea in Hawaii to ever rationed care because, as I said several times, we should move heaven and earth before we ever tell someone they can’t get care.”
Green suggested using other facilities by bringing in hundreds of additional federal care nurses and physicians, using monoclonal antibody treatment and utilizing long-term care facilities before considering rationing care.
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“All of those are possible solutions before we’d ever tell someone your mom or dad, or your elderly grandfather, does not qualify for care, we should never do that,” he continued.