In a massive disaster, care will be scarce
State guidelines lay framework for deliberately letting some people die.
By Dorsey Griffith -
dgriffith@sacbee.com Published 12:00 am PST Sunday, March 2, 2008
Story appeared in MAIN NEWS section, Page A1
Older, sicker patients could be allowed to die in order to save the lives of patients more likely to survive a massive disaster, bioterror attack or influenza pandemic in California.It's not how nurses and doctors are accustomed to doing things, nor how Californians expect to be treated. But it is part of a sweeping statewide plan being praised for its breadth, even as it rankles providers who will have to carry it out.
The new "surge capacity guidelines" released by the state Department of Public Health, depict a post-disaster health care environment that looks and feels nothing like the system most Californians depend on.
It provides for scenarios in which patients could be herded into school gymnasiums for life-saving care or animal doctors could stitch up the human wounded and set their broken bones.
The 1,900-page document lays the practical – and ethical – groundwork for local and county health departments, hospitals, emergency responders and any able-bodied health care worker likely to be called upon in a catastrophe.
Striking in its specificity and its frank focus on the need to suspend or flex established laws and to ration health care, the plan is being hailed as a model for the rest of the nation.
"Today, the practice of medicine is do everything you can for an individual patient," Lyman said. "This is, 'OK, we have limited resources. How do we best save the greatest number of lives?' That can mean saying to an individual patient, I can't give you a ventilator because I don't have enough for everybody."
The $5 million plan was developed as a result of Gov. Arnold Schwarzenegger's 2006 health care surge initiative. That $172 million effort included the stockpiling of millions of doses of antiviral medications, thousands of ventilators, mobile field hospitals and extra hospital beds.
But health care officials acknowledge that when and if a global pandemic or major disaster strikes, no amount of extra drugs or supplies will be sufficient to manage the impact on an already strained health care system.
That's why the state assembled public health professionals, hospitals, ethicists, nurses and others to hash out guidelines for procedures they hope will minimize red tape and maximize survival rates.
The plan lists, for example, which responsibilities and patient protections can be waived if the governor declares a state of emergency.
Hospitals will not have to report births, deaths, infectious disease outbreaks, medication errors, and suspected child or elder abuse. Existing rules that protect patients' privacy also can be tossed out.http://www.sacbee.com/111/story/753359.html
