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Alabama resolves complaint over old ventilator guidelines

MONTGOMERY, Ala. (AP) — Alabama agreed to remove old ventilator triage guidelines that advocates said discriminated against the elderly and disabled, the U.S Department of Health and Human Services announced Wednesday.

The difficult decisions about who could get a ventilator if there aren’t enough for all who need one has taken on new urgency as intensive care units prepare for surges in patients amid the COVID-19 pandemic. Federal officials cautioned states and doctors that civil rights laws still apply, and that decisions on who gets a ventilator should not be based on stereotypes about a person’s worth.

The Alabama document, created a decade ago during the H1N1 pandemic, included factors such as profound intellectual disabilities and severe dementia in weighing against providing the potentially life-saving treatment.

The Alabama Department of Public Health said a new plan had since been created, but federal investigators expressed concern that the older guidelines were “still available on some state webpages, and it was not clear whether any of their potentially problematic provisions could still be applied under the new guidelines.”

Alabama then agreed to remove all links to the outdated document, and to keep publicly clarifying that those guidelines don’t apply.

“These triage policies cannot discriminate on the basis of disability or age. They cannot be based on stereotypes or about a judgment about a person’s worth relative to others on the basis of disability,” said Roger Severino, director of the Office of Civil Rights at the U.S. Department of Health and Human Services. He said they are looking into similar complaints involving several states but did not specify how many.

The complaint against the Alabama policy was filed by the Arc of the United States and the Alabama Disability Advocacy Program, with help from a number of groups.

“States and hospitals across the country should heed OCR’s warning and take affirmative steps to ensure their policies do not discriminate against people with disabilities,” Cathy Costanzo, executive director of the Center for Public Representation, said in a statement.

The triage document was a suggestion, not a directive, for providers who may have to decide which patients get a respirator if the need overwhelms their availability, state officials said.

“All people deserve compassion and equal respect, and, the allocation of care cannot discriminate based on race, color, national origin, disability, age, sex, exercise of conscience or religion. This includes the use of ventilators during medical emergencies in addressing the needs of at-risk populations in Alabama,” State Health Officer Dr. Scott Harris said.

Alabama on Wednesday had more than 2,400 coronavirus cases and 66 reported deaths, with state numbers continuing to show a racial disparity. More than 52% of Alabama’s deaths caused by COVID-19 have been African Americans, even though about a fourth of the state’s population is black.

Twenty-five of the 48 verified deaths were African Americans, and 18 were white. The state is investigating additional deaths reported in COVID-19 patients but have not confirmed those fatalities yet.

Nationally, the virus appears to be killing African Americans at a higher rate, causing a growing outcry. Of the victims whose demographic data was publicly shared by officials — nearly 3,300 of the nation’s 13,000 deaths thus far — about 42% were black, according to an Associated Press analysis. African Americans account for roughly 21% of the total population in the areas covered by the analysis.

Infectious disease expert Dr. Anthony Fauci said at the White House on Tuesday that the pandemic is shining a “bright light” on unacceptable health disparities.

Diabetes, hypertension and asthma are disproportionately affecting minority populations, and those are the same conditions that increase risk for a “bad outcome with coronavirus,” Fauci said.

“Black people in Alabama and other places have what I call a triple whammy: Poverty is a factor. Lack of health insurance is a factor, and underlying health conditions are a factor,” former state Sen. Hank Sanders of Selma said Tuesday.

For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough. But for others, especially older adults and people with existing health problems, the highly contagious virus can cause severe symptoms or be fatal.

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