A draft letter outlining how “[p]atients who have the best chance of getting better” will be prioritized for ventilators or Intensive Care Unit beds while others will be given painkillers is said to have leaked from the Henry Ford Health System in Michigan.
The network of six hospitals first established in 1915 appeared to confirm the report which also appeared on NPR’s local Michigan radio website early Friday morning, though they say the policy is not currently in use.
“Patients who have the best chance of getting better are our first priority,” the letter says.
“Patients will be evaluated for the best plan for care, and dying patients will be provided comfort care.”
Conditions that could affect whether a patient is eligible for critical care are: “severe heart, lung, kidney or liver failure; terminal cancer; or severe trauma or burns.”
Dr. Adnan Munkarah, EVP & Chief Clinical Officer for Henry Ford Health Systems said on Friday morning:
“With a pandemic of this nature, health systems must be prepared for a worst case scenario. Gathering the collective wisdom from across our industry, we carefully crafted our policy to provide critical guidance to healthcare workers for making difficult patient care decisions during an unprecedented emergency. These guidelines are deeply patient focused, intended to be honoring to patients and families. We were pleased to share our policy with our colleagues across Michigan to help others develop similar, compassionate approaches. It is our hope we never have to apply them and we will always do everything we can to care for our patients, utilizing every resource we have to make that happen.”
A spokesman for Henry Ford Health told Michigan Radio NPR the letter represents a “worst case scenario” situation but is not active policy at this point.
Andrew Slavitt, former Affordable Care Act head for President Obama, tweeted that a “major hospital in the Midwest has reached its limits on ventilators minutes ago”.
He refused to give the name of the hospital, or cite a source for his apparently erroneous claim.
UPDATE: Slavitt removed his tweet hours later, claiming: “I removed a tweet because it enflamed a left-right contraversy about how bad the crisis is becoming in major hospitals running low or out of capacity. While I want to inform with the best knowledge I have, I won’t do that at the expense of that kind of discord right now.”
NOW: A major hospital in the Midwest has reached its limit on ventilators minutes ago.
They are handing out forms saying that only those “with the best chance of survival” will get care. Others will be getting pain medication. 1/
— Andy Slavitt @ 🏡 (@ASlavitt) March 27, 2020
The National Pulse reached out to the Henry Ford Health System for clarification on whether the policy is being implemented yet, per Slavitt’s assertion, and at the time of publication there had been no reply, though their Twitter account replied to one user: “…this policy was developed should we need to implement it. We have not needed it at this time.”
Hi @GumboJesus, this policy was developed should we need to implement it. We have not needed it at this time.
— Henry Ford News (@HenryFordNews) March 27, 2020
On Wednesday March 25th, Henry Ford said its facilities in Detroit (877 beds) and West Bloomfield (191 beds) were “quite full,” with over 400 confirmed or suspected coronavirus cases across their system.
“We feel like we’re on the front end of the surge,” said Dr. Betty Chu, Henry Ford’s associate chief clinical officer and chief quality officer.
“But we’re anticipating a significant increase in volume in the coming weeks…We feel like we’re on the rapid acceleration of a growth curve.”
In that same report, Henry Ford’s chief operating officer Bob Riney pointed to expanding capacity, rather than restricting patient access to required treatment.
“Our plan is to use all the capacity in our existing facilities first… And then, what we would hit – where we no longer had the ability to safely take care of patients – is those facilities would go to all of the additional capacity expansion [plans already being put into place, like converting surgical rooms into COVID units and doubling the bed counts in some ICUs.]”
On Thursday, however, the tone changed.
Michigan Radio’s Doug Tribou discussed the matters with two doctors from the Henry Ford Health System, Dr. Rana Awdish and Dr. Megan Bonanni.
“One scenario is rationing ventilators and making life-or-death choices about who gets them,” Tribou reported.
“There’s a recognition that these decisions can’t be improvised,” Dr. Awdish said.
She added: “So groups of people are coming together – clinical ethicists, palliative care physicians, ER physicians, ICU physicians, administrators – to write guidelines. The New England Journal of Medicine published theirs for allocation. And it’s really coming from an understanding that individual physicians should not be left alone to make decisions in a resource-constrained environment, that there has to be guidance.”