Hawaii’s critical standard of care is criticized

HONOLULU (KHON2) – The Government’s Plan for Allocation of Medical Care in Time of Crisis was made available to the public for reading on Wednesday September 15.

The Hawaii Department of Health (DOH) announced that its Crisis Standards of Care Triage Allocation Framework was created in 2020. It included contributions from health care providers across the state and served as preparation in case the state was ever in a serious COVID situation.

“It’s something that I completely oppose, the process of discussing and thinking is fine, but Hawaii should never bother about it, and of course it created a lot of fear,” said Lt. Gov. Josh Green, who is also a doctor in the emergency room.

“So I thought someone had to say something. It terrified our kupuna because the plan included care rationing under certain circumstances and a severe shortage of the elderly, and we cannot accept that, ”he continued.

the 36-page public document established a scoring system that healthcare institutions would use if they were ever faced with a triage situation.

According to the document:

A higher age was rejected as the primary triage criterion because it discriminates against older people. Age already flows indirectly into all criteria that assess a person’s general state of health, as the likelihood of suffering from chronic diseases increases with age and there are many cases in which an older person might have a better clinical perspective than a younger one. Therefore, clinical factors (with the exception of the COVID-19 disease-specific age criterion due to the known poor prognosis with increasing age) are used to assess 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 as a “tie-breaker”.

Hawaii Crisis Standards of Care Triage Allocation Framework document

The document also added that age would only be used when a situation required a tie-breaker.

“Age is only used in a tie-break situation. Evidence from several countries, including the US, shows that age over 65 is an indicator of a poor prognosis in COVID-19 patients. If the triage score is the same between two people, the Triage Officer / Review Committee should consider that a patient over 65 who is also COVID positive is less likely to benefit from the scarce resource. “

Green said he received dozens of calls by kupuna after the document was approved.

“If a 75-year-old woman comes to you and is afraid that she will not be able to go to hospital for life-saving treatment if she is sick, then you know you made a mistake,” said Green of the release of the document.

Two weeks ago, Oahu hospitals were in critical condition when nearly 450 COVID patients were hospitalized and triage tents were set up in most major hospitals to deal with any overflow.

Since then, hospital stays have decreased by 30%.

“I think it’s important that everyone realizes that we don’t need a care ration, I’ll fight against it,” said Green. “It was horrible, it’s a horrible idea in Hawaii to ever ration care because, as I have said several times, we should move heaven and earth before we ever tell anyone they can’t get care.”

Green suggested using other facilities, involving hundreds of additional federal nurses and doctors, treating monoclonal antibodies, and using long-term care facilities, before considering rationing of care.

“All of these are possible solutions before we ever tell anyone that your mother or father or older grandfather is not qualified to be cared for. We should never do that,” he continued.