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On September 15, 2021, Idaho activated Crisis Standards of Care (“CSC”) statewide in response to the Covid-19 pandemic and overwhelming surge on Idaho’s healthcare system. Crisis standards of care are guidelines that help healthcare providers and systems prioritize and triage delivery of care during extraordinary circumstances of an overwhelming disaster or public health emergency. The very fact that these guidelines were implemented represents an unprecedented and unwanted point in our state’s history.
On behalf of all Idahoans with disabilities, DRI wrote to Governor Little on September 28, 2021 urging that he address and end the discriminatory policies in the Idaho Crisis Standards of Care. DRI collaborated with the Department of Health and Welfare (“IDHW”) on CSC guidance through correspondence, comments, and recommendations on how to align the triaging protocols with the ADA, Section 504, and the Age Act. As of today, November 10, 2021 the CSC guidance has been changed to better serve individuals with disabilities and adopted by IDHW. The following list reflects some of the changes to the guidance that were made through DRI’s advocacy and comments:
- Exclusion of “life years”: Previously the guidance included the stated goal of saving “life years” in the triaging protocols and as a priority in the ethical framework. This provision risked importing quality of life criteria and unconscious bias into the process in a way that would discriminate against individuals with disabilities. The provision of this
phrase has been removed from the new guidance and replaced with the language “The focus is on saving the most lives, within the context of ensuring meaningful access for all patients, ensuring individualized assessments, and diminishing the negative effects of
social inequalities that lessen some patients’ long-term life expectancy.” - The triaging tool’s survivability consideration: The previous triaging tool allowed for points to be added to an individual’s score, deprioritizing them for treatment, if they had co-morbidities with substantial impact on near-term survival. The vagueness of the phrasing presented a risk that individuals with disabilities would be deprioritized for conditions that would affect their health beyond the acute hospital encounter. By providing further clarification on this point to IDHW, the triaging tool language was changed to only consider the survivability of the acute hospital encounter when adding
points to an individual’s score. - Reasonable modifications to the SOFA score required: The previous guidance instructed that when using triaging tools to calculate an individual’s SOFA score, modifications “may be a necessary accommodation”. However, without the inclusion of language that modifications “must” be used when assessing individuals with disabilities, there was a risk that the use of these tools would lead to discrimination by providing inaccurate assessments based upon disability related characteristics. The updated guidance reflects this mandatory language change.
- Removal of “lifecycles” in the tiebreaker language: The previous guidance contained a score tie resolution protocol that deprioritized patients based on lifecycle, prioritizing those patients who have lived through fewer lifecycles. This language conflicted with OCR guidance that medical care cannot be denied “on the basis of stereotypes, assessments of quality of life, or judgments about a person’s relative ‘worth’ based on the presence or absence of disabilities or age”. The use of this language has been removed from the tiebreaker and the score tie resolution is now based on clinical trajectory rather than age.
DRI thanks the State of Idaho Disaster Medical Advisory Committee on behalf of all Idahoans with disabilities for making the necessary changes to the CSC guidance. The revised guidance not only reflects a larger understanding of and consideration for the severe impact triaging protocols have on individuals with disabilities, but is also in compliance with guidance approved by the Office for Civil Rights thus far. DRI looks forward to continuing to collaborate with the department of Health and Welfare and continuing to advocate on behalf of all Idahoans with disabilities as we navigate the Covid-19 pandemic.