OMAHA — As COVID-19 cases started shooting up in early November, a group of Nebraska health care leaders began planning for a grim possibility.
They looked ahead to a time when COVID patients and others needing medical care might overwhelm the state’s health care system.
When there might not be enough intensive care beds or ventilators or dialysis machines for everyone. When oxygen would run short, hospital rooms would fill up and health care workers would be unable to squeeze enough hours out of a day to provide their usual level of care.
And when health care providers would be forced to decide who gets what care.
To help with those decisions, the group developed Nebraska’s first “crisis standards of care plan.” The plan has been endorsed by the Nebraska Hospital Association and Nebraska Medical Association.
In a joint statement, Omaha-area hospital groups CHI, Methodist and Nebraska Medicine called the plan “a proactive and much needed step for not only the health care providers in our state but more importantly the citizens of Nebraska.
“In so doing, patients seeking care across the state will be assured equitable and consistent treatment, regardless of where they live or where they seek care,” the statement continued.
The statement emphasized that Nebraska is not at a point in which the plan would need to be activated, although the number of people hospitalized with COVID has more than doubled in a month.
State Sen. Sara Howard of Omaha, who chairs the Legislature’s Health and Human Services Committee, described the plan as “guidance when there are no good options.”
The plan calls for making decisions based on patients’ likelihood of surviving their current illness, as well as their likelihood of living at least another year. Triage teams would measure survival chances using a system that assigns points for the number and severity of organ failures, with some adjustments for people with chronic medical conditions.
Those with the best chances would get the highest priority for care. All patients would get basic care and supportive counseling.
The plan, which was based on a Massachusetts model, specifically bars the use of other factors, including a person’s disability, in deciding who gets care.
Factors to be ignored include “race, gender, sexual orientation, gender identity, ethnicity, ability to pay, socioeconomic status, English language proficiency, perceived social worth, perceived quality of life, immigration status, incarceration status, homelessness or past or post-emergency user of resources.”
“Assessment of prognosis for survival and assignment of a priority score must not include subjective criteria such as quality-of-life or intrinsic worth,” the plan said.
The idea for crisis standards of care began in 2009, when the H1N1 virus, also called the swine flu, was spreading across the country. Preparedness officials in the U.S. Department of Health and Human Services asked the National Academy of Medicine to develop guidance for making decisions in disaster situations.
Some states developed their own plans in the following years. The coronavirus pandemic drove many more to do so this year. Most have official state backing. Nebraska is one of 13 states in which officials have not put a similar stamp of approval on a plan.
In a statement, Attorney General Doug Peterson’s office said that Nebraska’s Emergency Management Act does not specifically give such authority to the governor or any other state official. Gov. Pete Ricketts last week would not say whether he believes the governor should have that authority.
“That is something we would have to take up in a legislative session,” he said.
Howard said state backing would be useful in making sure all health care providers are on the same page in making decisions. Currently, some providers may choose to follow the plan and some may not, potentially making cooperation more difficult.
In addition, state backing would give providers a legal defense if sued for providing a lower standard of care, such as putting patient beds in classrooms or a converted parking garage, she said.
But Howard fell short in trying to get support for a special legislative session to give such authority to the governor. She also hoped the session would give local health departments the power to issue directed health measures without having to seek state approval. Currently, only the Lincoln-Lancaster County Health Department has such power.
She said she expects someone will introduce bills on both issues in the upcoming legislative session.
“As our cases continue to rise, our hospitals and medical providers become overwhelmed and our public health departments are forced to utilize their mass fatality plans, I truly believe these two statutory modifications will be necessary sooner rather than later,” she said.