The document provides a rare look into the factors medical professionals must consider when deciding how to use increasingly limited resources—such as beds, ventilators and personal protective equipment—when serving a large and sudden rush of patients during a crisis.
The department suggests that hospitals form teams to help make calls on who receives priority care. It also suggests that hospitals do their best to increase their number of ventilators and other treatment methods before a surge occurs and to set benchmarks so that administrators can identify when there’s a need to shift from conventional health care to “crisis care.”
The recommendations suggest that medical workers consider the severity of a patient’s symptoms along with their age, and other underlying chronic health conditions that could impair their ability to recover from debilitating symptoms when prioritizing care.
Health care providers are encouraged to take into account how “vital” patients are to relief efforts to fight the virus, potentially prioritizing care for health care workers and first responders over other patients.
With limited resources, patients who seem unlikely to recover from symptoms should receive palliative care that minimizes symptoms while not prolonging their deaths, the document says.
The document also suggests that, in the event of a limited number of badly needed ventilators, hospitals should give patients a “priority score” between one and eight which is affected by whether they have other chronic illnesses that reduce their overall life expectancy. The lower a patient’s score, the higher their priority.
For example, The L.A. Times says that a patient with “major life-limiting chronic diseases” like moderate cases of Alzheimer’s or chronic lung disease, might receive two points added to their score. A severe case of each illness might add four points.
When patients receive equal priority scores, younger patients receive higher priority. “Younger individuals receive priority because they have had the least opportunity to live through life’s stages,” the document states.
The document is similar to guidances released by state health officials in Minnesota and Colorado. The California Department of Public Health created its guidelines after examining scientific studies and consulting with other hospitals, physicians and health care groups to create the document over the last several weeks, according to the publication.
The document is meant to provide information and recommendations only and explicitly states that it “does not replace the judgment” of operational management, medical directors, legal advisors, clinical staff and “consideration of other relevant variables and options.”
“As your state public health officer, the gravity of what is contained within this document is felt deeply,” wrote Sonia Angell, MD, director of California’s Department of Health, in the document’s opening letter. “The conversations that will be prompted by its release will be difficult.”
“As professionals and leaders responsible for protecting the wellbeing of our state’s 40 million-plus residents,” she continued, “I am confident that the common ground provided by these guidelines will provide the transparency, mutual understanding and trust we will all need to get through the most trying of times, should they arrive.”
While Angell says she and other public officials are “cautiously optimistic” that the state’s preventative measures may have prevented an overwhelming of the state’s hospitals, she added, “We have seen the devastating impact that Covid-19 has had on health care delivery systems and communities in other countries and states.”
