Pandemic Triage Guidelines Violate Federal Law, Discriminate: Complaint

Disability advocates, others file federal complaint against North Texas hospital advisory group claiming mass care guidelines would exclude many with disabilities, certain conditions from hospital care

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A federal complaint filed in North Texas alleges that if the coronavirus pandemic worsens, local hospitals will be forced to ration medical resources using guidelines that discriminate against people with disabilities, older Texans, people of color, and other protected classes.

Disability Rights Texas is one of multiple advocacy groups and individuals that claim triage policies put in place by the North Central Texas Trauma Regional Advisory Council (NCTTRAC) violate federal disability laws.

Hospitals and medical professionals practice triage every day as a means of prioritizing who receives what level of care based upon the severity of their condition and their likelihood of recovery with and without treatment.

But during an event like the global coronavirus pandemic, with the possibility of hospital beds being in short supply, the concern over resource allocation has quickly become a reality.

The NCTTRAC originally drafted the North Texas Mass Critical Care Guidelines in 2014, and reaffirmed them during the ongoing pandemic.

“In a mass disaster when medical resources may be overwhelmed, these guidelines were created and adopted by all of the North Texas hospital, health system, and physician communities to best ensure survival for the most patients,” the NCTTRAC notes on its website. “They contain a framework in which healthcare providers, hospitals and other clinical settings can create decision-making tools during a mass disaster.”

The NCTTRAC is responsible for overseeing the provision of emergency medical services for almost 8 million Texans who reside in the Dallas-Fort Worth metro area and the surrounding eighteen counties, representing nearly 30% of the entire state, according to the complaint.

The triage system that the NCTTRAC is currently working from “penalizes patients with certain medical conditions, excluding some altogether from hospital admission, intensive care unit (ICU) admission, and ventilator access,” according to the complaint.

Language in the triage policy spells out several “exclusion criteria” that would deny hospital admission or transfer to critical care to any patient who presents any one of a wide variety of medical complications, should hospital resources be stretched to a certain level during the pandemic:

  • People in a persistent coma or vegetative state
  • People who have suffered severe burns, including infants and children, who have a less than 50% probability of “anticipated survival”
  • Certain patients suffering from conditions like cystic fibrosis, muscular dystrophy or other neuromuscular disorders
  • Patients who have a “short anticipated duration of benefit,” including some people with chromosomal abnormalities like Trisomy 13 or 18
  • Extremely premature infants with anticipated mortality rates greater than 80%
  • Severe dementia requiring assistance with activities of daily living
  • Severe traumatic brain injury requiring more than 10 units of blood transfusion

“While we understand that public officials and health care institutions are faced with the unenviable prospect of having to make difficult choices about how to allocate care, it is critical that the Office for Civil Rights of the U.S. Department of Health and Human Services take immediate steps to ensure that life-saving care is not illegally withheld from North Texans with disabilities, older adults, prisoners, and others with co-morbid conditions, due to discriminatory triage criteria,” the complaint states.

Mary Ann Pyron, of Sanger, Denton County is concerned that her son, Blake, could be excluded from care for any of a number of reasons should he need to be hospitalized for COVID-19.

Blake Pyron, 24, has received local and national acclaim for his business, Blake’s Snow Shack, and his advocacy on behalf of others living with disabilities.

Blake Pyron lives with Down syndrome, a heart condition, and sleep apnea. His mother stresses that Blake wants to be treated the same as everyone else should he become sick, and that her fears are reasonable, considering the guidelines.

“The fear that we have that, legally, they can deny Blake care,” Mary Ann Pyron said. “Or if he is admitted to the hospital, he can be placed on a lower priority of care. And Blake’s life is worth saving.”

Lisa Snead, a lead attorney for Disability Rights Texas, noted that the NCTTRAC has been very responsive since the complaint was filed, and is working with them to address their concerns over many of the guidelines.

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