So when it comes to picking who gets care and who does not ....

[Toast]

... you may find Massachusetts' rating system interesting.

Massachusetts has released its "Crisis Standards of Care" in the event the system begins to be overwhelmed in a pandemic. It's describes the rubrics that will be used to allocate care if it needs to be limited.

Fascinating reading. Things that will lower your chances of receiving care are items such as age [page 20], existing health conditions (a current cancer patient would be a loser) [page 15], and the like. Things that will not change your score include immigration status, incarceration status, etc. [page 4]. Medical workers and those who maintain "societal order" (which is certainly loose enough to include the state legislature) go to the front of the line [page 16].

In an expansion of Healy's whole cloth rule making, the rest of the state government looks to want to get into the game. Remember all those laws about age discrimination, ADA regulations, and so on? Apparently a state agency can issue guidance ignoring those. So, if it comes down to a choice between your 72 year old mom and a 27 year old illegal immigrant jailed for murder, mom loses.

Seriously, give this a read.

https://d279m997dpfwgl.cloudfront.net/wp/2020/04/CSC_April-7_2020.pdf?fbclid=IwAR1gFdJwEmn3bF5J10XmrBVgKEP6pAochJL1X2iguffnglntO-t6QEQg-7c

 

[greencobra]

don't care one way or the other, we all can't be saved so glad someone already made the choice. hopefully those that take exception to the decree have superior firepower. i guess that would be the tp vultures....

 

[mjbff]

Thats the written rule plan. What about the unwritten rule plan for the rich, politically connected,ect.

 

[Toast]

Thats the written rule plan. What about the unwritten rule plan for the rich, politically connected,ect.

The politically connected are covered. they help maintain "societal order" and are therefore prioritized per page 16.

The rich just pay for private care. Frankly, i'm fine with that, that's how our system works. It's when you dial out taxpayers who are too old in favor of criminals who contribute nothing that I begin to have problems.

 

[teamRR]

Sounds kinda like when MA was debating whether illegal aliens squatting in the state qualified for resident rates in state colleges. I think they decided "yes".. meanwhile as a law abiding contributor I can pay 5 figures in taxes working in MA, but will pay full non resident rates without so much as a tax deduction available - hell I can't even get a recreational lobster permit in MA. Illegal alien criminals living on welfare, of course they can.

 

[Fixxah]

Hot babes must be at the top. Then male late boomers.

 

[Zappa]

So when it comes to picking who gets care and who does not ....

In places like Mass, NY, NJ, or CA, I expect them to look up your voter registration first, if they see a "D", you get taken care of, if it's an "R", you're SOL.

 

[Dennis in MA]

The myth that we can provide equal care to everyone is just that - a myth. It always has been. It always will be. And what they discovered in Italy and Spain and the like is: When you create an everyone-is-equal healthcare system (but some are STILL more equal than others), EVERYONE suffers. Mortally.

 

[jaypap]

Just shout out I am here illegally and have no insurance. Those people get better treatment than me every where I go.

 

[Yazz]

Where is George Carlin when you need him!

 

[Camhabib]

In the worlds most prosperous country....the only reason any Md would have to make a choice on who gets resources and who doesnt is because some politician and central medical planner f***ed up and failed to stock basic shit needed to run a hospital

If a department holds 100 people, you can't just increase the "basic shit" and make it magically hold 2 fold more. There are physical limitations like space and qualified staff that usually limit how many people are given trauma center can handle. Add to that the fact that a lot of that "basic shit" isn't all that basic, and includes things like advanced imaging equipment, surgical suites, etc, that likely each cost more than most of us will make in a lifetime. I use a SIM-TIRF microscope daily that costs upwards of $4m for my research, and when the tech comes to service it, it's far from the most expensive piece of equipment he's seen that day. From experience and history, we've found that the most effective way to ensure that the greatest number of people survive is prioritizing the treatment of the ones most likely to have a positive prognosis. It's not "picking who gets care," it's trying to save the largest amount of lives, regardless of their background or anything else.

Yes, it is unfortunate that we have people who are driving up the cost of healthcare without contributing to paying for it (illegal immigrants, those without health insurance, etc) but if you honestly think someone deserves to die or their life is worth less because of that fact, than I would strongly suggest you take a step back and reassess the value of your own existence.

 

[deerdad]

Murdrerers, rapists, illegals, drug dealers and wife beaters need to go to the back of the line. Let them suffer the most. Those are the dregs that suck up taxpayer dollars.

 

[Rob Boudrie]

It's not a matter of someone "deserving to die" but priority of allocation. Should an individual who broke the law entering this country and made no contribution to pay for health care be placed ahead of a citizen, legal resident of visa holder because they have more potential life years than the citizen? Tough decisions, but assess what you would think if you were told "No vent for you, an illegal took the last one". Ditto for insurance/payment - if you have been paying your entire life, and will pay for your treatment, is it right to let someone who has never paid go ahead of you?

The scoring mentioned in the memo introduces a new form of "suitability" and opens the question of "what do I mention?". If you are in the ER of a hospital that does not have your medical records do you risk your access to a ventilator, and hence your life, by disclosing that solid cancer you had removed a few years ago or do you STFU to try for a higher triage score? It's sort like forgetting to mention that juvenile charge in another state at an LTC interview and hoping it is not discovered, but with far greater immediate consequences.

This happened in 1961. Dialysis was a new and somewhat experimental treatment. It extended life, but not on the scale it does today.There were a limited number of slots, and an allocation system was needed. Two absolute cutoffs were no older than 45 and the ability to cough up $10,000 per year for the treatment. Yes, the decision was made that with a surplus of qualifying candidates there were sufficient ones who could pay to exclude those who could not. A death panel was formed to make subjective decisions (not based on a scoring model) about who should be given a chance at life.

 

[enbloc]

Murdrerers, rapists, illegals, drug dealers and wife beaters need to go to the back of the line. Let them suffer the most. Those are the dregs that suck up taxpayer dollars.

Or, make them wash soiled bedpans...

 

[Toast]

From experience and history, we've found that the most effective way to ensure that the greatest number of people survive is prioritizing the treatment of the ones most likely to have a positive prognosis. It's not "picking who gets care," it's trying to save the largest amount of lives, regardless of their background or anything else.

Frankly, no. It's not the government's place (at least not here) to get to decide who rations care. We've always worked under a "if you're here and if treatment is available, you get it" model and this is no time to change that. Once you get the government, or for that matter medical "ethicists", making that determination, you've reduced people to commodities. Once you do that, you open up to "Well, there is a ventilator available, but your mom doesn't get it because it's the last one and we want to keep it open in case someone higher on the list comes in", or (as implied by Rob B below) "We're taking your mom off because someone higher on the list came in." That has no place in the US.

 

[Broc]

It's not a matter of someone "deserving to die" but priority of allocation. Should an individual who broke the law entering this country and made no contribution to pay for health care be placed ahead of a citizen, legal resident of visa holder because they have more potential life years than the citizen? Tough decisions, but assess what you would think if you were told "No vent for you, an illegal took the last one". Ditto for insurance/payment - if you have been paying your entire life, and will pay for your treatment, is it right to let someone who has never paid go ahead of you?

The scoring mentioned in the memo introduces a new form of "suitability" and opens the question of "what do I mention?". If you are in the ER of a hospital that does not have your medical records do you risk your access to a ventilator, and hence your life, by disclosing that solid cancer you had removed a few years ago or do you STFU to try for a higher triage score? It's sort like forgetting to mention that juvenile charge in another state at an LTC interview and hoping it is not discovered, but with far greater immediate consequences.

This happened in 1961. Dialysis was a new and somewhat experimental treatment. It extended life, but not on the scale it does today.There were a limited number of slots, and an allocation system was needed. Two absolute cutoffs were no older than 45 and the ability to cough up $10,000 per year for the treatment. Yes, the decision was made that with a surplus of qualifying candidates there were sufficient ones who could pay to exclude those who could not. A death panel was formed to make subjective decisions (not based on a scoring model) about who should be given a chance at life.

The best legal advice applies to anything regulated by the govt. Just STFU. Say your name and STFU.

Maybe mention allergies, that might be a good idea.

 

[Rob Boudrie]

Frankly, no. It's not the government's place (at least not here) who gets to decide who rations care. We've always worked under a "if you're here and if treatment is available, you get it" model and this is no time to change that. Once you get the government, or for that matter medical "ethicists", making that determination, you've reduced people to commodities. That has no place in the US.

It's one step to triage who gets on, but they are also taking about evictions.

 

[greencobra]

i don't believe there's anything in the often quoted constitution about separating muggers, rapists and thieves and "others" from the "good folks." i could be wrong so our constitutional experts please set me straight.

 

[308rifleman]

It's not a matter of someone "deserving to die" but priority of allocation. Should an individual who broke the law entering this country and made no contribution to pay for health care be placed ahead of a citizen, legal resident of visa holder because they have more potential life years than the citizen? Tough decisions, but assess what you would think if you were told "No vent for you, an illegal took the last one". Ditto for insurance/payment - if you have been paying your entire life, and will pay for your treatment, is it right to let someone who has never paid go ahead of you?

The scoring mentioned in the memo introduces a new form of "suitability" and opens the question of "what do I mention?". If you are in the ER of a hospital that does not have your medical records do you risk your access to a ventilator, and hence your life, by disclosing that solid cancer you had removed a few years ago or do you STFU to try for a higher triage score? It's sort like forgetting to mention that juvenile charge in another state at an LTC interview and hoping it is not discovered, but with far greater immediate consequences.

This happened in 1961. Dialysis was a new and somewhat experimental treatment. It extended life, but not on the scale it does today.There were a limited number of slots, and an allocation system was needed. Two absolute cutoffs were no older than 45 and the ability to cough up $10,000 per year for the treatment. Yes, the decision was made that with a surplus of qualifying candidates there were sufficient ones who could pay to exclude those who could not. A death panel was formed to make subjective decisions (not based on a scoring model) about who should be given a chance at life.

Money talks and bullshit walks. Hypothetically, if there were only two ventilators left and one of us peons had to compete with Taylor Swift and Beyonce for them, who do you think would get them? I don't think that I need Las Vegas oddsmakers to figure that one out. Larry Hagman, "Papa" John Phillips and David Crosby, among other celebrities who skirted the organ-donor list, would seem to prove my point.

 

[Camhabib]

Lets step back a few feet

Hospitals used to stock much much much larger stock of basics....masks to gloves to basic PPE

Hospitals also used to stock much much larger volumes basic drugs

The argument over "Space required" is silly......they used to have the space but now dont.......

Furthermore many/most of the hospitals and facilities built in the last 20 or so years are MONUMENTS and less health care facilities.....I hate to pick on DH again but look at the multi story open air glass enclosed waste of space they built as part of the hospital......and what did they fill the ground floor with?.....NOT treatment/care/other functions.......

How many millions was wasted to build it and how many large piles of money are wasted every year to heat/cool that space that does exactly nothing to contribute to health care........

This is all part and parcel to the utter failure of hospital administrators to ensure they have basics on hand not only to treat patients but to protect staff......

Various health related agencies in fed gov provide "grant" and other money to hospitals to prepare for various situations and purchase stocks/equipment/other......that money goes directly as well as is laundered thru state agencies to hospitals......anyone want to guess how poorly those taxpayer funds were spent?

On top of that, Hospital Administrators have become accustomed to "Lean" and "Just In Time" ordering instead of planning/stocking for emergencies.....this is a new thing......sit down and talk with the old timers that have been around for 25 plus years that remember......

As far as prices for advanced equipment.....how much of that cost is a product of bloated/excessive gov regulations? A lot.......same with drugs

As for your last point.....thats all yours.....not part of my post......

My only point is that in this day and age there's no excuse for hospitals not to have basics on hand

PPE is cheap.....N95's are $1 or less wholesale.....even now....wholesale for N95's being brokered in large lots are well under $2 each
Chloroquine is DIRT cheap.....$2.50 wholesale for a course of treatment

How well has that worked out

If anyone really think the thing limiting beds is PPE and medication stocks, then I've got a few bridges in Brooklyn to sell you. "Space" isn't just about physical square feet, it's the idea that if you have 100 patients, then you have the necessary MRI machines, x-ray equipment, phlebotomists to draw blood, IV machines, tele leads, etc to treat those people. If you double the number of beds, you need to double all these additional resources, otherwise you lower the quality of care to everyone and instead of saving an additional 100, you lose all 200. You can't just increase how many masks you have and be good to go. Supplies also go bad, and quickly. Even masks have expiration dates on them - you can't keep a facility permanently stocked for a pandemic, it isn't feasible or even possible, considering that there are 100 other scenarios just as likely as this one to happen which require a completely different set of resources.

I also don't know what hospital you work at, but there isn't a single square foot that goes unused. What isn't allocated to direct clinical use goes toward research space, support, and so forth. These machines don't cost millions because of "government regulations" either, they cost that much because of the research and work that goes into building them. Chloroquine (which half a dozen papers has confirmed does nothing for COVID-19, which isn't a surprise to anyone who got past freshman biology) is cheap, but treating patients isn't.

I'm not saying there aren't things that could be improved upon, but seriously people, take a step back and try to take an objective look at things and consider for a split second that, maybe, just maybe, you don't realize everything it takes to run an entire hospital or practice medicine.

 

[mac1911]

... you may find Massachusetts' rating system interesting.

Massachusetts has released its "Crisis Standards of Care" in the event the system begins to be overwhelmed in a pandemic. It's describes the rubrics that will be used to allocate care if it needs to be limited.

Fascinating reading. Things that will lower your chances of receiving care are items such as age [page 20], existing health conditions (a current cancer patient would be a loser) [page 15], and the like. Things that will not change your score include immigration status, incarceration status, etc. [page 4]. Medical workers and those who maintain "societal order" (which is certainly loose enough to include the state legislature) go to the front of the line [page 16].

In an expansion of Healy's whole cloth rule making, the rest of the state government looks to want to get into the game. Remember all those laws about age discrimination, ADA regulations, and so on? Apparently a state agency can issue guidance ignoring those. So, if it comes down to a choice between your 72 year old mom and a 27 year old illegal immigrant jailed for murder, mom loses.

Seriously, give this a read.

https://d279m997dpfwgl.cloudfront.net/wp/2020/04/CSC_April-7_2020.pdf?fbclid=IwAR1gFdJwEmn3bF5J10XmrBVgKEP6pAochJL1X2iguffnglntO-t6QEQg-7c

They already do these things on a day to day basis.

 

[Waher]

In places like Mass, NY, NJ, or CA, I expect them to look up your voter registration first, if they see a "D", you get taken care of, if it's an "R", you're SOL.

I'm sure anyone with a LTC/FID is going to be left to die as a threat to public safety and stability according to Obergruppenfuehrer Healey.

 

[Camhabib]

Frankly, no. It's not the government's place (at least not here) to get to decide who rations care. We've always worked under a "if you're here and if treatment is available, you get it" model and this is no time to change that. Once you get the government, or for that matter medical "ethicists", making that determination, you've reduced people to commodities. Once you do that, you open up to "Well, there is a ventilator available, but your mom doesn't get it because it's the last one and we want to keep it open in case someone higher on the list comes in", or (as implied by Rob B below) "We're taking your mom off because someone higher on the list came in." That has no place in the US.

Honestly, truthfully, do you really think that these guidelines were written by a politician or a doctor? If the former, then I suggest you spend more time getting aquatinted with a field before criticizing it. If the latter, do you really think you know how to practice medicine better than a few century of doctors and medical experience?

This isn't a "government rationing care." It's a standardized protocol of treatment, dictated by years upon years of experience, to insure that regardless of where you go, you'll receive the same level of care, and that people won't be trying to decide which hospital to go to to get a "better chance."

 

[Toast]

Honestly, truthfully, do you really think that these guidelines were written by a politician or a doctor? I

I'm sorry, you appear to be laboring under the impression that I care about who wrote them. I don't.

That being said, it was written by a commission convened and controlled by the state which included doctors and "ethicists" from large and small hospitals (and presumably state staff as well). You will note that both categories are "front of the line" parties in the triage guidelines. Past that, I'm not sure why a panel of doctors would even think to be concerned about excluding "incarceration status" from the triage protocols. While I wouldn't expect them to care, I wouldn't expect them to include it, either. Based on its inclusion, it's reasonable to assume that there was a heavy politicial component to the process.

If the latter, do you really think you know how to practice medicine better than a few century of doctors and medical experience? I

Really. A "few centur[ies] of doctors and medical experience". Well, yes, in many cases I would be more qualified to practice medicine better than a 19th century doctor who practiced without washing his hands, accepted bloodletting, and any other number of accepted medical practices. For that matter, consider 20th century uses of radium in wholly inappropriate ways.

This isn't a "government rationing care." It's a standardized protocol of treatment, dictated by years upon years of experience, to insure that regardless of where you go, you'll receive the same level of care, and that people won't be trying to decide which hospital to go to to get a "better chance."

Ah, the argument to authority. Worse, an incorrect argument to authority, as these guidelines have apparently been created because the "years and years of experience" system won't work. If the "years and years" system did work, they (a) wouldn't have needed to create these and (b) wouldn't be introducing legislation to give themselves legal immunity from suits over treatments that deviate from current standards of care.

 

[Camhabib]

Its the "Medical Policy Experts" that make the rules and write contorted/absurd procedures that tie the hands of Md's and others and too frequently prevent Md's from choosing/recommending course of treatment that actually is in best interest of their customers.....

What I'm trying to convey is that (as someone in the medical field) these aren't rules that "tie the doctors hands." These are the rules that doctors have come up with for how to best save lives. After countless incidents, we've come up with a system to best limit the loss of life. These scoring and triage criteria are what we have been using for years, before Obama or any of us were even born, to best decide how to handle health care.

 

[Camhabib]

Almost makes one wonder why people go to medical school at all when the random interwebs people have it all figured out.

Wish you guys well and hope the armchair from which you practice medicine and policy never breaks.

 

[Dennis in MA]

Murdrerers, rapists, illegals, drug dealers and wife beaters need to go to the back of the line. Let them suffer the most. Those are the dregs that suck up taxpayer dollars.

Convicted or just charged of said-crimes? What about those who paid their debt to society and are now free men? How do you process all that due process????

 

[Toast]

Almost makes one wonder why people go to medical school at all when the random interwebs people have it all figured out.

A totally serious question: Where in the medical school canon is an aspiring physician taught that "Medical workers and those who maintain societal order" go to the head of the line when there's a triage situation?

 

[Picton]

A totally serious question: Where in the medical school canon is an aspiring physician taught that "Medical workers and those who maintain societal order" go to the head of the line when there's a triage situation?

You're asking whether triage is taught in medical school? I'm not clear on where your confusion lies.

Of course it is. Triage is a vital feature of crisis medicine. Someone makes the choice, always, and they're always medical workers.

 

[Camhabib]

A totally serious question: Where in the medical school canon is an aspiring physician taught that "Medical workers and those who maintain societal order" go to the head of the line when there's a triage situation?

I didn't think I'd really ever have to spell this out for anyone but, if the doctors all die during the middle of a pandemic that's killing people, who is going to treat the rest of the people? This seems more like basic logic than something that should have to be taught to a person.