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| Who Gets Lifesaving Care? Tennessee Changes Rules After Federal Complaint | Who Gets Lifesaving Care? Tennessee Changes Rules After Federal Complaint |
| (about 20 hours later) | |
| Health officials on Friday announced sweeping changes to guidelines in Tennessee on who would get lifesaving treatments, and who would not, if resources fell dramatically short during a medical crisis like the coronavirus pandemic. | Health officials on Friday announced sweeping changes to guidelines in Tennessee on who would get lifesaving treatments, and who would not, if resources fell dramatically short during a medical crisis like the coronavirus pandemic. |
| The action came after disability groups filed a federal civil rights complaint, arguing that key features of the plan were discriminatory. Multiple states and hospitals have adopted similar rules on rationing care, raising questions about whether change is afoot elsewhere. | The action came after disability groups filed a federal civil rights complaint, arguing that key features of the plan were discriminatory. Multiple states and hospitals have adopted similar rules on rationing care, raising questions about whether change is afoot elsewhere. |
| “We think this is a great model and hope other states will follow Tennessee’s lead in being comprehensive in accounting for the rights of persons with disabilities,” said Roger Severino, the director of the Office for Civil Rights at the U.S. Department of Health and Human Services, which received the complaint and worked with Tennessee to resolve it. | “We think this is a great model and hope other states will follow Tennessee’s lead in being comprehensive in accounting for the rights of persons with disabilities,” said Roger Severino, the director of the Office for Civil Rights at the U.S. Department of Health and Human Services, which received the complaint and worked with Tennessee to resolve it. |
| “People with disabilities are already more vulnerable to bad outcomes during this crisis,” Mr. Severino added. “This is a time to provide more protections, not fewer.” | “People with disabilities are already more vulnerable to bad outcomes during this crisis,” Mr. Severino added. “This is a time to provide more protections, not fewer.” |
| The new plan allocates medical care based on how likely patients are to survive their immediate illness if they receive treatment. The previous plan considered their long-term survival prospects as well. That provision was removed because it could disproportionately penalize those who are older or have disabilities. | The new plan allocates medical care based on how likely patients are to survive their immediate illness if they receive treatment. The previous plan considered their long-term survival prospects as well. That provision was removed because it could disproportionately penalize those who are older or have disabilities. |
| Some critics argued that factoring in who might live the longest could also disadvantage members of racial minority groups that have higher rates of underlying health conditions. Many of the same groups — particularly African-Americans, Native Americans and Hispanics — have seen a higher incidence of illness and death from Covid-19. | Some critics argued that factoring in who might live the longest could also disadvantage members of racial minority groups that have higher rates of underlying health conditions. Many of the same groups — particularly African-Americans, Native Americans and Hispanics — have seen a higher incidence of illness and death from Covid-19. |
| The new guidance contains other changes. When patients have underlying speech and movement disorders, doctors may need to modify their survival scoring system because its assessment of brain injury could be inaccurate. And the new rules state that if age or disability may require longer treatment or more resources, patients should not be made a lower priority because of that. | The new guidance contains other changes. When patients have underlying speech and movement disorders, doctors may need to modify their survival scoring system because its assessment of brain injury could be inaccurate. And the new rules state that if age or disability may require longer treatment or more resources, patients should not be made a lower priority because of that. |
| Both versions of the guidelines provide for removing ventilators — with or without consent — from patients if they are not improving after a certain period so the machines can go to others. Those who rely on personal ventilators to survive in their normal lives are exempted under the new plan. “No person with disabilities on a ventilator should ever be afraid of going to a hospital because it might be taken away from them,” Mr. Severino said. | Both versions of the guidelines provide for removing ventilators — with or without consent — from patients if they are not improving after a certain period so the machines can go to others. Those who rely on personal ventilators to survive in their normal lives are exempted under the new plan. “No person with disabilities on a ventilator should ever be afraid of going to a hospital because it might be taken away from them,” Mr. Severino said. |
| Tennessee’s plan also no longer categorically excludes certain patients from receiving hospital care, including those with conditions such as multiple sclerosis, amyotrophic lateral sclerosis and spinal muscular atrophy who require ventilators or assistance with common activities. One of the people who brought the complaint against the state has A.L.S. | Tennessee’s plan also no longer categorically excludes certain patients from receiving hospital care, including those with conditions such as multiple sclerosis, amyotrophic lateral sclerosis and spinal muscular atrophy who require ventilators or assistance with common activities. One of the people who brought the complaint against the state has A.L.S. |
| Hospitals and nursing homes that are limiting visitation to control the spread of the virus should consider allowing visits at the end of life, to facilitate the exercise of religion and to support people with disabilities, the new policy says. | Hospitals and nursing homes that are limiting visitation to control the spread of the virus should consider allowing visits at the end of life, to facilitate the exercise of religion and to support people with disabilities, the new policy says. |
| Updated August 4, 2020 | |
| “We think today’s a big deal,” said Alison Barkoff, advocacy director at the Center for Public Representation, one of several groups that have jointly filed about a dozen disability-related civil rights complaints during the pandemic. “We hope that states really look closely at their own plans, and we think it will give a lot of momentum to a number of other complaints.” | “We think today’s a big deal,” said Alison Barkoff, advocacy director at the Center for Public Representation, one of several groups that have jointly filed about a dozen disability-related civil rights complaints during the pandemic. “We hope that states really look closely at their own plans, and we think it will give a lot of momentum to a number of other complaints.” |
| Last week, her group and others alleged in a letter to the civil rights office that Nebraska’s drive-through Covid-19 testing program was inaccessible to people at high risk of the disease in group and nursing homes, arguing that the state had made little provision for testing those who lacked access to the sites. “It’s shocking,” she said. “The highest risk people are excluded.” | Last week, her group and others alleged in a letter to the civil rights office that Nebraska’s drive-through Covid-19 testing program was inaccessible to people at high risk of the disease in group and nursing homes, arguing that the state had made little provision for testing those who lacked access to the sites. “It’s shocking,” she said. “The highest risk people are excluded.” |
| The groups expect to continue their efforts. “We will keep fighting for revisions to discriminatory policies that could mean the difference between life and death for people with disabilities,” said Shira Wakschlag, director of legal advocacy for The Arc, a disability rights organization. | The groups expect to continue their efforts. “We will keep fighting for revisions to discriminatory policies that could mean the difference between life and death for people with disabilities,” said Shira Wakschlag, director of legal advocacy for The Arc, a disability rights organization. |
| A spokeswoman for Tennessee’s health department said it cooperated with disability advocates and the civil rights office to make the changes. It was not found to be legally liable. | A spokeswoman for Tennessee’s health department said it cooperated with disability advocates and the civil rights office to make the changes. It was not found to be legally liable. |
| This is the fourth time during the pandemic that the office reached a resolution with a state regarding disability discrimination. Two of those cases involved smaller changes to triage guidelines. In the most recent, Connecticut ordered hospitals to make exceptions to no-visitor policies so that people with disabilities may have family members or care providers present if needed. | This is the fourth time during the pandemic that the office reached a resolution with a state regarding disability discrimination. Two of those cases involved smaller changes to triage guidelines. In the most recent, Connecticut ordered hospitals to make exceptions to no-visitor policies so that people with disabilities may have family members or care providers present if needed. |