A letter from Massachusetts Congresswoman Ayanna Pressley argues that the state’s Crisis Standards of Care perpetuate decades-old health equity issues for people of color.
The Massachusetts Crisis Standards of Care, or the protocol for triaging medical resources should hospitals in the state reach past maximum capacity, might perpetuate health equity shortcomings, putting patients of color at an unfair disadvantage, according to Congresswoman Ayanna Pressley of the Massachusetts 7th District.
Crisis Standards of Care are the unfortunate guidelines hospitals may follow should they become strapped for resources. Specifically during the coronavirus pandemic, this might refer to ventilators, staff care, or other COVID-19 resources within the hospital.
States are left to develop their own Crisis Standards of Care guidelines informed by state departments of public health, healthcare ethicists, and leaders from both large academic and smaller community hospitals. These guidelines are meant to promote health equity, ensuring that each patient has an equal chance of receiving the treatment that may benefit her.
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“The foundation of the Commonwealth’s approach to crisis standards of care is that such tragically difficult decisions must be based on criteria that ensure that every patient has equitable access to any care from which they might benefit,” reads the Massachusetts Crisis Standards of Care guidelines, released on April 7.
“These criteria must be as clear, transparent, and objective as possible, and must be based on biological factors related only to the likelihood and magnitude of benefit from the medical resources.”
Factors that Massachusetts said do not influence the benefit of COVID-19 treatment, and therefore are not to be considered during triage, include:
- Race
- Disability
- Gender
- Sexual orientation
- Gender identity
- Ethnicity
- Ability to pay
- Socioeconomic status
- Perceived social worth
- Perceived quality of life
- Immigration status
- Incarceration status
- Homelessness
- Past or future use of resources
Instead, Massachusetts is zeroing in on patients with comorbidities or underlying conditions.
But it’s that very principle that may put the notion of health equity in danger, according to Pressley, whose district includes Boston, Cambridge, and Chelsea and has a large black and Latinx population.
“Given that these guidelines invoke the use of co-morbidities as a measure to determine which patients would receive critical care resources in the event that a hospital is at capacity, a number of medical providers, elected officials, and public health experts have voiced their concern about the devastating impact these protocols would have on communities of color and the disability community,” Pressley wrote in a letter to Massachusetts Governor Charlie Baker.
This is because black and Latinx patients are more likely to have a chronic illness, such as asthma, diabetes, and hypertension than their white counterparts.
Pressley acknowledged that Crisis Standards of Care guidelines and a plan for patient triage are important during these dire circumstances. However, she also argued that they are built on years of structural inequality that has made it difficult for communities of color to engage with the healthcare system, making them predisposed to developing chronic illness.
“Undoubtedly, this crisis will force our physicians and frontline healthcare workers in hospitals, clinics, and community health centers to make difficult decisions that affect the lives of Massachusetts residents,” she wrote. “But these decisions cannot be guided by a set of standards that devalues the lives of individuals with disabilities and people of color.”
Pressley recommended that the Massachusetts DHS convene with leaders from black and Latinx communities to define caveats and specifics within the Crisis Standards of Care. This community health collaboration could help create guidelines that are more equitable, Pressley suggested.
Beyond that point, Pressley largely pressed the importance of health equity, the disproportionate share of illness seen in black and Latinx communities around Boston, and the need for changes in the state’s Crisis Standards of Care guidelines to ameliorate that issue. Pressley did not offer specific guidelines for the Crisis Standards of Care.
“Every community deserves the peace of mind of knowing health care providers will do everything in their power to save their lives during this pandemic, regardless of their race, zip code, disability, or current health status. Ethically and morally there is a strong case to be made that it is in fact because of these factors, not in spite of them, that we must prioritize the health, safety and wellbeing of our most vulnerable above all else.”
Source: PatientEngagement HIT