Hospital Outlines Shocking Protocol for COVID-19

(Portion of a protocol letter from Henry Ford Health Center, posted on Twitter, concerning the emergency protocols for treating novel coronavirus patients in the event of an emergency triage situation where supplies become limited.)

A document has been circulating on social media that purports to explain new COVID-19 procedures from Henry Ford Health System in Detroit, Michigan. The new protocols are alarming and have caused extreme concern over how people in the most dire situations could possibly be denied critical life support measures, such as a ventilator if they meet certain triage criteria.

Henry Ford has now confirmed that this letter is authentic and has issued the following statement: “With a pandemic, we must be prepared for worst case. With collective wisdom from our industry, we crafted a policy to provide guidance for making difficult patient care decisions. We hope never to have to apply them. We will always utilize every resource to care for our patients.”

The letter disseminated to the community reads as follows:

To our patients, families and community:

Please know that we care deeply about you and your family's health and are doing our best to protect and serve you and our community. We currently have a public health emergency that is making our supply of some medical resources hard to find. Because of shortages, we will need to be careful with resources. Patients who have the best chance of getting better are our first priority. Patients will be evaluated for the best plan of care and dying patients will be provided comfort care.

What this means for you and your family:

1. Alert staff during triage of any current medical conditions or if you have a Do Not Resuscitate (DNR)/Do Not Attempt Resuscitation (DNAR) or other important medical information.

2. If you (or a family member) becomes ill and your medical doctor believes that you need extra care in an Intensive Care Unit (ICU) or Mechanical Ventilation (breathing machine) you will be assessed for eligibility based only on your specific condition.

3. Some patients will be extremely sick and very unlikely to survive their illness even with critical treatment. Treating these patients would take away resources for patients who might survive.

4. Patients who are not eligible for ICU or ventilator care will receive treatment for pain control and comfort measures. Some conditions that are likely to may make you not eligible include:

• severe heart, lung, kidney or liver failure

• Terminal cancers

• Severe trauma or burns

5. Patients who have ventilator or ICU care withdrawn will receive pain control and comfort measures:

6. Patients who are treated with a ventilator or ICU care may have these treatments stopped if they do not improve over time. If they do not improve this means that the patient has a poor chance of surviving the illness — even if the care was continued. This decision will be based on medical condition and likelihood of getting better. It will not be based on other reasons such as race, gender, health insurance status, ability to pay for care, sexual orientation, employment status or immigration status. All patients are evaluated for survival using the same measures.

7. If the treatment team has determined that you or your family members does not meet criteria to receive critical care or that ICU treatments will be stopped, talk to your doctor. Your doctor can ask for a review by a team of medical experts (a Clinical Review Committee evaluation.

The hospital network responded directly to a Free Press request for confirmation, providing a statement explaining that the Henry Ford Health System letter is part of a larger policy document developed for an absolute worst case scenario. It is not an active policy within Henry Ford, but a part of emergency response planning, as is standard with most reputable health systems.

The hospital network has provided a statement to the Detroit Free Press on Thursday:

“With a pandemic of this nature, health systems must be prepared for a worst case scenario. Gathering the collective wisdom from across our industry, we carefully crafted our policy to provide critical guidance to healthcare workers for making difficult patient care decisions during an unprecedented emergency. These guidelines are deeply patient focused, intended to be honoring to patients and families. We shared our policy with our colleagues across Michigan to help others develop similar, compassionate approaches. It is our hope we never have to apply them and we will always do everything we can to care for our patients, utilizing every resource we have to make that happen." — Dr. Adnan Munkarah, Executive Vice President and Chief Clinical Officer of Henry Ford Health System

While there is no confirmation or reason to believe at this point that these protocols have been enacted, we don’t have exact information about what circumstances or changes might trigger the policy and how far away this facility is from this kind of scenario. The area currently showing the most COVID-19 cases right now is New York and we have no information about which emergency protocols have been enacted in this location. If a facility in Michigan has prepared hospital staff for this emergency possibility, it is not unlikely that similar protocols are also in place for other areas who are currently handling an influx of more patients.

It is also reasonable to assume that hospitals would enact emergency standards in the event that there was an unforeseeable shortage or problem, but the federal government has known about this impending pandemic for months now. Governor Andrew Cuomo, who is trying to manage the epicenter of the outbreak within the United States, has continued to ask for support and supplies, only to be met with incredulous response statements from the Trump administration. After giving another press conference yesterday where Governor Cuomo stressed the need for more ventilators, Trump responded last night on Fox News by minimizing the need for equipment in New York.

“I have a feeling that a lot of the numbers that are being said in some areas are just bigger than they’re going to be. I don't believe you need 40,000 or 30,000 ventilators. You go into major hospitals sometimes, and they’ll have two ventilators. And now all of a sudden they’re saying, ‘Can we order 30,000 ventilators?’” — Donald Trump responding to the request for more federal assistance

If frightening protocol letters describing which patients will inevitably be sacrificed and requests by state leadership are all dismissed by the president as an inaccurate inflation of actual need, what will make a difference in commanding this administration to help America? The experts weigh in daily and explain what is coming and yet Trump and his team continue to respond to each crisis several days late, if at all.

Will none of it matter until we are already counting the dead and the dead include those within the White House? What does it take to reverse course and can we even turn a ship this big around in enough time to actually make a difference? We need real answers we can trust and real leadership from someone who has proven to have the best interests of Americans at heart and nothing we have seen so far from the Trump administration indicates that we will get this now or any time soon.

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Amee Vanderpool writes the “Shero” Newsletter and is an attorney, contributor to magazines and newspapers and an analyst for BBC radio. She can be reached at avanderpool@gmail.com or follow her on Twitter @girlsreallyrule.