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The Conversation

Lieutenant Governor Wants More Health Care Resources, Not Rationed Care

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AP Photo/Jae C. Hong, File
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Hawaiʻi Lt. Gov. Josh Green is urging the federal government to help states avoid rationing medical care during the pandemic — a policy that has concerned many older adults and their families.

Green, also an emergency room doctor on Hawaiʻi Island, said he is encouraged that the state's hospitalization numbers are on a downward trend but is worried about the "Crisis Standards of Care: Triage Allocation Framework" updated last week by the Hawaiʻi Department of Health.

If a surge in hospitalized critical patients led to prioritizing who receives medical care, the crisis standards of care could be implemented.

"What I do know is that they put it together — these are great people — but they put it together in a very different time when we were dealing with a different scenario," Green said. "First of all, we now have far more of our people vaccinated and so we have the capacity to stop the virus from spreading."

Green said Hawaiʻi also has the capacity to expand medical services with mobile hospitals, increasing medical workers, and using monoclonal antibodies which were not available when the framework was first published in August 2020.

"All of these different scenarios now make it possible for us to move far, far away from ever rationing care. I think it's as bad as an idea as you could possibly have right now," he told Hawaiʻi Public Radio.

According to the document, a patient's age is a factor only in a "tie-breaker" situation, not as a primary criterion.

"Evidence from multiple countries including the U.S. show that age >65yo is an indicator for poor prognosis in COVID-19 patients," the crisis standards of care say. "If the triage score is equal between two individuals, the Triage Officer/Review Committee should use the consideration that a patient >65yo who is also COVID-positive is less likely to benefit from the scarce resource."

Hawaiʻi's COVID-19 positivity rate is 5.8%, much lower than Idaho's 25% where hospitals are overflowing, Green said.

"I know they were gaming out worst-case scenarios. But we're 30% down from our peak, we were at 448 individuals on Sept. 3 in the hospital, as of yesterday morning we are at 327 and falling still this morning," he said. "So there's no reason on earth to invoke this crisis standard of care rule, not only because it scares people, but it could even have other consequences."

Green says he reached out to the U.S. Surgeon General this weekend to ask for more support.

"I'm asking the Surgeon General to consider taking to President Biden support for all states that would otherwise consider rationing care. I think that they've helped us immensely and they will continue to help us, we know, with our response in life saving," he said. "I think they should go to places like Texas and Idaho and Alabama and South Carolina, and they should provide extra services, extra nurses, extra facilities, any means necessary to keep people alive because I think that would help unite the country."

Last week, the executive director for Hawaii AARP said she appreciates the state preparing for a worst-case scenario by updating the triage allocation framework, but she also had concerns.

"The truth of the matter is there's lots of different biases that folks can have. We're all human. And we believe age should not be one of those," Lopez told HPR's The Conversation. "The federal government in some of its guidance most recently — so we're hoping the Department of Health is looking at that — has come out and said age should not be a factor."

Read the updated "Hawaiʻi Crisis Standards of Care: Triage Allocation Framework" in the box below or click here.

This interview aired on The Conversation on Sept. 20, 2021.

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