St Charles covid (copy)

Nurses in the St. Charles Bend intensive care unit treat a COVID-19 patient in May 2021.

Medical staff at Memorial Medical Center in New Orleans were arrested after Hurricane Katrina struck in 2005. They were charged with speeding up the deaths of their patients when hospital resources were limited.

It raised agonizing questions about which patients should get care in a crisis. Who should decide? What factors should be weighed? And how should medical professionals be held responsible for their decisions?

It’s more than a decade later and finding the right answers is no less agonizing. Because of the pandemic, St. Charles Health System has come up with its own plan. It’s the hospital’s constrained resource policy. When the community’s health care demands “overwhelm the health system’s availability of life-saving care, St. Charles created its policy to serve as a framework for how to allocate constrained resources.”

We will summarize the policy as best we can, because the community should know what it is. St. Charles wants you to know, too. You can read the policy for yourself. We also attached it to the online version of this article. It’s just over a page long, but you could fill books on the questions it raises.

Four principles from state health officials guide the St. Charles policy: non-discrimination, health equity, patient-led decision making and transparent communications. The goal of the St. Charles policy is to do the greatest good for the greatest number “while considering two factors:

• Historical and current health inequities that lead to further inequitable access to life-saving resources

• The likelihood an individual patient will survive and be discharged from that particular hospitalization”

If a patient is unlikely to survive to discharge from the hospital with or without access to a resource, the patient will be referred to a triage team different from their caregivers. The team will consist of senior clinicians and an ethicist. They will evaluate if the patient should have access to any constrained resources. The decision is based on the medical evidence of the patient’s physiological profile and ability to survive. COVID vaccination status would not be a consideration. Decisions made by the triage team may be appealed.

Dr. Cynthia Maree, infectious disease chief at St. Charles, told The Bulletin’s community editorial board the hardest thing would be making a choice to deny a resource. It would not be taken lightly. Medical professionals don’t want to do that. They are not trained to do that. They are trained to give patients care, not decide a patient should not get care.

Dr. Doug Merrill, chief medical officer at St. Charles, said in one way the pandemic already did force the hospital to limit care to patients. Elective surgeries were put on hold. So far, it has not needed to take steps beyond that. It may. The wait for COVID testing on Tuesday at the hospital in Bend was three and a half hours long.

Oregon had a state health care crisis policy in 2018. It no longer exists. It was dropped out of concern it was discriminatory. A new state policy may actually be coming out soon, Dr. Jeff Absalon, chief physician executive at St. Charles, told us. But St. Charles didn’t know that and took action to be better prepared if the worst happens.

If you are interested in what happened at Memorial Medical Center after Katrina, the book to read is “Five Days at Memorial” by Sheri Fink.

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