Planning for the unthinkable

While the curve is flattening, America is not out of the woods with COVID-19. Social distancing and isolation are proving effective. Yet there’s every expectation for a second surge, be it because we’ve reopened society too soon or because cooler weather in the fall triggers a second outbreak. Despite the positive trends, the risk of healthcare providers reaching capacity with staff, beds and equipment such as ventilators remains.

Although stories have circulated in the press, neither our health care providers nor the public are prepared for “rationing” and for the decisions by health care providers as to who receives potentially life-saving treatment and who does not. Those decisions may become necessary, and they will cause understandable distress among everyone – families, caregivers and communities. This could, in turn, erode the public’s trust of and support for their community hospitals.

In recent days, we have seen individual states mandate development of rationing protocols by healthcare providers. These edicts provides some relief for those organizations, as state mandates should help mitigate the risk of liability for failing to provide care.

Even so, hospitals must still plan for these events and prepare to talk about them. Regardless of the legal framework, it will be the hospital’s name in any story about rationing and it will be asked hard questions.

Here are a few recommendations for hospital and health system leaders to prepare for the unthinkable:

  1. Have medical professionals begin to establish evidence-based criteria for making these decisions. Review criteria for inherent bias against race, poverty or the uninsured, disability or other unintended factors.
  2. Begin these discussions with your boards. They must be prepared long before you have to make these decisions. As community representatives, it is imperative that board members participate in decisions, be fully informed and understand the issues and be able to speak to them should they take place.
  3. Prepare resources for the emotional, spiritual and psychological support your professionals caring for these patients will need. These decisions go against every fiber of our being, and the dissonance will create tremendous stress and, potentially, PTSD.
  4. Begin working on your communications now. In a communication about something so highly emotional and perhaps shocking to many people’s expectations, every word choice is critical. You’ll want to be prepared on a variety of fronts:
    • Press and media statements in response to a family going to them with the death of a loved one
    • A communication to your board notifying them that this issue has materialized, that stories are likely to appear in the local press and be picked up by the national media and talking points for each board member
    • A communication to physicians and employees so they do not learn this from the media and so you are able to thank those involved for their extraordinary efforts to save as many lives as possible and to highlight support resources available to them
    • A communication to local and state leaders so they are not surprised as they may be contacted by families and concerned citizens
    • A communication to donors and other community stakeholders to maintain their trust and engagement and prevent erosion of the relationship if they are caught unaware

I remain hopeful that this issue will not come to pass, and, as of this moment, the likelihood seems to be decreasing day-by-day thanks to the efforts of everyone from frontline caregivers to medical device and other companies. We will all continue to work for the best possible outcome in this difficult situation, even as we create plans for the worst.

David Pate, MD, JD