A spokesman for the Henry Ford health care system told CNN, “The letter is part of a larger policy document that was developed for an absolute worst-case scenario.”
“It’s not an active policy within Henry Ford, but it’s part of our contingency planning,” said the spokesman.
The letter was not passed on to patients, but is said to explain that the coronavirus pandemic has made it difficult to find medical care.
“Due to bottlenecks, we have to be careful with resources,” the letter said, aimed at patients, families, and the community. “Patients with the best chance of improvement are our top priority.”
“Patients treated with a ventilator or an intensive care unit may be discontinued,”; it says, “if they do not improve over time.”
The letter also said that patients with severe heart, lung, kidney or liver failure, severe trauma or burns, or terminal cancer may not be eligible for a ventilator or intensive care unit. Instead, these patients receive “pain control and comfort measures”.
“This decision will be based on health and the likelihood of improvement,” the letter said.
“What they bring out is honest,” says the mayor
The letter is not only an indication of the situation in a Michigan health care system, but also shows the widespread challenges that hospital systems across the country have described to CNN against dwindling resources when they have difficulty caring for patients during the pandemic.
In an email to CNN, Henry Ford Health System said that none of its hospitals had reached the capacity of Covid-19 patients and that the hospitals had not reached their ventilator limits. The health system had 373 coronavirus patients in its hospital facilities on Friday morning, according to its website.
According to Dr. Adnan Munkarah, executive vice president and chief clinical officer of the healthcare system, all healthcare systems must be prepared for the worst case scenario.
Henry Ford Health System “has carefully elaborated our guidelines to provide healthcare professionals with important guidance for making difficult decisions regarding patient care during an unprecedented emergency. These guidelines are highly patient-oriented and are intended to serve patients and families,” said Munkarah in an explanation.
“We hope that we will never have to use them, and we will always do everything we can to care for our patients and use all the resources we need.”
When asked about CNN’s letter from Jim Sciutto, Detroit Mayor Mike Duggan said that other major hospital systems dealing with major coronavirus outbreaks are having the same conversations internally.
“Henry Ford is one of America’s largest healthcare systems,” said Duggan. “And what they bring out is honest.”
“You would be irresponsible as CEO of the health care system,” added the mayor, “if you weren’t preparing for this opportunity.”
“We’re all together at Titanic now”
Arthur Caplan, director of the Department of Medical Ethics at the Grossman School of Medicine at NYU, said he agreed that it would be irresponsible if hospitals were not prepared for rationing.
“It’s good to be public, it’s good to be transparent, it’s good to be open,” said Caplan of Henry Ford’s letter. Other hospital systems across the country have similar policies if they don’t already have them.
Caplan is not surprised when people are upset, he said, but it is inappropriate to simply say, “Rationing is wrong and you cannot do it.”
“This ignores reality,” he said, adding, “if there are 10 people and 3 ventilators, a decision will be made.”
Hospitals will aim to “maximize the likelihood that you can save lives by giving access to the resource,” he said. You will also consider factors such as a patient’s health and age.
Caplan added that rationing within the healthcare system is nothing new, suggesting insurance and organ transplants.
“The discovery that rationing is happening in healthcare is only shocking because most people have never been confronted with it,” said Caplan. “If you had no insurance, if you were homeless, you were rationed. It was always sadly true, it just caught nobody’s attention.”
The public, Caplan said, must accept that this is “a reality”.
“We’re all on Titanic together now,” he said. “And it’s pretty clear that there aren’t enough lifeboats and lifebuoys.”