Alabama removes disability triage guidelines after HHS complaint

shutterstock 245503777 3 Sign outside the Department for Health and Human Services, Washington DC. | Mark Van Scyoc/ Shutterstock

The Department of Health and Human Services (HHS) has resolved a disability rights case with Alabama after the state removed controversial triage guidelines recommending that people with severe intellectual disabilities be denied ventilators in the event of shortages at medical facilities.

The Department of Health and Human Services (HHS) said April 8 that it had conducted a compliance review of the state following complaints that its 2010 guidelines for triage care allegedly discriminated against people with intellectual disabilities. Alabama has agreed to remove its ventilator rationing guidelines from state websites, HHS said on Wednesday.

The issue of healthcare rationing plans in different states has raised ethical concerns as the coronavirus pandemic leads to anticipated strain on critical care facilities across the country. 

"It's about saying that people with intellectual disabilities must be treated the same way, and not be treated as somehow less fit, or less worthy, of having their lives saved, compared to somebody who has greater intellectual abilities," stated Roger Severino, head of the HHS Office for Civil Rights (OCR), in a Wednesday conference call with reporters.

"That's what this resolution is about, and that's a message that we want to convey to other states when they're putting these [rationing] plans together," Severino said.

The Alabama Disabilities Advocacy Program and The Arc of the United States, a community-based disability advocacy organization, both filed a complaint with HHS over Alabama's 2010 guidelines for triage care in the event of a public health emergency and a lack of sufficient number of ventilators.

Even though Alabama recently issued Crisis Standards of Care (CSC) guidelines on February 28, its 2010 standards-the "Criteria for Mechanical Ventilator Triage Following Proclamation of Mass-Casualty Respiratory Emergency"-were still posted on state websites, HHS said.

Those 2010 guidelines, HHS said, "allegedly allowed for denying ventilator services to individuals based on the presence of intellectual disabilities, including 'profound mental retardation' and 'moderate to severe dementia.'"

For instance, the guidelines stated that "persons with severe mental retardation, advanced dementia or severe traumatic brain injury may be poor candidates for ventilator support."

HHS also warned that the old guidelines could "be used to impose blunt age categorizations" to discriminate against patients solely on the basis of their age.

The issue of triage care during the pandemic has led advocates for people with disabilities to warn that medical supply shortages could result in the denial of care to patients simply based on a disability or their advanced age.

Advocates for people with disabilities have also filed a complaint with HHS about the state of Washington's proposed guidance for triage care, saying it would discriminate against people with disabilities and the elderly.

On March 28, HHS OCR issued a bulletin saying that it is enforcing existing laws to protect against discrimination in health care during the pandemic. The laws include the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, the Age Discrimination Act, and Section 1557 of the Affordable Care Act.

"As such, persons with disabilities should not be denied medical care on the basis of stereotypes, assessments of quality of life, or judgments about a person's relative 'worth' based on the presence or absence of disabilities or age," HHS said.

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