Alabama removes controversial ventilator guidelines that denied coronavirus care to disabled

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Alabama has removed controversial guidelines regarding who should receive a ventilator in the event of a shortage, the Trump administration announced Wednesday.

Advocates had raised the alarm that the state’s disaster preparedness plan would prioritize the treatment of able-bodied individuals over people with physical and intellectual disabilities. A complaint was filed with the Health and Human Services (HHS) Office for Civil Rights (OCR).

Responding to the HHS investigation, Alabama said the guidance was not in effect. The state said it has issued new guidelines, and has completely disavowed the previous ones.

Every state should be aware there are lines that should not be crossed,” OCR director Roger Severino said on a call with reporters.

Alabama had incorporated a 2010 guidance for ventilator triage into its emergency preparedness plan. The criteria said that “persons with severe mental retardation, advanced dementia or severe traumatic brain injury may be poor candidates for ventilator support.” 

Individuals with AIDS could also have been excluded, though the guidance noted that HIV “is not an automatic exclusion.”

Severino said HHS was concerned that ventilator services would be stopped or completely denied to people with intellectual disabilities. 

Additionally, he said there was a concern the guidelines could be used to “impose blunt age categorizations, such that older persons might automatically be deemed ineligible for life-saving care without any individualized assessment or examination and based solely on missing a strict age cutoff.”

As states and hospitals develop plans about where to prioritize resources in the event care needs to be rationed, the administration recently issued a bulletin to say it is still enforcing civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age and sex.

Decisions about whether an individual is a candidate for treatment should be based on the best available objective medical evidence. 

Severino praised Alabama for its quick response, and said the state responded “within days” when OCR opened its review. However, he said there are still other states the agency is investigating.

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