The reality of rationing assistance is that the hospital beds fill up and the staff is short

“We’re in a very tough place, Kate,” she told CNN’s Kate Bolduan. “We’ve called strike teams from FEMA, the National Guard, we’ve deployed nursing students across the state, we’ve taken hospital tests just to release more people.”

“Healthcare rationing is not new”

When hospitals run out of beds or when the staff is low, difficult decisions have to be made about which patients become the first to be cared for. In general, hospitals and health systems have plans on the table to address an overflow of patients and make such difficult decisions.

“All hospitals and health systems have plans to deal with an increase in patients. These plans may include actions such as adding beds, included in non-traditional care areas of a hospital such as a cafeteria or car park, changing patients. between hospitals, and working with their local and state health departments to find other places to care, ”Akin Demehin, policy director of the American Hospital Association (AHA), wrote Friday in an email to CNN.

“Sometimes this includes sending patients to hospitals in nearby states that may have the ability to treat them,” Demehin wrote. “Another option some hospitals have taken is to reduce or pause so-called non-emergent elective procedures that can be safely delayed for a period of time.”

However, for the most part, hospital capacity is not just the number of beds that are filled (a hospital can usually add beds), but many facilities are much more concerned about enough staff to attending to patients, according to Demehin.

“Hospitals and health systems have entered the COVID-19 pandemic already facing the shortage of qualified caregivers and the last 18 months have exacerbated it,” wrote Demehin, who added that AHA called on the Biden administration to work as a partner in the development of strategies to address the shortage of health personnel.

In general, decision-making about rationing care may differ depending on the type of medical facility (a hospital or a private medical office).

“There are different decisions whether it’s a doctor’s office or an emergency room,” Art Caplan, a professor of bioethics at NYU Langone Health in New York, told CNN.

“You don’t have the right to be cared for by a primary care doctor. There’s still no right to health care that way; the doctor has the ability to decline,” Caplan said, adding, for example, that some Doctors may refuse to take Medicaid is an insurance for a patient or may refuse treatment to patients who have not received certain vaccines, as it may pose a risk to the doctor or to the health of other patients.

Still, “in emergencies, there’s a federal law that says you have to accept anyone, even if you don’t have money, and stabilize them. It’s called EMTALA and it’s been around for a long time,” Caplan said.

“Healthcare rationing is not new to the U.S. health care system,” he added. “It’s Covid that’s new, but not the rationing.”

Who gets a UCI bed?

Now, during the pandemic, many of the Covid-19 patients filling hospital beds are not vaccinated. EMTALA’s obligations remain in force.

“Hospitals generally don’t take into account why there is a seriously ill patient,” Caplan said. “The way it might be relevant is if you think it was a predictor of a bad outcome.”

For example, if a hospital has few beds or mechanical ventilators, it may prioritize care for patients who are considered more likely to respond to care and survive, that is, a 26-year-old Covid-19 patient with no underlying health. conditions for care for a 90-year-old patient with lung failure and other medical problems could be prioritized, Caplan said.

“Or, if you don’t get vaccinated and have lung failure you are more likely to survive than someone who has just arrived with asthma and lung problems but is vaccinated,” Caplan said. “Many sites would prioritize the patient with vaccinated asthma over the patient with unvaccinated lung failure. What they are seeing is the outcome and the likelihood of success.”

In hospitals so overrun that they have to take care of the ration, those decisions should not be based on whether a person chose to be vaccinated against Covid-19, Dr. Anthony Fauci said Thursday.

“If you ask, if you prefer a vaccinated person to an unvaccinated person, this is something that is always widely discussed, but in medicine I know that no person is harmed by their behavior,” Fauci, director of the National Institute of ‘Allergies and Infectious Diseases,’ he told CNN’s Anderson Cooper.

“You just don’t do it in medicine,” Fauci said.

Fauci added that the decision on where to direct “scarce resources” should be based on a “medically sound” reason, “not punitively for someone’s behavior.”

“We are in a situation of limited resources”

Throughout the pandemic, Covid-19 has strained the U.S. health care system, and hospitals continue to make difficult decisions about which patient has priority when staffing is low and beds are full.

“If the beds in the intensive care unit are full of patients with ventilators due to pneumonia, surgeries should be postponed,” Brown said. “We have situations where people can get into the hospital with a heart attack and have to stay in the emergency room for extended periods while waiting for a bed to open.”

Unfortunately, in some cases, having a bed available means that a patient has died.

“It’s a sad situation that we haven’t really seen in American history in a very, very long time.” Brown said. “We are now in a situation of limited resources and, when you have limited resources, we are in triage situations, and it is possible that some people die as a result.”