By Dr. John M. Livingston | Medical Policy Adviser
The Idaho Department of Health and Welfare oversight board voted earlier this week to have the government play a central role in who lives and who dies.
As a retired surgeon, I simply can’t believe that people who have never taken care of a sick patient have now inserted themselves into a doctor-patient relationship. Although the board-approved Crisis Standards of Care is billed as a response to a pandemic, it does much more, with long term consequences.
Under the rules approved by the board Friday, in the event there’s an emergency that makes health care resources scarce, the Department of Health and Welfare director would have a central role in on-the-ground healthcare decision-making. It would be up to him to convene a panel that would decide whether medical facilities could begin rationing care according to a state-approved formula. Members of the panel include representatives of the Idaho Hospital Association, “healthcare entities,” and long-term care facilities. The panel would also include employees of the Department of Health and Welfare, public health districts, and anyone else the director might deem appropriate.
This unwise decision puts state agencies in the middle of a discussion that could easily be managed by the medical providers themselves. There’s nothing stopping the state’s hospitals, clinics, and individual practitioners from collaborating in an emergency, sharing intel, and resources. The Department of Health and Welfare board, the department, and its director shouldn’t be part of the discussion. They’re not needed.
In short, they would be practicing medicine without a license.
The proper way of handling an emergency would be to indemnify those providers who may have to make decisions about resource allocation.
The process of a doctor, a family, and a patient talking to each other doesn’t change because of the triage status of an institution. If public health officials try to become involved in making medical decisions, the central interests of the government — cost, public relations, and politics — are then brought into the equation.
Having the government step in and assume core responsibilities also puts taxpayers on the hook when public officials get things wrong. Need proof? Simply look at how the state of New York is now under legal threat because the governor and public health officials decided to transfer infected Covid patients back to nursing homes.
It’s also important to remember that the standard of medical practice (what clinicians actually do) should define the standard of care. Standard of medical practice is very different from the standard of care. What is written in law or with bullet points entitled “best practices” may or may not be what is done within a community or under various conditions. Medical providers should be the ones who make the decisions about what that looks like, depending on conditions unique to that community. individual health clinic, or practice.
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