Ford Hospital’s letter outlining coronavirus protocols was to plan for ‘extreme emergency’

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DETROIT — A document that drew an outcry on social media this week outlining the guidelines Henry Ford Health System would use to decide who gets life-saving treatment and who does not in the surging coronavirus pandemic was drafted for planning purposes only, hospital officials said.

It was part of a 50-page plan, a protocol for what to do in the event that the hospital system is overwhelmed with critically ill patients in an “extreme emergency” in the absolute worst-case scenario, said Dr. Adnan Munkarah, Henry Ford’s executive president and chief clinical officer.

“Given the pandemic of the nature that we are seeing at the present time, we must all be prepared. We’d be foolish if we are not prepared,” Munkara said Friday.

The instructions outlined in the guidelines have “not been activated at Henry Ford Health System. We’ve not initiated that protocol. We have no immediate plan, and hopefully we’ll never have to activate such a document or such processes,” he said.

The document was initially posted to Twitter on Thursday by Nicholas Bagley, a University of Michigan law professor, and the outcry on social media was swift.

Some were shocked, others saddened, and still others challenged the authenticity of the document, which appeared to be on Henry Ford Health System letterhead.

The letter reads:

“To our patients, families and community:

Please know that we care deeply about you and your family’s health and are doing our best to protect and serve you and our community. We currently have a public health emergency that is making our supply of some medical resources hard to find. Because of shortages, we will need to be careful with resources. Patients who have the best chance of getting better are our first priority. Patients will be evaluated for the best plan of care and dying patients will be provided comfort care.

What this means for you and your family:

1. Alert staff during triage of any current medical conditions or if you have a Do Not Resuscitate (DNR)/Do Not Attempt Resuscitation (DNAR) or other important medical information.

2. If you (or a family member) becomes ill and your medical doctor believes that you need extra care in an Intensive Care Unit (ICU) or Mechanical Ventilation (breathing machine) you will be assessed for eligibility based only on your specific condition.

3. Some patients will be extremely sick and very unlikely to survive their illness even with critical treatment. Treating these patients would take away resources for patients who might survive.

4. Patients who are not eligible for ICU or ventilator care will receive treatment for pain control and comfort measures. Some conditions that are likely (to) make you not eligible include:

Severe heart, lung, kidney or liver failure

Terminal cancers

Severe trauma or burns

5. Patients who have ventilator or ICU care withdrawn will receive pain control and comfort measures:

6. Patients who are treated with a ventilator or ICU care may have these treatments stopped if they do not improve over time. If they do not improve this means that the patient has a poor chance of surviving the illness — even if the care was continued. This decision will be based on medical condition and likelihood of getting better. It will not be based on other reasons such as race, gender, health insurance status, ability to pay for care, sexual orientation, employment status or immigration status. All patients are evaluated for survival using the same measures.

7. If the treatment team has determined that you or your family members does not meet criteria to receive critical care or that ICU treatments will be stopped, talk to your doctor. Your doctor can ask for a review by a team of medical experts (a Clinical Review Committee evaluation.)”

The health system responded to Bagley’s Twitter post at 11:22 p.m. Thursday, writing in a Twitter post: “With a pandemic, we must be prepared for worst case. With collective wisdom from our industry, we crafted a policy to provide guidance for making difficult patient care decisions. We hope never to have to apply them. We will always utilize every resource to care for our patients.”

The health system hosted a virtual press conference Friday to further explain it.

Munkara told journalists that the document was developed by Henry Ford Health System’s ethics committee, “and has been reviewed by our specialists and experts in critical care medicine, pulmonary care, our hospitalist group, our chief medical officers, nursing leaders … over 50 people have looked at that.”

He said health systems around the country have similar plans at the ready for pandemic response.

“These sorts of guidelines are not new to large health care institutions,” he said. “And in fact, there’s been ongoing conversations among us across the nation, looking at numerous different guidelines. They’ve been shared widely amongst us professionally, and our teams and work together to develop which ones we thought would work best for our system.”

In recent days, the CEO of Beaumont Health described the current crisis as “our worst nightmare” and the novel coronavirus health crisis as a “biological tsunami.” He warned the public of limited supplies and the need to stay at home to limit the spread. Gov. Gretchen Whitmer issued an executive order on March 23 requiring residents to stay in place until April 13.

Munkara said like other health systems in the region, Henry Ford also is seeing a surge in hospitalizations of about 100 new COVID-19 patients a day, and for now, he said, the health system is managing.

“There has been some concern regarding our capacities in our hospitals,” he said. “Yes, we are busy in our hospitals. We are busy for regular times, but these are not regular times. And this is why we develop emergency plans.”

The hospital system already has converted part of its Fairlane Medical Center in Dearborn into a 16-bed inpatient unit for non-coronavirus patients.

All non-time sensitive procedures, surgeries and clinic appointments are postponed. Complex neurosurgery, advanced ophthalmology and cancer procedures are being performed temporarily at Henry Ford West Bloomfield Hospital instead of Henry Ford Hospital.

It is also looking at ways to maximize the supplies it has, Munkara said. Henry Ford plans to convert some anesthesia machines into ventilators. In same cases, he said, it will be able to share a single ventilator among two patients

“We have all the equipment that we need to be able to share and continue at double or triple the capacity that we have at the present time,” he said.

And if there comes a time when the coronavirus surge overwhelms Henry Ford, and its hospitals cannot handle the load, patients will be transferred to other hospitals in the state with more open beds before the protocols described in the letter would take effect.

“Our over-arching goals throughout our hospitals is to make sure that in case of extreme emergency and extreme crisis, we are providing the highest rate of survival during that pandemic,” he said, “and at the same time, being transparent to our patients and to their families, about our health care in how we are making decisions. Our clinical decisions are always governed by objective medical evidence. This is how we have built these … guidelines.”


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