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April 21, 2020

DPH updates crisis care guidelines

Massachusetts Department of Public Health

State public health officials on Monday revised crisis care standards after the initial voluntary standards were criticized following their April 7 release.

"This revised document makes clarifications in response to comments received from stakeholders, including from hospitals about operationalizing the guidelines and, especially, from members or representatives of vulnerable and marginalized communities," the Department of Public Health wrote in its update to a 37-page document. The agency said "every effort has been made to use equity as the foundation of this framework, recognizing that we begin in a context where many populations face discrimination, poverty and structural racism, each of which leads to unfair health burdens."

The Massachusetts Black and Latino Legislative Caucus on April 9 raised concerns that the guidelines could disadvantage people of color who need treatment. The caucus said the guidelines "allow hospitals to choose which comorbidities to consider in their decision-making process" but added that "many comorbidities disproportionately impact minority communities due to health inequities from years of systemic racial injustices."

"It is apparent that some severe diseases and conditions may warrant a standard of care protocol," said caucus chair Rep. Carlos González (D-Springfield). "However, utilizing points for conditions that we already know are rampant in low-income communities due to historic health disparities is unconscionable."

The state Senate last Thursday rejected an amendment to a health care worker liability bill that sought to address the state's crisis standards of care, a set of voluntary guidelines intended to help hospitals determine how to resources during the pandemic when demand outpaces supply. On Thursday night, House and Senate leaders issued a statement vowing legislative action in connection with the standards; no sessions have been held since then and no bill has emerged to date.

State officials for weeks have described the struggle to acquire personal protective equipment and life-saving ventilators. On Monday, Gov. Charlie Baker said that he was "starting to feel pretty good" about the state's ventilator supply and confidently stated that "we have a health care system that is not going to be overwhelmed by this thing."

President Donald Trump on Monday said many ventilators have been built and there are "so many now that, at some point soon, we're going to be helping Mexico and Italy and other countries." Thousands more ventilators are being built, he said, adding, "Nobody that needed a ventilator in this country didn't get one."

New DPH data released Monday showed newly confirmed COVID-19 cases fell for the fourth straight day.

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