Leaked Draft Letter Reveals Michigan Hospital’s Policy to Ration Ventilators for Coronavirus Patients

A draft letter by one of southeast Michigan’s major hospital systems was leaked online Thursday revealing the hospital’s policy to prioritize care for “patients who have the best chance of getting better” in the event of a shortage due to the coronavirus pandemic.

The letter was drafted by officials at the Henry Ford Health System and is addressed to “our patients, families and community.” It outlines the criteria for which patients will be eligible for care if the hospital reaches capacity and is forced to ration limited 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.”

The letter explains the policy in the event of a shortage of ICU beds and ventilators: “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.”

Some of the conditions that may make a person ineligible are listed as “severe heart, lung, kidney or liver failure; Terminal cancers; Severe trauma or burns.”

A statement issued Thursday night by Dr. Adnan Munkarah, executive vice president and chief clinical officer of Henry Ford Health System, confirmed the authenticity of the draft letter, but stressed that it reflects a “worst case scenario.”

“With a pandemic of this nature, health systems must be prepared for a worst case scenario,” Munkarah said. “Gathering the collective wisdom from across our industry, we carefully crafted our policy to provide critical guidance to healthcare workers for making difficult patient care decisions during an unprecedented emergency.”

He added, “These guidelines are deeply patient focused, intended to be honoring to patients and families. We shared our policy with our colleagues across Michigan to help others develop similar, compassionate approaches. It is our hope we never have to apply them and we will always do everything we can to care for our patients, utilizing every resource we have to make that happen.”

The draft letter was leaked online Thursday when Nicholas Bagley, a University of Michigan law professor, tweeted out an image of the letter on what appeared to be official hospital letterhead.

The full contents of the letter was printed by the Detroit Free Press:

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 may [sic] 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.)

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