If North Texas runs out of ICU hospital beds, doctors can consider a patient’s vaccination status

This would be a big change in health care, but doctors have yet to announce it. So The Watchdog does it for them.

North Texas doctors have quietly developed a plan that seeks to prepare for the possibility that due to the COVID-19 surge the region will run out of intensive-care beds.

If that happens, for the first time, doctors officially will be allowed to take vaccination status of sick patients into account along with other triage factors to see who gets a bed.

A copy of an internal memo written by Dr. Robert Fine, co-chair of the North Texas Mass Critical Care Guideline Task Force, was sent to members of the task force — and leaked to The Watchdog. It summarizes the latest work by the task force, a volunteer group that periodically updates medical guidelines for hospitals in our region. There are about 50 members from various hospitals in the group. Although their recommendations are not enforceable, the guidelines are generally followed.

The one-page summary memo is a “heads up” alert in the event things get worse, says Dr. Mark Casanova, director of clinical ethics for Baylor University Medical Center and a spokesperson for the task force. After Monday’s meeting, doctors had yet to make plans to inform the public.

“We’re trying to decide how to explain this addition to the public,” Casanova said.

But after studying the memo and interviewing doctors involved in the decision for two hours this week, The Watchdog can explain it to you.

Although doctors make triage decisions all the time, the proposed guideline addition is significant. Casanova predicted that if this change were copied by others medical care, for as long as the crisis persists, “is going to look and feel different for everybody who is alive right now in the United States of America.”

Yet a leading medical ethicist who studies how COVID-19 affects communities says he worries that adding vaccination status to the triage of patients will unfairly harm low-income people and people of color. These groups are historically disadvantaged when it comes to obtaining proper medical care.

One important note: A non-vaccinated person will not necessarily be denied care when competing with a vaccinated patient for an ICU bed, doctors say. Other medical factors come into play, such as underlying conditions and the likelihood that a patient will get better and leave the hospital.

Dr. Mark Casanova checks on a patient at Baylor University Medical Center in Dallas. Casanova is one of the doctors explaining how vaccination status could soon become an accepted part of triage for hospital admittance.(Ashley Landis – Staff Photographer)

The memo

The online meeting involving several dozen doctors representing many area hospitals took place Monday. Afterward, in his email, co-chair Fine summarized decisions made by the task force. He boiled it down to three bullet points. Here they are:

1. “COVID-19 vaccination decreases severe infection and death. Vaccine status therefore may be considered when making triage decisions as part of the physician’s assessment of each individual’s likelihood of survival.”

2. “When vaccination status is considered, accommodations may be needed when the reason for non-vaccination is beyond the patient’s control such as but not limited to caretaker refusal to have a disabled dependent vaccinated, recent COVID-19 infection, or medical contraindication.”

3. “Many are understandably angry and frustrated with the unvaccinated, but triage must remain grounded upon likelihood of survival. Health care professionals should continue to honor duties of care and compassion.”

Fine concludes, “I encourage the medical professionals on the task force to share these ideas within their respective organization ethics committees, triage committees and/or any physicians who might be involved in triage decisions.”

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Imagine that.