A Government Accountability Office study released last week said HHS should do more to provide states with guidance on providing altered standards of care during major emergencies.
HHS should offer more emergency guidance: GAO
Used in testimony at a congressional hearing of the House Homeland Security Committee’s Management, Investigations and Oversight Subcommittee held in Danville, Pa., last week, the study provided a summary of a June 2008 report about health systems planning for a medical surge after a mass-casualty event, such as an earthquake or a hurricane.
After reviewing documents and conducting interviews of 20 state emergency preparedness officials, the GAO found that states had made efforts in three of four key components of a medical surge that the GAO had identified: increasing hospital capacity, identifying alternate-care sites and registering medical volunteers.
Less successful were efforts to implement altered standards of care. “In its role of assisting states’ efforts to plan for medical surge, HHS has not collected altered standards of care guidelines that some states and medical experts have developed and made them available to other states,” the GAO said in its report. “Once a mass casualty event occurs, difficult choices will have to be made, and the more fully the issues raised by such choices are discussed prior to making them, the greater the potential for choices to be ethically sound and generally accepted.”
For its part, HHS said it is developing a “clearinghouse” that will “serve as a source for analytical products that integrate mass casualty preparedness efforts across local, state and federal levels when medical resources are scarce,” according to an e-mail from Elleen Kane, an HHS spokeswoman. HHS expects the clearinghouse to be ready by December 2010.
Jamil Bayram, an assistant professor of emergency medicine at 681-bed Rush University Medical Center in Chicago, said altered standards of care adopt a utilitarian approach because the goal is “to provide the most good for the most people.” As he explained, a lot of hospitals nationwide are struggling with the concept of altered standards of care because of the host of medical, legal and bioethical issues tied to this form of medical treatment. In its report, the GAO cited these same concerns from state officials who said these were reasons why they had not started to work on developing such guidelines. And another worry, Bayram said, is reimbursement. “If you go to altered standards of care, are you going to be reimbursed for that?” Bayram asked.
“There are a few states that have taken the initiative and put out some guidelines,” Bayram said, adding that some peer-reviewed journals also address the topic. “However, there is no national consensus on the measures that need to be adopted,” which, Bayram added, could provide some closure to some of the related medical, legal and ethical questions.
There is also good news, as Bayram said he believes each year the nation improves in its disaster-preparedness efforts. According to the GAO report, from fiscal 2002 to 2007, the federal government awarded states about $2.2 billion through HHS’ Office of the Assistant Secretary for Preparedness and Response’s Hospital Preparedness Program to support preparedness goals, including a medical surge.
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