Mass. lawmakers say the state’s ventilator, bed rationing guidelines prioritize whites over patients of color

"Prioritizing those without comorbidities inevitably ranks people of color lower than others."

Congressman Joe Kennedy III
Congressman Joe Kennedy III. –Elise Amendola / AP, File

Congressman Joe Kennedy III and state Rep. Jon Santiago are calling on the Baker administration to abandon the points system at the heart of the ventilator and intensive care bed rationing guidance released to hospitals this week, arguing that the state’s recommendations would, in practice, prioritize white patients over people of color.

“The Massachusetts guidance prioritizes those without serious comorbid illnesses,” the lawmakers wrote in a letter sent to Gov. Charlie Baker and state public health leaders Thursday evening. “People of color are more likely to have pre-existing conditions given long standing inequities within every system in the United States.”

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The guidelines, released Tuesday, spell out a system for how health care professionals could consider making “tragically difficult decisions” as the anticipated surge in COVID-19 cases is expected to pinch the supply of critical medical resources, such as intensive care equipment.

State officials say the guidance is by no means mandatory, but was released in response to requests from across the health care system about how hospitals could handle those situations.

“We have a moral obligation to ensure there are transparent and ethical guidelines available to our medical professionals if they have to make these excruciating decisions,” Baker said Wednesday.

The guidance closely mimics a proposal from the University of Pittsburgh that’s been adopted by several states, according to Baker. The 34-page set of guidelines suggests hospitals and medical facilities use a “priority scoring” system, if at capacity, to determine which patients receive critical care resources.

The recommendations explicitly state that factors that should not be considered include race, disability, gender, socioeconomic status, sexual orientation, ethnicity, homelessness, ability to pay, immigration status, incarceration status, and perceived social worth, among others.

Patients instead would receive scores based upon factors such as existing comorbid conditions that can limit life expectancy, giving preference to healthier patients who are more likely to survive a serious illness.

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Kennedy and Santiago say that while the recommendations make sense fundamentally, in practice, the guidance would serve whites at the expense of people of color, who disproportionally suffer from higher rates of comorbidities such as diabetes, stroke, and cancer.

Those inequalities are born out of long-standing and deep-seated racial disparities across not only the health care system, but also “housing, criminal justice, climate and environmental justice, and community development,” the lawmakers wrote.

“These all result in higher rates of lead exposure, high blood pressure, poor respiratory health, asthma, and heart disease,” the letter penned by Kennedy and Santiago says. “Prioritizing those without comorbidities inevitably ranks people of color lower than others.”

Kennedy and Santiago added that the racial inequalities impact both patients’ pre-existing conditions and lifespan, the other factor used to prioritize access to resources.

“Comorbidities reduce life expectancy and therefore disproportionally effect people of color,” the two Democrats wrote. “Additionally, all African Americans, specifically African American men, have a far shorter life expectancy at every age than any other race or ethnicity. This is a result of long standing racism in the United States that ranges from criminal injustice to implicit bias in our health care system.

“Racial bias is inescapable, expansive, and is persisting during the COVID-19 pandemic and while not purposeful, is inherently woven throughout the ventilator guidance recently issued,” they wrote.

The letter comes just as data released this week shows the stark contrast in how coronavirus is impacting Black residents at a higher rate than white residents in Boston.

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In confirmed cases where race of a patient was reported, 40.3 percent of cases involved patients identified as Black or African American, who account for 25 percent of the city’s population.

“Whether it’s in Boston or across the country, minority communities seem to be disproportionately impacted and infected with COVID-19,” Santiago, a Boston Democrat and emergency room doctor at Boston Medical Center, said in a video on Twitter Wednesday.

Meanwhile, white residents made up 28.4 percent of the total cases, despite making up 45 percent of the city’s population. Nearly 5 percent of cases included Asian residents and 14.2 percent of cases involved Hispanic and Latino residents — levels also falling below their respective percentages in Boston’s total population.

Kennedy, earlier this week, called on public health leaders to collect and release statewide demographic data on testing and treatment of the virus. Sens. Elizabeth Warren and Ed Markey and Congresswoman Ayanna Pressley renewed a call Friday for racial data to be released at the federal level.

On Thursday, Mayor Marty Walsh announced the formation of a 24-member COVID-19 Health Inequalities Task Force to analyze the disparities.

“We’ll be taking a good hard look at the numbers in Boston to understand and address any inequities that exist. Because we believe that data is critical,” Walsh said. “We’ve been working to collect as much data as possible about race and ethnicity in patients in Boston and I’ve asked the state and our surrounding communities to help us do the same.”

The Baker administration released racial and ethnic information regarding coronavirus patients in the state Wednesday, but the incomplete data only accounted for less than a third of all those infected. Still, the data released showed Blacks and Latinos contracted the virus at higher rates than white residents.

“Racial and ethnic minorities are often overlooked during health care crises, often experience the brunt of pandemics, and this time is no different,” Kennedy and Santiago wrote. “Reporting has shown that racial and ethnic minorities are disproportionately affected by COVID-19 in both number of cases and deaths. The way ventilator prioritization in Massachusetts is currently set up only compounds these disparities.”

At Boston City Hall this week, City Councilor Ricardo Arroyo also filed a hearing order, requesting the council discuss the guidelines and “ensure racism does not play an intentional or unintentional role in deciding who gets medical care during the COVID-19 pandemic.”

“Health inequity is deeply impacted by race and using those inequities to deny care is racist,” Arroyo wrote on Twitter.



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