ICU triage: The potential legal liability of withdrawing ICU care during a catastrophic event
DOI:
https://doi.org/10.5055/ajdm.2011.0072Keywords:
disaster medicine, triage, ICU, liabilityAbstract
In the event of a catastrophic disaster, healthcare resources may be completely overwhelmed. To address this, the federal Agency for Healthcare Research and Quality has recommended using “crisis standards of care” during such an event.These standards would recommend allocating scarce medical resources to do the greatest good for the greatest number of patients.
In a dire catastrophic event, such standards may include the allocation of intensive care unit (ICU) resources to maximize patient survival.Triage protocols that seek to efficiently allocate ICU resources during a disaster have been reviewed by the Institute of Medicine. Such protocols suggest the exclusion of patients with high mortality or high resource requirements from ICU care to do the most good for the greatest number of patients. In extreme circumstances, these protocols recommend withdrawing ICU resources from sicker patients in favor of more salvageable patients.
However, if providers were to follow the earlier protocols in a disaster and withdraw and reallocate ICU care, criminal or civil liability could result. Two legal solutions to avoid this potential for liability have been suggested in this article.
References
Mareiniss DP, Hirshon JM, Thibodeau BC: Disaster planning: Potential effects of an influenza pandemic on community healthcare resources. Am J Disaster Med. 2009; 4(3): 163-171.
Stroud C, Altevogt BM, Nadig L, et al.: Crisis Standards of Care: Summary of a Workshop Series. Institute of Medicine.Washington, DC: National Academies Press, 2010. IOM Web site. Available at http://books.nap.edu/openbook.php?record_id=12787. Accessed February 9, 2010.
Altevogt BM, Stroud C, Hanson SL, et al. (eds.): Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report. Institute of Medicine.Washington, DC: National Academies Press, 2009. IOM Web site. Available at http://books.nap.edu/openbook.php?record_id=12749&page=R2. Accessed April 18, 2010.
Agency for Healthcare Research and Quality Archives: Altered Standards of Care in Mass Casualty Events. Publication No. 05- 0043. AHRQ Web site. Available at http://archive.ahrq.gov/research/altstand/. Accessed November 2, 2011.
Government Accountability Office: Emergency Preparedness: States Are Planning For Medical Surge, But Could Benefit From Shared Guidance For Allocating Scarce Medical Resources.Washington, DC: General Accounting Office, 2008. GAO Web site. Available at http://www.gao.gov/new.items/d08668.pdf.Accessed February 18, 2010.
Devereaux AV, Dichter JR, Christian MD, et al.: Definitive care for the critically ill during a disaster: A framework for allocation of scarce resources in mass critical care from a task force for mass critical care summit meeting. January 26-27, 2007, Chicago, IL. Chest. 2008; 133(5): 51S-66S.
Hoffman S: Responders’ responsibility: Liability and immunity in public health emergencies. Georgetown Law J. 2008; 98: 1913-1969.
Rubinson L,Vaughn F, Nelson S, et al.: Mechanical ventilators in US acute care hospitals. Disaster Med Public Health Prep. 2010; 4: 199-206.
Bartlett JG: Planning for avian influenza. Ann Intern Med. 2006; 145: 141-144.
Osterholm MT: Preparing for the next pandemic. N Engl J Med. 2005; 352: 1839-1842.
Devereaux A, Christian MD, Dichter JR, et al.: Summary of suggestions from the task force for mass critical care summit, January 26-27, 2007. Chest. 2008; 133(5 Suppl): 1S-7S.
Rubinson L, Hick JL, Hanfling DG, et al.: Definitive care for the critically ill during a disaster: A framework for optimizing critical care surge capacity from a task force for mass critical care summit meeting, January 26-27, 2007, Chicago, IL. Chest. 2008; 133(5 Suppl): 18S-31S.
Hoffman S,Goodman RA,Stier DD:Law, liability, and public health emergencies. Disaster Med Public Health Prep. 2009; 3: 117-125.
Annas GJ: Standard of care—In sickness and in health and in emergencies. N Engl J Med. 2010; 362: 2126-2131.
Hodge JG, Courtney B: Assessing the legal standard of care in public health emergencies. JAMA. 2010; 303(4): 361-362.
Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP): Legal and Regulatory Issues, Department of Health and Human Services May 2006. The Center for Law and the Public’s Health Web site. Available at http://www.publichealthlaw.net/Research/PDF/ESAR%20VHP%20Report.pdf. Accessed April 14, 2010.
MD Code Ann. Pub. Safety 14-3A-06 (2010).
VA Code Ann 8.01-225.02 (2010).
Emergency Management Assistance Compact Web site. EMAC Legislation. EMAC Web site. Available at http://www.emacweb.org/?13. Accessed February 18, 2010.
Uniform Emergency Volunteer Health Practitioner Act. Uniform Law Commission Web site. Available at http://www.uniformlaws.org/Act.aspx?title=Emergency Volunteer Health Practitioners; http://www.uniformlaws.org/Act.aspx?title=Emergency%20Volunteer%20Health%20Practitioners; http://www.law.upenn.edu/bll/archives/ulc/uiehsa/2007act_final.htm. Accessed November 2, 2011.
The Center for Law and the Public’s Health at Georgetown and the Johns Hopkins University: The Model State Emergency Health Powers Act. The Center for Law and the Public’s Health Web site. Available at http://www.publichealthlaw.net/MSEHPA/MSEHPA. pdf. Accessed February 18, 2010.
United States Code. Federal Volunteer Protection Act of 1997. Available at http://uscode.house.gov/download/pls/42C139.txt. Accessed February 9, 2010.
US Department of Health & Human Services: Public Readiness and Emergency Preparedness Act Questions and Answers. HHS Web site. Available at http://www.phe.gov/Preparedness/legal/prepact/Pages/prepqa.aspx. Accessed November 2, 2011.
Immunity of Health Care Providers—Louisiana Revised Statute 29:735.1 (2010). Available at http://www.legis.state.la.us/lss/lss.asp?doc=410329. Accessed December 4, 2010.
Black HC: Black’s Law Dictionary. 6th ed. St. Paul: West Publishing Co., 1990.
AMA Code of Medical Ethics. Opinion 2.20—Withholding or Withdrawing Life-Sustaining Medical Treatment. American Medical Association Web site. Available at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medicalethics/opinion220.shtml. Accessed August 30, 2010.
Vacco v Quill, 521 US 793 (1997).
Levin PD, Sprung CL:Withdrawing and withholding life-sustaining therapies are not the same. Crit Care. 2005; 9(3): 230-232.
Cruzan v Director, Mo. Dept. of Health, 497 US 261 (1990).
Compilation of Social Security Laws, 42 USC 1320b-5(b)(3) (2010). Available at http://www.ssa.gov/OP_Home/ssact/title11/1135.htm. Accessed August 22, 2010.
Garner BA: Black’s Law Dictionary. 2nd Pocket ed. St. Paul: West Group, 2001.
40 American Jurisprudence 2nd Homicide §93 (2010).
61 American Jurisprudence 2d Physicians, Surgeons, and Other Healers §355 (2010).
Barber v Superior Court of Los Angeles, 147 Cal App 3d 1006 (Cal Ct App 1983).
Texas Health & Safety Code §166.046 (2010).
Foregoing Treatment and other End-of-Life Issues in: Mathew Bender & Company, Inc. Treatise on Health Care Law. At §18.04 Copyright 2010.
Okie S: Dr. Pou and the hurricane—Implications for patient care during disasters. N Engl J Med. 2008; 358(1): 1-5.
MD Code Ann Pub Safety 14-3A-02 (2010).
Rothstein MA: Malpractice immunity for volunteer physicians in public health emergencies: Adding insult to injury. J Law Med Ethics. 2010; 38(1): 149-153.
Kruger KJ: Government immunity in Maryland: A practitioner’s guide to making and defending tort claims. U Balt L Rev. 2006; 36: 37-76.
Cohen H, Burrows VK: CRS Report for Congress: Federal Tort Claims Act. December 11, 2007. Available at http://www.fas.org/sgp/crs/misc/95-717.pdf. Accessed April 14, 2010.
United States v Gaubert, 499 US 315 (1991).
Jacobson v Massachusetts, 197 US 29 (1905).
United States Constitution Amend. X.
Emergency Management Act, Chapter 31—Liability—Del. Code Ann. 20 §3144 (2010). Available at http://delcode.delaware.gov/title20/c031/sc05/index.shtml. Accessed December 2, 2010.
Strouse DS: Public Health Law: A Judicial Reference Guide for Arizona Courts. Available at http://www2a.cdc.gov/phlp/docs/Judiciary%20-%20Arizona%20Bench%20Book%202.pdf. Accessed December 2, 2010.
Stafford Act codified 42 USC §5149(b) (2010). Available at http://codes.lp.findlaw.com/uscode/42/68/III/5149. Accessed December 4, 2010.
National Disaster Medical System law codified 42 USC §300hh- 11(d)(1) (2010). Available at http://vlex.com/vid/preparednessbioterrorism-emergencies-19253094. Accessed December 4, 2010.
5 CFR §213.3102(i)(2) (2010). Available at http://edocket.access.gpo.gov/cfr_2002/janqtr/5cfr213.3102.htm. Accessed December 4, 2010.
Hodge J, Anderson ED: Principles and practice of legal triage during public health emergencies. NYU Ann Surv Am L. 2008; 64: 249-291.
United States Constitution Amend.V.
United States Constitution Amend. XIV.
Published
How to Cite
Issue
Section
License
Copyright 2007-2023, Weston Medical Publishing, LLC
All Rights Reserved
