Hospitals warned against denying care to those with disabilities

The federal government has issued new guidance advising healthcare organizations to ensure proper treatment of patients with disabilities.

The U.S. Department of Health and Human Services issued the guidance Friday. The agency said those with disabilities must not be denied essential care and said scarcity of resources is not an excuse. Denying treatment to patients with disabilities is a violation of federal law, the agency said.

HHS Secretary Xavier Becerra said civil rights laws aren’t to be ignored in public health emergencies or disasters. The department said that includes the COVID-19 public health emergency.

“The pandemic has shone a light on the disparities in our healthcare system and provided us with a new opportunity to address them in a meaningful way,” he said in a statement. “Protecting people with disabilities from being discriminated against in crisis situations is a critical part of this work, and we are continuing to evaluate our operations Department-wide to ensure accessibility.”

Specifically, the guidelines also apply to healthcare providers operating under “Crisis Standard of Care” plans that prioritize resources. The guidelines were issued by the HHS Office of Civil Rights.

Lisa J. Pino, director of the HHS Office of Civil Rights, said bias can’t be a determining factor in who gets care.

“During a public health emergency like the COVID-19 pandemic, biases and stereotypes may impact decision-making when hospitals and other providers are faced with scarce resources,” Pino said in a statement.  “OCR will continue our robust enforcement of federal civil rights laws that protect people with disabilities from discrimination, including when Crisis Standards of Care are in effect.”

Healthcare providers can’t deny those with disabilities “medical supplies, administration of medication, hospitalization, long-term care, and intensive treatments and critical care, such as oxygen therapy and mechanical ventilators.”

Healthcare organizations can’t deny COVID-19 testing, the department said.

To avoid discrimination, healthcare providers using Crisis Standards of Care should weigh each patient’s likelihood of recovery with treatment.

Hospitals can deny care if a treatment is unlikely to be effective, but the assessment should come after determining “that patient’s ability to respond to the treatment being sought.”

HHS advises against using the disability in the decision, “unless that underlying condition is so severe that it would prevent the treatment sought from being effective or would prevent the patient from surviving until discharge from the hospital or shortly thereafter.”

Hospitals are also advised in weighing mortality predictions on the condition that requires treatment and not on the patient’s disabilities. The HHS guidance said weighing the disability in mortality predictions is less grounded in medical evidence, and providers may lack the knowledge of life expectancy for every disability or underlying condition.

The department included a list of frequently asked questions regarding the civil rights for those with disabilities.

There’s been increased attention focused on the quality of care involving individuals with disabilities. Pregnant women with disabilities have been found to have more complications, according to one recent study. Doctors need to be more comfortable treating pregnant women with disabilities, the researchers said. Another study found doctors lack confidence in treating people with disabilities.

Last month, Rochelle Walensky, director of the U.S. Centers for Disease Control and Prevention, apologized after saying it was “encouraging” that many of those who died due to the Omicron variant had other comorbidities. More than 150 advocacy groups for those with disabilities signed a letter urging her to apologize and said many with disabilities have lost trust in health leaders during the pandemic.

“The public health response to COVID-19 has treated people with disabilities as disposable,” the letter stated.