Transcript scholarworks.iupui.edu

Pandemic Influenza Response:
Virginia’s Approach to Providing
Care
Karen Remley, M.D., M.B.A.
Virginia State Health Commissioner
Steven D. Gravely, J.D., M.H.A.
Partner, Healthcare Practice Group
Troutman Sanders LLP
Virginia’s Preparedness Efforts
• 2004 – Rewrite Virginia’s Quarantine and Isolation
statutes
• 2005 – Create immunity for MRCs and CERTs
• 2006 – HIPAA and EMTALA legal analysis
• 2006 – Initiate altered standards of care planning project
• 2007 – Develop HR Consensus Policy Statements and
Report
• 2008 – Statute granting immunity for healthcare
providers providing care during emergency goes into
effect
• 2008 – Continuity of operations and financial
sustainability initiative
• 2008 – Development of alternate care site planning tool
• 2009 – Implementation of alternate care site planning
tool
Altered Standards of Care:
The Context
• Healthcare system is under significant
stress
• Staff shortages currently exist
• “Just in time” model is prevalent
Introduce a significant event into this
environment and substantial disruptions to
the delivery of care are inevitable.
What is an “altered”
standard of care?
• “Altered standards of care” is somewhat
misleading
– Confusion between the “medical” standard of care
and the “legal” standard of care
• Focus should be allocation of scarce critical
resources
• Health care providers must plan now for
allocating scarce resources in disasters
• This is difficult to do in a legal vacuum
“Ideally, hospitals should be able to follow
guidance and decision support tools to make
resource allocation decisions that are sanctioned
and approved at the Federal level and distributed
by the State. Even with the support of these tools
or policies, however, it is the hospital that will
have to take on the role of implementing them…If
no guidance exists, it will be incumbent on the
hospital to have a plan or strategy for bringing
together the appropriate personnel who can make
the best decisions possible and reevaluate the
situation during each planning cycle.”
Source: AHRQ Providing Mass Medical Care with Scarce Resources:
A Community Planning Guide (November 2006)
Virginia’s Response
• Healthcare providers are essential to any
disaster response and recovery scenario
• Healthcare providers need assurance that
they will not be unfairly singled out after a
disaster for liability
Altered Standards of Care Work
Group
• Convened by VHHA in 2006
• Diverse representation from across the
state
– Hospitals
– Providers
– Emergency Planners
– Health Department
– General Assembly
Providing care with limited
resources
• Two possible deliverables from Work Group:
– Detailed standards and algorithms for determining treatment
– Detailed process that hospitals can use to develop facility
specific algorithms
• Work Group chose process
– Consensus that VDH should not prescribe how to provide care
and allocate scarce resources
– No “one size fits all” algorithm
– Consistency in process is the goal rather than consistency in
result
• Work Group developed a comprehensive planning guide
for dealing with shortages of critical resources
– Initial version 2006
– Updated June 2008
Planning Guide Framework
• Pre-Event/Preparedness
–
–
–
–
–
Establish critical resource planning committee
Conduct critical resource vulnerability analysis
Establish baseline ethical principles to guide responses to a shortage
Address operational issues
Develop critical resource response plans
• Shortage of material resources
• Shortage of physical space
• Critical personnel shortage
– Create triage protocols
– Create mechanisms to operationalize intra-event ad hoc response plan
development
– Modify EOP and ICS
– Educate staff
– Exercise/drill
Planning Guide Framework
• Intra-Event/Response
– Report critical resource shortage
– Determine whether there is an existing critical resource response
plan
– Develop ad hoc critical resource response plans, if needed
– Implement plan
– Modify plan as needed
– Terminate critical resource response plans
• Post-Event/Recovery
– Provide psychological support services to employees, staff and
MDs
– Evaluate critical resource response plans
– Modify plans as needed
– Provide support services to patients and their families
For questions, please contact
Karen Remley
[email protected]
(804) 864-7005
or
Steve Gravely
[email protected]
(804) 697 - 1308