Texas considers making vaccination status a factor for ICU access

With bed shortages possible, doctors revisited decision-making guidelines

Texas medical leaders preparing for potential ICU bed shortages have discussed taking a patient’s vaccination status into account when making critical care decisions.

The Dallas Morning Post published the contents of a leaked email sent to members of the North Texas Mass Critical Care Task Force from  co-chair Dr Robert Fine.

It quoted a section that said: “COVID-19 vaccination decreases severe infection and death. Vaccine status therefore may be considered when making triage decisions as part of the physician’s assessment of each individual’s likelihood of survival.”

The planned strategy caused outcry, as medical ethicists pointed out that factoring in vaccination status would unfairly impact low-income people and people of colour – groups who have been historically disadvantaged when it comes to accessing medical care.

Dr Harald Schmidt, a professor of medical ethics and health policy at the University of Pennsylvania, said such an approach would risk adding to existing injustices.

“This policy pretends that it is just focusing on objective medical knowledge, but it ignores societal injustices,” Dr Schmidt said. “In such cruel clarity, COVID-19 has exposed the consequences of the structural inequities that we’ve had so long. That’s why it’s critical that we don’t add to that, and in this case, we risk that.”

Dr Mark Casanova, a spokesperson for the task force was interviewed about the planned policy on NBC 5 shortly after the email was leaked. He described it as a brief internal memo summarising task force discussions for members, adding that vaccine status was something doctors could consider in limited situations.

However, in a second interview later the same evening, Dr Casanova appeared to reverse the group’s decision. Having spoken with members of the task force, he said the email had been a “homework assignment” to prompt feedback.

In the future, he clarified, vaccination status would not be among the factors hospitals are told to consider when making critical care triage decisions.

“In the midst of this reconvening, and exploration and discussion with various triage committee members, the consensus is vaccination status, or more specifically a lack of a vaccine will not be considered as part of any exclusion criteria for treating patients,” he said.