HEALTH

Disability rights groups file federal complaint about 'medical rationing' in Arizona

Stephanie Innes
Arizona Republic

Two Arizonans and several advocacy groups have filed a federal complaint that argues that the state's crisis standards, allowed because of COVID-19, discriminate against older Arizonans, people of color and those with disabilities.

The crisis standards guide the allocation of scarce resources to patients based on factors such as their likelihood for survival. Arizona Department of Health Services Director Dr. Cara Christ on June 29 authorized hospitals in the state to activate the standards if needed.

The protocols in Arizona's Crisis Standards of Care and an addendum to the standards are putting some Arizonans at risk for "imminent harm," says the 20-page July 17 complaint to Roger Severino, director for the Office for Civil Rights at the U.S. Department of Health and Human Services.

The complainant asks the Office of Civil Rights to review the Arizona "Crisis Standards of Care" and addendum, "to ensure discriminatory decisions regarding the allocation of life-saving medical care do not occur in Arizona."

Longstanding discrimination against people with disabilities and people from communities of color by the U.S. health care system had led to a higher rate of underlying health conditions and lower life expectancy among those groups, the complaint says. For that reason, the complaint says, triaging people based on life expectancy is inherently unfair.

Arizona Gov. Doug Ducey's office is aware of the complaint, spokesperson Patrick Ptak wrote in an email.

"Our priority is ensuring all Arizonans have access to medical care, and that is the case," Ptak wrote. "Arizona hospitals have capacity and are not triaging care — nor has any hospital at any point in the outbreak triaged care."

Two individuals with disabilities part of complaint

The crisis standards offer the potential for some people with disabilities being "erroneously perceived as having a shorter life expectancy," says the complaint, filed by the Arizona Center for Disability Law, the Arc of Arizona, the Arizona Center for Law in the Public Interest and the Native American Disability Law Center.

Several other disability and civil rights groups signed on in support, including the American Civil Liberties Union of Arizona and the Bazelon Center for Mental Health Law.

In addition to disability and civil rights groups, the complaint was filed by two individuals, both Arizona residents — Donna Jeffrey, 47, who has muscular dystrophy, and Joseph “Joey” Zachary, 27, who has cerebral palsy. Both have outlived medical providers' original estimates and are worried that if they are hospitalized with COVID-19, their life expectancy would be similarly misjudged.

The Arizona Crisis Standards of Care and an addendum to the document "place many people with disabilities, older adults, and people from communities of color, at significant risk of harm, and possibly death," says the complaint, filed to the U.S. Department of Health and Human Services July 17.

"These protocols offer the potential for systemic and systematic discrimination against vulnerable populations across Arizona in the provision of healthcare, including those represented by the individuals and organizations that are party to this complaint."

Arizona ranks second in U.S. for its COVID case rate

Although the original crisis standards document and addendum contain general prohibitions against using race or age to justify de-prioritizing care, the complaint argues that the addendum contains several provisions that could lead to discrimination against people with disabilities, older Arizonans and individuals from communities of color.

Factors such as an evaluation of one- to five-year mortality could easily lead to discrimination against communities of color because, for example, Black people statistically have a shorter life expectancy than white people, the complaint states.

"Further, accurate predictions of life expectancy of up to five years are extremely difficult under normal circumstances, and in the context of a pandemic where expedited triage decision-making will occur, it is nearly impossible," the complaint says.

Christ told reporters June 29 that allowing hospitals to activate the standards was a "proactive step."

“It gives the hospitals a framework that allows them to determine if they do get short of resources, how they can allocate those,” Christ said at the time.

Public health experts have begun to notice signs Arizona's COVID-19 outbreak may be moderating, but more time is needed to know for sure. 

Still, Arizona continues to be severely impacted by COVID-19. As of Monday, Arizona ranked second in the country for its rate of COVID-19 infections per 100,000 people behind New York City, data from the U.S. Centers for Disease Control and Prevention's COVID Tracker said. The CDC separates New York City from New York state in the rankings.

Arizona's rate of COVID-19  is 2,002.7 cases per 100,000 people, the CDC data says. The U.S. average is 1,147.5 cases per 100,000 people.

Arizona's death rate remains lower than many other hard-hit areas. Its death rate is 38.5 deaths per 100,000 people. The COVID-19 death rate in New York City, by comparison, is 287.7 deaths per 100,000 people, according to the CDC data.

Arizona Republic reporter Alison Steinbach contributed to this article.

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes

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