Univeral HC won’t be universal. In the event of a pandemic influenza (like swine flu) or other public health emergency, the demand for healthcare resources and services will dramatically increase. Out of necessity, scarce resources and patient care will have to be allocated so as to “do the greatest good for the greatest number”.
The patient is excluded from hospital admission or transfer to critical care if ANY of the following is present:
1) Known “Do Not Resuscitate” (DNR) status per 64J-2.018, Florida Administrative Code
2) Severe and irreversible chronic neurologic condition with persistent coma or vegetative state.
3) Acute severe neurologic event with minimal chance of functional neurologic recovery (physician judgment.) This includes traumatic brain injury, severe hemorrhagic stroke, hypoxic ischemic brain injury, and intracranial hemorrhage.
4) Severe acute trauma with a Revised Trauma Score < 2. (See Appendix 2)) GCS: _______ SBP: _______ RR: _______ RTS: _______
5) Severe burns with < 50% anticipated survival (patients identified as “Low” or worse on the Triage Decision Table for Burn Victims (Appendix 4) . Burns not requiring critical care resources may be cared for at the local facility (e.g. burns that might have been transferred to a burn center under normal circumstances). Score: ________
6) Cardiac arrest not responsive to ACLS interventions within 20-30 minutes.
7) Advanced untreatable neuromuscular disease (such as amotrophic lateral sclerosis, end stage multiple sclerosis, or spinal muscular atrophy) requiring assistance with activities of daily living or requiring chronic ventilator support.
8) Known chromosomal or untreatable disorders that are uniformly fatal in the first 2 years of life.
9) Incurable metastatic malignant disease.
10) End-stage organ failure meeting the following criteria:
Heart: NYHA class III or IV heart failure (Appendix 6).
Lung: (any of the following)
- COPD with Forced Expiratory Volume in one second (FEV1) < 25% predicted baseline, Pa02 < 55 mm Hg, or severe secondary pulmonary hypertension.
- Cystic fibrosis with post-bronchodilator FEV1 < 30% or baseline Pa02 < 55 mm Hg.
- Pulmonary fibrosis with VC or TLC < 60% predicted, baseline Pa02 < 55 mm Hg, or severe secondary pulmonary hypertension.
- Primary pulmonary hypertension with NYHA class III or IV heart failure, right atrial pressure > 10 mm Hg, or mean pulmonary arterial pressure > 50 mm Hg.
Liver: Pugh score > 7, when available (Appendix 5). Includes bili, albumin, INR, ascites, encephalopathy. Total score: ______
11) Those patients who meet “low priority” criteria (MSOFA score= 0) as defined in Table 1.
Source: Florida Dept. of Health
Yes, death panels are NOT specifically in any of the ObamaCare plans. But the wealthy can’t support ObamaCare more than a couple years then, like Florida, resources will be rationed. Terminal patients – just let’em croak. Elderly patients – just let’em croak. That is what we can expect from ObamaCare.
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