Spilka, DeLeo slam crisis care standards

Promise legislative action but offer no specifics

VOWING LEGISLATIVE ACTION, the heads of the Massachusetts House and Senate on Thursday night said they agree with lawmakers who do not believe that Baker administration guidance on COVID-19 crisis care standards adequately accounts for health care disparities among communities of color.

“We are committed to creating a response to this pandemic that protects all residents of Massachusetts while addressing treatment and outcome disparities among communities of color,” House Speaker Robert DeLeo and Senate President Karen Spilka said in a joint statement. “The Legislature will act to ensure a mechanism for robust data collection and establish a diversity task force to make recommendations around equitable access to care during this public health emergency.”

The House and Senate leaders said they agree with lawmakers who say the recently announced Department of Public Health standards must be improved, and are “united in our strong belief that we must be vigilant about the disparate impacts of the COVID-19 pandemic on communities of color in Massachusetts.”

The statement did not reference a legislative proposal or say when the Legislature would take action, but the matter is time-sensitive since the care standards govern access to potentially life-saving treatment in situations where overwhelmed health care providers may have to choose which patients to prioritize.

The April 7 guidance, while voluntary, is intended to give hospitals a roadmap if the number of coronavirus cases in Massachusetts surges, as is feared, to the point that health care facilities encounter shortages of equipment, staff or beds to accommodate the need.

If it becomes a crisis, the guidance recommends that providers focus on maximizing the number of life years saved, not simply trying to save the most lives. Race, gender, ethnicity, disability or incarceration status are among the qualifiers that should have no bearing on the determination.

“Patients who are more likely to survive with intensive care are prioritized over patients who are less likely to survive with intensive care. Patients who do not have serious comorbid illness are given priority over those who have illnesses that limit their life expectancy,” the guidance recommends.

On March 22, DeLeo and Spilka issued another joint statement touting legislation that they said would offer a critical safety net to renters and homeowners at risk of eviction or foreclosure due to the COVID-19 crisis. That bill is close to final passage, but stalled Thursday in the House, which was meeting without a quorum.

DeLeo and Spilka aides did not respond when asked how they could be sure the Legislature would act on their time-sensitive idea since opposition or concerns from any member can slow bills down during informal sessions.

The Legislature has ceased holding well-attended formal sessions during the state of emergency due to social distancing guidelines that everyone has been urged to follow to slow the spread of COVID-19. At formal sessions, decisions can be made by majority vote; individual members have more power in informal sessions.

On April 9, the Massachusetts Black and Latino Legislative Caucus wrote a letter to Baker urging him to pause the just-announced standards. The caucus said the guidelines “allow hospitals to choose which comorbidities to consider in their decision-making process” but added that “many comorbidities disproportionately impact minority communities due to health inequities from years of systemic racial injustices.”

“It is apparent that some severe diseases and conditions may warrant a standard of care protocol,” said caucus chairman Rep. Carlos González (D-Springfield). “However, utilizing points for conditions that we already know are rampant in low-income communities due to historic health disparities is unconscionable.”

In their statement Thursday night, DeLeo and Spilka also said that they continue to have policy discussions “about how to anticipate which communities will be unduly affected by COVID-19 and how to respond accordingly to ensure that all populations are treated equitably during this crisis.”

Carlene Pavlos, executive director of the Massachusetts Public Health Association, applauded the DeLeo-Spilka statement.

Meet the Author
“Massachusetts cannot stand idly by while this outbreak sweeps through communities of color and other marginalized populations, exacerbating already-staggering health inequities,” Pavlos said. “Today’s commitment from the Senate President and Speaker is an important statement of principle that the status quo is unacceptable, and we applaud them for it. Time is of the essence as we tally up higher and higher death counts by the day; we ask now for swift action from the legislature and the Baker Administration to put these principles into action.”

The next House and Senate sessions are at 2 p.m. Friday.