Utah’s political leaders and health care associations would have veto power over future medical rationing plans brought forward by the state’s health department under a new bill.
The bill touches on one of the latest political flashpoints related to the pandemic — the rationing of scarce COVID-19 treatments — with right-wing personalities and some Utah Republicans complaining about considering race when allocating medical resources.
Last month, the Utah Department of Health (UDOH) eliminated race and sex from the list of factors used to determine who gets monoclonal antibodies and antiviral treatments. Those characteristics were originally included as factors based on clinical data showing men and patients of color are at heightened risk of hospitalization or death from coronavirus.
The new legislation sponsored by Sen. Lincoln Fillmore would require the state health department to send any future medical rationing proposals to the governor, Senate president, House speaker and UDOH executive director for review. If the criteria would affect hospitals or health care workers, the plan would also have to go to the main professional associations representing them in the state.
The drafted criteria would have to remain on hold for at least 10 days, and even then, couldn’t take effect without approval from all the state officials and groups listed by the bill.
The bill, SB194, would also call on a legislative panel to examine all the state health department’s existing medical rationing plans and offer recommendations about whether to continue, suspend or modify them.
UDOH officials would have to report back to the Administrative Rules Review Committee within 15 days about whether it would follow the panel’s recommendations and would have to explain the rationale behind any refusal to comply.
The legislation would not prevent private groups from developing their own rationing plans.
The department last month cited “legal concerns” as the reason it took sex and race out of the formula for determining which patients should get prioritized for monoclonal antibodies and antiviral pills. These attributes were just two of the many factors the agency had used in calculating a patient’s “risk score.”
Just weeks before that, Tucker Carlson of Fox News falsely claimed that health officials in Utah and other states were giving priority to people of color to “punish” white people. Shortly thereafter, a conservative advocacy group, America First Legal, threatened to sue Utah for including race and ethnicity in its risk calculator.
New York, unlike Utah and Minnesota, chose not to eliminate race and ethnicity from its scoring system. And America First Legal, a group led by former Trump adviser Stephen Miller, has taken New York to federal court over its criteria.
Dr. Andrew Pavia, pediatric epidemiologist at Intermountain Primary Children’s Hospital, posted an article about the legal action on Twitter and said the controversies are based on inaccurate information and efforts to inflame.
“The well-oiled outrage machine claiming a ‘threat to white people’ appears to have derailed data driven attempts to address health disparity in [Utah] and [Minnesota],” Pavia tweeted. “Former Trump adviser falsely claims states are rationing scarce covid treatments based largely on race.”
When asked about Fillmore’s bill, Pavia said “there are best practices for making these hard decisions that have been developed over years.”
“Assembling medical experts, public health experts, an ethicist and a representative(s) of the public and specifying the values you are trying to achieve provides expertise and balance,” he continued. “This should not be a purely political decision.”
Fillmore, R-South Jordan, didn’t immediately respond to a request for comment on his bill.
Greg Bell, president and CEO of the Utah Hospital Association, says a committee of experts is currently in charge of developing the state’s health care rationing plans. UDOH contracts with the hospital association to assemble the crisis standards of care workgroup, which has representatives from the state’s primary health systems and from the health department.
The group prepares medical triage plans for situations when Utah’s health providers are overwhelmed, such as after a major earthquake or mass shooting, he said. The state’s governor is in charge of invoking these plans, called “crisis standards of care,” during an emergency.
Some states have moved to these crisis standards during the pandemic, and while Utah has come close, it has never had to resort to health care rationing, Bell said.
The crisis standards workgroup also supervised the creation of the prioritization plan for distributing limited monoclonal antibody and antiviral treatments, he added. Policies proposed by the workgroup are then adopted by UDOH, he said.
Bell declined to comment on the particulars of Fillmore’s bill.