The U.S. Office of Civil Rights said Wednesday it has resolved a review of an Alabama public health document which included "discriminatory" guidelines for doctors and hospital staff who might be forced to triage life-saving ventilator treatment in the event of a pandemic.

The 2010 document outlined a worst-case scenario where, as a last resort, doctors would have to prioritize care. The document, which the Alabama Department of Public Health said was invalidated by updated guidelines released in February, came to light amid the global coronavirus pandemic, when medical staff in heavy hit areas such as Italy have had to ration some medical treatment as waves of infections overwhelmed hospitals.

The 2010 protocol stated that "persons with severe or profound mental retardation, moderate to severe dementia, or catastrophic neurological complications such as persistent vegetative state are unlikely candidates for ventilator support." Individuals with AIDS may also be excluded, though the protocol says that the presence of HIV "is not an automatic exclusion."

The OCR said in a statement Wednesday it opened a review over concerns that the 2010 guidelines could run afoul of federal anti-discrimination laws, particularly over disability or age discrimination.

OCR Director Roger Severino commended Alabama for "extraordinarily quick action" to address the OCR's concerns in recent weeks.

“OCR commends Alabama for quickly disavowing problematic triage plans and coming into compliance with federal civil rights laws within days of being contacted by our office,” Severino said in a statement. “Persons with disabilities have equal worth and dignity and should not be deprioritized for health care based on a supposedly lower ‘quality of life’ compared to persons without disabilities. Older Americans in Alabama can take solace knowing that their state will not impose blunt age cutoffs for ventilator allocation if, God forbid, there is a shortage.”

More:Alabama ventilator use protocol is 'last resort' guidance, not a directive

The Alabama Department of Public Health said on March 24 that the 2010 protocol was “not a directive.”

The protocol stated that if a hospital exhausts all other resources to provide access to ventilators, it may shift their use away from individuals suffering end-stage organ failure, including neurological failure.

"Alabama and other states are free to and encouraged to adopt clear triage policies, but they must do so within the guardrails of the law," Severino said.

Alabama has agreed to remove all links to the 2010 criteria and will not use similar language in future guidelines, the OCR said.

"Everybody should be treated with dignity and respect," Severino said. "We commend the state for coming forward quickly and working with the Office of Civil Rights."

Severino said Alabama responded "within days" when OCR opened its review.

“Decision(s) for care remain those of the medical professional, as the treating provider, in discussion with the patient and the patient’s family,” ADPH said in a statement in March. “Sometimes clinicians at the bedside will be faced with very difficult decisions, and in a true catastrophe, clinicians will be tasked with making the best possible decisions.”

Severino said in a press call Wednesday that it is a "trying" time because of the coronavirus pandemic, and also said the OCR is reviewing similar plans in other states. He acknowledged that physicians and medical personnel do need guidelines in the event triaging medical treatment is needed.

"My sister is an E.R. nurse. We owe it to people like her to give them clarity on what can and should be done in a crisis situation," Severino said. "They're under enough burden already, and they deserve clear guidance."

Severino said the working plan in New York, one of the hardest hit areas in the U.S., is "thoughtfully crafted" and could be good guidance for other states to follow. The New York guidelines offer sensitivity to disability and age, Severino said, and is "very careful" about what "exclusionary criteria is used in the denial of live-saving care."

"It doesn't mean that everything is perfect. We do have questions about ventilator reallocations in New York," Severino said.

Contact Montgomery Advertiser reporter Melissa Brown at 334-240-0132 or mabrown@gannett.com.