4

HOSPITALS are using a points system heavily weighted against the elderly to determine which patients should be sent to intensive care during the pandemic, the Irish Sun has learned.

The patient evaluation process at major hospitals along the west coast ranks patients by age and medical conditions and sometimes by gender.

⚠️ Read our coronavirus live blog for the latest news & updates

4 Patients are given points for their age with people over 80 hit with seven points – just one shy of the exclusion total (Stock Image) Credit: Getty Images - Getty

4 People will receive points in the scoring system for pre-existing medical conditions (Stock Image) Credit: Getty Images - Getty

4 The document then advises that patients with a score of over eight points they should not be admitted to ICU for intubation or mechanical ventilation (Stock Image) Credit: Getty Images - Getty

Guidelines established by the Saolta Hospital Group show that anyone who scores more than eight points in the system should not be sent to ICU during the Covid-19 crisis.

A document, seen by the Irish Sun, was circulated to key staff working in hospitals such as UH Galway, Sligo UH, Mayo UH, Letterkenny UH and Roscommon UH.

The Covid Evaluation Scoring System kicks in when hospitals are unable to determine on the basis of age, infirmity or severe illness alone whether they should be sent to ICU or not.

The system is used to determine whether a combination of factors would make them unlikely to survive treatment on a ventilator.



POINTS SYSTEM

Patients are given points for their age with people over 80 hit with seven points – just one shy of the exclusion total - despite government ethical guidelines advising that patients should not be excluded from treatment because of their age.

Men also on occasion receive more points than women in the scoring system with one point given to males aged between 50 and 60 and no points given to females in the same age bracket.

The points climb with age with two points for men ages 61 to 65 and one point for women in the same age sector.

Three points are given to men between 66 and 70 (two for women), five points for men between 71 and 75 and four points for women of the same age.

Patients between 76 and 80 are given six points and those over 80 are given seven points regardless of gender.

The Government’s Ethical Framework for Decision Making in a Pandemic states that exclusion for treatment on the basis of age should be avoided as “this can imply that some age groups are worth saving more than others.”

MEDICAL CONDITIONS

People will also receive points in the scoring system for pre-existing medical conditions such as congestive heart failure with clocks up two points and hypertension which costs one point.

People with respiratory issues have higher points with COPD given two marks and those on home oxegen given three.

Patients with neurological conditions also rank poorly with dementia giving two points and advanced parkinson’s disease giving three points.

One or two points is given for diabetes depending on the severity of the condition with obesity also effecting people’s ability to receive intensive care.

People suffering from obesity receive points ranging from one for those with a BMI of 35-40 to 6 for anyone with a BMI of greater than 60.

The document then advises that if a patient has a score of over eight points they should not be admitted to ICU for intubation or mechanical ventilation.

The document states that many patients will have “insufficient physiological reserve to survive intubation and mechanical ventilation to the point of hospital discharge.”

ETHICAL FRAMEWORK

It says: “A score of 8 or more makes the patient a poor candidate for intensive care and unlikely to be offered an intensive care bed.”

Under the scoring system an 80 year old man with dementia, a 76 year old woman with advanced Parkinson’s or an otherwise healthy 71-year-old man who had received a solid organ transplant would not be sent to ICU if they attended hospital with COVID19.

The guidelines advise that these patients may still benefit from aggressive therapy and enhanced nursing but if their condition doesn’t improve they should be given palliative care.

The Irish Sun understands that patients who are deemed not fit enough to be intubated or put on mechanical ventilation – both of which can be difficult to come off of – are put on non invasive ventilation in other wards in the hospital with oxygen masks.

The document was circulated among the Saolta Hospitals critical Care Division and it is unclear if the same points system is in operation in different hospital groups.

A spokesperson told the Irish Sun: “All patients are given treatment based on their clinical need and the potential benefit of the treatment to the patient. These are the same principles that are used prior to the Covid-19 pandemic.

“In a pandemic, while the ethical principles are the same, it is necessary to switch from a strictly medical ethics approach to decision-making (aimed at the individual level) towards a public health approach (population level) and this ethical framework takes cognisance of this.”

The HSE sent us the same statement when asked about the policy.

A spokesperson said: "The Department of Health published the guidance document Ethical Considerations Relating to Critical Care in the context of COVID-19 on Friday, 3rd April last. The HSE has since disseminated the guidance across the healthcare system.

"This guidance aims to support clinicians in their response to a pandemic to ensure decisions are made in a manner that is equitable, reasonable, proportionate, in compliance with national and international law and which does not discriminate against particular groups or individuals.

"All patients are given treatment based on their clinical need and the potential benefit of the treatment to the patient. These are the same principles that are used prior to the Covid-19 pandemic.

"In a pandemic, while the ethical principles are the same, it is necessary to switch from a strictly medical ethics approach to decision-making (aimed at the individual level) towards a public health approach (population level) and this ethical framework takes cognisance of this."

A source in Dublin’s Mater Hospital said that consultants decide with families whether patients should try intubation or mechanical ventilation.

A hospital source said: “People do have to be prioritised for care because some patients will not be able to cope with intensive care and a lot of families don’t want their loved ones going through it.

“Families are always consulted even if it takes staff asking gardai to help track down a family member for a patient.

“Most of the patients in intensive care since the COVID19 outbreak are in their 50s but there have been some people in their 70s admitted into the ICU.”

Earlier this month, the European Commissioner for Equality Helena Dalli said the virus has revealed discriminatory attitudes towards older people.

DISABILITIES

Head of the Irish Patients Association Stephen McMahon told the Irish Sun: “While it could be argued that age is not ‘a categorical exclusion’ in the Saolta document, the table of weightings clearly suggests that as age increases it becomes a huge handicap on access to intervention settings such as ICU.

“It does not appear to take into account that some elderly people are physically fitter than some young people who will not attract similar weightings.

“What I am advocating for, is that the methodology to assist clinicians to make their clinical decisions is transparent, fair, and ethical, for patients and their families to understand.”

It comes as people with disabilities yesterday raised concerns that they will be lower down the list when it comes to accessing intensive care due to their conditions.

In a report on RTE’s Morning Ireland, Dubliner Tom Clonan, whose 18-year-old son has neuromuscular disease, called for the Government’s ethical guidelines for treatment during a pandemic be changed to add a promise that people with disabilities will not be discriminated against due to their conditions.

He said: “For example, things like down syndrome, autism, cerebral palsy, what I’m looking for is a simple one line amendment or addendum to that document to give us that reassurance.”

MOST READ IN NEWS Exclusive ebb & flu Ireland faces Covid spike lockdown misery at least every four months, prof warns TRAVEL ALERT New Green List with travel restrictions for Irish arrivals at 5 of 7 locations PARTY FURY Gardai disperse crowd at Dublin party on first day of new Covid-19 restrictions ROAD CRASH Man, 40s, dies and two men hospitalised after N7 collision in early hours road tragedy Man, 40s, killed in horror two-car crash in Sligo as three seriously injured hissss-toric find Boy, 9, discovers one of world's most dangerous snakes in back garden

Disabilities Minister Finian McGrath yesterday told the Irish Sun that he has raised this issue a number of times at Cabinet meetings since the COVID19 outbreak began in Ireland.

Representatives of Nursing Home Ireland met with Health Minister Simon Harris to discuss how to tackle the spread of the infection with 149 clusters of the virus breaking out in nursing homes.

Some 167 deaths from COVID19 in Ireland have been patients who came from nursing homes – representing almost half of the death toll.