Sheri Fink, ProPublica – by October 16, 2009 6:44 pm EDT

Florida health officials are drawing up guidelines that recommend barring patients with incurable cancer, end-stage multiple sclerosis and other conditions from being admitted to hospitals if the state is overwhelmed by flu cases.

The plan, which would guide Florida hospitals on how to ration scarce medical care during a severe flu outbreak, also calls for doctors to remove patients with a poor prognosis from ventilators to treat those with better chances of survival. That decision would be made by each hospital.

The flu causes severe respiratory illnesses in a small proportion of cases, and people who need ventilators and are deprived of them could die without the breathing help the machines provide.

In June, Florida Surgeon General Ana M. Viamonte Ros sent the draft guidelines (PDF [1]), which already had undergone a series of internal revisions, to 16 state medical organizations for comment.

But the state has not yet publicized the guidelines or solicited input from the general public.

The Health Department released a version of the draft plan at the request of ProPublica, a nonprofit news organization, which provided a copy to the Orlando Sentinel.

The document, drawn up by a team from across Florida that included Orange County Health Director Dr. Kevin Sherin, addresses one of the most delicate issues in medicine: what to do if the number of severely ill people needing ventilators and other treatment dramatically exceeds what is available.

The goal, the plan says, is to focus care on patients whose lives could be saved and who would be most likely to function better if they were given whatever resources were available. It says those decisions are not to be made based on patients’ perceived social worth or social role, but the plan calls for different rules for some populations.

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