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NYU Langone Health, one of the nation’s top academic medical centers, told emergency-room doctors that they have “sole discretion” to place patients on ventilators and institutional backing to “withhold futile intubations.”
A March 28 email from Robert Femia, who heads the New York health center’s department of emergency medicine, underscored the life-or-death decisions placed on the shoulders of bedside physicians as they treat increasing numbers of coronavirus patients with a limited supply of ventilators.
New York state guidelines, established in 2015, recommend that hospitals appoint a triage officer or committee—someone other than the attending physician—to decide who gets a ventilator when rationing is necessary. The guidelines say that removing the decision from the physician treating the patient avoids a conflict of interest, allows an officer or committee with access to overall ventilator availability to make the call and prevents health worker burnout and stress.
Femia said in his email, which was reviewed by The Wall Street Journal, that experts and leaders at NYU Langone were creating internal guidance on how to allocate ventilators, which are in short supply across New York City. But the emergency department couldn’t afford to wait, he said.
“In Emergency Medicine, we do not have the luxury of time, data, or committees to help with our critical triage decisions,” he wrote. “Senior hospital leadership recognizes this and supports us to use our best clinical judgment.”
Femia wrote that decisions about “airway management” and whether to use a ventilator or other respiratory support devices were at the sole discretion of treating physicians, but he told doctors to “think more critically about who we intubate.”
“For those patients who you feel intubation will not change their ultimate clinical outcome (for example cardiac arrests, some chronic disease patients at end of life, etc) you will have support in your decision making at the department and institutional level to withhold futile intubations,” he wrote, referring to the tubes attached to ventilators that are inserted in the mouths of patients and sit above the lungs.
Jim Mandler, a spokesman for NYU Langone Health, said Femia’s email outlined guidance that had long been in place.