By Susan Brinkmann, OCDS Staff Journalist Florida health officials have drawn 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. According to ProPublica.com, the plan guides Florida hospitals on how to ration scarce medical care during a severe flu outbreak. It also calls for doctors to remove patients with poor prognoses from ventilators to treat those who have better chances of surviving. That decision would be made by the hospital. Florida Surgeon General Ana M. Viamonte Ros sent the draft guidelines to 16 state medical organizations for feedback in June, but has yet to publicized the guidelines or solicited input from the general public. The Florida Department of Health released a copy of the draft plan at the request of ProPublica, a nonprofit news organization. The goal of the plan is to focus care on patients whose lives could be saved and who would be most likely to improve. Even though these decisions are not to be made based on a patients' perceived social worth or role, it does provide different plans for certain populations. The guideline’s list of conditions that would disqualify someone from being admitted to a hospital would only be applied in a worst case scenario, or if they were being transferred from “other institutional facilities” such as nursing homes and mental health facilities. However, in the case of a much more severe outbreak, the guidelines call for hospitals to turn away anyone whose doctor has signed a "Do Not Resuscitate" order, which instructs rescuers not to revive a patient whose heartbeat or breathing stops. The Florida plan also calls for intensive care unit patients and those using ventilators to be reassessed after 48 to 72 hours. “Those whose chances of survival have significantly worsened would be taken off the machines or discharged from critical care to make way for others who may have a better chance of survival,” ProPublica reports. “If needed, they would be given palliative care to keep them comfortable.” The guidelines also outline how the health care system should stretch critical resources before moving to ration care, such as reusing supplies, canceling unnecessary surgeries and training staff to perform additional tasks. Florida's draft guidelines aim to provide the "greatest good for the greatest number" when doing the best for all patients is no longer possible. Florida plans to accept public input after the guidelines are revised by health officials, ProPublica reports. However, in many states, doctors, lawyers and ethicists are writing guidelines for hospitals with little or no engagement with the public, or with groups representing children, the elderly and the disabled. For instance, when Utah tested a similar plan in late August, the drill revealed many difficulties that Florida clinicians and patients will be likely to encounter if the guidelines are approved. Utah family physician Pete DeWeerd told ProPublica that he had to tell a mock patient's mother that her seven year-old daughter, who had cerebral palsy and was suffering from the flu, would be turned away from the hospital and likely die. "I don't like to tell you this," he said he told her, "it feels unfair, but our list is our list is our list." He added: "It was awful. You get a huge lump in your throat." Dr. Tom Kurrus, medical director of St. Mark's Hospital in Salt Lake City, called it "emotionally draining" when mock patients and family members yelled, screamed and took issue with who was denied treatment. "The major weakness in our preparedness had to do with security," he said. Ken Goodman, who directs the University of Miami bioethics program and the Florida Bioethics Network, said guidelines determining how care will be given during an emergency should be open to the public and always subject to revision. "This should be an ongoing process that includes new evidence as it becomes available and that includes, in an open society, the participation of citizens," he said. © All Rights Reserved, Living His Life Abundantly®/Women of Grace®  http://www.womenofgrace.com