BOISE — An advocacy group for older adults has filed a civil rights complaint against Idaho over the state’s “crisis standards of care” guidelines for hospitals that are overwhelmed by patients amid the coronavirus pandemic.
The group Justice in Aging asked the U.S. Department of Health and Human Services on Tuesday to investigate Idaho’s health care rationing plan — contending it discriminates against older adults and especially older Black and Native American adults by using factors like age in prioritizing which patients may get access to life-saving care.
“Older adults are facing serious risk of discrimination, resulting in death,” because of Idaho’s crisis standards, Justice for Aging attorneys wrote in their complaint letter.
Other states have faced similar complaints in recent months. Since the pandemic began, public health officials in Arizona, Utah and northern Texas have modified their crisis care plans amid complaints from Justice in Aging and other disability rights and civil rights organizations.
Idaho activated crisis standards of care earlier this month after a surge of COVID-19 patients exhausted the resources available in most Idaho hospitals.
Crisis care standards are designed as ethical and legal guidelines for health care rationing, directing scarce resources like intensive care unit beds or ventilators to patients most likely to survive. If there is a shortage of resources, other patients may be treated with less effective methods or, in dire cases, given pain relief and other palliative care.
Idaho Department of Health and Welfare spokesman Greg Stahl said Friday that the department was unaware of the complaint.
“The Patient Care Strategies for Scarce Resource Situations document is grounded in ethical obligations that include the duty to care, duty to steward resources, distributive and procedural justice, and transparency,” Stahl wrote in an email to The Associated Press. “It’s guiding principal is that all lives have value and no patients will be discriminated against on the basis of disability, race, color, national origin, age, sex, gender or exercise of conscience and religion.”
But Justice in Aging said that the standards discriminate by using patients’ remaining “life-years” as a tiebreaker if two generally similar patients need the same resources.
“The tiebreaker language in Idaho is not limited to situations where there are large age differences between the two people needing care. By its terms, it would be applied in situations where there may be very little difference, such as a 60-year-old man and a 61-year-old man,” Justice in Aging’s attorneys wrote to Health and Human Services’ Office of Civil Rights Acting Director Robinsue Frohboese.
The letter added: “When they are so clinically similar as to require a tie-breaker, this would lead to absurd and ageist result of denying care to the 61-year-old man simply because he is as little as one year older.”
Idaho’s standards also a “Sequential Organ Failure Assessment” or “SOFA” score to help doctors determine patients’ likelihood of surviving an illness or injury.
The score considers how well patients’ major organ systems are functioning. But Justice for Aging attorneys say recent studies from Yale University researchers indicate it is not an accurate measure of survival for Black adult patients.
Using age as a tie-breaker violates the federal Age Discrimination Act of 1975 and the Affordable Care Act, said Justice for Aging litigation director Regan Bailey.
The individual patient assessments in the guidelines already account for the impact aging has on the human body, Bailey said, and using it again as a tie-breaker essentially amounts to double-counting age to the detriment of older patients.
“We want the state to not include age as a stand-alone factor,” and to move away from SOFA scores, Bailey. “We’re concerned with the continued reliance on a tool that’s been shown to disproportionately steer Black people away from life-saving care.”
Several entities were involved in crafting Idaho’s crisis plan, including a Disaster Medical Advisory Committee, the Board of Medicine, Idaho State Independent Living Council, officials from the Idaho Attorney General’s office and the Department of Health and Welfare, Stahl said. So far, the tie-breakers haven’t been used in Idaho, he said.
“The need for tiebreaker criteria is expected to be very rare,” Stahl wrote.
Idaho’s coronavirus numbers have continued to surge, leading to record-high hospitalization rates. And the state’s coronavirus vaccination rates remain among the lowest in the nation, with only about 51% of eligible residents fully vaccinated.
Hospitals and health care providers are struggling to treat everyone, with new patients sometimes staying on gurneys for days as doctors desperately try to find enough beds and other resources.
Hospital officials have also reported that the mechanical systems their hospitals use for delivering oxygen into hospital rooms is also struggling to keep up with the high demand from the massive influx of COVID-19 patients.
There were more than 760 coronavirus patients hospitalized statewide as of Sept. 20, according to the Idaho Department of Health and Welfare, including 202 people in intensive care unit beds.
BOISE — Booster doses are now available for certain individuals who received the Pfizer/BioNtech COVID-19 vaccine, the Idaho Department of Health and Welfare announced Friday.
The announcement follows the Food and Drug Administration’s authorization and recommendations from the Centers for Disease Control and Prevention.
Those who are eligible for a single booster dose are those who received their second dose of the Pfizer vaccine at least six months earlier and fall into one of the following categories:
Booster doses are available to the general public at pharmacies, clinics and health care providers statewide, but not at local hospitals. For information about locations, available vaccine brands and appointment details, use the Vaccine Finder at vaccines.gov.
Proof of eligibility is not required, nor is a prescription, according to the release. All doses of the vaccine are free of charge to the patient.
Individuals who received the Moderna or Johnson & Johnson vaccine are not currently eligible for a booster dose.
Visit cdc.gov to see the CDC’s final recommendations.
BOISE — The U.S. Department of Defense is taking input on its plan to build an advanced mobile nuclear microreactor prototype at the Idaho National Laboratory in eastern Idaho.
The department began a 45-day comment period on Friday with the release of a draft environmental impact study evaluating alternatives for building and operating the microreactor that could produce 1 to 5 megawatts of power. The department’s energy needs are expected to increase, it said.
“A safe, small, transportable nuclear reactor would address this growing demand with a resilient, carbon-free energy source that would not add to the DoD’s fuel needs, while supporting mission-critical operations in remote and austere environments,” the Defense Department said.
The draft environmental impact statement cites President Joe Biden’s Jan. 27 executive order prioritizing climate change considerations in national security as another reason for pursuing microreactors. The draft document said alternative energy sources such as wind and solar were problematic because they are limited by location, weather and available land area, and would require redundant power supplies.
The department said it uses 30 terawatt-hours of electricity per year and more than 10 million gallons (37.9 million liters) of fuel per day. Powering bases using diesel generators strains operations and planning, the department said, and need is expected to grow during a transition to an electrical, non-tactical vehicle fleet. Thirty terawatt-hours is more energy than many small countries use in a year.
The department in the 314-page draft environmental impact statement said it wants to reduce reliance on local electric grids, which are highly vulnerable to prolonged outages from natural disasters, cyberattacks, domestic terrorism and failure from lack of maintenance.
The department also said new technologies such as drones and radar systems increase energy demands.
But critics say such microreactors could become targets themselves, including during transportation. Edwin Lyman, director of Nuclear Power Safety at the Union of Concerned Scientists, a nonprofit, said he questioned using microreactors at military bases either at home or abroad.
“In my view, these reactors could cause more logistical problems and risks to troops and property than they would solve problems,” he said. “And unless the Army is willing to spend what it would take to make them safe for use, especially in potential combat situations or foreign operating bases, then I think it’s probably unwise to deploy nuclear reactors in theaters of war without providing the protection they would need.”
He said the reactors would likely be vulnerable during transport.
“There is always going to be a way that an adversary can damage a nuclear reactor and cause dispersal of its nuclear content,” he said.
The Idaho National Laboratory is on the U.S. Department of Energy’s 890-square-mile (2,305-square-kilometer) site in high desert sagebrush steppe, about 50 miles (80 kilometers) west of Idaho Falls. All prototype reactor testing would take place on the Energy Department site.
The lab is considered the nation’s leading nuclear research lab, and has multiple facilities to aid in building and testing the microreactor.
The Defense Department said a final environmental impact statement and decision about how or whether to move forward is expected in early 2022.
If approved, preparing testing sites at the Idaho National Lab and then building and testing of the microreactor would take about three years.
Two mobile microreactor designs are being considered, but the department said detailed descriptions are unavailable as both are in early stages of development. The department said both designs are high-temperature gas-cooled reactors using enriched uranium for fuel.
The type of enriched uranium to be used can withstand high temperatures, “allowing for a reactor design that relies primarily on simple passive features and inherent physics to ensure safety,” the draft environmental impact statement states.
Building the mobile reactor and fuel fabrication would be done outside Idaho, and then shipped to the Idaho National Laboratory where the final assembly, fuel loading and a demonstration of the reactor’s ability to operate would occur.
That demonstration would include startup testing, moving the reactor to a new site, and testing at the second location. The second location would mimic a real-world situation by testing the reactor’s ability to respond to energy demands.
The department said the microreactor would be able to produce power within three days of delivery and can be safely removed in as few as seven days.
PHOENIX — A Republican-backed review of the 2020 presidential election in Arizona’s largest county ended Friday without producing proof to support former President Donald Trump’s false claims of a stolen election.
After six months of searching for evidence of fraud, the firm hired by Republican lawmakers issued a report that experts described as riddled with errors, bias and flawed methodology. Still, even that partisan review came up with a vote tally that would not have altered the outcome, finding that Biden won by 360 more votes than the official results certified last year.
The finding was an embarrassing end to a widely criticized, and at times bizarre, quest to prove allegations that election officials and courts rejected. It has no bearing on the final, certified results. Previous reviews by nonpartisan professionals that followed state law found no significant problem with the vote count in Maricopa County, home to Phoenix. Biden won the county by 45,000 votes, key to his 10,500-vote win of Arizona.
For many critics the conclusions, presented at a hearing Friday by the firm Cyber Ninjas, underscored the dangerous futility of the exercise, which has helped fuel skepticism about the validity of the 2020 election and spawned copycat audits nationwide.
“We haven’t learned anything new,” said Matt Masterson, a top U.S. election security official in the Trump administration. “What we have learned from all this is that the Ninjas were paid millions of dollars, politicians raised millions of dollars and Americans’ trust in democracy is lower.”
Other critics said the true purpose of the audit may have already succeeded. It spread complex allegations about ballot irregularities and software issues, fueling doubts about elections, said Adrian Fontes, a Democrat who oversaw the Maricopa County election office last year.
“They are trying to scare people into doubting the system is actually working,” he said. “That is their motive. They want to destroy public confidence in our systems.”
Trump issued statements Friday falsely claiming the review found widespread fraud. He urged Arizona Attorney General Mark Brnovich, a Republican vying for his party’s U.S. Senate nomination, to open an investigation.
Brnovich, who has been criticized by Trump supporters for not adequately backing the review, did not commit: “I will take all necessary actions that are supported by the evidence and where I have legal authority,” he said in a statement before the report was made public.
The review was authorized by the Republican-controlled state Senate, which subpoenaed the election records from Maricopa County and selected the inexperienced, pro-Trump auditors. On Friday, Senate President Karen Fann sent a letter to Brnovich, urging him to investigate issues the report flagged. However, she noted the review found the official count matched the ballots.
“This is the most important and encouraging finding of the audit,” Fann wrote.
Despite being widely pilloried, the Arizona review has become a model that Trump supporters are pushing to replicate in other swing states where Biden won. Pennsylvania’s Democratic attorney general sued Thursday to block a GOP-issued subpoena for a wide array of election materials. In Wisconsin, a retired conservative state Supreme Court justice is leading a Republican-ordered investigation into the 2020 election, and this week threatened to subpoena election officials who don’t comply.
None of the reviews can change Biden’s victory, which was certified by officials in each of the swing states he won and by Congress on Jan. 6 — after Trump’s supporters, fueled by the same false charges that generated the audits, stormed the U.S. Capitol to try to prevent certification of his loss.
The Arizona report claims a number of shortcomings in election procedures and suggested the final tally still could not be relied upon. Several were challenged by election experts, while members of the Republican-led county Board of Supervisors, which oversees elections, disputed claims on Twitter.
Election officials say that’s because the review team is biased, ignored the detailed vote-counting procedures in Arizona law and had no experience in the complex field of election audits.
Two of the report’s recommendations stood out because they showed its authors misunderstood election procedures — that there should be paper ballot backups and that voting machines should not be connected to the internet. All Maricopa ballots are already paper, with machines only used to tabulate the votes, and those tabulators are not connected to the internet.
The review has a history of exploring outlandish conspiracy theories, dedicating time to checking for bamboo fibers on ballots to see if they were secretly shipped in from Asia. It also served as a content-generation machine for Trump’s effort to sow skepticism about his loss, pumping out misleading and out-of-context information that the former president circulates long after it’s been debunked.