By Dan Carden, Times of Northwest Indiana

INDIANAPOLIS | Some cancer patients, heart attack sufferers and burn victims would be removed from ventilators and left to die if pandemic flu patients overwhelmed Indiana's hospitals.

The goal would be to save the most lives as possible, according the Indiana State Department of Health.

But a draft copy of Indiana's "Altered Standards of Care" guidelines reveals that if faced with overwhelming demand, Indiana hospitals would establish what amount to "death panels."

A "triage review officer" would decide who gets access to hospital staff and equipment and, likely, who lives and who will die.

In a pandemic emergency, hospital patients and those seeking care would be scored every day using a system known as the Sequential Organ Failure Assessment. The same system would be used across the state to ensure accountability and gain public confidence, according to the August 2008 draft guidelines.

Based on their score, patients either would receive treatment, get to stay in their hospital bed for another day or be sent home to die.

"Decisions on the use of scarce resources must be heavily weighed against the chances for survival," the 27-page guidelines say. "Age, social worth and job function will not affect triage-allocation decisions."

Ventilators, machines that move air in and out of the lungs for people with difficulty breathing, are expected to be especially scarce in a flu pandemic.

According to the guidelines, ventilator tubes would be literally pulled out of patients "with the highest probability of mortality."

Those patients would be transferred to palliative care, which focuses on reducing pain and suffering before death.

The equipment would be transferred to treat someone deemed more likely to survive.

"Difficult decisions will need to be made regarding patient care and allocation of scarce resources," the guidelines acknowledge. "Hospitals will no longer be able to provide all things to all people."

Northwest Indiana residents actually may be in the best position in the state, because they can more readily seek treatment in Illinois or Michigan hospitals if Indiana's cannot provide services.

The guidelines already recommend Hoosier hospitals try to place children in out-of-state hospitals if there's no room for them in Indiana.

Jennifer Dunlap, a spokeswoman for the state health department, confirmed that this is Indiana's plan.

The guidelines remain in draft form because officials are still revising the criteria under which they'd take effect, she said Friday.

President Barack Obama declared on Oct. 23 that the H1N1 flu pandemic, also known as swine flu, is a national emergency. That declaration gives the U.S. Department of Health and Human Services the power to bypass federal rules and open additional hospitals or other centers for treatment.

A similar Indiana emergency declaration is not imminent, Dunlap said.

She said H1N1 flu "is starting to become a challenge" for hospitals. "But it isn't anywhere near where they're feeling overwhelmed and would need to get to the point of alternative standards of care."

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