Two powerful senior advocacy groups are seeking to remedy the state’s health care rationing plan, which uses age as a tiebreaker to deny care under certain conditions.

Hawaii’s COVID-19 surge has not gotten bad enough to invoke its Crisis Standards of Care Triage Allocation Framework, which is a statewide effort to plan for worst-case scenarios in the event there are not enough medical resources for everyone.

The framework, which was not written by the state, was developed last year by 21 Hawaii physicians representing health care systems across the state.

Kokua Council sent a letter to Hawaii Gov. David Ige and Dr. Libby Char, state Department of Health director, on Monday asking them to revise or rescind the plan. AARP Hawaii also is writing to the Department of Health and the Triage Allocation Framework Core Development Team to inform them that guidance from medical ethicists and the Office of Civil Rights in the Department of Health and Human Service Administration has changed, and that the latest plan should remove age discrimination.

The state’s most recent plan for health care rationing was updated Sept. 15 and posted to the DOH website at bit.ly/398XbXB. Ige and Char have declined to say whether they support the plan. But Lt. Gov. Josh Green, an emergency room physician, has been speaking out against health care rationing in Hawaii or in any other state.

Keali‘i Lopez, AARP Hawaii state director, said in a statement that “based on recent actions and guidance from the Office of Civil Rights, we believe not specifying that age should not be considered in the Crisis Standards of Care and including concepts like life cycle and age 65 as a cutoff for health care in tiebreaker situations may violate federal age discrimination laws.”

“We also note that the latest guidance from The American Academy of Medicine specifically states that age should be removed as a factor in Crisis Standards of Care.”

Larry Geller, speaking on behalf of the Board of Kokua Council, said in a Sept. 20 letter to Ige and Char, “The entire document should be reviewed and cleansed of discriminatory language. Allocation of scarce resources should be based on clinical needs and medical condition as in any customary triage situation.”

Geller’s letter said older patients had poorer outcomes in 2020 than they do now, especially since almost 100% are vaccinated in Hawaii.

Geller said the framework also goes against federal guidelines by giving “tacit approval to discrimination by age,” each time it fails to list age as a protected category.

He added that another example of age discrimination is denying resources to those with a Portable Medical Order, or POLST, calling for comfort measures only, as younger people do not often have a POLST on file, and it’s inapplicable in a situation where death is not expected.

Geller’s letter said Kokua Council also “supports and strongly recommends that all who are eligible get vaccinated.”

“That way we avoid as much as possible placing ourselves in a situation where others will be making decisions about our care,” he said.

Jodi Leong, a spokeswoman for Ige, said, “The governor appreciates the Kokua Council’s input and support of vaccinations for all who are eligible. He must review and discuss this proposal with Dr. Char, the Attorney General and the healthcare community before he is able to comment.”

This is the second time that the Kokua Council has pushed back on the state’s pandemic policies, and the third time that it’s taken DOH to task in recent years.

The Hawaii Supreme Court ultimately denied Kokua Council’s petition last year to compel the Department of Health to increase the number of COVID-19 contact tracers in Hawaii and to require that the agency improve translation services.

But Geller said Kokua Council’s actions, along with DOH whistleblower Dr. Jennifer Smith and the Senate Special Committee on COVID-19, resulted in the resignation of former DOH Director Dr. Bruce Anderson as well as the state adding more contact tracers and translators.

Geller said about four years ago the Kokua Council successfully sued the DOH because the department was not posting inspection reports of state-licensed care facilities online as had been required by a 2013 law.