Obama's emergency step aimed to help implement disaster plans

Oct 26, 2009 (CIDRAP News) – In a measure designed to help hospitals respond more quickly to surging numbers of pandemic H1N1 cases, President Barack Obama on Oct 24 signed an emergency declaration that will help facilities establish alternative care sites and protocols for triage and transport.

Pandemic H1N1 flu activity is now widespread in 46 states, according to a recent status update from the US Centers for Disease Control and Prevention (CDC). National indicators point to intensifying pandemic activity that could overwhelm local hospitals and emergency departments.

At least two hospitals that experienced a surge of flu patients have already had to alter their flu triage and treatment by setting up tents adjacent to the emergency departments: Memorial Hospital in Bakersfield, Calif., in mid October and Dell Children's Memorial Hospital in Austin, Tex., in mid September.

The emergency H1N1 declaration fulfils one of two conditions that would be needed for the Department of Health and Human Services (HHS) to grant a waiver of section 1135 of the Social Security Act, which would ease certain restrictions on healthcare facilities in an emergency.

The waiver still requires individual requests from facilities and would only apply to a specific emergency area and period and within 72 hours of when a hospital has instituted its disaster protocol.

In the past, section 1135 waivers have been made for events including Hurricanes Katrina, Ike, and Gustav, Obama's inauguration, and North Dakota flooding.

The waiver affects requirements in several government health programs that provide certain patient protections that also may impair the ability of healthcare institutions to fully implement their disaster medical plans. The government programs include Medicare, Medicaid or the Children’s Health Insurance Program (CHIP), the Emergency Medical Treatment and Active Labor Act (EMTALA), and the Health Insurance Portability and Accountability Act (HIPAA).

In background materials on the HHS's flu.gov Web site, federal officials said the waiver doesn't suspend HIPAA privacy rules. It said, however, that the president's emergency declaration and an HHS secretary waiver could temporarily shield affected hospitals against sanctions for not complying with some provisions such as securing patient approval for the medical team to speak with family or friends involved in their care.

Paula Steib, a spokeswoman with the Association of State and Territorial Health Officials, told CIDRAP News that Obama's signing of the emergency declaration wasn't unexpected.

"It was a continuation of similar actions taken this past spring to ensure all authorities are in place so the federal government and the states have the flexibility to respond to needs should they arise," she said.

"It was not related to any specific events or vaccine supply issues, but an effort to be as prepared as possible."

In late April after the first novel H1N1 illnesses were identified, federal officials declared a public health emergency, which they said was a routine measure that allowed the government to free up resources to respond to the outbreak and deploy antiviral medications from the Strategic National Stockpile to states.

See also:

Oct 24 background information on Obama's H1N1 emergency declaration
http://www.flu.gov/professional/federal/h1n1emergency10242009.html

Oct 25 White House blog post
http://www.whitehouse.gov/blog/2009/10/25/president-obama-signs-emergency-declaration-h1n1-flu

Oct 23 CIDRAP News story "Spikes in US indicators point to intensifying pandemic"

Apr 26 CIDRAP News story "US swine flu cases rise as feds call health emergency"

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