Robert Femia, MD, chair of the department of emergency medicine, advised NYU Langone's emergency department physicians they have "sole discretion" to put patients on ventilators and the system’s backing to "withhold futile intubations," according to a March 28 email reviewed by the Wall Street Journal.
Dr. Femia noted that NYU Langone leaders and experts were drafting internal guidelines to inform the allocation of ventilators, but the ED does not have time to spare. Decisions about airway management are left to the discretion of treating physicians, who he advised to "think more critically about who we intubate," according to the email.
NYU Langone Medical Center recorded 332 coronavirus patients in hospital beds on Monday, an 84 percent increase since Thursday, according to internal figures cited by the WSJ.
The email was sent as New York, like other states, faces a shortage of ventilators given the number of critical COVID-19 patients expected as the state nears its apex. New York Gov. Andrew Cuomo has pointed to projections that show the state could need 140,000 hospital beds and 40,000 ventilators when the coronavirus pandemic is expected to peak in April.
"In Emergency Medicine, we do not have the luxury of time, data, or committees to help with our critical triage decisions,” he wrote. “Senior hospital leadership recognizes this and supports us to use our best clinical judgment.”
Several physicians expressed confusion and concern to the WSJ over the email. One unnamed physician noted that there is no evidence of any care withheld thus far from patients, but moving forward, “I don’t know how to make the call.”
The email also reminds ED physicians that, per system policy, they are not to speak with news reporters without permission from NYU Langone's office of marketing and communications. Press interviews or the dissemination of information without explicit permission from the communications office will result in disciplinary action, including termination.
A system spokesperson said the policy is enforced to ensure that only NYU Langone officials with the most up-to-date information about coronavirus speak to reporters.