New Jersey now has a statewide plan to determine who would get scarce critical care resources, such as ventilators, in the worst-case scenario that the region runs out of lifesaving equipment while caring for the increasing number of coronavirus patients, officials detailed publicly Monday.

Patients will not be denied care based on factors such as disabilities, race, sexuality, lack of insurance, age or socioeconomic status, the policy states. 

“Individual assessments will be taken, no matter in terms of judgment of a person’s worth,” Gov. Phil Murphy said. “Turns out you can’t buy your way into salvation, and that’s the way it should be.”

This is a plan of “last resort” that officials hope never to have to put into place, Murphy said. All ventilators in the state and region would first have to be exhausted, as well as other machines that can be used to support breathing, such as anesthesia machines, home ventilators or BiPAP machines. 

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Hospitals should create an “acute care triage team” of at least one physician, nurse and administrator, to avoid a conflict of interest and “minimize moral distress” so patients’ clinicians are not the ones making the decisions. 

Patients will be assigned a score from 1 to 8 based on how likely they are to survive or benefit from critical care.

If triage teams need a tiebreaker, higher priority should be given to younger patients, or sick health care workers and others “critical to the public health response” or “maintaining societal order.” Doctors and other essential workers, like maintenance staff that disinfect hospital rooms, should be given a better chance at critical care, the policy says.

If there is still a tie, the triage team can use a lottery system. 

All patients will be examined, and no factor will disqualify a patient from being considered to receive critical care. However, this scoring system does not apply to children or babies, and triage teams should use their “best clinical judgment” for young patients. 

Those who do not receive critical care will still be treated for their symptoms and psychological stress. 

Patients will be reassessed at least twice a day, and those who appear to have a low chance of survival will be moved off critical care. 

“It ensures that discrimination based on race, creed, color, national origin, nationality, ancestry, marital status, domestic partnership or civil union status, sex, sexual orientation, gender identity or expression, disability, place of residence, socioeconomic or insurance status is explicitly avoided and to the extent possible, those making allocation decisions should be unaware of these patient characteristics,” state Health Commissioner Judith Persichilli said. 

Close to half of states have a rationing policy that could harm people with disabilities, and disability advocates filed formal complaints against four states so far, according to an analysis by the nonprofit newsroom Center for Public Integrity.

A professional advisory committee in New Jersey crafted the 13-page document with inspiration from a University of Pittsburgh policy. Persichilli said that a lot of these policies are already in place in New Jersey. The state became a “leader in bioethics committees” after considering the case of New Jersey resident Karen Ann Quinlan, the center of a right-to-die debate and litigation after doctors refused her parents’ request to disconnect her from a respirator while she was in a vegetative state. 

If a health care facility adopts this Department of Health policy, its workers will not be civilly liable for any damages if a patient is injured under this policy. Attorney General Gurbir Grewal also directed prosecutors not to bring criminal charges against health care facilities or workers who adopted these state guidelines. 

New Jersey announced Saturday that its statewide stockpile had just 61 ventilators, though slightly more than half the ventilators in hospitals, or 1,611, are currently in use. The federal government sent another 200 ventilators to New Jersey over the weekend, giving the state a total of 1,550 from the federal stockpile. New Jersey has an outstanding request for 950 ventilators. 

New Jersey also ended all elective surgeries and has inventoried health care facilities and other businesses in the state to determine what supplies they have that can be used as ventilators. The state has a large number of anesthesia machines, Persichilli said, though the exact amount is unclear. 

According to the Department of Health’s hospital dashboards, there were 407 critical and intensive beds available across the state as of April 11. That does not include the new spaces being brought online, such as field hospitals and formerly closed hospitals and hospital wings. The expanded capacity as of April 11 was close to 18,000 beds, but it’s unclear how much of that inventory could provide critical care to patients.

According to the latest predictions Murphy mentioned Monday, the worst-case scenario in New Jersey could result in 36,000 hospitalizations at one time, with close to 10,000 patients in the ICU and 6,000 on ventilators.

Follow reporter Ashley Balcerzak on Twitter: @abalcerzak 

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