►
From YouTube: Committee on Public Health on April 22, 2020
Description
Docket #0638
Order for hearing on the proposed guidelines for ventilator distribution and ICU beds in the event of a shortage and ensuring that health inequities do not dictate medical care during the COVID-19 pandemic
A
If
there's
panelists,
that's
names
that
you
don't
see
there,
if
you,
if
you
want
to
send
them
a
message
to
come
on,
but
for
the
record,
my
name
is
Ricardo
Roy,
oh
I'm,
the
chair
of
the
Boston
City
Council
Committee,
on
Public
Health
I'm
joined
by
my
colleagues,
councillor
Flynn,
councillor
Campbell,
councillor,
Bach,
councilor,
brain
and
councillors,
I'm
George,
councillor,
O'malley,
council,
flower,
tea,
Council,
President,
Kim,
Janey,
I.
Believe
that's
everybody
as
I
work
through
this
list.
I
want
to
remind
everybody
that
this
is
a
public
hearing.
A
It
is
being
recorded
and
will
be
rebroadcast
'add
on
Comcast
aid,
our
CN
82
and
horizon
1964
at
a
later
date.
It
is
currently
being
streamed
at
Boston
gov,
slash,
City,
Council
TV.
We
will
also
take
public
testimony
at
the
end
of
the
hearing.
If
you
are
somebody
watching
this
and
are
interested
in
testifying,
please
email
run
cop
at
Boston.
A
A
Today's
hearing
is
on
docket
zero,
six
three
eight,
which
is
the
order
for
a
hearing
on
the
proposed
guidelines
for
ventilator
distribution
and
I,
see
events
and
the
events
are
the
shortage
and
ensuring
that
health
inequities
do
not
dictate
medical
care
during
the
cold
in
1910
I
start
pandemic.
Our
speakers
today
are
dr.
Joseph
Weinstein
from
Stuart
healthcare,
Michael
Curry
or
a
representative
from
the
mass
legal
community
health
centers,
dr.
Lena
abash
from
the
Boston
Medical
Center,
dr.
hazhar
Kadir
or
Massachusetts
General
Hospital,
dr.
A
Wendy
Macias,
constant
of
stop
konstantopoulou
from
the
Massachusetts
General
Hospital,
dr.
Alistair
Martin
from
the
Massachusetts
General
Hospital,
but
also
the
Harvard
Medical
School
is
social
equity,
Oh
Nene
gik
from
Massachusetts
General
Hospital,
radhika,
Jane,
Radhika
Jane
from
Massachusetts
General,
Hospital
hospital
Cody,
situates
chicklets
sari
from
Mass
General,
desta,
dest,
lisanna
from
Mass
general
Brigham's
and
women's
as
represent
Onika
Otago
and
dr.
andrew
marshall,
from
beth.
A
Israel
deaconess
are
all
here
with
us
today
and
so
the
format
for
this
there's
a
number
of
speakers
there,
because
there's
so
many
first-line
responders
who
were
unsure
how
many
folks
would
be
able
to
actually
make
it
I'm
grateful
to
all
of
you
for
actually
being
here
to
speak
on
something
as
important
as
racial
equity
in
crisis
of
care
guidelines
to
very
clearly
kind
of
just
give
a
run
of
show.
I'm
gonna
give
an
opening
I'm
going
to
kick
it
over
to
the
original
co-sponsor
Andrea
Campbell.
A
To
also
give
an
opening
at
that
point,
we're
going
to
go
to
the
panelists
I
know
that
dr.
Jose
Weinstein
from
stored
health
care
has
a
heart,
stop
and
so
we're
gonna.
Let
him
go
first
and
then
open
it
up
some
questions
after
he
speaks
and
then
I'll
open
it
up
to
the
rest
of
our
panel
for
the
folks
on
the
panel
speaking
I'm
gonna
try
and
keep
everybody
two
up
two
to
five
minutes.
A
If
you
could
please
respect
that
time
for
the
counselors
that
are
here,
I'm
gonna
go
in
order
of
appearance,
I'm
gonna
try
and
keep
you
to
five
minutes
if
you'd
like
to
give
an
opening
in
that
five
minutes.
If
you
don't
have
a
question
or
you
want
to
operate
that
into
your
statement,
that's
fine
at
the
end
of
the
hearing.
A
It
was
creating
point
systems
based
on
pre-existing
conditions
and
other
factors
that
are
heavily
impacted
by
race
and
social
equity
and
social
impact,
but
claiming
that
in
doing
so,
it
was
creating
sort
of
a
race
blind
system
for
crisis
of
care
and
rationing.
The
update
to
that
has
dealt
with
some
of
that,
but
not
all
of
it
guys.
It's
created
something.
A
That's
the
me
pause
that
I'd
like
to
let
our
doctors
kind
of
speak
on,
and
the
goal
here
is
to
try
to
create
from
folks
in
the
field
the
best
guidelines
we
can
create
for
a
race,
something
that
takes
race
into
account
in
a
positive
way
that
make
sure
that
there's,
no
just
proportionate
impact
with
the
social
inequities
that
we
see
on
a
daily
basis
are
addressed,
and
so,
with
that
I'm
going
to
kick
this
over
to
councillor
Campbell
and
actually
just
one
other
thing.
I
do
want
to
thank
everybody.
Who's
here.
A
I
also
want
to
note
those
that
aren't
here.
We
did
receive
two
letters,
one
from
Reed
and
the
others
from
the
Boston
Public
Health
Commission
another
from
you
just
get
the
name
Patricia
McMullen
from
the
conference
of
Boston
teaching
hospitals
I
want
to
be
clear,
I
believe
that
should
have
been
sent
out
to
all
the
counselors,
but
for
those
on
the
phone
or
on
video.
A
B
I
also
want
to
thank
the
healthcare
providers,
the
doctors
and
all
those
who
took
time
out
of
what
I'm
sure
is
an
extremely
busy
schedule
to
join
us
at
this
hearing
this
conversation,
it's
really
important
that
people
in
the
community
have
an
opportunity
to
learn
more
about
what
these
guidelines
are
so
more
about
the
crisis
standards
I
will
tell
you
up
until
koba
19
much
of
the
language.
I
didn't
know
myself,
and
so
you
can
imagine
the
late
person
not
having
understanding.
B
So
this
hearing
really
is
about
creating
a
public
space
to
have
a
conversation
on
something
that
is
extremely
important.
That
is
a
matter
of
life
and
death,
and
we
hope
that
some
point
will
not
have
to
use
these
guidelines
or
crisis
care
standards.
But
if
we
do,
people
have
a
right
to
know
what
they
are
to
be
able
to
weigh
in
and
I
think
councillor
Arroyo
and
I
recognized
the
lack
of
public
process
here.
B
So
this
is
the
platform
we
wanted
to
use
to
make
sure
that
there
was
a
public
process
but
appreciate
you
guys
taking
your
time
to
join
us.
Thank
you
for
your
expertise.
Thank
you
for
the
work
you
do
every
day
and
lastly,
I
will
say-
and
I
said
this
before-
that
we
often
are
hearing
from
folks
that
they
don't
want
to
take
race
into
consideration
that
this
is
not
about
race.
This
is
not
about
black
and
brown
and
I've
said
plainly,
that's
a
total
mistake.
B
B
So
I'm
really
excited
to
have
this
conversation
with
you
guys
to
learn
more
I.
Think
councillor
Royal
did
sum
it
up.
Well
the
piece
that,
while
there
have
been
changes
to
the
guidelines
at
the
state
level,
folks
want
understand,
of
course,
what
they
are,
but
they
also
want
to
understand
how
our
individual
hospitals
in
the
hospital
systems
applying
those
guidelines
using
those
guidelines.
B
What
are
the
conversations
amongst
the
board
members
of
these
various
hospitals
about
these
guidelines
and
what
ultimately
will
be
implemented
if
we
were
to
come
to
a
place
where
we
have
to
use
these
because
of
the
limitation
on
ventilators
and
ICU
beds?
I,
don't
want
to
talk
the
entire
time.
I'm
gonna
do
a
lot
of
listening,
Thank
You
councillor
Royale
for
the
partnership,
and
thank
you
to
my
colleagues
as
well
and.
A
With
that
I
just
want
to
knowledge,
councillor,
Mejia
and
councillor
will
have
both
joined
us,
and
so
with
that
I'm
going
to
go
directly
to
dr.
Joseph
one
I
seen
if
you
can
give
sort
of
a
background,
a
brief
background
and
also
if
you
can
just
give
your
presentation
and
then
I'll
open
up
to
questions
to
the
councils
at
that
point
in
order
of
interest.
Thank
you,
you're
unmuted,
now,
actually,
not
yet
just
waiting
for
it.
I'm
you!
There
you
go
now.
You're
unmuted.
C
Thank
you
good
afternoon,
chairman
Arroyo
and
members
of
the
council.
I
just
want
to
make
sure
you
can
hear
me
yeah.
We
can
hear
you.
Thank
you.
My
name
is
dr.
Joseph
Weinstein
and
I
am
the
chief
medical
officer
for
steward
healthcare
system,
of
which
both
Kearney
Hospital
in
Dorchester
and
st.
Elizabeth's
Medical
Center
in
Brighton,
are
apart.
C
Our
preparation
began
months
ago,
when
the
virus
initially
emerged
in
the
United
States,
we
launched
a
substantial
program
to
applier
and
stockpile
specialty
equipment
to
treat
these
patients,
including
ventilators
and
personal
protective
equipment.
Many
of
these
resources
have
been
strategically
distributed
to
our
hospitals,
including
Kearny
and
Dorchester,
and
st.
Elizabeth's
in
Brighton.
Since
the
beginning
of
March,
we
have
tested
more
than
16,000
patients
across
Massachusetts
Burke
over
19
and
we've
handled
over
1,400
inpatient
admissions
across
Massachusetts
from
a
statewide
capacity
perspective.
C
We
completed
expansion
of
our
medical
surgical
beds
by
207
to
a
total
of
899
in
beds
across
our
system,
and
we
increased
our
expansion
of
ICU
beds
by
77
beds
to
a
total
of
two
hundred
and
two
beds.
We
were
also
able
to
supplement
our
staff
with
63
experienced
nurses
and
respiratory
therapists
from
out
of
state
Stewart
facilities
and
added
239
temporary
nurses
from
outside
the
steward
system,
with
more
than
120
steward
Massachusetts
nurses,
who
volunteered
to
be
reassigned
to
the
communities
with
the
greatest
need.
C
These
moves
have
enabled
us
to
better
serve
communities
across
eastern
Massachusetts,
including
Dorchester,
Brighton,
Boston
and
other
communities
that
we
serve
with.
All
of
this,
both
of
our
Boston
hospitals
are
well
positioned
to
manage
the
search
of
copán
19
patients.
As
of
April
20th
at
Kearney
Hospital,
we
have
77
Cobie
positive
patients.
Our
hospital
capacity
was
at
64%.
C
We
have
expanded
our
ICU
bed
capacity
by
6
to
a
total
of
16
beds
and
expanded.
Our
medical
surgical
bed
capacity
by
33
for
a
total
of
59
beds.
We
currently
have
32
total
ventilators,
including
invasive
and
non-invasive
ventilators,
and
currently
have
no
shortage
of
ventilators
at
Kearney
Hospital
at
Saint
Elizabeth's
Medical
Center.
As
of
April
20th,
we
have
over
50
Kovac
positive
inpatients.
Our
hospital
capacity
was
at
57%.
C
We
have
a
total
of
140
medical
surgical
beds
and
expanded.
Our
ICU
bed
capacity
by
52
now
have
a
total
of
43
beds.
In
total,
we
currently
have
51
total
ventilators
there,
including
invasive
and
non-invasive
ventilators,
and
again
have
more
than
adequate
capacity
to
handle
the
inpatients
and
the
patients
we
expect
in
our
emergency
room.
We
continue
to
monitor
trends
in
caseloads
and
are
working
closely
with
both
the
Massachusetts
Department
of
Public
Health
and
the
Boston
Public
Health
Commission.
C
A
You
so
much.
It
means
a
lot
that
you're
here
under
the
conditions
to
address
our
communities
and
make
these
things
clear,
and
so
at
this
point,
though,
everybody
else
will
give
testimony
later
as
a
group
and
then
answer
questions
sort
of
as
a
group
for
this
particular
testimony.
We're
going
to
open
it
up
to
the
council.
I'll
begin
with
my
questions,
which,
frankly,
thank
you
for
being
here
and
in
terms
of
steward
healthcare.
C
We
have
not
had
to
deny
any
patient
any
form
of
life-sustaining
care,
including
ventilators,
medication
or
other
any
other
life-sustaining
treatment.
We
have
been
more
than
able
to
handle
the
capacity
which
has
presented
to
our
institutions
and
again,
we've
been
fairly
strategic
and
acquiring
stockpiles
of
resources
to
make
sure
when
the
surge
did
hit.
We
were
more
than
able
to
handle
that.
So
the
answer
to
your
question
is
no,
no
one
has
been
died,
care
at
Kearney
or
st.
Elizabeth's
or
any
of
our
steward
facilities.
That's.
A
I'm
glad
to
hear
that
and
I
guess.
The
second
question
on
this
is
in
the
event
that
the
surge
leads
to
a
situation
where
we
may
have
to
do
that
at
Kearney
or
steward.
What
crisis
of
care
guidelines
are
you
currently
using
to
make
those
decisions?
Are
you
using
the
state
guidelines
or
using
some
of
the
state
guidelines?
Well,
not
all
of
the
state
guidelines.
You
do
have
some
internal
guidelines
that
you
created
for
that
scenario.
A
C
We
had
an
internal
set
of
guidelines
that
we
had
created
as
you're
aware
the
state
just
released
additional
sets
of
guidelines
just
48
hours
ago,
which
we're
currently
in
the
process
of
reviewing
and
making
a
determination
about
adopting
those
guidelines.
Currently,
though,
we
take
care
of
patients
in
very
socioeconomically
disadvantaged
communities,
I
mean
we're
in
Dorchester
and
we're
in
Brockton
and
we're
in
affluent
and
Fall
River
and
Taunton.
So
we
really
don't
find
any
evidence
that
you
know
we.
We
have
to
make
a
decision
about
one
individual
versus
another.
C
A
Thank
you
I
appreciate
that,
and
this
is
my
final
question
before
I.
Kick
it
to
my
other
counselors
here
in
terms
of
the
new
guidelines.
They
they
have
a
guideline
there.
That
is
particularly
troubling
to
me
when
it
comes
to
socio-economic
impact
and
racial
impact,
which
is
the
ability
for
doctors
to
essentially
assess
or
determine
whether
or
not
somebody
will
be
surprised
that
their
survival
chances
in
the
next
five
years
or
their
patients
survival
for
up
to
five
years
in
terms
of
the
decision
making.
A
That
would
go
into
making
a
call
like
that
in
those
conditions
for
doctors,
what
kinds
of
things
would
if
he
were
to
even
do
that?
What
what
kinds
of
things
need
to
be
taken
into
account
there
as
a
layperson
to
me
that
language
sounds
like
or
suggests
that
should
be
taking
into
account
underlying
conditions
like
diabetes
or
heart
disease,
or
you
know,
hypertension
or
things
like
that.
C
So,
first
let
me
just
say
that
I
think,
by
virtue
of
the
fact
that
we've
had
adequate
resources
and
that
we've
been
able
to
plan
and
well
in
advance
for
the
surge
we
thank
goodness
have
not
had
to
make
those
decisions.
Secondly,
we
have
chosen
to
use
more
short-term
survival
guidelines
like
Sokka
scores
and
other
assessments
of
survival
within
a
hospitalization.
C
Third
and
again,
I
think
I
commented
on
this
earlier.
We
live
in
communities
and
work
in
communities
and
provide
care
in
communities
which
basically
are
very
heavily
affected
by
heart
failure,
diabetes
and
other
such
economic
conditions,
including
drug
abuse,
alcohol
abuse
and
others.
So
I
would
just
say
that
we
have
not
used
a
five
year
survival
tool,
we'll
continue
to
study
the
crisis,
standards
of
care
that
were
released
and
recently
released
by
the
Department
of
Public
Health.
C
Again,
our
tools
predominantly
have
been
short-term
survival,
as
opposed
to
looking
at
anything,
that's
a
long
term
survival
tool.
The
soak,
the
tool
that
we
have
seen
incorporated
both
in
the
initial
set
of
guidelines,
as
well
as
in
Stuart
internal
guidelines,
just
looks
at
someone's
ability
to
survive
the
acute
care
hospitalization.
We
have
not
chosen
to
look
at
anything
in
terms
of
longer
care
hospitalization
frankly,
because
all
of
our
patients
tend
to
have
some
of
those
socio-economic
comorbidities.
C
A
C
We're
still
studying
the
the
document
that
came
out
again
at
some
forty,
some
odd
pages
was
just
released
36
hours
ago
and
I
I
would
be
reluctant
to
basically
say
that
we've
committed
to
an
absolute
solution.
Thankfully
we
do
not
have
to
make
those
decisions
today,
but
I
think
we
are
looking
we're
looking
more
at
short-term
survival
and
we
have
been
at
long-term
survival
when
we
have
been
trying
to
figure
out
how
we
would
make
that
decision
if
it
went.
If
and
when
it
came
about.
Thank.
A
B
You
and
thank
you
dr.
Weinstein
for
being
here,
I,
really
appreciate.
It
know
how
busy
you
are,
and
also
thank
you
for
the
work
you're
doing
at
Stewart
and
in
the
Kearney
and
in
particular
a
lot
of
my
folks.
Go
there
and
understand
the
population.
You
serve
similar
to
many
of
the
community
health
centers.
A
couple
of
just
quick
questions.
One
is,
and
if
you
hear
a
baby,
it's
my
four
month
old
who's,
saying
hello,
but
if
the
first
is
do
you
have
a
timeline
with
respect
to
when
your
your
hospital
will
review?
B
What
just
came
out
like
you
said
36
hours
ago
and
come
up
with
what
will
be
your
plan
and
then
the
second
is
any
public
process
or
community
process
with
respect
to
how
your
individual
system
does
that
and
then
my
last
question
is
on
notification.
If
you
know,
god
forbid,
we
have
to
utilize
these
standards.
If
we
get
to
that
point
and
hopefully
we'll
we
will
not
well
your
institution-
and
this
will
be
my
question
I
for
others
as
well-
notify
folks
with
respect
to
implementation
of
your
systems,
guidelines
and
standards,
the.
C
First
of
all
counts
all
of
them
and
say
hello
to
your
grand.
You
did
South
say
hello
to
your
son's
for
us
as
well.
Thank
you.
Secondly,
just
we
met
last
night
to
review
the
revised
crisis
standards
of
care.
We
are
studying
them
in
and
looking
at
them
and
making
a
determination
about
next
steps.
I
think
it
will
probably
take
us
a
few
days
to
get
to
the
point
where
we
make
a
decision
about
whether
or
not
we
would
like
to
incorporate
them
or
not.
C
Secondly,
in
regard
to
your
just
your
questions,
we
believe
that
every
patient
should
have
goals
of
care
discussed
with
them,
literally
on
arrival.
Some
patients
are
going
to
choose
that
they
would
like
to
have
less
heroic
measures
instituted
for
them
if
they're
95
years
old,
if
they
have
a
terminal
malignancy,
they
may
wish
to
have
comfort
measures
instituted
as
opposed
to
heroic
measures.
C
But
if
we
got
to
the
point
in
time
where
everyone
was
short
on
ventilators,
we
could
make
that
discussion
and
that
decision
as
a
health
care
system,
not
one
group
of
hospitals,
but
every
group
of
hospitals
together
coming
together
and
saying
you
know
we're
getting
close
to
being
out
of
ventilators
or
we're
at
ninety
percent
utilization.
It's
time
to
have
that
discussion.
B
B
Not
sure
if
councillor
Arroyo
as
a
chair
we've
received
okay,
because
that
would
be
helpful.
So
obviously
you
guys
have
your
standards
and
your
and
you're
gonna
decide
whether
or
not
you're
going
to
incorporate
or
follow
any
of
the
guidelines
from
the
state.
The
revised
guidelines,
but
I
I'm
curious.
If
you
could
share
a
copy
of
what
the
current
standards
are
for
the
steward
system,.
C
So
Councilwoman
we
don't
have
we
have
a
draft
of
the
standards
that
we
had
developed
and
then
we
were
waiting
for
the
state,
their
first
iteration
and
then
again
their
second
iteration
came
out
Monday
afternoon.
So
we're
looking
at
that
I
think
we've
tried
to
come
up
with
an
a
mechanism
to
review
that
and
compare
to
where
our
draft
was.
We
will
have
something
at
some
point
for
the
Commission
to
look
at.
C
What
we
have
currently
from
internally
is
a
draft
document,
and
we
have
not
shared
it,
because
it's
still
in
draft
format
and
again,
thank
goodness,
we've
not
had
to
get
to
the
point
in
time.
We've
not
had
the
urgency
to
kind
of
make
that
decision
again
we're
using
about
60
to
70
percent
of
our
ventilators,
we're
nowhere
near
that
ninety
percent
threshold,
where
we
thought
we
would
need
to
begin
to
invoke
crisis
standards
of
care
and
then.
B
My
last
is
just
a
comment.
Thank
you
again
for
joining
us
and
I
want
to
be
mindful
of
my
other
colleagues
and
and
if
at
some
point-
and
this
will
be
true
for
all
the
systems
or
hospitals,
we
would
love
to
see
a
copy
of
this.
We
would
love
whenever,
whenever
the
finalized
version
is
because
that's
useful
to
the
conversation
in
community
as
well,
now
that
more
people
are
paying
attention
to
these
issues.
Thank
you,
dr.
Weinstein,
and
thank
you
council
royal.
Thank.
D
D
Is
there
a
way,
I
think
I
think
councillor
Campbell
referenced
it,
but
is
there
a
way
that
we
are
able
to
pull
the
equipment
that
is
needed
so
that
there's
one
central
location
for
the
just
critical
equipment?
And
so
then
it
gets
told
out
to
a
hospital
that
that
needs
it
in
it's
in
it's
done
in
a
fair
cross
like
that
or
or
is
that
more
Hospital
by
hospital.
D
C
I
can
only
speak
to
house
to
ER.
Does
it
so
we
obviously
procure
equipment
as
a
system.
For
example,
we
went
out
and
bought.
You
know
a
large
number
of
ventilators
and
made
sure
we
had
them
on
hand,
don't
think
you
could
cool
them
and
put
them
in
a
central
location.
The
decision
about
when
a
patient
needs
a
ventilator
is
a
decision
that's
made
literally
in
minutes,
and
you
couldn't
necessarily
transport
a
ventilator
from
a
central
location
to
one
of
our
facilities,
for
example
in
Massillon
or
Fall
River
or
Dorchester,
or
st.
C
Elizabeth,
with
with
the
ability
of
meeting
that
that
short
time
frame.
One
of
the
things
we've
learned
in
kovat
19
is
that
when
these
patients
do
deteriorate
and
decompensate
and
require
a
ventilator
to
help
them
breathe,
that
decision
is
made
in
minutes
and
the
process
of
placing
the
breathing
tube
and
placing
them
on
a
ventilator
needs
to
be
made
in
minutes
as
well.
I
would
not
recommend
placing
them
in
a
central
location.
C
I
would
be
fearful
that
we
would
not
necessarily
meet
the
guideline
of
getting
the
ventilator
to
the
patient
in
time,
so
these
ventilators
are
at
individual
hospitals
and
I
gave
you
in
my
opening
statement.
How
many
we
have
at
each
hospital
and
again
I
would
be
reluctant
to
suggest
that
a
central
location
for
storage
would
be
an
acceptable
format
in
this
day
and
age,
and
my
apologies,
no.
D
That's
that's
good
information.
Thank
you,
doctor
and
I.
Think
my
last
my
last
question
doctor
was:
did
we
to
the
medical
community
envision
that
there
would
be
this
type
of
breakdown
in
the
system
as
it
relates
to
equipment
or
the
huge
discrepancy
along
racial
lines?
I
know
we
studied
in
public
health,
but
what's
now
it's
here
and
it's
it's,
it's
realistic.
D
C
C
I
think
people
have
been
doing
drills,
I,
think
the
rapidity
with
which
it
came,
I
think
may
have
caught
a
few
people
off-guard,
but
all
of
us
I
think
have
been
working
to
make
sure
our
institutions
are
prepared
for
mass
casualty
events,
both
mass
traumas,
similar
to
you,
know,
9/11
and
and
Patriots
day.
You
know
what
happened
here
five
years
ago
in
Boston
with
the
Marathon
bombings,
but
we've
also
been
prepared
for
pandemics
and
getting
ready
so
that
we
have
the
resources
in
place
operationalizing.
A
E
Thank
You
councillor
Rio
and
a
quick
question
just
with
regard
to
the
planning
in
an
emergency
situation
under
a
lot
of
stress
the
notion
that
do
you
have
time
to
discuss
the
patient's
wishes
with
them
and
their
situation
I.
Just
wonder
how
how
that's,
how
that
happens
and
in
an
emergency
situation.
E
You
talked
about
the
plan
that
the
patient's
individualized
plan
of
care,
depending
on
their
house
status.
I,
know
everyone's
under
incredible
stress
and
that's
in
the
present
situation
is
that
do
people
have
time
to
have
those
conversations
at
the
moment
or
is
that
something
that
you
try
and
charge?
And
if
they're,
regular
patients
of
yours
have
you
got
a
system
of
charting
that
their
their
end-of-life
plans
are
documented.
E
C
It's
you're
welcome
and
thank
you
again
ma'am.
So
in
many
cases
there
is
a
health
care
proxy
form
that
we
can
identify
within
the
chart.
In
some
cases,
a
patient
wishes
have
been
documented
in
the
chart
that
they
do
not
want
to
be
on
life-sustaining
treatment.
They
do
not
want
dialysis
instituted;
they
may
not
want
to
been
later
for
those
patients
who
do
not
have
any
documentation
of
their
wishes.
Regarding
life-sustaining
treatment,
it
is
important
to
have
a
goals
of
care
discussion.
We
would
not
want
to.
C
It
would
be
much
worse
for
us
to
place
a
breathing
tube
into
that
individual
than
it
would
be
to
have
that
quick
discussion
and
Institute
comfort
measures
to
make
sure
that
individual
is
treated
in
accordance
with
their
wishes
and
so
I
do
think.
It's
a
combination
of
all
the
above.
It's
looking
at
the
chart.
E
Thank
you
and
thank
you
for
all
your
work.
This
is
a
really
incredibly
difficult
time
for
all
healthcare
professionals
and
I
appreciate
it.
I
think
the
the
situation
with
covent
in
the
sense
that
your
immediate
health
care,
proxy
or
immediate
caregiver
or
family
member-
it's
not
necessarily
standing
beside
you.
As
you
discuss
your
plan
of
care
with
a
doctor.
It
makes
the
whole
situation
even
more
difficult,
I
think
you're.
C
A
You
do
I
want
to
acknowledge
that
we've
been
joined
by
Morgan
McCallister
from
the
community,
the
legal
community,
health
centers,
and
she
also
via
statements
and
again
or
other
panelists
on
the
call
after
this
first
round
with
dr.
Joseph
Weinstein,
we'll
go
back
to
the
panelists
in
the
booths
ends.
Well,
thank
you
for
your
patience.
Counselor
flower
tea,
followed
by
counselor,
Janie
Thank.
F
You
mr.
chairman,
obviously
want
to
thank
the
medical
professionals
that
are
wrong
with
us
here
today
for
the
great
work
that
they're
doing
and
take
this
opportunity
to
dispel
some
of
the
Facebook
rumors
that
the
Boston
City
Council
are
trying
to
play
the
role
as
bioethicists
indoor
trying
to
take
over
the
ER
in
icy
decisions.
We're
gonna
leave
that
up
to
the
folks
that
know
that
better
than
us,
but
this
is
an
opportunity
for
us
to
have
a
discussion
as
to
I
guess
how
decisions
are
made
and
how
moving
forward
we
could
encourage.
F
You
know
that
the
the
lens
around
equity
be
placed
on
on
you
know
within
our
health
care
providers.
So
I
appreciate
the
attention
to
detail
that
you
guys
are
playing
on
the
front
line,
helping
us
with
our
Cobra
19
response
cannot
understand,
and
you
know
appreciate
the
day-to-day
rigors
that
you
know
all
of
our
medical
professionals
and
personnel
are
going
through
on
a
day
to
day
basis
or
I
felt.
C
G
F
You
know
from
for
me,
obviously
my
colleagues
in
the
entire
city
and
in
much
continued
success
as
we're
weathering
through
the
surge
and
would
just
like
to
well.
We
have
medical
professionals
on
just
get
someone's
opinion
on.
I
know
that
as
we're
looking
at
sort
of
the
demographic
and
the
ethnic
breakdowns
as
to
where
this
is
impacting,
I
also
want
to
make
sure
that
we
continue
to
put
an
emphasis
on
the
into
body
therapy.
F
That
seems
to
be
providing
some
results,
but
also
we
should
be
putting
an
emphasis
on
on
those
individuals
and
I
know
it's
hard
to
you
know
when
someone's
been
through
it
and
then
blunt
through
ICU
and
they've,
been
on
the
ventilator
and
they've
come
home.
The
last
thing
they
want
to
do
a
couple
weeks
later
is
to
return
to
donate
plasma
and
platelets
etc.
But
it
is
critical
that
we
encourage
those
that
have
been
impacted
and
it
suffered
through
Kogan
19
to
to
maybe
pay
it
forward.
F
If
you
will,
as
a
show
of
respect
for
our
frontline
responders
to
maybe
make
those
donations
so
that,
in
the
event
of
others
coming
down
like
over
19
or
if
we
get
what
some
are
expecting
a
potential
boomerang
effect
where,
if
this
thing
comes
back,
we'll
be
in
a
better
position
to
fight,
and
so
as
much
as
it
is
about
the
data
collecting
and
gathering
of
existing
situations
it.
You
know,
for
me:
it's
about
life
safety,
it's
about
all
of
our
people.
F
It's
making
sure
that
no
matter
who
gets
it
gets
access
to
the
most
invest
available,
treatment
and
antibiotic
therapy
seems
to
be
playing
big
dividends
and
encouraging
folks
that
have
it
to
participate
in
to
what
to
donate.
That
plasma
is
critical
and
would
love
to
get
your
thoughts
on
that
and
I
think
we
need
to
track
that
as
well
as
we
continue
to
pour
resources
into
areas
where
we
know
that
we're
seeing
it
increase
an
uptick
in
for
a
variety
of
different
reasons
which
we're
on
this
zoom
to
discuss.
F
We
also
need
to
be
putting
an
emphasis
on
when
those
patients
recover
that
that
they
would
be
willing
to
pay
a
full
lid
so
that
fellow
fellow
citizens
get
the
benefit
of
of
the
antibiotic
therapy
that
will
help
them
recover
as
well.
So
thank
you
for
your
time
and
attention.
We
look
forward
to
hearing
your
answers
so.
C
That
does
need
to
be
given
to
individuals
that
are
have
the
same
blood
type,
so
it
can't
be
given
if
you're
all
positive,
you
can't
give
to
someone
who's,
B,
negative
and
vice
versa,
and
it
also
usually
requires
at
least
28
days
from
your
recovery
to
make
sure
that
you
have
nothing
antibodies
that
can
be
administered
to
other
people.
We
certainly
are
cautiously
optimistic
about
the
potential
that
convalescent
plasma
may
have
utility
in
the
treatment
of
Cova,
19
I'm.
C
Sure
you
and
other
members
of
the
council
are
aware
that
we
don't
have
currently
really
effective
treatment
for
this
disorder
and
that
right
now,
there's
no,
you
know
licensed
approved
antiviral
therapy
that
is
effective
for
it.
That
many
things
are
somewhat
anecdotal
and
we
really
don't
have
any
randomized
clinical
trials
that
show
efficacy
or
for
a
lot
of
different
things
that
are
being
tried
right
now.
C
We're
certainly
looking
forward
to
seeing
data
that
would
show
that
this
is
an
effective
form
of
therapy
and
for
right
now
we
certainly
encourage
anyone
is
well
enough
at
28
days
to
be
able
to
donate.
You
know
their
convalescent
plasma
so
that
it
can
be
administered
to
individuals
and
hopefully,
effectuate
a
positive
outcome
for
those
people
that
are
so
sick
again.
F
A
If
I
can
just
make
a
comment
really
briefly
on
trying
to
keep
the
time
sure
we
have
a
lot
of
medic
professionals
on
heart
stops
and
things
of
that
nature
we're
trying
to
make
sure
we
get
to
all
of
them.
So
in
terms
of
the
questions
you
know,
if
we
can
just
make
sure
that
we're
directing
them
and
that,
if
somebody
else
is
able
to
lift
it
up
and
that's
great
counselor
Janie,
followed
by
counselor
Scotty
George
council
president
Janie
thank.
H
H
Thank
you
for
all
of
the
work
that
you're
doing
I
know
how
hard
everyone
is
working
to
deal
with
this
pandemic.
You
know,
I,
think
this
conversation
really
important
in
timely
and
I
hope.
We
never
get
to
a
point
where
we
have
to
make
decisions
about
who
gets
a
ventilator
and
who
doesn't
I.
Think
what
we
have
learned
from
all
of
our
discuss
around
kovat,
whether
it
be
looking
at
the
economic
impacts,
whether
looking
at
the
impacts
of
education
and
our
school
children.
H
What
we
see
is
how
cope
it
really
is
shining
a
spotlight
on
existing
inequities
and
so
important
that
we
have
this
conversation
and
that
we
understand
that
these
inequities
are
baked
into
our
system
and
that
we
didn't
get
here
by
accident
when
we're
talking
about
groups
of
people
who
have
pre-existing
conditions
that
those
conditions
just
didn't
appear
by
personal
choice,
but
our
conditions
that
are
bred
in
deep
poverty
and
so
I
just
wanted
to
lift
that
up
and
I.
Wonder,
as
you
do
incredible
work
day-to-day
dealing
with
this
crisis.
H
You
know
what
what
you're
thinking
is
so
kind
of
a
follow-up
to
councilor
Royals
question
around
what?
How
do
you
consider
when
you're
making
these
tough
decisions
in
the
moment,
you
know
what
kind
of
information
beyond
the
health
of
the
patient?
Are
you
considering,
when
you're
thinking
about
whether
or
not
they
can
recover
within
a
time
frame
and
then
I,
just
wonder
or
which
of
your
institutions,
are
tracking
data
by
race
and
by
neighborhood
and
by
language
and
and
I
know,
I
think
we
are
just
hearing
from
dr.
Weinstein?
H
C
So,
first
of
all,
thank
you
so
much
Councilwoman
for
for
your
comments.
I
just
wanted
to
basically
say
a
few
things
in
terms
of
of
this
so
number
one.
This
continues,
thank
goodness
to
be
a
hypothetical
discussion
we
have
not
had
to
at
this
point
in
time
and
certainly
given
that
we
believe
we're
at
the
peak
or
near
the
surge
of
patients.
We
do
not
believe
at
this
point
in
time.
C
They
we
will
have
to
come
to
crisis
standards
of
care,
to
making
a
decision
regarding
allocating
scarce
medical
resources
between
patients
and
making
a
decision
that
one
patient
is
more
deserving
than
another.
Patient
I
will
say
that
in
all
of
the
ethical
documents
that
basically
look
at
this,
there
are
many
different
determinants
that
individuals
have
used.
Some
look
at
short
term
mortality.
We
talked
a
little
bit
about
sofa,
which
is
again
an
organ
failure.
C
Assessments
for
that
basically
predicts
likelihood
of
surviving
the
patient's
hospitalization,
that's
commonly
used
when
patients
are
admitted
to
any
intensive
care
unit.
We
we
look,
you
know
at
age,
we
look
at
other
things
that
basically
can
come
into
play.
But
again,
these
are
all
hypothetical
and
again,
I
would
just
make
sure
that
everyone
understands.
We
are
not
thank
goodness
in
a
position
where
we
have
to
make
a
decision
about
deciding
who
should
get
an
essential
form
of
therapy.
C
H
And
I
certainly
share
that
and
I
hope.
I
was
clear
as
I
asked
the
question
that
I
am
grateful
and
hope
that
we
never
get
there.
Let
me
ask
this
question
then,
and
this
will
be
my
final
mr.
chair
in
terms
of
we
currently
have
just
looking
at
inventory,
particularly
around
ventilators.
Is
there
a
cushion
that
institutions
like
to
see
when
it
comes
to
the
number
of
patients
in
ICU
that
might
need
a
ventilator
and
how
many
you
actually
have?
C
We
talked
about
two
different
metrics:
one
is
percent
utilization
under
ventilators.
When
you
get
to
ninety
percent
utilization
of
your
available
ventilators,
that's
clearly
when
I
think
most
of
us
become
very
concerned
about.
You
know
how
we're
going
to
either
get
additional
ventilators
very
quickly,
ie
accessing
the
federal
stockpile,
borrowing
from
other
institutions
or
you
know
getting
additional
orders
in
from
manufacturers.
C
That's
one
metric
is
percent
utilization
of
your
available
ventilators.
The
other
is
we'd
like
to
make
sure
we
absolutely
always
have
one
ventilator
at
times
like
this,
during
global
pandemics,
for
every
ICU
bed
and
for
every
potential
ICU
bed.
So
we
want
to
make
sure
that
we
have
a
cushion.
Sometimes
the
ventilator
may
not
always
work
well,
and
sometimes
you
have
to
switch
it
out,
but
we
want
to
make
sure
you
have
again.
C
You
know
at
least
100
percent
for
all
your
ICU
beds,
having
ventilators
for
all
of
those
and
then
when
you
get
to
in
our
minds
when
you
get
to
90
percent
utilization
of
ventilators.
That's
when
you
have
to
make
a
decision,
are
we
going
to
go
get
more
quickly
or
are
we
going
to
have
to
begin
to
think
about?
C
C
You
know
to
any
institution
that
has
had
a
need
and
and
again
we're
very
grateful
to
the
governor
for
his
leadership
and
and
again
the
secretary
for
her
leadership,
the
Department
of
Public,
Health
and
others,
because
we
have
not
again
gotten
even
remotely
close
to
the
point
where
we've
had
to
do
this.
The
statistics
I
gave
in
my
opening
we're
at
about
55
to
60
percent
utilization
of
available
ventilators.
So
we're
even
close
to
the
point
where
we
would
have
to
make
that
decision.
I
C
I
C
Again,
there's
not
really
a
medication
that
we
can
use
for
this,
although
in
other
situations
I
think
we
would
be
looking
for
medicines.
We
have
seen
some
shortages
of
some
critical
care
medications
so
fentanyl,
which
is
sometimes
been
as
a
dirty
word,
for
the
fact
that
it's
been
abused.
It's
a
very
common
critical
care
medication
used
to
sedate
and
treat
patients.
We've
seen
some
shortages
of
fentanyl
we've
seen
some
shortages
of
propofol,
but
again
we've
gotten
more
than
adequate
resources.
Lately
and
again,
we
never
got
to
the
point
where
those
medications
were
in
shortage.
C
C
Again,
we
don't
have
an
antibiotic
or
antiviral
therapy,
so
there's
no
shortage
there,
but
the
councilman
earlier
did
mention
that
convalescent
plasma
is
is
in
short
supply
for
those
patients
that
need
it
and
again,
that's
not
something
that
the
healthcare
system
can
provide.
It
actually
comes
from
patients
who
again
have
the
same
blood
type
and
our
28
days
or
more
out
from
their
infection.
That
I
think
would
be
the
biggest
thing
we
would
love
to
be
able
to
get
our
hands
on
and
then
I'll
be
frank
in
that.
We
need
a
vaccine
for
this.
C
If
we
don't
have
a
vaccine,
there's
been
talk
about
a
potential
recurrence
of
this
disease
and
I
think
we're
all
very
concerned
about
what
that
could
look
like
and
I
think
we
also
need
additional
testing
capabilities.
I
think
you've
heard
probably
in
in
lay
press.
We
don't
think
that
there's
enough
tasting
capability
across
the
United
States
for
this
disease
to.
I
C
Again,
convalescent
serum
has
to
be
28
days
from
or
out
from
the
acute
infection.
Thank
goodness
most
of
our
patients
have
left
our
hospital
by
the
time
that
occurs,
and
so
we
certainly
encourage,
but
most
of
those
patients
have
left
our
care
and
hopefully
are
either
at
home,
recurrent
recovering
or
in
an
acute
care
facility,
a
subacute
or
an
acute
care
facility
getting
on
their
care
at
that
point
in
time,
all.
I
J
You
very
much
mr.
chairman
I
will
be
brief.
It's
more
important
I
think
we
hear
from
us,
and
these
really
talented
health
professionals
so,
first
and
foremost,
I
know
all
my
colleagues
join
me
in
thanking
you
for
your
exceptional
service
during
this
incredibly
difficult
time.
Thank
you
particularly
dr.
Weinstein,
for
this
first
round
of
overview
very
sobering
indeed,
and
just
certainly
again
reinforces
the
magnitude
of
what
we
are
up
against.
No
further
questions
look
forward
to
hearing
from
the
subsequent
panels.
Thank
you.
Thank.
A
L
K
K
Great
so
I
am
time
crunch.
Thank
you
again
for
hosting
this.
I
do
have
several
questions,
though.
Mine's
are
specifically
around
language
access,
curious
as
to
whether
or
not
what
support
systems
are
in
place
for
folks
who
may
not
understand
the
language
when
they
are
when
you're
interacting
with
patients.
K
There
was
recently
an
article
that
we
came
across
in
our
office
in
probably
public
in
regards
to
folks
who
were
having
issues
with
language
access
and
some
who,
unfortunately,
passed
and
so
I'm
just
curious
as
to
how
the
hospitals
are
dealing
with
the
issues
of
language
access
here
and
then.
The
other
piece
that
I'm
really
curious
about
is
there's,
there's
a
lot
of
lack
of
trust
with
government
and
institutions
and
with
great
reason,
right.
It's
hard
to
believe
that,
often
times
that
people
are
gonna
have
our
best
interest.
K
C
C
We
don't
have
hospitals
in
very
affluent
communities,
and
so
we
believe
that
we
are
very
much
a
reflection
of
the
communities
that
we
serve
and
we
believe
strongly
that
we
have
both
people
in
our
communities
that
work
at
our
hospitals
and
we
have
patients
that
we
serve
that.
We
feel
strongly
that
we
represent
the
values
that
they're
looking
for
so
I
guess.
C
I
would
just
say
that,
while
trust
may
be
difficult
to
to
basically
have
out
of
the
gate,
it's
something
that's
earned
over
time
and
we
believe
that
our
institutions,
by
being
long-standing
members
of
the
peace
communities
again
each
one
of
which
is
unique.
Basically
by
virtue
of
both
employees
and
patients
being
very
comfortable
at
these
institutions.
We
believe
that
we
have
gradually
earned
their
respect
and
their
trust
and
that
we
work
to
continue
to
maintain
that.
Thank.
K
You
for
that,
and
then
just
one
quick
follow-up,
I'm
just
curious
in
terms
of
the
role
that
c-like
can
excuse
me
counselor
Janie
mentioned
earlier
in
terms
of
all
right.
It
may
have
been
a
counselor
Campbell
in
regards
to
just
really
understanding
the
language
and
how
accessible
it
is
for
guidelines.
I'm,
just
wondering
whether
or
not
there
was
an
opportunity
for
community
input.
K
I
know
for
me:
I
have
to
google
half
the
things
that
come
out
of
certain
spaces,
just
so
that
I
can
understand
them
so
just
curious
in
terms
of
the
cultural
competency,
not
just
in
terms
of
language,
access
and
translation,
but
really
just
a
tone
and
and
just
the
the
information
from
being
able
to
be
shared
in
ways
that
the
everyday
person
can
actually
understand
it,
just
wondering
what
that
looked
like
in
terms
of
your
process.
So
again.
C
When
we
developed
our
own
internal
document,
we
clearly
had
again
people
from
different
cultural
backgrounds
as
part
of
our
committee
that
helped
develop
the
internal
draft
document.
Again,
it's
it's
not
been
finalized
and
it
certainly
is
not
something
that
we
have
put
in
place.
The
document
developed
by
the
Department
of
Public
Health,
the
crisis
standards
of
care
I
believe
there
was
20
25
people
that
were
involved
in
the
the
drafting
of
that
document
and
I
I
will
be
an
honest
council.
I
mean
I
cannot
speak
to
the
cultural
diversity
of
those
individuals.
C
I,
don't
know
many
of
them
by
name
and
I,
certainly
don't
know
their
their
cultural
backgrounds
to
be
able
to
speak
to
that,
so
I
I
would
pass
that
on
either.
I
can
certainly
do
research
and
get
back
to
you.
I
would
ask
that
you
direct
that
question
to
someone
who
could
answer
it
in
a
better
fashion,
for
you.
K
C
A
Alistair
Martin,
and
just
to
give
you
a
brief
intro
on
how
to
do
this.
I'm
gonna
try
and
go
from
Doctor
to
doctor
to
doctor
here
introduce
yourself
as
you
would
coalition
or
how
you're
representing
and
what
what
you'd
like
to
say
in
terms
of
and
what
you're
saying
and
then
I'll
open
it
up
after
we've
had
all
of
you
speak
to
the
counselors
and
they
can
ask
the
questions
to
the
group
as
a
whole.
A
M
Of
all
Thank
You
chairman
into
the
city
councillors
for
providing
the
opportunity
to
speak
today
in
this
shining
light
on
what
is
an
incredibly
important
issue.
My
name
is
Alistair
Martin
and
I'm,
an
ER
physician
and
a
member
of
the
mass
coalition
health
equity.
A
group
represents
80
physicians
across
five
major
Boston
hospitals,
and
we
came
together
for
a
simple
purpose
to
speak
out
against
the
administration's
crisis
standards
of
care
that
we
felt
would
unfairly
bias
against
communities
of
color
and
those
with
disabilities.
The
very
communities
that
are
most
impacted
by
Co
vat19.
M
Our
coalition
started
open
letters
that,
to
date,
have
collected
the
signatures
of
over
a
thousand
physicians,
nurses,
social
workers
and
frontline
staff
in
response
to
our
advocacy
and
the
advocacy
of
dozens
of
other
groups
across
the
Commonwealth.
The
administration
released
updated
guidelines
on
April
20th.
We
are
here
today
to
say
that
these
revised
guidelines
are
a
step
in
the
right
direction,
but
not
the
final
des
nation
on
our
journey
towards
true
health
equity.
M
The
original
document
stated
that
quote
on
quote:
underlying
medical
illnesses
would
count
against
you
that
you
would
get
points
for
diseases
like
diabetes
and
heart
failure,
which
some
Massachusetts
hospitals
considered
using
to
help
determine
who
got
a
ventilator
and
who
did
not.
Many
of
those
diseases
considered
were
found
at
higher
rates
in
communities
of
color,
giving
them
more
points
and
less
access
to
a
ventilator.
M
These
this
major
list
is
supposed
to
reference
diseases
that
can
lead
to
death
and
five
years
now
we
will
get
into
why
this
is
vague
and
obscure
and
nothing
more
than
a
transparent
attempt
for
false
reassurance,
but,
furthermore,
the
guidelines
still
leave
it
up
to
hospitals
to
decide
what
their
specific
diseases
will
be
on
that
list.
That
will
count
against
patients.
M
This
is
troubling
because
it
invites
variability
between
what
hospitals
will
consider
as
diseases
that
will
and
will
not
be
considered
as
factors
that
will
deny
patients
life-saving
resources
that
variability
in
principle
means
in
a
patient
who
needs
a
ventilator
may
be
denied
at
one
Hospital,
but
could
very
well
be
given
a
ventilator
at
another
hospital
simply
because
of
the
diseases
which
each
Hospital
chose
to
consider.
That's
unclear,
that's
unfair.
When
we
can
do
better.
A
A
N
O
A
May,
and
actually
just
because
there
as
a
panel,
if,
when
you
finish
speaking,
if
you
could
just
say
who
was
next
in
the
in
the
docket
for
y'all,
that
would
be
great
right
and
then
we
can
make
it
easier
and
just
be
clear,
dr.
Martin!
Thank
you
so
much
dr.
Martin
thumbs
up
if
you
were
complete,
I,
didn't
want
to
cut
you
off
if
you
weren't,
okay,
great
dr.
hazhar,
Qadir
hi,.
P
Everyone
Thank
You
councilman
for
allowing
me
to
speak
and
join,
and
our
very
robust
discussion
around
this
really
important
topic.
So
the
revisions
to
the
guidelines
that
were
released
by
the
Department
of
Public
Health
a
few
days
ago,
state
that
those
who
develop
and
oversee
institutional
crisis
standards
of
care
protocols
should
reflect
the
full
diversity
of
our
communities.
P
They
go
on
to
say,
to
the
extent
possible
triage
officers
in
triage
teams
who
are
for
everyone
to
kind
of
be
on
the
same
page
are
actually
the
individuals
within
specific
institutions
who
will
be
deciding
which
patients
get
critical
care
resources.
Those
those
individuals.
Those
teams
should
include
members
that
adequately
represent
the
diversity
of
the
patient
populations,
served
by
the
hospital
again.
They
say
that
to
the
extent
possible,
they
should
reflect
the
diversity
of
the
patient
populations.
So
we
believe
that
these
changes
fall
short
for
three
main
reasons.
P
The
language
that's
used
around
diverse
perspectives
is
framed
as
to
the
extent
possible
I
think
we
can
all
recognize
that
this
is
baked.
It
creates
a
loophole
that
would
relieve
hospitals
of
strict
obligations
to
ensure
diversity,
and
so
we
that
this
statement
fall
short
because
the
DPH
should
ensure
that
hospitals
are
required
to
achieve
adequate
representation
of
the
diversity
of
their
communities.
This
is
not
an
option
and
should
not
done
half-heartedly.
P
Secondly,
there
is
no
explicit
instructions
on
what
constitutes
adequate
representation
on
triage
and
oversight
committees.
We
know
that
the
demographic
makeup
of
institutions
can
vary
dramatically.
The
cultures
and
resources
of
institutions
can
also
be
even
more
variable
and
we
are
all
lucky
as
a
part
of
the
Massachusetts
coalition
of
health
equity
to
practice
of
institutions
that
have
long
established
committees
and
centers,
whose
whole
purpose
is
to
ensure
diversity,
inclusion
and
to
fight
for
health
justice.
But
we
also
recognize
that
there
are
hospitals
that
may
not
have
existing
systems
to
address
health,
equity
and
diversity
issues.
P
P
We
all
know,
as
some
of
us
are
people
of
color-
that
people
color
are
historically
at
risk
of
tokenism
where
their
race
or
ethnicity
is
exploited
as
a
checkmark
for
meeting
metrics,
but
their
agency
to
advocate
for
their
communities
in
an
authentic
way
is
hindered
by
institutional
norms
and
by
institutional
power
structures.
So
this
really
challenges
the
main
purpose
of
establishing
diversity
within
these
teams
that
are
going
to
be
operating
and
leading
crisis,
centers
of
care
rollout
in
Nona
into
theoretical
situation
that
they
have
to
be
invoked
and
in
hindering
the
diversity
initiatives.
P
We're
also
hindering
our
our
efforts
to
bolster
and
ensure
health,
equity
and
critical
resource
allocation.
So,
for
those
reasons,
we
believe
that
the
Department
of
Public
Health
needs
to
add
some
since
to
the
stated
commitment
to
achieving
adequate
representation
by
providing
explicit
guidance
to
hospitals
on
how
they
should
recruit,
diverse
members
to
their
crisis
standards
of
care
committees
and
provide
them
support
and
establishing
diversity
within
these
committees.
Lastly,
there
is
no
method
of
accountability
related
to
ensuring
diversity
within
institutional
crisis
standards
of
care
committees,
so
the
DPH
just
provides.
P
The
Department
of
Public
Health
should
institute
a
system
to
check
that
triage
review
and
oversight
teams
are
adequately
representative
of
the
demographic
communities
that
they
serve
and
then
related
to
this
issue
of
tokenism
that
we
brought
up.
There
should
also
be
a
confidential
process
that
will
allow
triage
officers
to
blow
the
whistle
on
concerns
around
equity
and
disparities,
without
fear
of
repercussions
from
their
institutions
and
the
whole
function
of
adding.
P
The
substance
to
the
state
of
commitment
within
the
updated
guidelines
is
to
try
to
create
a
more
robust
structure
and
to
ensure
that
we
do
actually
achieve
diversity
across
all
hospitals
across
the
Massachusetts
and
not
just
at
institutions
like
ours,
where
we
already
have
a
structure
system
and
resources
to
provide
the
bolster
diversity,
inclusion
and
to
champion
health
equity
around
a
critical
resource
allocation.
So
with
that
I'm
gonna
actually
pass
on
the
mic
to
when
my
colleagues
Oni
who's
going
to
be
talking
about
essential
workers
referenced
in.
Q
Doctor,
okay,
good
afternoon,
my
name
is
Nikki
aka
I'm,
an
ER
physician
also
here
with
the
Massachusetts
Coalition
on
health
equity.
Thank
you
all
for
having
us
pair
the
guidelines.
If
multiple
patients
have
the
same
to
score
and
lifecycle
considerations
are
similar,
then
participation
in
public
health
response
and
maintenance
of
societal
order
will
be
used
in
assigning
priority.
Q
Determining
who
would
be
considered
as
critical
in
public
health
response
or
maintaining
societal
order
is
too
vague
of
a
guideline
and
is
open
to
by
ass.
Some
may
overlook
custodial
staff
grocery
store,
clerks
bus
drivers
and
sanitation
workers,
all
of
whom
we
all
know,
provide
essential
services
while
placing
themselves
at
risk.
In
addition,
unemployed
people
are
also
maintaining
societal
order
and
should
not
be
considered
to
be
of
a
lesser
value.
Q
We
erode
public
trust
by
communicating
that,
in
times
of
crisis,
when
many
have
lost
their
jobs,
while
still
caring
for
family
friends
and
neighbors,
some
of
whom
are
sick,
elderly
or
disabled,
that
we
will
use
employment
status
as
a
criteria
for
deciding
who
gets
critical
care
resources.
If
equity
is
important
in
our
state's
guidelines,
then
prioritizing
wildlife
over
another
on
the
grounds
of
employment
description
violates
the
ethical
principle
of
justice.
This
will
further
worsen
inequities
that
we
already
see
in
our
society.
Q
A
N
Afternoon,
thank
you
for
having
me
my
name
is
an
echo
to
go
and
I'll
be
talking
about
the
fiber
survival.
So
the
revisions
use
a
five-year
survival
as
a
right
area
for
allocation
define
five-year
survival
is
difficult.
It
is
unclear
how
you
standardize
five-year
survivability.
Does
the
physicians
decide?
Does
a
triage
office
to
decide?
Is
the
government
supposed
to
decide
this
could
lead
to
a
subjective
interpretation
attempting
to
standardize
five-year
survival?
Is
the
state
giving
a
false
sense
of
security?
N
First
wing,
as
others
have
stated,
this
kind
of
estimate
is
honestly
just
a
guess,
particularly
in
a
crisis
like
this.
This
estimate
ends
up
reflecting
broad
stereotypes
of
an
individual's
diagnosis.
There
are
tens
of
thousands
of
people
walking
around
today
who
are
told
that
they
had
less
than
five
years
to
live,
10,
20
or
even
30
years
ago.
Secondly,
even
those
estimates
are
accurate.
Five
years
is
a
long
time.
It's
long
enough
to
see
your
kids
grow
up
to
finish
your
life's
work
and
to
do
all
the
things
that
we
value
as
a
society.
N
A
M
You
needed
to
fulfill,
but
the
point
is
simple:
to
better
understand:
what's
driving
this
epidemic,
we
need
better
data
and
it
was
only
with
the
release
of
the
initial
demographic
information
tied
to
Cove
at
19
that
we
started
to
better
understand
how
it
was
affecting
our
vulnerable
communities
to
ensure
that
the
allocation
of
the
resources
in
a
crisis
is
equitable.
We
need
to
do
two
things.
First,
we
must
build
models
to
test
the
scoring
systems
that
we
propose.
M
We
must
examine
the
factors
we
are
using
a
score
patience
carefully,
including
comorbid
conditions
to
ensure
that
they
are
not
causing
over-representation
or
underrepresented
of
any
group
of
patients
that
may
need
a
scarce
resource.
Second,
we
need
clear
requirements
for
monitoring
allocation
of
scary
experience
resources.
The
CSC
guidelines,
as
of
the
20th
of
April,
outlines
that
the
public
will
need
access
to
up-to-date,
accurate
and
transparent
use
of
CSC.
Although
the
revised
guidelines
do
specify
the
demographic
information
will
be
released,
DPH
at
their
request.
M
R
Okay,
thank
you.
Thank
you.
Sorry
I
was
having
technical
difficulties
with
my
video
for
some
reason,
but
that's
fine
counsel,
Thank
You,
chairman
Arroyo
and
members
of
the
Boston
City
Council
for
inviting
us.
My
name
is
Lana
havoc
I'm,
a
family
physician
who's
been
working
in
the
Boston
community
for
over
20
years
and
I'm.
A
member
of
the
Massachusetts
Coalition
on
health
equity.
R
You've
already
heard
how
the
revised
crisis
standards
of
care
will
negatively
impact
access
to
life-saving
care
for
many
communities
in
Boston,
including
indigenous
people,
black
people,
Latin,
X
people,
other
communities
of
color,
elders,
immigrants,
asylees
refugees
and
those
who
are
undocumented,
uninsured,
incarcerated,
homeless,
experiencing
poverty
or
living
with
disabilities.
These
communities
already
suffer
from
significant
health
disparities
as
a
result
of
structural
racism,
economic
and
justice
and
ableism.
The
crisis
standards
as
currently
written,
will
still
intensify
these
disparities.
The
original
crisis
standards
of
care,
Advisory
Committee,
was
composed
of
16
people.
R
Not
one
of
these
people
was
from
the
Black
Latin,
Acts,
Haitian
or
Cape
Verde
and
community.
Not
one
represented
the
interests
of
undocumented,
uninsured,
homeless
or
incarcerated
people.
Not
one
represented
the
interests
of
low-income
families.
It
was
only
after
public
ad
because
see
that
the
committee
was
reconvened
to
revise
the
standards
in
response
to
the
demand
for
community
oversight.
One
member
was
added
to
the
committee
just
one
while
a
step
in
the
right
direction.
This
is
not
community
oversight.
We
can
do
better
for
there
to
be
equity
in
health
care
and
crisis
response
communities.
R
Most
impacted
by
kovat
19
must
be
centrally
involved
in
developing
the
government.
Policies
that
will
impact
their
lives.
Tokenism
won't
create
equity.
The
community
participation
will
true.
Community
oversight
will
require
transparency
of
decision-making
processes,
public
access
to
real-time
demographic
data,
public
access
to
real-time
hospital
resource
data,
community
participation
in
the
creation
of
just
standards
that
account
for
health
disparities
and
Hospital
triage
committees
with
community
membership
that
is
representative
of
the
population
and
has
real
decision-making
power.
Boston
has
a
long
history
of
communities
creatively
solving
community
problems.
R
O
You,
council
members,
thank
you
for
having
us
in
allowing
us
to
lend
our
voice
and
shine
a
light
on
the
concerns
of
the
community
to
be
collectively
represent
today.
My
name
is
dr.
Wendy
messiahs,
konstantopoulou
I'm,
an
emergency
physician
and
serving
the
Greater
Boston
area
for
approximately
17
years,
and
a
member
of
the
Massachusetts
Coalition
on
health
equity.
O
While
we're
grateful
to
the
Advisory
Committee
and
to
the
state
for
their
reconsideration
of
the
crisis
standards
of
care
guidelines,
the
new
version
released
on
April
20th
continues
to
continues
to
have
some
potential
loopholes
and
blind
spots
that
we
would
like
to
highlight
and
that
we
have
done
so
today.
Of
greatest
concern
is
the
vast
gray
zone
that
has
been
created
by
the
vagueness
around
which
comorbidities
qualify
as
major
underlying
conditions
for
as
those
that
qualify
as
severely
life
limiting
conditions.
O
This
nonspecific
language
creates
a
lot
of
room
for
variability
qualifiers,
such
as
to
the
extent
possible,
or,
if
available
and
feasible,
also
provides
nonspecific
language
that
allows
for
too
much
room
for
variability
well,
it
may
have
the
appearance
of
being
a
reasonable
approach
in
times
of
crisis,
it
simply
leaves
room
for
variable
and
uneven
and
biased
interpretation
and
application
of
the
standards.
Standardization
of
an
equitable
process
for
allocating
critical
care
resources
should
be
the
ultimate
goal
and
variation
should
be
minimized
if
not
limited
eliminated.
O
Loopholes
and
blind
spots
stand
to
exacerbate
inequalities.
We
have
the
opportunity
here
to
use
this
time
in
our
history
to
course-correct
and
justices
and
disparities
that
have
been
centuries
in
the
making
to
ensure
that
our
systems
close
the
health
gap
and
rise
to
meet
the
needs
of
all
our
communities.
We
must
safeguard
against
procedures
and
policies
that
will
intensify
the
very
structural
disparities
that
had
led
to
the
uneven
playing
field
on
which
we
stand
today
and
which
complicates
the
process
of
invoking
crisis
standards.
O
The
process
of
allocating
scarce
intensive
care
resources
must
account
for
the
uneven
distribution
of
health
in
our
society,
an
inequality
that
results
from
the
seemingly
normal
and
hidden
layers
of
historic
and
system
and
systemic
injustice
--is,
and
the
resultant
unequal
distribution
of
social,
political
and
economic
empowerment,
ultimately,
for
crisis
standards
of
care
to
be
considered
ethical,
fair,
just
and
equitable,
they
must
be
developed
transparently
and
with
the
input
from
the
communities
they
threatened
to
disproportionately
impact.
Thank
you.
Thank.
T
My
name
is
Bhavik
a
Jane
I
am
a
second
year
resident
physician
in
the
Department
of
Medicine,
at
Massachusetts,
General
Hospital
and
together
with
dr.
Lozano
and
dr.
Chicka,
wits
I
represent
a
group
of
residents
at
MGH,
and
the
burden
of
anomic
Women's
Hospital
were
part
of
the
Cova
19
resident
working
group
on
equity.
T
We
actually
me
personally,
for
the
last
month,
I
have
been
taking
care
of
patients
with
lung
kidney
and
heart
failure
due
to
kovat
19
in
our
medical,
intensive
care
units
and
many
of
our
residents
across
both
hospitals
and
many
hospitals
in
the
partner
system.
Are
you
taking
care
of
patients
who
have
been
affected
by
Kovach
language,
and
so
we
bring
to
this
conversation
a
real
urgency
based
on
our
clinical
experiences?
T
In
the
last
few
weeks,
we've
already
heard
from
many
of
the
physicians
on
this
hearing
the
very
real
reasons
why
we
worry
that
our
critical
scarcity
of
essential
life-saving
resources
may
inadvertently
exacerbate
existing
inequities
under
the
current
crisis
in
needs
of
care,
but
even
though,
as
dr.
Weinstein
mentions.
Luckily,
we
haven't
reached
a
point
of
reaching
us
our
city
of
those
event
to
leaders.
T
We
are
grateful
for
the
changes
that
have
already
been
made
and
also
want
to
say
that
we
represent
a
broad
coalition
of
providers,
both
doctors,
nurses,
medical
students,
social
workers,
administrative
managers
across
the
partnered
system.
We're
really
concerned
about
these
crisis
standards
of
care.
More
than
600
of
our
health
care
workers
signed
a
letter
encouraging
more
consideration
of
equity
in
these
standards.
I
want
to
turn
it
over
to
dr.
Chicka,
wits
and
dr.
Lozano
to
talk
more
about
a
couple
of
specific
suggestions
that
we
have.
T
S
We
stand
in
unity
with
many
of
the
other
physicians
that
are
testifying
today
in
calls
for
more
specificity
to
the
guidelines
that
have
been
released,
specifically
I'd
like
to
talk
about
the
data
collection
from
hospitals
in
the
state
that
are
recommended
by
the
current
guidelines.
Currently,
as
mentioned
earlier,
the
guidelines
state
that
there
will
be
a
retrospective
review.
Should
the
CSU
guidelines
be
implemented.
We
believe
the
data
reporting
should
be
more
clearly
defined.
It
should
be
actionable
and
timely.
S
Specifically,
we
suggest
that
data
be
released
on
a
daily
or
weekly
basis,
if
daily,
not
possible.
That
includes
detailed
demographic
information,
including
race,
ethnicity,
disability
status,
primary
language.
That's
spoken
in
the
nine
digit
zip
code
for
patients
that
are
admitted
to
the
hospital,
with
both
presumed
and
confirmed
coded
cases.
Whether
or
not
the
crisis
standards
of
care
are
activated.
We
believe
that
this
will
help
us
identify
whether
or
not
resources
are
utilized
in
patients
courses
in
an
equitable
fashion.
S
These
data
should
be
made
publicly
available
de-identified
in
an
aggregate
format,
so
there's
transparency
for
the
communities
that
are
most
affected.
We
also
recognize
that,
while
the
CSD
might
not
get
activated,
there
are
other
resources
and
therapies
and
our
hospitals
that
may
become
spares
during
these
this
pandemic.
Any
data
that's
reported
should
not
only
be
on
the
crisis
standards
of
care,
but
other
things
that
include
access
to
things
like
dialysis
clinical
trials,
drugs
released
from
the
FDA
under
compassionate
use
and
preferred
medications
that
may
be
needed
in
the
ICU.
S
We
want
to
ensure
that
equity
is
extended
to
these
situations
as
well.
Finally,
we've
seen
great
variability
and
the
quality
of
the
data
reported
from
the
state
with
many
participant
or
many
patients
having
missing
or
unknown
demographic
information
is
essential
with
the
state
and
city
oversee
data
collection
and
push
for
quality
so
that
we
can
act
appropriately
and
get
resources
to
our
most
marginalized
communities
and
with
that
I'll
pass
that
off
to
desta
wasana.
Dr.
U
Thank
you.
My
name
is
dusty.
Lozano
I'm,
a
first
year
resident
physician
in
the
Department
of
Psychiatry
at
the
combined
Mass
General
McClain
program,
I
cared
for
kovat
positive
patients
on
a
surge
floor
and
late
March
when
we
were
first
beginning
to
see
how
this
virus
was
devastating
vulnerable
communities
starting
next
week,
I
will
be
working
at
McLean
Hospital,
where
I'll
be
working
with
patients
with
severe
mental
illness.
U
Many
of
these
patients
take
medications
that
increase
their
risk
for
developing
obesity,
diabetes
and
heart
disease
conditions
that
we
know
increase
their
risk
for
having
a
severe
COBIT
infection.
It
is
these
patients
and
other
vulnerable
patients
that
I
fear
may
be
left
behind,
and
discussions
of
crisis
standards
of
care
I'm
grateful
to
be
here
to
have
the
opportunity
to
lend
my
voice
on
their
behalf.
My
colleagues
have
already
made
excellent
points
regarding
the
shortcomings
of
the
crisis.
Standard
of
crisis
standards
of
care,
as
I
already
worded.
U
For
my
part,
I
want
to
add
my
voice
to
underline
the
point
about
ensuring
diverse
representation
on
all
committees,
working
on
the
development,
implementation
and
assessment
of
these
standards
of
care
at
the
State,
Hospital
and
city
level.
Given
the
disproportionate
impact
of
copa90
non
marginalized
communities,
it's
essential
communities
have
a
voice
and
a
seat
at
the
table
when
allocation
of
resources
is
being
decided.
U
Finally,
we
call
for
implicit
bias,
training
for
all
individuals
who
are
writing
crisis
standards
of
care
and
making
triage
decisions.
The
state
of
Massachusetts
and
the
city
of
Boston
has
a
real
opportunity
here
to
set
the
tone
for
crisis
standards
of
care
across
the
country,
as
well
as
to
facilitate
equitable
decision-making
across
Massachusetts,
diverse
hospitals
and
I
hope
that
these
recommendations
will
be
a
good
step
toward
making
that
goal
a
reality.
U
A
G
You,
chairman
aru
and
members
of
the
council,
my
name
is
Morgan
McAllister
I'm,
an
analyst
and
the
governmental
affairs
and
public
policy
division
of
the
Massachusetts
League
of
community
health,
centers
I'm,
testifying
today
in
place
of
Michael
Curry,
our
deputy
CEO
of
the
mass
league,
to
give
some
background
on
who
we
are.
The
math
League
represents
52
Community
Health
Service,
serving
over
a
million
patients
out
of
over
314
practice
sites
throughout
the
Commonwealth,
22
of
which
are
located
right
here
in
the
city
of
Boston.
G
This
is
the
birthplace
of
community
health
centers,
which
were
born
out
of
the
civil
rights
movement
aimed
at
responding
to
the
generations
of
health,
inequity,
disparate
treatment,
neglect
and
abuse
and
obtaining
our
country's
healthcare
system.
These
inequities
persist
today
and
community
health
centers
remain
on
the
front
lines
over
50
years
later
serving
communities
with
higher
rates
of
diabetes,
heart
disease,
asthma
and
a
host
of
other
illnesses.
We
provide
medical,
dental,
Behavioral,
Health
vision
and
substance
use
services,
as
well
as
other
social
services
to
one
and
to
residents
in
the
city
of
Boston.
G
Our
patients
come
from
diverse
racial
and
economic
backgrounds
and
are
being
disparately
impacted
by
the
the
COBIT
19
pandemic
and,
as
recent
data
reveals
in
Boston,
in
the
Commonwealth
and
across
the
country,
our
patients
are
at
higher
risk
of
testing
positive
and
losing
their
lives
to
this
disease.
So
the
league
is
here
to
join
the
chorus
of
voices
challenging
any
crisis
standard
of
care
that
would
cause
our
patients
to
be
denied
life-saving
measures
due
to
scoring
factors
based
on
pre-existing
health
conditions,
comorbidities
or
long-term
survivability.
G
We
challenge
any
standard
that
fails
to
benefit
at
its
conception
from
diverse
voices
and
perspectives
it
had.
This
has
unintended
contended
consequences
of
denying
any
member
in
the
communities
that
we
serve
of
their
right
to
life
and
their
right
to
our
world-class
medical
technology
and
care
that
could
prevent
them
from
succumbing
to
this
disease.
We
also
challenge
any
standard
that
will
result
in
more
individuals
of
color
losing
their
lives
in
this
pandemic,
based
on
our
collective
failure
to
address
the
societal
Iliff
racism.
G
Sadly,
this
is
our
Katrina
moment
where
inequities
are
laid
bare
and
the
policy
decisions
that
we
make
will
determine
the
number
of
patients.
We
must
watch
fall
victim
to
this
virus.
The
league
is
a
participant
in
the
Massachusetts
Public
Health
Association
and
its
health
equity
task
force.
Our
deputy
CEO
serves
on
the
coab
it
19
health
and
equities
task
force
and
is
working
with
the
Department
public
health
to
address
inequity
issues.
We
encourage
strongly
this
body
to
ask
the
critical
questions,
challenge
any
policies
and
lend
its
voice
against
any
standard
of
care.
A
So
much,
and
so
with
that
that
concludes
the
panel's
opening
presentation.
We're
going
to
open
it
up
to
questions
from
the
council
before
we
do
that.
I
just
want
to
commend
everybody
who
has
taken
time
to
put
together
the
things
that
you
put
together
today
over
and
over
during
your
presentation,
I
thought
to
myself
about
how
powerful
it
is
to
have
you
here.
A
Raising
these
issues,
you're,
doing
heroes,
work
in
our
hospitals
and
you're,
doing
heroes
work
out
of
them,
and
so
please
take
that
sincerely
for
me
that,
as
somebody
who
and
as
the
only
man
of
color
frankly
on
the
City
Council
as
somebody
who
wishes
that
there
was
somebody
from
the
administration
present
for
this
hearing
or
that
there
was
somebody
representative
of
many
of
the
hospitals
that
you
work
at
here.
For
this
hearing
to
speak
to
these
issues
and
to
tell
us
specifically
what
guidelines
they
are
following,
what
their,
what
their
impact
is.
A
I
want
you
to
understand
that,
as
you
speak
to
us,
you
are
also
speaking
to
the
public
and
in
in
this
work
that
I've
done.
I
have
found
that
light
is
the
best
disinfectant.
When
you
do
bring
these
issues
out,
when
you
bring
voice
to
them
or
voiced
so
many
others,
and
so
thank
you
so
much
for
this
work
in
the
in
the
challenges
that
you're
facing
and
making
these
changes
happen,
and
please
do
consider
me
a
partner
in
any
way
that
I
can
be
in
the
work
that
you
are
continuing
to
do.
So.
A
Thank
you
very
much
to
all
our
panelists
and
with
that
said,
I
do
think
you
gave
us
a
lot
there
to
work
with
and
I
deeply
appreciate
that
my
question-
and
this
is
to
the
panel
as
a
whole
and
some
of
you
are
off
camera,
and
so,
if
you
have
access
to
the
ability
to
raise
the
blue
hand
on
any
of
the
questions,
I
get
that
get
asked
by
the
council.
Please
do
let
us
know
if
you
want
to
answer.
A
A
One
of
the
things
that
I
think
is
so
powerful
is
we
haven't
reached
the
point
where
these
data
lines
have
to
be
enforced,
they're,
actually
in
a
position
where
we
can
prevent
kahan,
we
can
be
proactive,
not
reactionary,
and
so
what
are
the
steps
that
you
would
like
to
see?
Both
elected
officials
hospitals
be
taking
right
now
to
kind
of
correct
the
problems
that
we
see
as
an
immediate
issue
before
we're
making
these
difficult
decisions,
we
do
have
an
opportunity
right
now
to
save
lives
and
I'm.
Just
gonna
kick
back
to
the
group.
A
Anybody
who
would
like
to
answer
that
please
to
raise
your
hand
or
let
me
know
if
you're
on
video,
you
can
raise
a
hand
and
then,
when
I
see
you
I'll
answer
on
you.
If
you
want
to
use
the
blue
button,
you
can
do
that,
but
one
of
the
things
concrete
steps
that
you
believe
we
could
take
is
did
I
see
a
doctor
can
do.
Did
you
have
your
hand
up?
I
can
tell
a
doctor
Martin.
Okay,
there
we
go,
I
can.
M
I
can
certainly
start
us
off
and
then
maybe
have
some
other
folks
hop
in.
There
are
three
things
that
I
think
are
critical
sort
of
next
steps
to
prevent
us
from
hitting
this
crisis
standard
of
care
threshold,
which,
thankfully,
we
haven't
hit
yet
the
first
is
around
math
testing,
and
that
is
the
idea
that
we
need
to
figure
out
who
is
sick
and
who
is
not
sick
and
then,
from
there
take
next
steps
to
better
protect
our
communities.
We've
done
this
the
exact
opposite
way.
M
We've
we've
applied
this
health
equity
lens
at
the
end
of
this
process.
In
reality,
this
much
start
with
health.
Excellent.
These
sorts
of
decisions
have
to
start
through
the
lens
of
how
do
we
take
care
of
the
folks
who
have
been
most
impacted
by
social
determinants
of
health
and
so
doing
targeted
and
intentional
mask
testing
in
some
of
our
poorest
and
most
low
resource
communities
is
incredibly
important
and
national
we're
starting
to
do
some
of
that
work,
and
hopefully
we
will
be
able
to
catch
up.
M
The
second
is
around
providing
sort
of
concrete
resources
for
patients
to
do
the
things
that
we
tell
them
to
do.
I'll
tell
you
a
quick
story:
I
took
care
of
a
patient
two
or
three
weeks
ago,
who
was
a
young
woman
in
her
early
30s,
who
was
a
mother
of
three
and
had
her
elderly
mother
living
with
it
in
a
one-bedroom
in
Dorchester
and
after
we
got
her
Cove,
it
was
back.
She
had
cope
in
nineteen
and
symptomatic
and
I
told
her.
You
know
you
have
to
go
home
and
self
isolate.
M
She
looked
at
me
doctor.
How
do
I
self
isolate
I
live
with
my
three
kids
and
I
live
with
my
mother,
who's
in
her
60s
and
so
I
didn't
have
a
response
for
her.
Our
public
health
system
does
need
a
response.
We
need
to
figure
out
what
it
could
look
like
to
maybe
take
patients
who
live
in
cramped
quarters
like
that
and
and
admit
them
to.
M
You
know
other
sorts
of
intermediary
types
of
housing
or
ways
to
make
it
easier
for
people
to
self
isolate,
quarantine
at
home,
and
the
third
is
just
around
equal
access
to
any
vaccines
or
treatments
that
that
can
that
might
come
out
of
this
process
of
development
discovery
that
we're
in
right
now.
You
know
we
already
saw
who
the
winners
and
losers
were
with
regard
to
who
got
access
to
copa90
tests
and
so,
for
example,
the
first
couple
of
weeks
that
we
had
testing
available.
M
We
only
had
twenty
tests
for
our
entire
Hospital
and
our
hospital
is
not
any
different
than
any
other
Hospital
across
this
country,
and
so
we
ended
up
in
scenarios
where
patients
were
thinking
that
they
would
be
able
to
get
tested
because
they
looked
on
their
social
media
free
even
on
Twitter
and
on
the
news
and
saw
that
the
entire
Brooklyn
Nets
was
tested.
But
then
they
come
to
our
hospital
and
they've
got
symptoms.
They
probably
have
Kovan
and
we
tell
them
I'm.
Sorry.
We
can't
give
you
a
test.
A
Thank
you
for
that.
If
anybody
else
wanted
to
take
a
stab
at
the
question
of
wait,
we
can
practice
and
do
work
right
now
to
get
ahead
and
be
proactive
other
than
reactionary
to
some
of
these
racial
equity
issues
and
I'll
just
say
one
thing
because
I
know
was
mentioned
earlier.
The
ICU
bed
situation
that
we
have
in
Boston
is
very
different
than
the
ones
around
the
region.
A
That's
not
only
a
question
about
guidelines
for
right.
This
second,
but
also
the
CDC,
has
said
that
we
might
be
facing
this
outbreak
worse
than
we
are
right
now
in
the
fall,
and
so
these
are
issues
that
we
want
to
really
get
in
front
of,
and
so
just
a
second
question
in
my
final
question
for
this
up,
I
see
a
doctor
here,
yeah
add.
P
We
all
understand
that
these
guidelines,
and
essentially
all
of
the
the
recommendations
that
are
published
in
our
medical
journals,
are
like
the
dogma
and
essentially
they
become
set
in
stone
once
they
are
published
until
unless
you
quickly
and
fiercely
advocate,
and
make
changes
immediately
and
so
I
think.
The
the
the
point
of
trying
to
push
for
change
as
forcefully
as
possible
at
this
moment
is
try
to
such
a
change.
P
The
narrative
and
change
the
the
standards
that
are
going
to
be
applied
for
decades
to
come
in
in
anticipating
the
next
pandemic,
the
next
disaster,
the
next
public
health
emergency
that
we're
going
to
face.
So
it's
not
just
about
this
moment
it's
about
this
pandemic.
It's
about
again,
as
I
was
saying
pushing
this
conversation
forward.
Every
time
we
hear
about
it,
a
public
health
emergency.
We
read
about
how
cooking
bold
color
we're
disproportionately
affected.
It's
all
retrospective.
P
A
A
Can
any
of
you
speak
to
either
issues
or
areas
of
concern
that
you've
seen
on
the
floor
or
in
the
work
that
you're
doing
right
now
that
we,
like
highlighted
in
sort
of
address
in
a
public
fashion
or,
alternatively,
to
that
ways
in
which
we
can
really
start
pushing
for
equity
and
other
factors
that
deal
with
our
health
in
this
crisis
right
now
in
terms
of
who's
receiving
care
and
how
they're
receiving
their
care
and
then
I'll
go
to
councillor
Campbell?
If
anybody
would
like
to
answer
that,
I
see
yeah
one
second,
thank
you.
Q
Martin
mentioned
this,
but
we
also
have
to
consider
that
we
are
distracting
these
patients
to
homes
where
they're
not
able
to
self
isolates
food
deserts
places
where
they
do
not
have
the
opportunity
to
use
their
own
personal
transportation
when
they
do
have
to
go
to
work
so
areas
where
they
may
not
be
able
to
have
their
medications
delivered.
So
I
think
we
also
have
to
emphasize
the
role
that
community
health
care
workers
and
the
community
itself
is
really
going
to
help.
With
this
pan
pandemic.
We
have
to
figure
out.
Q
Yes,
all
the
PPE,
all
the
ventilators,
all
the
medications
for
other
patients
in
the
hospital
for
a
good
portion
of
patients
are
also
getting
discharged
home.
The
last
thing
that
we
need
is
for
patients
who
have
been
discharged
to
come
back
to
God
the
hospital,
because
somehow
they
didn't
get
their
medications
or
their
nutrition
was
inadequate
or
the
way
we
expose
to
the
virus,
so
I
think
also
some
discussion
and
some
work
has
to
be
done
on
that
level.
Q
A
B
You
councillor,
oh
and
thank
you
to
the
panelists
for
not
only
the
work
you're
doing
in
your
respective
fields,
but
for
your
fierce
advocacy
right.
Many
of
you
could
just
continue
the
work
and
say
you
know
someone
else
can
advocate
for
these
guidelines
to
change,
but
I
appreciate
the
intentionality
that
each
of
you
have
offered,
not
only
in
this
conversation
but
at
the
state
level,
in
any
space,
where
it's
important
that
you
raise
up
your
voice
to
talk
about
the
importance
of
equity,
I
I
also
wanted
to
sort
of.
B
B
You
know
where
people
are
dying
right,
so
if
it's
not
hearing
from
folks
who
have
lost
a
loved
one
to
kovin
nineteen
who
have
had
testing
done,
you
know
one
or
two
times
and
the
barriers
and
how
hard
it
is
to
get
tested.
Those
folks
who
are
at
home
after
a
call
with
their
doctor
self
quarantine
and
not
knowing
how
to
do
that
still
having
questions
around.
What
does
that
mean?
B
B
I
also
just
wanted
to
raise
on
what
counsel
royal
said
about
other
municipalities
that
we're
paying
attention
to
which,
of
course,
what's
happening
in
Boston,
doesn't
isn't
separate,
and
apart
from
what's
happening
in
Worcester
or
Springfield
or
other
municipalities
as
well,
my
I
guess
my
one
question
and
I
want
to
be
mindful
at
the
time.
I
know
you
guys
have
obviously
jobs
and
work
to
do,
but
is
what
is
the?
B
What
are
you
finding
to
be
the
barriers,
the
pushback
from
the
state
level,
with
respect
to
you
trying
to
get
them
to
open
their
eyes
to
what
we
already
in
this
group
agree
upon
right,
we
get
it.
We
see
it
I,
think,
counsel,
Roy
and
I.
Can
speak
to
the
pushback,
the
politics,
the
political
layers
of
all
of
this,
but
I'm
curious
from
your
perspective?
What
some
of
that?
B
The
barriers
are
currently
even
post
the
revised
guidelines
which
people
are
pushing
out
as
a
win
and
that
we
know
now
they're
expecting
us
just
to
move
on.
You
know
what
are
some
of
the
barriers
and
pushback
in
sort
of
concrete
terms
that
you're
hearing,
particularly
from
folks
in
power,
those
in
the
political
space,
because
I
think
we
are
more
than
willing
to
sort
of
take
this
on
with
such
a
sense
of
urgency
that
you
guys
are
because
we
know
our
constituents
are
dying
and
will
continue
to
die
as
a
result
of
Kover
19.
V
A
T
One
thing
what
I
think
would
be
helpful
is
better
data
collection
at
the
state
level,
I
think
that
is
still
lacking
when
we
look
at
our
we've
started
to
collect
data
on
a
hospital
level
about
the
demographics
of
our
patients,
but
at
the
state
level
we're
finding
that
up
to
a
third
to
40
percent
of
the
numbers
have,
for
example,
other
or
unspecified
for
race
and
ethnicity,
which
does
make
it
more
challenging
to
really
pin
down
of
the
demographics
of
this
and
really
target
our
interventions.
I
think
also
at
a
state
level.
T
It's
important
to
make
sure
that
the
messaging
going
out
to
communities
is
language,
concordant
and
culturally
sensitive,
given
that
we,
as
you've
mentioned,
lived
in
such
diverse
communities,
and
that
these
really
cultural
factors
and
the
realities
that
people
live
with
remain
II,
do
have
to
still
go
to
work,
to
support
themselves,
it's
impossible
to
stay
home
or
to
self
isolate,
so
I.
Think
coordinating
those
efforts
on
the
state
level
would
be
immensely
helpful
and
getting
that
data
that
clarity
of
data
will
really
help
guide
their
response.
Moving
forward.
B
And
I'm
just
curious.
What
else
are
people
hearing
in
response
to
you
know?
We've
been
talking
at
the
local
level
in
Boston,
I
think
for
some
time
around
the
importance
of
testing
in
dr.
Mart
and
I
think
spoke
to
this
as
others
as
well,
that
targeted
testing,
particularly
in
certain
neighborhoods,
certain
populations
of
people
and
the
response,
is
well.
The
federal
government
has
to
change
guidelines
or
the
state,
the
state,
and
it's
like
okay.
Why,
at
what
point
does
do
we
sort
of
mobilize
as
a
collective
to
say?
B
That's
unacceptable,
like
what
is
within
our
power
to
change
now
and
what
isn't?
What
will
work
on
those
pieces
and
so
I
find
myself
often
confused
as
to
what
we
can
do,
what
we
can't
do,
what
the
state
can
do,
what
the
federal
government
can't
so
I'm
curious
to
hear
what
what
are
some
of
the
other?
The
other
sort
of
pushback
in
Barrie's
are
hearing
not
just
around
guidelines
around
testing
targeted
testing
as
to
why
this
just
isn't
happening
any.
A
O
O
There
are
efforts
that
are
ongoing
to
try
to
improve
our
supply
chains,
to
make
sure
that
we
have
enough
testing
to
stand
up
labs
that
are
able
to
process
these
tests
in
a
timely
fashion,
and
there
have
been
efforts,
as
I
believe
was
already
mentioned
by
dr.
Martin,
to
go
out
into
the
community
and
reach
into
the
people
by
using
and
leveraging
some
of
the
resources
in
those
communities.
You
know
this
is
it's
great
that
we're
doing
this,
but
in
if
we
could
do
it?
O
All
over
again,
this
is
something
that
needs
to
happen
from
the
very
beginning.
So
at
the
very
start
of
when
we
start
to
hear
that
this
is
becoming
a
pandemic,
we
know
where
those
numbers
are
going
to
come
from.
We
know
who
are
going
to
be
the
hardest
hit
people
communities
neighborhoods,
so
we
have
to
be
able
to
go
in
there
and
immediately
start
to
implement
preventive
strategies
that
will
prevent
you
know
the
numbers
from
escalating
out
of
control.
O
O
It's
been
very
difficult
to
get
prepared
because
of
the
limitations
and
the
sequestration
of
shipments,
so
so
that
has
certainly
impeded
some
of
our
capacity
and
ability
to
to
get
ahead
of
this
fast
enough,
and
then
the
only
the
only
other
thing
I
will
add
is
that
one
very
sort
of
real
operational
challenge
is
how
to
how
to
coordinate,
in
real
time
across
multiple
hospitals
across
the
entire
Commonwealth,
to
ensure
that
we
have
real
time
data
of
where
these
ICU
beds
are
and
where
the
vents
are
located.
And
then
we
have
to
think
about.
O
You
know
the
the
difficulties
that
maybe
a
respiratory
technician
who
has
trained
with
two
or
three
different
brands
of
ventilators
might
have
if
they
are
then
provided
a
ventilator
that
they've
never
worked
with
before.
So
you
know
just
trying
to
think
about
on
the
ground
real
challenges
and
situations
that
perhaps
are
not
push
back,
but
that
are
realities
that
have
to
be
addressed.
T
Q
At
a
point,
along
with
with
a
testing
I,
think,
there's
also
going
to
be
an
amount
of
education
that
we
have
to
give
to
the
public
to
that
test
is
only
about
70
percent
sensitive,
so
there
will
be
points
if,
even
if
we
do
massive
testing,
where
there
will
be
false
negatives
and
I,
think
in
that
case
we
just
have
to
educate
the
public
like
that.
Even
though
your
test
is
negative,
you
are
in
an
area.
Dyes.
Q
B
Thanks
I
appreciate
you
raising
that,
because
I
came
up
on
a
call
just
for
the
Constituent
today
who
tested
negative
and
then
went
back
anything
tested,
positive,
and
so
we've
heard
that
quite
a
bit
in
certain
neighborhoods
and
while
you
still
need
to
be
taking
care
of
yourself
and
fall
in
the
costume,
so
I
appreciate
you
raising
that
Thank
You
councillor
oil
I
want
to
be
respectful
of
our
colleagues.
Thank.
A
You
and
so,
and
there
will
be
a
second
round
as
long
as
folks
are
and
stay
round.
So
it's
councillor,
Janey
or
our
president
Janey
rather
councillor
Braden,
followed
by
councillor
Bach,
followed
by
councillor
Mejia
I,
sorry
followed
by.
Let
me
just
give
you
the
first
one
and
then
I
stood
up
to
the
rest
of
its
councillor,
Janey,
followed
by
councillor
Braden.
Thank
you.
The
floors
are,
as
president
Jamie
hi
thank.
H
You
so
much
and
I
again
want
to
say
thank
you
to
the
panel,
not
just
for
being
here
for
this
very
thoughtful
discussion,
but
also
for
the
work
that
you
do
every
day
and
certainly
to
the
the
makers
of
this
hearing
order.
Counselor
royal
and
councillor
Campbell,
the
two
of
them
plus
myself.
We
represent
Roxbury
Dorchester
in
Mattapan,
so
certainly
areas
within
our
city
that
are
known
to
have
health
disparities,
certainly
areas
within
our
city,
where
people
of
color
live
and
oftentimes
are
living
in
poor
communities.
H
So
this
hits
home
for
me
for
sure
my
district
alone.
Looking
at
district
7,
you
know
there's
a
30-year
difference
and
the
life
expectancy
between
white
people
and
black
people
in
my
district,
depending
on
where
you
live
in
my
district,
and
so
these
issues
again
hit
home
I'm
interested
in
understanding
from
your
perspective
really
talking
to
the
panel
here.
H
A
I
Thank
you
for
thank
you,
everybody
to
for
sticking
it
out.
I
know
this
is
a
long
hearing,
but
it's
I'm
certainly
very
informative
and
I.
Think
along
the
lines
of
councillor
Janie's
question.
What
is
it
that
the
City
Council
can
do
because
I
think
we're
all
looking
for
action
steps,
and
this
has
certainly
been
very
informative
and
certainly
creates
for
me
personally,
a
deeper
thinking
about
this
situation
and
in
the
crisis
that
we
find
ourselves
in.
So
two
questions
for
you
and
again
I
appreciate
all
of
your
time
here
today.
I
What
can
we
do
in
particular
at
the
City
Council,
and
then
this
crisis
standards
of
care
I
didn't
know
about
this
prior
to
this
coab
in
crisis,
I'm,
just
learning
so
much
about
it
when
defeated
side.
What's
that
trigger
point
that
we
create
a
standard
of
care
and
when
this
is
written,
how
do
we
make
sure
that
the
right
people
are
at
the
table
when
we're
determining
this?
So
those
are
my
two
questions.
Q
Believe
the
question
was
well
at
what
point
do
institutions
creates
a
crisis
standard
of
care,
I
think
most
is
most
institutions
most
at
least
hospital
institutions.
Part
of
their
emergency
preparedness
is
to
have
a
crisis
standard
of
care.
It's
the
same
thing
when
when
they
do
incident
a
command,
you
know
we
use
the
crisis
standards
of
care
when
demand
exceeds
resources
and
as
institutions
as
hospitals.
That
should
always
be
part
of
the
plan.
So
in
terms
of
at
what
point
today
creates
it,
it's
I
think
it
is
there.
What
the
question
is
at,
what
point?
Q
P
That
question
so
I
think
the
concept
of
crisis
centers
of
care
actually
originated
after
the
h1n1
influenza
kind
of
mini
pandemic,
and
one
of
our
institutions
are
of
the
week
of
they'll
be
kind
of
regarded
as
kind
of
the
one
of
the
Gospels
of
our
medical
field.
It's
called
the
Institute
of
Medicine,
now
called
the
National
Academy
of
Science.
They
released
a
document
that
specifically
addressed
the
concept
of
needing
to
ration.
P
Essentially,
if
our
healthcare
system
were
to
be
overwhelmed
and
we
would
not
have,
we
would
not
have
enough
resources
for
everyone,
and
so
they
they
turned
to
this
shift
from
what
we
would
consider
our
normal
standards
of
care,
where
we
would
do
everything
for
everyone
to
a
crisis,
standard
of
care
and
it's
rooted
in
bio,
ethical
principles
and
so
I
think.
The
key
here
is
that
a
lot
of
these
theories
that
are
applied
to
crisis
centers
care
the
concepts
of
utilitarianism.
P
You
know
trying
to
help
the
most
number
of
people
concepts
of
justice,
which
is
you
know
something
that
we
all
are
very
passionate
about.
They
they
went
into
forming
kind
of
a
structure
for
coming
up
with
these
crisis
stages
of
care.
But
again
we
haven't
really
come
close
to
having
to
use
it
until
this
point,
and
so
it's
time
to
take
these
theories
and
and
make
them
practical
and
make
them
up-to-date
and
reflective
of
our
values
and
reflective
of
the
disparities
that
are
within
our
communities
of
color
and
who.
P
That's
a
great
question
and
I:
don't
know
if
there's
a
a
an
answer
that
I
at
least
I
am
aware
of.
It
seems
like
a
lot
of
the
processes
of
responding
to
public
health
emergencies.
Are,
you
know,
led
like
by
the
DPH
by
some
disaster,
medicine
folks,
and
then
there
are
a
lot
of
stakeholders
that
are
involved
in
making
these
decisions
like
ICU
doctors
and
but
I'm,
not
sure
how
they
select?
Who
is
on
the
committee
that
ultimately
determines
the
guidelines?
I
think
it's
variable
institution,
institution
and
state
to
state
I
can.
U
U
Standards
of
care
committee
are
medical
professionals,
I
think
the
majority
are
doctors,
there's
also
some
nurses
when
we
inquired
about
having
non-medical
folks
on
the
on
the
committee,
it
was
brought
up
that
often
it's
very
helpful
to
have
folks
who
are
who
have
a
medical
background,
because
often
it
requires
going
into
patient
health
records
such
as
epic
and
being
able
to
navigate,
and
some
of
that
stuff
is
very
tricky
to
do.
If
you
don't
have
that
kind
of
experience.
N
O
I
will
echo
that,
because
you
know
this
movement
of
health
equity
is
really
something
that
has
been
born
in
our
communities
and
the
communities
that
we
represent.
And
if
you
don't
have
that
representation
on
these
committees,
then
it's
easy
to
have
blind
spots
that
you
are
so
embedded
in
thinking
about
crisis
standards
of
care
from
perhaps
a
disaster
perspective,
or
perhaps
a
you
know,
a
very
sort
of
academic
ethics
perspective.
O
T
To
your
question
about
what
the
City
Council
can
do,
I
think
certain
institutions
have
more
capacity
to
really
think
about
these
crisis
standards
of
care
and
have
these
large
committees
within
our
Hospital
and
potentially
having
some
guidance
from
the
state
level.
That's
much
more
explicit
about
the
need
for
diversity
on
these
committees
will
be
very
useful
for
the
many
hospitals
across
the
state
that
may
not
have
the
capacity
to
be
thinking
as
deeply
about
this
in
the
moment
and
so
I
think
as
a
city
council.
T
One
thing
that
would
be
would
be
so
helpful
is
you
can
also
advocate
up
to
the
state
level
and
within
the
city
to
make
sure
that
it
committees
at
state
level
and
at
the
Department
of
Public
Health
that
are
establishing
these
crisis
standards
of
care
are
diverse,
are
reflective
of
the
communities,
because
that
will
ultimately
trickle
down
and
influence
their
policies
that
hospitals
are
putting
into
place
as
well.
I.
R
Think
also,
just
to
add
an
echo.
My
colleagues
points
I
think
it's
important
to
also
keep
in
mind
that
community
health
workers
and
community
advocacy
groups
have
been
doing
this
work
outside
the
context
of
a
you
know
this
particular
crisis
and
have
been
doing
it
for
quite
a
long
time
and
know
what
the
everyday
barriers
are
to
health
for
the
communities
that
they
work
with,
and
those
are
the
kind
of
not
having
that
kind
of
participation
is
what
creates
the
kind
of
blind
spots
that
were
mentioned
by
my
colleague
and
so
I.
I
I
A
V
Thank
you
all
so
much
I
listening
to
this
whole
hearing,
iock
sorry
I,
wasn't
able
to
ask
questions
earlier
I
wanted.
Thank
you
for
your
advocacy
I
think
that,
although
we
haven't
gotten
where
we
need
to
be
yet
that
your
voices
and
voices
like
yours
have
really
made
a
difference,
I
mean
even
in
the
changes
that
have
already
and
I,
really
appreciate.
V
That's
what
one
of
you
just
said
about
the
fact
that
that
these
are
things
where,
if
you
don't
challenge
them
right
when
they
get
issued,
they
kind
of
get
into
the
water
and
then
it's
very
hard
to
roll
them
back.
So
really
appreciate
the
work
on
that,
even
though
I'm
frustrated
that
frustrated
in
some
ways
that
all
of
you
here,
you
know
wearing
white
coats
have
to
be
spending
time
in
the
middle
of
a
crisis
on
it.
V
V
V
It
strikes
me
as
someone
who's,
not
not
somebody
with
a
medical
background,
but
somebody
who
thinks
a
lot
I
did
a
PhD
in
the
history
of
ethics
and
I.
Think
one
of
the
challenges
that
I've
always
struggled
with
these
the
medical
ethics
is
kind
of
the
natural
tilt
into
utilitarianism.
As
soon
as
you
start
talking
about
systems
just
because
it's
like
the
easiest
way
to
make
things
numerical
and
kind
of
add
up
pluses
and
minuses
and
sort
of
say,
hey,
we
got
big
the
greatest
good
for
the
greatest
number,
isn't
necessarily
night
net
Reich
right.
V
It's
just
highly
quantifiable
and
I.
Wonder
the
wonder
whether
and
to
me
it's
often
in
a
limitation
on
us
helping
our
most
vulnerable
populations
and
I.
Think
about
the
fact
that,
even
with
the
connection
between
housing
and
health
that
we
started
to
see
more
and
more
in
some
ways
what
really
got
the
ball
rolling
on.
That
was
the
recognition
that
our
unhoused
folks
were
costing
the
medical
system
so
much
money.
V
So
it
sort
of
it
became
in
certain
ways
about
the
dollars
and
cents
and
then
I
think
we
started
to
see
some
of
the
some
of
the
real
reasons
for
doing
it.
But
I
guess
my
question,
for
you
is:
do
you
think
there
are
any
non-crisis
of
care
spaces
in
the
medical
space
where
you
see
a
kind
of
different
and
more
full
justice
perspective
on
medicine
and
actually
like
taking
hold
and
pushing
back
on
some
of
the
kind
of
easy
slide
into
utilitarianism?
V
O
I'm
not
entirely
sure
that
this
will
answer
your
question,
but
I'll
just
throw
it
out
there.
There
are
efforts
across
the
u.s.
to
move
towards
value-based
care
and
much
of
value
based
care
is
looking
to
improve
the
health
and
well-being
of
those
who
are
probably
the
most
complex
patients
and
whose
social
needs
tend
to
be
so
profound
that
it
in
they
interfere
with
health
and
their
ability
to
maintain
their
health
and
so
I
guess
in
non
crisis
times.
O
There
might
be
some
lessons
to
be
learned
about
that
way
of
thinking
that
you
have
to
put
extra
resources
and
extra
effort
into
helping
those
communities
and
those
individuals
who
are
just
on
a
different
different
playing
field
there.
They
definitely
require
more
resources
and
and
effort,
and
if
we
are
going
to
maintain
health
and
and
help
them
to
access
care,
to
adhere
to
medical
treatments
to
make
sure
that
they
have
a
refrigerator
where
they
can
put
their
insulin,
you
know
whatever
it
may
be.
P
Back
in
this
is
like
a
global
health
example
when
the
HIV
epidemic
was
having
an
effect
in
the
African
continent.
I
think
initial
guidance
from
the
w-h-o
said
that
in
a
RT
antiretroviral
therapy
was
being
given
to
American
citizens,
citizens
of
Western
countries.
The
WTO
initially
released
guidance
that
they
actually
did
not
recommend
that
that
give
antiviral
therapy
to
people
in
Africa,
essentially
because
there
was
this
assumption
made
that
there
would
be
lack
of
adherence
and
then
that
would
make
them
at
officience
less
effective.
P
So
it
almost
is
kind
of
a
similar
concept
in
that
they
there
was
an
assumption
made
that
in
order
to
help
the
greater
society
and
make
these
medications
more
effective,
that
we
would
deny
a
certain
group
of
people
by
this
medication
and
it
was
through
local
community
groups
and
actually
researchers
are
who
proved
that
the
assumption
was
incorrect
and
that
long
Africa
would
actually
have
better
adherence
and
to
these
medications,
and
so
now
it's
universally
available
on
women
African
continent.
So
that's
kind
of
a
yeah.
V
I
think
that's
that's
really
helpful,
and
it
just
seems
to
me
that
yeah
a
policy,
a
policy
judgment
like
that
involves,
like
you
know,
just
thinking
of
people
as
interchangeable
and
I,
think
the
work
of
you
know
in
a
lot
of
ways
the
work
of
anti
racism
in
our
society.
It's
really
giving
everybody
dignity
in
a
way
that
doesn't
make
them
interchangeable
and
yeah.
V
It's
just
as
somebody
I
represent
the
district
that
most
of
the
hospitals
in
the
city
are
in,
and
district
8,
which
runs
all
the
way
from
the
West
End,
where
MGH
is
all
the
way
through
Beacon
Hill,
a
Back
Bay,
the
whole
Longwood
area
out
to
Mission
Hill
and
just
thinking
about
the
difference
in
life
expectancy
from
one
end
of
my
district
to
the
other
is
astonishing
and
I.
Think
it's
really
important
to
me
that
the
that
the
care
that's
being
offered
there.
V
A
K
You
so
at
first
I
just
want
to
say
thank
you
to
all
the
doctors
that
have
stayed
on
this
long
and
I
also
want
to
just
express
my
sincere
disappointment
and
the
fact
that
we
were
having
the
conversation
with
people
who
deeply
care
about
our
people
and
then
no
one
here
si
you
know,
there's
no
one.
The
doctor
who
was
here
earlier
had
to
leave.
K
So
I
think
that
it's
really
important
for
us
to
to
continue
having
these
conversations
but
I've
gotten
to
a
point
where
I
want
to
move
beyond
the
dialogue.
Earlier
I
asked
the
question
specifically
about
who
was
at
the
table
in
terms
of
even
designing
this.
The
system
of
chair
I
find
even
that
language
of
care
to
be
even
misleading,
because
if
it's
really
about
care
or
standards
of
care
or
whatever
the
case
is
I
feel
like
there
are,
people
are
not
feeling
as
though
we're
being
cared
for,
and
so
I
think.
K
You
know
young
people,
low-wage
workers,
immigrants,
people
who
are
undocumented
I,
believe
all
of
those
voices
need
to
be
at
the
table
informing
what
this
looks
like,
because
we
all
have
a
very
different
experience,
and
we
all
interpret
things
through
our
own
little
lived
experience
in
our
lens
right.
So
I
think
that
cultural
competency
is
really
important
as
we
continue
to
move
forward.
This
conversation
is
recognizing
that
I'm
and
I
don't
know
who,
which
one
of
you
all
talked
about
the
race
in
the
tokenism
situation.
K
We
have.
We
have
a
mandate
from
the
people
who
put
us
in
office
that
we're
gonna
represent
them
and
we're
gonna
fight
for
their
best
interest,
and
that
includes
making
sure
that
were
holding
all
systems
accountable,
including
institutions,
and
so,
if
they're,
there
are
hospitals
in
the
city
of
Boston
who
are
doing
business
in
the
city
of
Boston.
At
the
very
least,
we
need
to
figure
out
how
we
can
hold
those
institutions
accountable
to
changing
their
language
and
being
more
inclusive
and
whatever
it
takes
for
us
on
the
council
to
move
that
work
forward.
K
K
Sometimes
we
don't
go
to
the
hospital
because
they
don't
trust
the
hospital,
but
then
they
go
to
the
hospital
and
they
told
just
to
go
home
and
ride
this
out
and
I.
Think
that
I'd
love
to
hear
actually
I
do
I
do
have
a
question
I'd
love
to
hear
you
are.
What
can
we
say
to
our
people
aside
from
just
going
home
and
riding
this
out?
Thank
you.
So
much
raising
hands.
R
I
I
just
wanted
to
comment
on
something.
You
said
that
I
thought
was
so
important,
and
that
is
that
you
know
there
is
kind
of
a
model
of
health
care
and
healing
that
talks.
It's
called
healing
centered
engagement,
which
was
brought
up
by
Sean
Ginn
right
and
healing
centered
engagement
is
approaching
health
from
the
standpoint
that
trauma
for
the
trauma,
racism,
the
trauma
to
economic
injustice
that
creates
that
health,
our
collective
experiences
and
so
people
need
to
have
collective
healing,
and
this
collective
healing
happens
through
political
engagement.
R
Q
Q
She's
definitely
led
efforts
where,
when
we're
having
difficult
conversations
with
with
with
a
patient
and
is
actually
going
to
be
someone
there
who
speaks
their
language,
especially
for
spanish-speaking
patients,
and
we
she's
had
a
system
where
there's
like
placards,
that's
that
the
physicians
can
actually
place
by
the
bedside
and
then
ask
so
I
think
those
efforts
actually
being
implemented
and
those
concerns
are
being
being
heard.
So
I
want
you
to
know
that
people
are
actively
working
on
those
efforts.
P
One
other
thing
that
we're
working
on
in
the
department
of
emergency,
medicine
and
creative
partnerships
with
the
department
of
internal
medicine
and
some
other
folks
are
on.
This
call
is
a
mechanism
to
try
to
reach
out
and
and
check
in
on
patients
who
we
sent
home,
because
there's
a
lot
of
anxiety
that
people
feel
and
going
home
and
most
people
do
okay
with
this
illness.
But
we
are
making
a
lot
of
assumptions
about
people's
understanding
of
what
they
need
to
do
when
they
go
home.
P
We're
making
a
lot
of
assumptions
about
what
resources
they
have
access
to
their
abilities
to
solve,
isolate,
and
so
we've
really
sort
of
try
to
figure
out
how
we
can
support
people
once
they
leave
the
emergency
department
and
doing
things
like
doing
a
very
detailed
health.
Related
social
needs
survey
to
try
to
connect
them
with
resources
and
then
checking
in
in
a
couple
of
days,
see
how
their
symptoms
have
progressed
and
tried
to
see
if
they
need
to
be
instructed
to
come
back
to
the
emergency
department
and
encourage
them
to
do
that.
P
If
they,
if
they
do,
have
worsening
symptoms
and
we're
actually,
one
of
our
cogs
of
the
department
of
emergency
medicine
is
created.
This
paramedicine
program,
where
they
will
check
in
on
patients
at
home,
can
check
their
oxygen
levels,
can
give
them
IV
fluids,
and
so
people
are
starting
to
think
about
ways
that
we
can.
We
can
do
better
and
we
can
kind
of
affect
some
of
these
social
factors
that
actually
have
probably
the
most
impact
on
how
people
do
with
this
with
this
illness,
because
it's,
it's
not
biologic,
why?
P
You
know
people
of
color
and
people
who
are
marginalized
or
died
at
higher
rates
because
of
these
social
factors
that
have
already
led
them
to
be
unhealthy,
that
prevent
them
from
getting.
You
know,
taking
care
of
themselves
being
able
to
secure
themselves
in
a
way
that
that
you
know
makes
their
immune
system
robust
enough
to
be
able
to
fight
this.
Thank.
K
You
thank
you
Ricardo,
yes,
I
know,
you're
facilitating,
but
I
wanted
to
one
more
thing:
I
just
wanted
to
say
that
I
found
it
very
passionate.
I
wasn't
yelling
at
anywhere
yeah,
because
you
want
my
people
and
you
all
get
it
so
that
was
more.
That's
just
me
being
expressed.
So
I
just
really
be
mindful
of
my
tone:
I
don't
want
to
scare
anyone
and
then
the
other.
K
So
I
think
that
that's
something
concretely
that
we
can
walk
out
of
this
conversation
with
in
terms
of
exploring
how
we
make
sure
that
we
have
access
that
we
create
opportunities
for
people
to
be
in
this
space
as
well.
So
I.
Just
want
to
say
thank
you
again
for
all
of
your
work
and
for
being
here
and
counselor.
I
know
you
for
facilitating
this
very
important
that
and
to
councillor
Campbell
for
bringing
this
to
our
attention
and
my
colleagues.
So
thank
you
again.
I'm
going
to
another
zoom,
but
I
love,
y'all,
we'll
see
y'all
later.
A
Thank
you
so
much,
and
so
we're
gonna
start
a
second
round.
I
really
only
have
two
requests
and
one
that
I
always
wanted
like
this,
but
one
to
just
refocus
the
state
guidelines
as
they
are
currently
written,
and
this
is
something
that
I'm
gonna
speak
to
my
own
opinion
on
this.
The
next
I
want
to
get
the
panels
that
are
still
here
and
I
think
it
came
through
loud
and
clear,
but
I
want
to
make
sure
it's
clear.
The
original
state
guidelines
and
prices
of
care
were
racist.
A
They
had
incredible
racial
inequity
built
into
them,
and
the
outcomes
would
have
been
racist
and
inequitable.
The
revision
that
happened,
48
hours
or
48
hours
ago,
has
not
completely
cured
that
problem
and
I
just
want
to
be
for
me
and
I
just
want
to
be
clear
with
the
doctors
that
we
do
have
here.
Whether
or
not
anybody
here
believes-
and
you
can
just
say
yes,
if
it's
so
that
the
current
crisis
of
care
standards,
as
currently
written
with
the
revision
from
48
hours
ago,
is
actually
one
that
doesn't
further
racial
inequity.
A
Does
anybody
here
believe
that
those
prices
of
care
standards
as
revised,
no
lumber,
further
racial
inequity
and
going
once
going
twice,
got
it
all
right?
So
that's
one,
so
anybody
who's,
listening
or
paying
attention
to
this
was
holding
up
his
revision
and
somehow
carrying
these
state
guidelines
of
racial
inequity.
I
haven't
heard
from
a
single
panelists
here,
including
who
we
had
here
for
dr.
Weinstein
for
Stewart,
that
they
believe
that
these
new
guidelines
actually
were
implementable
without
creating
some
kind
of
racial
disparity
for
Stewart.
A
He
never
said
that,
specifically,
what
he
said
is
they're,
not
using
them
they're
using
short
term
or
big
morbidity,
and
so
I
just
want
to
make
that
clear
in
terms
of
justice.
Hearing
that
there's
work
to
be
done
there,
that
the
revisions
aren't
or
should
not
be
complete
and
then
to
here's.
My
question
for
all
of
you
individually.
Is
there
a
question
that
wasn't
asked
of
you
today
that
you
wanted
asked
or
that
you
would
like
to
answer?
And
then
what
is
your
answer
to
that
question
and
that's
for
everybody?
A
A
A
Doing
both
in
and
out
of
hospitals,
this
is
deeply
deeply
moving
for
me
to
have
so
many
doctors
of
color
here
speaking
directly
to
issues
that
really
reflect
deep-seated
generational
inequities
in
our
communities.
The
way
you
fight
for
your
patients
in
and
out
of
hospitals
was
moving
to
me
and
a
great
example
to
others,
and
so
thank
you
so
much
with
that.
I'm
gonna
just
ask
other
counselors
that
are
on
here,
whether
or
not
they
would
like
to
make
any
closing
statement.
A
B
Thank
You
councillor,
oh
and
from
aid
in
my
four-month-old
to
you,
doctors.
Thank
you
so
much
for
staying
on.
Thank
you
for
participating
in
this
conversation
for
the
work
you
do
every
day.
I
will
follow
up
with
councillor
audio
in
terms
of
next
steps,
because
there
is
some
continued
advocacy
we
can
do
in
this
space
around
the
guidelines.
The
new
guidelines
that
people
think
have
solved
the
problem
around
individual
institutions
and
systems
having
their
own
standards
that
they're
reviewing.
We
haven't
seen
finalized
versions
of
those.
B
We
have
no
idea
if
they're
adopting
the
guidelines,
what
they're
doing
with
the
guidelines
I
think
those
are
still
a
lot
of
unanswered.
Questions
for
community,
in
particular
for
us,
which
we
can
follow
up
on.
In
addition,
I
think
point
that
councillor
Mejia
made
with
respect
to
how
we
as
a
body
as
councillors
who
represent
folks
on
the
ground,
can
be
a
part
of
some
of
your
advocacy
in
conversations
not
just
in
the
midst
of
covert
19,
but
on
other
shoes
that
come
up
in
the
medical
space.
B
I
think
we
probably
should
thinking
about
what
could
that
look
like
in
terms
of
consistent
advocacy
around
these
issues?
Healthcare
related
and
particularly
with
through
the
equity
lens
I,
also
want
to
just
I
think
flag.
Oh
no
I
just
want
to
speak
to
the
on
the
record.
I
I
was
frankly,
council,
Roy
and
I
were
texting
at
different
moments
during
this
hearing
was
very
disappointed
or
extremely
disappointed
that
no
one
from
the
administration
came
on
whether
it's
from
our
Health
Commission
from
the
mayor's
office
I
mean
we
talked
about
this
issue.
B
B
Obviously
so
I
was
extremely
disappointed
and
I
understand
how
busy
our
people
are,
and
we
have
a
lot
of
hearings,
but
in
the
case
where
the
council
hearings
are
related
to
covin
19
in
particular,
and
a
pressing
issue,
I
do
think
it's
important
that
folks
show
up
if
you're
able
to
spend
as
much
time
as
you
did
with
us
today.
I
think
it's
important
that
the
administration
do
so
too,
and
so
we
will.
We
will
bring
that
that
concern
back
and
I
know.
B
My
team
also
works
participating
on
the
call
and
taking
notes,
so
other
things
come
up
for
you
as
individual
providers
around
some
of
the
housing
issues,
unemployment
issues
other
case
issues
we're
also
a
resource
for
your
constituents
with
respect
to
that
or
your
patients
so
use
us.
We
have
folks
who
are
out
of
jobs
when
we've
been
helpful
in
getting
them.
B
Unemployment
benefits
other
financial
resources,
small
business
owners
who
need
help
all
the
other
things
that
are
forming
their
health
right
now
we
can
be
helpful
to
so
use
as
a
resource
with
respect
to
that
do
spread
our
information
around
most
of
it
is
on
the
website.
We
are
responsive.
I
can't
speak
for
everyone.
B
My
team
and
I
are
responsive
and
we
try
to
be
responsive
within
24
to
48
hours,
understanding
the
immediate
needs
so
to
use
us
for
that,
and
thank
you
so
much
I
do
think
it's
powerful
that
I
think
all
the
ladies
are
left
behind
and
so
kudos
to
us,
women,
Thank,
You,
counselor
and
stay
safe.
You
guys!
Thank
you,
I!
Don't.
A
E
Thank
you
so
much,
and
thank
you
to
all
that
the
panel
I
I'm,
a
healthcare
professional
myself,
I'm,
a
physical
therapist
by
profession,
like
I,
owe
the
agonizing
I
have
had
the
agonizing
experience
of
standing
at
a
hospital
bed
with
someone
who's
in
a
medical
crisis
and
I'm
trying
to
do
in
UK.
We
do
we
do
we
don't
have
respiratory
therapists
and
physical
therapists
do
a
lot
of
the
respiratory
care.
E
So
in
those
desperate
moments,
when
you
know
someone
needs
a
ventilator
and
you're
in
a
small
community
hospital
that
doesn't
have
access
to
a
ventilator,
and
you
know
the
person's
going
to
die,
it's
very
intense
and
it's
it's
incredibly
difficult
work
conditions
that
you
folks
are
working
on
there
every
day
and
I
really
appreciate
the
the
your
passion
and
your
dedication
to
seeking
justice
and
equity
in
our
healthcare
system
here
in
this
moment
of
crisis.
But
we
need
to
address
this
going
forward.
It's
not
going
to
go
away
when
this
crisis
is
over.
E
A
Jane,
your
President
President
Cheney
or
councillor
Bach-
if
you
have
closing
comments
into
camera,
goes
on
out
no
counselor,
counselor,
Bach,
you're,
good,
okay,
and
so
with
that
I'm
going
to
essentially
close
it
out
for
the
panel
and
allow
public
comment
we
do
have
somebody
waiting
in
the
waiting
room
can
give
public
comment.
I've
been
very
patient.
I
just
want
to
reiterate
in
my
closing
how
grateful
I
am
to
all
of
you
being
here.
Please
do
stay
safe.
Please
do
reach
out
to
us
or
any
kind
of
auxilary
issues
or
adjacent
issues.
A
If
you
have
patients
who
have
needs,
please
reach
out
to
our
office,
please
consider
us
resources
for
that.
If
there's
advocacy
issues
that
we
cannot
live
to,
please
bring
that
to
our
attention.
Our
work
does
not
stop
here
on
these
guidelines.
These
guidelines
are
a
matter
of
life
and
death
for
many.
If
we
reach
that
stage,
they
were
matter
of
life
and
death.
A
For
many
in
my
district
in
the
districts
of
others,
I
know
councillor
Campbell
has
a
high
proportion
or
disproportionate
rate
as
far
as
population
to
infection,
and
so
this
is
a
very
major
issue
for
us.
It's
a
significant
issue,
I
echo,
my
colleagues
and
hoping
that
in
the
future
on
issues
like
this,
you
know
just
not
just
even
as
the
city
councilor
just
as
a
resident
of
Boston.
A
It
doesn't
include
whether
or
not
they
are
putting
in
place
these
guidelines,
whether
they
couldn't
place
their
own
guidelines
with
their
issues
with
this
guideline
is
actually
just
a
quote.
It
very
loosely.
It
says
the
commonwealth
crisis
standards
of
care
guidelines
were
updated
on
april
20th
and
posts
Oba
19
website.
Our
testimony
will
reflect
our
strong
support
for
the
critical
updates,
the
guidelines
and
I've
continued
welcoming
to
broad
public
input
on
guidelines.
A
A
So
thank
you
so
much
for
everything.
You've
done
and
we'll
make
sure
to
keep
you
in
touch
in
ways
in
which
we
can
continue
to
work
on
with
this
world
forward.
So
thank
you
so
much
with
that
I'm
gonna
switch
it
over
to
public
comment.
Lorena
is
Stratta,
Martinez
is
here
and
so
I'm
gonna
get
your
unmuted.
Can
you
hear
me
hi.
A
W
Know
I.
Thank
you
so
much
for
everything
that
you
guys
are
doing.
My
just
this
figure
in
the
last
unit
are
some
of
the
stuff
that
you
all
have
at
the
moment
and
really
I'm.
My
name
is
not
in
the
stomach
like
humans,
Basten's,
hopefully,
environment,
most
apparently
Gaston
Institute
at
UMass
learned.
He
was
part
of
the
task
force
and
we
were
talking
a
lot
about
this
in
Augusta
and
how
it
impacts
the
specifically
lab.
You
know,
I'm
glad
the
next
community,
mr.
W
Boston,
but
more
broadly,
and
we
were
trying
to
figure
out
how
the
best
gathered
a
that
more
vegan
early
and
how
could
we
help
facilitate
that
process
and
thrifty
about
may
training?
Isn't
a
fair
analogy,
so
I'm
trying
to
sort
of
figure
out
how
to
best
a
gather
information
that
would
help
the
necessary
resources,
know
us
really
in
Boston,
but
some
of
the
smaller
cities.
W
A
W
A
And
so
maybe
some
of
the
dock
and
just
give
some
semblance
of
how
our
data
gathering
could
be
done
at
the
grassroots
level
at
their
hospitals.
I
can
tell
you
that
the
data
that
I'm
seeking
just
very
specifically
is
data
on
who's
not
getting
tested.
We
currently
don't
have
data
on
who's
being
told
that
they
don't
have
a
test
or
that
they
can't
be
tested
and
essentially
being
told
the
self
quarantine
in
just
assume
they
have
it.
A
We
don't
have
that
data
I,
don't
have
data,
for
instance
complete
data
on
racial
demographics,
yet
I
don't
have
complete
data
on
income
socioeconomic
brackets,
I,
don't
have
complete
data
on
whether
or
not
somebody
is,
for
instance,
using
public
transportation
or
using
personal
transportation
or
whether
or
not
somebody
is
what
their
occupations
are.
There's
a
there's
a
lot
of
incomplete
data
there,
everything
from
a
government
perspective.
It
makes
it
difficult
to
be
prescriptive
with
policy,
and
so
in
terms
of
how
we
do
that.
A
Also
I
don't
have
data
on
whether
or
not
a
patient
is
monolingual
or
bilingual.
So,
there's
a
lot
of
assumptions
that
happen
in
that
boy.
For
instance,
if
the
Latino
population
is
a
specific
component
of
the
racial
data,
does
that
mean
that
their
component
there
is
based
on
the
fact
that
they
don't
speak
English
or
is
it
similar
so
without
knowing
if
they're
monolingual
or
bilingual
I
can
actually
speak
to
that
right
and
so
I'm
Latino?
A
If
I
was
positive,
the
issue
would
not
be
that
I,
don't
speak
English
and
so
there's
a
lot
of
assumptions
that
get
made
in
that
boy
that
make
it
so
that
we
can't
be
as
prescriptive
as
possible
from
a
policy
standpoint
and
where
we
give
our
assistance
for
resources,
I'm
sure
it's
equally
frustrating
for
our
doctors
and
so
I
guess
the
question
would
be
there's
data
that
you
believe
should
be
getting
collected
that
could
be
collected.
What
is
it
I
guess
what
banana
is
asking
and
also
what?
A
O
So
I
will
just
maybe
suggest
that
one
of
the
data
points
that
you
might
want
to
collect
information
on
is
households
a
number
of
members
living
in
any
given
household
and
how
that,
in
terms
of
the
square
footage,
how
does
that
implicate
their?
You
know
health
risk
for
transmission
and
their
inability
to
socially
distance
from
family
members?
That
would
be
interesting
to
know
like
the
density
of
the
households
in
any
given
zip
code.
A
A
Okay,
and
so,
as
things
come
across,
I'll
send
that
to
to
you
latina
in
terms
of
the
Gaston
Institute,
and
also
there
are
things
that
I'm
uplifting
myself
every
day
on
that
front
and
I
believe
that
concludes
all
of
our
public
comment
at
this
moment,
and
so
thank
you
again,
everybody.
This
would
adjourn
our
council
hearing.
Thank
you
so
much
for
giving
nearly
three
hours
of
your
time
to
really
digging
in
I'm.
A
Actually,
we
have
staff
watching
this
I'm
probably
going
to
rewatch
this
just
because
the
amount
of
data
and
information
that
you
give
it
is
really
good
and
really
prescriptive
and
things
that
I
can
now
lift
up
and
really
work
with
my
partners
and
government
to
make
sure
that
we
address
them
in
real
ways
and
looking
forward
figuring
out
ways
in
which
we
can
use
the
minds
and
the
brilliance
in
front
of
us
and
then
folks
in
the
field
to
really
start
getting
ahead
of
these
issues
before
we.
We
have
our
next
pandemic
right.