If a deadly flu epidemic hit Maryland, the governor could decide which patients would be put on life-saving ventilators — and which wouldn't.
Maryland's attorney general issued an opinion in December that found that the Catastrophic Health Emergencies Act of 2002 gives the governor the authority to ration the machines that support breathing in flu patients suffering respiratory complications.
That doesn't mean the governor would decide personally who gets a ventilator. Rather, he or she would declare a public health emergency and hospitals would rely on a set of criteria to allocate resources.
Those criteria, however, don't exist yet.
The Johns Hopkins University and other institutions have held public meetings to gather input on the potentially grim task of doling out ventilators and plan to share their findings this year.
Officials at the state Department of Health and Mental Hygiene said they plan to continue funding the development of policies to allocate scarce resources including ventilators.
It's not clear when the criteria will be finished. Or when they may be needed.
The flu typically sickens and kills thousands in the United States every year, but pandemics remain uncommon. During the last one, in 2009, a vaccine hurried into production was credited with stemming a virus that led to about 12,000 deaths.
Federal planners suggest the system could be strained by a moderate pandemic like the one in 1957 that caused 70,000 U.S. deaths, or another in 1968 that led to 34,000 deaths.
A severe pandemic like the Spanish flu of 1918, which led to more than 500,000 U.S. deaths, likely would necessitate rationing.
A severe pandemic today could sicken 90 million people and lead to 1.9 million deaths, the planners estimated. Some 740,000 ventilators could be needed.
Studies show U.S. hospitals have about 70,000.
"Fortunately, we have not experienced a pandemic event that has resulted in a ventilator shortage in the U.S," said Alan C Regenberg, director of outreach and research support at Hopkins' Berman Institute of Bioethics.
But "even a more moderate event would push our current capacity to its limits," he said, "and a severe event would leave us with major mechanical ventilation shortages."
New York was the first state to develop rationing criteria that emphasized saving the most lives. Del. Terri Hill, the Howard County Democrat who requested the attorney general's opinion on the governor's powers, said there isn't need for further legislation but there is need for a state plan.
"It's better to draw up the criteria in advance, rather than have a reactionary response during an emergency," said Hill, who is a physician. "You can make bad decisions in an emergency situation."