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OCR Provides Technical Assistance to the State of Arizona to Ensure Crisis Standards of Care Protect Against Age and Disability Discrimination

The Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) has resolved a complaint against the State of Arizona involving its crisis standards of care ("CSC") guidelines.  The complaint was brought by the Arizona Center for Disability Law, the Arc of Arizona, the Arizona Center for Law in the Public Interest, the Native American Disability Law Center, and a number of national and local disability and aging advocacy groups. OCR provided technical assistance and used a collaborative process to revise the State of Arizona’s guidelines to reflect legal requirements and best practices regarding the needs of people with disabilities and older adults. This effort builds on OCR's continuing work to ensure non-discrimination during COVID-19.

As a result of this work, Arizona has issued an updated CSC plan that incorporates the following:

  • Prohibition on the use of a patient's long-term life expectancy as a factor in the allocation and re-allocation of scarce medical resources;
  • Prohibition on the use of categorical exclusion criteria, instead requiring an individualized assessment based on the best available objective medical evidence;
  • Prohibition on the use of resource-intensity and duration of need as criteria for the allocation or re-allocation of scarce medical resources. This protects patients who require additional treatment resources due to their age or disability from being given a lower priority to receive life-saving care due to such need;
  • Inclusion of reasonable modifications to the use of clinical instruments for assessing likelihood of short-term survival when necessary for accurate use with patients with underlying disabilities;
  • Inclusion of new protections against providers "steering" patients into agreeing to the withdrawal or withhold  life-sustaining treatment, clarifying that patients may not be subject to pressure to make particular advanced care planning decisions or require patients to consent to a particular advanced care planning decision in order to continue to receive services from a facility; and
  • Inclusion of language ensuring that long-term ventilator users will be protected from having a ventilator they bring with them into a hospital setting taken from them to be given to someone else.

“Productive collaborations between OCR, local stakeholders who filed the complaint and the State of Arizona led to development of plans to help ensure non-discriminatory access to medical resources during this public health emergency for older adults and persons with disabilities,” said Robinsue Frohboese, Acting Director of the HHS Office for Civil Rights.   “The COVID-19 pandemic has presented considerable challenges for our health care systems to address but the fundamental principles of non-discrimination remain, and all people should be treated with dignity and respect and may not be denied access to resources simply because of who they are.”

To see Arizona’s new CSC guidelines, please visit

For more information about how OCR is protecting civil rights during COVID-19, please visit

To learn more about non-discrimination on the basis of sex, race, color, national origin, age, and disability; conscience and religious freedom; and health information privacy laws, and to file a complaint with OCR, please visit

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