Introduction

Webcast archive: Repairing medical equipment in the COVID-19 pandemic

This week, we examine some of the underlying issues and obstacles to ventilator repairs during the coronoavirus pandemic, as well as a statement calling on nursing homes to take precautions for the safety of residents and staff.

Webcast archive: Repairing medical equipment in the COVID-19 pandemic

During the COVID-19 pandemic, we will not present our webcast, due to technical problems caused by heavy internet usage. However we’re providing the text as a bulletin to offer up-to-date information about assisted suicide, euthanasia and ending-of-life practices for the disability community.

REPAIRING MEDICAL EQUIPMENT IN THE COVID-19 PANDEMIC

  • Many people are adjusting to life at a much slower pace, in order to limit the spread of the COVID-19 virus and prevent healthcare systems from being overwhelmed. Disability rights advocates have written about the consequences of a ventilator shortage, which puts disabled people even more at risk in a medical system that already discriminates. This week, we’ll look at how manufacturers make it difficult to repair medical equipment, and some solutions.
  • Hospitals will need to provide breathing support to many people with the Coronavirus at the same time, and inevitably, some of the ventilators will break down. Getting those machines fixed quickly can be difficult, especially when manufacturers impose barriers to making repairs.  One such obstacle comes from digital locks, which allow only technicians licensed by the manufacturer to open and adjust the machines. Companies often use non-standard parts in designing the machines, and are the only supplier of those parts, thus cornering the market and keeping the prices high.  Manufacturers even limit access to repair manuals. So even if a hospital has staff who could repair equipment, or could call an independent technician, they may be prevented from fixing a life-saving device.
  • Despite the claims of some manufacturers that independent repairs are unsafe and ineffective, the US Food and Drug Administration found in 2018 that “the continued availability of third party entities to service and repair medical devices is critical to the functioning of the U.S. healthcare system.”
  • A website called iFixit is putting together an online database of information needed for hospital equipment repairs. They are asking medical professionals to send in model numbers of ventilators, BiPAP, and anesthesia machines, information about parts that are likely to break, and substitutes for items that will need to be reused.
  • The US Public Interest Research Group also released a statement calling for “device manufacturers [to] immediately release all repair documentation and software.” Nathan Proctor, director of US PIRG’s “Right to Repair” campaign, said “The fastest repair service is when hospital technicians have what they need to do repairs in-house, or can hire qualified technicians at their discretion. Preventing repair is generally a bad idea. That is even more true in a crisis, when systems are under stress. It could mean the difference between life and death.”
  • Do-it-yourself repair has become popular over the last few years due to increased concern about waste, excess production, and their effect on the environment. “Repair cafes,” have appeared in communities across Canada, where people bring household goods like lamps or kettles to be fixed, and learn how to do more of that work themselves.
  • Planned obsolescence, where a product is designed to fail after a certain amount of time, should be familiar to many smartphone owners. Manufacturers no longer support nor update them, and parts are specialized so that only a licensed professional with the right training and resources can fix them. Digital copyrights are another obstacle preventing repairs by non-licensed technicians.
  • In response, the European Union and some US states have adopted “right to repair” legislation. These laws require manufacturers to design products to be repair-friendly, to use standardized parts, to make repair manuals available, and bans the use of digital locks.  A bill proposed in the Ontario legislative assembly by Liberal MPP Michael Coteau focusing on “electronic products” was defeated in 2019, due to lobbying by companies like Apple, Samsung, and Microsoft.
  • Repairing equipment is not the only issue hospitals are confronting. At this point, no one knows:
    • How many ventilators are available right now;
    • How many will be needed through the course of the pandemic;
    • If and how used CPAP and BiPAP machines can be repaired and repurposed to provide respiratory support to people with the coronavirus; and,
    • Who will operate and calibrate the equipment if trained professionals (for example, respiratory therapists) come down with the virus.
  • In a time of crisis, we are all relearning that there is no such thing as absolute independence. The truth is that we’re interdependent. Even as only “essential” services are running in various provinces, everyone needs manufacturing, shipping and utilities to survive. We hope that preserving the lives of disabled people will not be considered a waste of these precious resources.

NURSING HOMES AND COVID-19: “WE’RE NOT READY”

  • In a press release issued on March 19, Jonathan Marchand (President of Coop ASSIST) and Daniel Pilote (the named plaintiff in a class action lawsuit) appealed to the government of Quebec to improve conditions in nursing homes (known as CHSLDs) during the outbreak. Following are some excerpts from their statement:
  • “Yesterday it was announced that the first death related to COVID-19 was in a nursing home. In addition, a nursing home worker tested positive. We believe that institutions are not ready to face this challenge!
  • We are people with disabilities with special needs and whistleblowers who are forced to live in nursing homes, because the government refuses to provide us with the assistance we need to live at home.
  • Even without a crisis, the organization of nursing home services unnecessarily endangers our lives because of ministerial rules, professional and union orders that are rigid. Often, only nurses, who are overwhelmed, are allowed to assist us. Sometimes there is only one person responsible for more than 100 residents who can help us.
  • The government expects a lot of absenteeism in the healthcare system, as workers exposed to the virus will have to quarantine themselves. The situation in the nursing homes at the staff shortage is already severe.
  • The government has prohibited visits to nursing homes and residences for the elderly. However, very little is done to reduce the risks from employees.
  • To ensure our safety, ensure the safety of all residents and to ensure continuity of service during this crisis, we request that:
    • Non-professional workers (for example, attendants) should be allowed to help nursing home residents by performing basic care. This includes respiratory and other care, without restrictions. If necessary, training should be provided.
    • One caregiver per resident should be allowed to visit with restrictions. If the government does not allow visitors to help, it must provide the assistance necessary to meet the basic needs of residents. Currently, visits are prohibited and there is no plan to make up the shortfall. Many people survive with the assistance of a visiting caregiver.
  • Additional prevention and protection measures in nursing homes:
    • Take the temperature of all workers and those entering the institution. Currently, those who enter are only asked about their health.
    • A COVID-19 testing regime for workers must be put in place. If a worker suspects they are infected, they must be tested. The same applies to a visiting caregiver, subject to the government’s ability to test.
    • Management must communicate openly when there is an infection, a risk of infection or an investigation. Currently, the facts are not reported to employees, residents and families. The government is communicating openly with the public; managers of nursing homes must do the same to maintain everyone’s confidence.
    • Limit the use of “roving teams” of workers. These workers visit several units and institutions per week. It is a dangerous practice for the spread of the virus. Workers should stay at the same location as much as possible.
    • Protective equipment must be provided to workers in the event of an outbreak. (N95 mask, goggles, etc.). If the equipment is available, workers must be informed.
    • Communicate clear directions to employees, residents and families on what will happen in the event of an outbreak at a facility. Explain the protocols to follow so that everyone is on the same page. Again, transparency is important. Currently, there are many questions.
    • Issue strict rules to employees regarding their activities outside of work. Currently, employees continue to participate in gatherings and do not respect the social distancing measures promoted by the government.
    • Avoid gatherings among residents and employees, whether for meals or other activities.
    • For new admissions to nursing homes, establish a quarantine of 14 days.”