Regulators can save lives by protecting medically vulnerable facility users

Peggy – a patient with Dr. Kahn – needs an oxygen concentrator, a respirator and an inhaler in her home, which are critical medical equipment. For people like Peggy who depend on specialized medical equipment for life support, disconnecting utility service can be life-threatening. As she struggles to make ends meet, her utility bill is always the top priority. Living without oxygen or a ventilator is simply not an option.

every year, Millions of families are cut off from utility services Because they are unable to afford their monthly bills. Although facility closures can be harmful to any home, they are especially dangerous for medically vulnerable individuals like Peggy. In some cases, disconnection due to non-payment of the bill resulted in Serious injury or death.

To avoid such tragic outcomes, most states offer some form of protection against lockdowns for medically vulnerable individuals. However, recently survey 50 states by National Center for Consumer Law (NCLC) found that “many existing state laws and regulations are too narrow, create protections that are difficult to access and not widely known, or provide an extremely short period of protection.”

Recently disclosed data on Michigan’s medical protection programs provide a rare look at some of the challenges facing current programs. Michigan provides two types of protection for medically vulnerable people. so called “Critical care clients—Those who rely on life-supporting medical equipment and for whom loss of service would be “immediately life-threatening” — can apply for protection from facility closures on an annual basis. Those who do not meet critical care criteria can still apply for Exemption for “medical emergencies” If they have a condition that will be exacerbated by loss of service. This exemption only lasts 21 days, however, each person may receive protection only 3 times each year.

For both programs, the applicant must provide a certificate signed by a healthcare professional. However, the decision to approve the application is ultimately made by the utility company. Furthermore, key terms such as “immediate threat to life” are not defined, which opens the possibility that utilities can interpret rules restrictively.

In July, a A working group operated by a Michigan utility regulator Data from program implementation – and the numbers are worrying. DTEan electric and gas company serving approximately 2.3 million customers in the Detroit area, Rejected nearly 70 percent of applications for the Emergency Medical Program between 2019 and 2021. Consumer Energywhich serves about 6.7 million customers in the state, Rejected about 1 out of 3 applications during the same period.

Denial rates from the critical care program have been more balanced but remain alarmingly high, with the two companies rejecting about 35 percent of people seeking protection in 2021.

While it’s not clear from the data why so many people in Michigan are denied protection, this is ultimately off-topic. When decisions about medical protection are made by entities other than the health care provider with the best interest of the patient in mind, unnecessary suffering can result.

Logical reforms could dramatically improve medical protection programs like those in Michigan, saving lives. First and foremost, medical professionals should be solely responsible for determining whether a person’s condition puts them at risk of closure. In other words, a medical professional’s certification that the person meets the criteria should be discretionary.

In the event of a dispute, the utility shall be required to formally oppose the request before the utility regulator. If the company is significantly challenging the client’s physician, it should be required to provide testimony from an independent, third-party medical expert. This approach will turn the burden into the benefit to justify the refusal, relieving the stress of the person experiencing medical difficulties.

Other best practices identified in NCLC Report These programs can be further improved. For example, application forms should be short, easy to understand and fill out, and available in multiple languages. More high-quality data reporting, ideally by zip code, is also critical to understanding what’s happening and why.

Regulators and facilities can also explore ways to automate registration – for example, by coordinating with health care providers to provide automatic protection for patients receiving life-supporting medical equipment.

Additionally, utilities and regulators should consider ways to address any debt that accumulates while people are registered. Although medical protection programs eliminate the immediate threat of closure, monthly fees continue to accrue during the protection period. If a family is late in making payments, debt can build up to uncontrollable levels. This problem requires other solutions, such as display Reduced energy prices for customers with home medical equipment Or provide pathways out of debt through debt write-off programs.

For medically at risk individuals like Peggy, continued access to utility service can be a matter of life or death. With the increasing complexity of medical equipment and the movement to transform healthcare into a home environment, we expect the need for medical protection to increase exponentially over time. Ensuring continued access to utility services in these circumstances is not only a matter of sound public health but also of a fundamental human right.

Sam Whillans is co-director of the Yale University Environmental Conservation Clinic at Yale Law School and a Fellow of the Natural Resources Defense Council. He works on issues related to climate, housing, utility access, and affordability. The above information is provided for identification purposes only; Any opinions expressed here do not represent the views of the Yale University Environmental Conservation Clinic, Yale Law School, or the Natural Resources Defense Council.

Charlie Harke is a senior attorney for energy and utilities issues at the National Center for Consumer Law. It represents consumers before regulators, testifies in legislative hearings, and provides legal and policy advice to low-income advocates, legal services attorneys, and government officials. He is co-author of the bookProtecting critically ill consumers from utilities cut-off: What states can do to save lives now(February 2021).

Dr. Peter Kahn is a fellow in the Division of Pulmonary, Intensive Care, and Sleep Medicine at Yale University School of Medicine. He graduated from the Albert Einstein College of Medicine with honors and a master’s degree in public health from the Johns Hopkins Bloomberg School of Public Health in the Department of Health Policy and Management. Dr. Kahn’s research has focused on health policy with a particular interest in the impact of climate change and facilities on health policy. Follow him on Twitter Tweet embed

Leave a Comment