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California Weighs Order Canceling Elective Surgeries As COVID Surges

HEALTH WATCH - As a third of hospitals report critical staffing shortages, California’s health department is considering issuing an order postponing many elective surgeries.

Many procedures, including a lung transplant, already have been canceled.

In Los Angeles, a severely ill patient has to wait for a new lung after his transplant, scheduled for last Friday, was canceled.

In San Diego, brain surgery to ease the chronic pain of a 7-year-old girl was called off last week.

In Arcadia, as many as 60 patients will likely have their surgeries canceled this week. In Folsom, at least 11 operations already were scrapped last week. And at one hospital in Anaheim, a patient waited on a gurney for back surgery for three hours before he was sent home because of lack of staff. 

Throughout California, as COVID-19 infections deplete their staff of nurses, anesthesiologists and other essential workers, hospitals are canceling or postponing so-called “elective” surgeries to repair injured knees and aching back, remove kidney or bladder stones, and repair cataracts or hernias, among other procedures.

Alarmed by a growing shortage of specialized health care workers, the California Department of Public Health is evaluating whether to issue an order to hospitals statewide to suspend elective surgeries in cases in which patients wouldn’t be immediately harmed.

For now, the decision is voluntary for hospitals. But the state health department’s chief deputy director, Susan Fanelli, on Thursday told a meeting of county health officers, “We know (a directive on elective surgeries) has to be on the table.” Officials with the public health department did not respond to CalMatters’ requests for more information.

“Elective” means a surgery is not an emergency and can be scheduled in advance; it does not mean it’s optional.  Waiting in some cases can be life-threatening.

Hospitals are carefully weighing which surgeries can be delayed, executives say. A cataract surgery or knee replacement might be canceled, for example, but not heart surgery or a breast cancer biopsy.

In response to the shortages, the state health department on Saturday issued controversial new guidance to hospitals and skilled nursing facilities. Workers who are infected with COVID-19 but have no symptoms may immediately return to work without isolation or additional testing. Exposed health care workers may also work. The new guidelines remain in effect until Feb. 1.

Health workers immediately attacked the new policy.

SEIU-United Healthcare Workers member Gabe Montoya, an emergency room technician in Downey, called the policy dangerous and disappointing.”

“No patient wants to be cared for by someone who has COVID-19 or was just exposed to it,” he said.

Many surgeries already scrapped

On Friday, a scheduled lung transplant at a University of Southern California hospital had to be delayed for lack of specialized staff, according to Michael Simonton, a USC intensive care unit nurse. Further details were unavailable.

Also on Friday, at a Kaiser Permanente hospital in Anaheim, Joe Sanders, a 74-year-old retiree from La Habra, waited on a gurney for three hours after being prepped for surgery to treat serious lower back pain. He dozed until his surgeon appeared at his bedside. 

“I have some bad news for you,” the surgeon told Sanders. There wasn’t enough staff for the operating room so the long-awaited procedure, scheduled two months earlier, would have to be postponed several days, Sanders told CalMatters. 

“I was disappointed, my wife and I were looking forward to this. I’m in pain all the time,” Sanders said. “But I knew the pandemic was raging and we hadn’t reached the zenith of this thing. I knew it was going to be touch and go.”

At Methodist Hospital in Arcadia, east of Los Angeles, nearly a tenth of nurses were out sick or isolating last week. Only 17 of its 40 licensed intensive care beds could be staffed – and all of them were full, Clifford Daniels, senior vice president and chief strategy officer, told CalMatters on Friday.

Starting this week, the 348-bed hospital will cancel elective procedures such as gallbladder surgeries, joint replacements and colonoscopies, but not cancer treatments, Daniels said.

“We’re using every resource we can possibly find, including traveler and registry nurses at extraordinary costs,” he said.

In the Sacramento region, at least 11 elective procedures at Mercy Hospital of Folsom had to be postponed last week because of staffing shortages, said Dr. Brian Evans, CEO of the Folsom facility and Mercy General Hospital in Sacramento. Evans could not provide details about the types of procedures that will be canceled.

The two hospitals, both owned by Dignity Health, had about 54 patients admitted specifically for COVID-19 on Friday, but “we’re seeing many of our workers and health providers getting sick as well. We expect next week to be worse,” Evans said.

More than twice as many California hospitals reported critical staffing shortages last week than last summer — although not as many as a year ago. 

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(Barbara Feder Ostrov, Contributing Writer for CalMatters, has reported on medicine and health policy for more than 15 years. She most recently covered California and national health issues for Kaiser Health News.)