California Considers Canceling Elective Surgeries as Covid Surges

Patients are held in the hallway as St. Mary Medical Center responds to a surge in COVID-19 cases in Apple Valley, on January 12, 2021. Photo by Mike Blake, Reuters

By Barbara Feder Ostrov

This story originally appeared on CalMatters

In Summary: 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.

it’s recently been brought to my attention that most ppl don’t know what “elective surgery” means.

I have a brain tumor for which my neuro/oncology team is planning surgery within the next ~2 months.

This surgery is categorized as elective.

— Carolyn Ownbey, PhD (@carolynownbey) January 5, 2022

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.

Stanford Medical Center in Palo Alto has about 5 percent of its total workforce out sick, spokeswoman Julie Greicius said Saturday. “We have seen a doubling of nurses calling off per shift, reporting that they are ill,” Greicius said.
California ranks fifth in the nation in the percentage of hospitals reporting severe labor shortages.

Hospitals in Florida, New Jersey and Missouri have canceled surgeries, and Massachusetts state health officials last month directed hospitals to postpone all elective surgeries if they have less than 15 percent capacity.

A year ago, during the last surge, the state health officer directed hospitals for about one month to cancel certain procedures if their intensive care capacity was less than 10 percent.

Since then, the highly contagious omicron variant has transformed California’s COVID-19 landscape and hospitals’ decision-making. Omicron appears to cause less severe disease, but it’s more likely to infect vaccinated people than the original novel coronavirus and the delta variant. As a result, even though about 71 percent of eligible Californians are vaccinated and 38 percent of them are boosted, more people – including health care workers – are becoming infected, many with mild or no symptoms.

“This is not about beds, this is about the staff to care for the patients in those beds,” said Kiyomi Burchill, group vice president of policy for the California Hospital Association.

Exacerbating the problem: labor strife and an exodus of nurses and other hospital staffers who have quit or retired, citing burnout and lack of protections on the job.

Fanelli told county health officers last week that the state is working on other measures to support hospitals as they cope with yet another surge. The state health department predicts as many as 53,000 hospitalizations a day in the coming weeks.

A $614 million funding proposal

In response, the state plans to send up to 1,500 health care workers to hospitals with staffing shortages and has stockpiled oxygen, saline and other supplies ahead of the surge. Officials also are working with hospitals to help them adapt spaces to triage patients and more quickly find placements for patients ready to be discharged, she said.
Gov. Gavin Newsom’s new proposed emergency funding package, revealed Saturday, includes $614 million to help hospitals and other health facilities augment their staff.

“The bottom line is that we are worried about the…level of staff infections and the need for isolation and quarantine among the staff,” California Health and Human Services Secretary Dr. Mark Ghaly told reporters last week.

Many hospital emergency rooms also are packed with patients, some of whom arrived for other reasons than COVID-19 but happened to test positive upon arrival. Those patients then have to be isolated to protect other patients and hospital staff.

And intensive care beds already are in short supply around the state.

In 27 counties, fewer than five ICU beds remained available as of Jan. 5, according to state data. Statewide the number of available intensive care beds has dropped by about 10 percent since Jan. 1.

A dearth of COVID tests also means only patients who come to Methodist’s emergency room with COVID-19 symptoms will be tested, Daniels said. Those who aren’t symptomatic who come in for other reasons won’t get a test, and people coming to the ER just for tests will be sent to Los Angeles County testing sites.

Michael Simonton, an intensive care unit nurse at the 60-bed USC Norris Comprehensive Cancer Center in Los Angeles, said he’s been working without breaks and lunches; some of his colleagues are working 18-hour shifts to care for a flood of patients.

“People are having to stay over(time) because there’s no one else to relieve them,” Simonton said.

A member of the California Nurses Association, a union that represents some 1,400 USC nurses, Simonton places some blame on hospital administrators for the staffing shortage.

“This is a crisis that’s basically been manufactured by the hospital,” Simonton said. “They were choosing temp workers rather than investing in (permanent employees) who are committed to their workplace, and now patients are paying the price.”

Reporter Kristen Hwang contributed to this story.

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