Hospitals across the state have canceled hundreds of non-urgent surgeries for patients, including joint replacements and weight-loss operations, leading procedures to plummet 30 to 50 percent at some large facilities.
Elective procedures and routine medical care are being postponed around the country because of the coronavirus, creating distress for patients, sharp public disagreements among doctors, and worries for hospital executives whose institutions are likely to face steep financial repercussions.
Doctors and health care executives in Massachusetts said patients have been mostly supportive, knowing hospitals need to free up nurses and doctors to treat coronavirus patients and conserve protective equipment like masks, gloves, and gowns. "People understand this is a new reality for us,'' said Nancy Shendell-Falik, president of Baystate Medical Center in Springfield.
Still, the dreaded cancellation phone call has brought deep disappointment to some patients.
Justin O’Connor, 67, scheduled his hip replacement surgery at Newton-Wellesley Hospital two months ago, an operation he badly needs to relieve pain that makes it hard to walk, even with a cane.
On Friday his surgeon said he hoped to squeeze in O’Connor’s operation before the hospital began shutting down elective procedures. Then, on Sunday at noon, O’Connor got the phone call: His surgery scheduled for 8 the following morning was indefinitely postponed because of the coronavirus.
"I understand at some point as the virus spreads this kind of stuff makes sense,'' said O’Connor, who lives in Woburn. "My other feeling is that today that surgical suite went unused and the doctor’s talent went unused and my pain is still there.''
Some hospitals had already started to cancel discretionary procedures and non-essential medical appointment last week, but that effort intensified over the weekend as the Baker administration directed all Massachusetts hospitals to stop performing “non-essential elective procedures.” At some hospitals, doctors made personal calls to their patients while at others assistants were handed lists to work from.
The results have already been dramatic.
On Monday, surgeries at Baystate fell 40 to 50 percent, at Tufts Medical Center in Boston, operations were down 30 to 40 percent, and at Brigham and Women’s Hospital, they decreased 30 percent.
"We are trying to take the pressure off our provider workforce, which is also under some threat,'' said Dr. Gerard Doherty, surgeon-in-chief at the Brigham, which normally does 700 operations a week. "We don’t know how many COVID-positive patients we will be taking care of next week.''
Hospital executives and doctors said they are canceling elective surgeries, as well as certain low-risk cancer surgeries and cardiac bypass surgery, when the patient is stable. Operations that can’t be postponed include trauma surgery, appendectomies, perforated ulcers, and cancer surgery when putting off the operation could worsen the patient’s chances of survival.
The challenge is that about half of all operations fall somewhere in the middle, gray areas where hospitals are largely leaving decisions in the hands of the surgeons who know their patients best. At Baystate, for example, one neurosurgeon planned to postpone spine surgery when a patient’s only symptom was radiating leg pain, but proceed with surgery when a patient developed additional symptoms such as difficulty controlling their foot.
"Our chiefs and chairs will talk with surgeons about where we are drawing the line,'' said Dr. Saul Weingart, chief medical officer at Tufts Medical Center. "We are trying to get people aligned on having a common set of expectations given that we are getting ready for an influx [of coronavirus patients]. There are probably some borderline cases we want to get done early.''
Hospitals nationally have bristled at what they consider blanket calls by Trump administration officials to cancel elective procedures.
On Saturday morning, the US Surgeon General, Vice Admiral Dr. Jerome Adams, tweeted to hospitals and health care systems to “PLEASE CONSIDER STOPPING ELECTIVE PROCEDURES until we can #FlattenTheCurve!”
Hospital & healthcare systems, PLEASE CONSIDER STOPPING ELECTIVE PROCEDURES until we can #FlattenTheCurve! 👇🏽— U.S. Surgeon General (@Surgeon_General) March 14, 2020
Each elective surgery you do:
1) Brings possible #Coronavirus to your facilities
2) Pulls from PPE stores
3) Taxes personnel who may be needed for #COVIDー19 response https://t.co/WAUTXF5Vyc
Hospital groups fired back the next day in a memo to Adams that they made public.
"We are concerned about recent comments by government officials that could be interpreted as recommending that hospitals immediately stop performing ‘elective’ surgeries without clear agreement on how we classify various levels of necessary care,'’ wrote the American Hospital Association and three other groups.
"We cannot completely cease caring for illness in our community that is not directly related to the COVID-19 crisis. Our ability to respond to patients must not be prevented by arbitrary directives, but any curtailment must be nuanced to meet the needs of all severely ill patients,'' they said, citing as examples repair of faulty heart valves, removal of a serious cancerous tumors, or pediatric hernia repair.
In Massachusetts, Governor Charlie Baker was not specific with his directive, just saying "Hospitals must cancel non-essential elective procedures.'' The administration did not provide detailed guidance, apparently leaving it up to hospitals to decide what can be delayed and what cannot.
Liz Kowalczyk can be reached at firstname.lastname@example.org.