Brigham and Women’s nurses accuse hospital of defying state order to delay certain surgeries

Brigham and Women's Hospital in BostonJonathan Wiggs/Globe Staff

Nurses at Brigham and Women’s Hospital are accusing hospital leaders of flouting state rules to cancel certain surgeries and are asking Massachusetts officials to investigate.

The Massachusetts Nurses Association, a union that represents 3,500 Brigham nurses, told the Department of Public Health in a letter on Monday that the hospital’s operating rooms remain as busy as ever, despite a state order to curtail scheduled surgeries to make space for other patients who urgently need care.

The union wrote that nonessential surgeries such as tummy tucks were continuing unabated as patients who need urgent surgery for broken bones and brain injuries were sometimes waiting for operating rooms.

“We don’t see any action by the hospital at all to try to curb elective surgeries,” said Trish Powers, an operating room nurse who chairs the union bargaining committee at the Brigham.

“We feel extremely overwhelmed, not just the nurses, but physicians, technicians — everybody is so overwhelmed,” she said. “We’re understaffed and have way too many patients.”

Brigham officials told the Globe they were following the rules, which required hospitals on Nov. 29 to start reducing “non-essential, non-urgent scheduled procedures” by 30 percent. As of Wednesday, the Baker administration has ordered hospitals to cut those surgeries even further, by 50 percent, but only when delays won’t harm patients.

The order applies to surgeries that require patients to stay overnight in the hospital, not outpatient procedures that allow patients to go home the same day.

The requirement to curtail surgeries is similar to rules implemented during earlier surges of COVID. This time, the Baker administration said the reductions are necessary because hospitals are running short on beds and staff as they face unprecedented demand from people sick with all kinds of medical problems, including a growing number of COVID patients. Across the state this weekend, 1,355 patients were hospitalized with COVID, up more than 200 patients in just a week.

Scheduled surgeries, also known as elective surgeries, are often booked weeks or months in advance. But they’re not necessarily optional: They include surgeries for patients with cancer and other serious conditions, as well as less critical but still important procedures such as joint replacements and hernia repairs.

Scheduled surgeries bring in a significant share of revenue for hospitals.

For some patients, delays can cause pain and complications. Surgeons are still catching up on cases that were deferred earlier in the pandemic.

Hospitals have some leeway in determining which surgeries fit the category of nonessential and nonurgent.

Brigham spokeswoman Lori Schroth said the hospital is complying with state rules and deciding which surgeries to postpone based on criteria developed by a group of experts, including doctors and nurses. She said procedures such as tummy tucks do not require inpatient stays.

“We are carefully balancing against the need to avoid contributing to the wave of patients that we are now seeing who require more intense care as a result of previously deferred care,” she said in a statement. “We are also closely monitoring our patient volume and making decisions on a day-to-day basis that ensure we are doing everything possible to meet the needs of our community.”

The Mass General Brigham system, which includes Brigham and Women’s Hospital, is postponing only a small share of surgeries. Dr. Ron Walls, chief operating officer at Mass General Brigham, previously told the Globe that the health system was postponing about 15 surgeries a day to comply with the November state order.

Surgeons at Mass General Brigham are also shifting some cases from inpatient procedures to outpatient procedures if the patients can safely go home without staying overnight.

But Powers, the Brigham nurse, said hospital officials are not doing enough. She said the hospital is so crowded that after surgery, patients sometimes have to wait for an inpatient bed where they can recover.

“If you’re going to do elective surgery, you need to know the patient has a bed after surgery,” she said.

DPH officials declined to comment except to confirm they received the union’s complaint and are reviewing it.

Some hospitals are stopping more surgeries than the state rules require. Tufts Medical Center reduced scheduled procedures that require hospital stays by 70 percent early this month, and it’s now stopping all such procedures if they can be safely delayed. Starting Monday, Tufts said it’s also postponing some outpatient procedures, such as colonoscopies.

“At this time, we are postponing cases through the end of the calendar year, but will be carefully watching the situation and will adjust that date to earlier or later based on the inpatient demand,” chief operating officer Diana Richardson said in a statement.