Editor’s note, 3/19/20: After this story was published, Gov. Jared Polis issued an executive order temporarily suspending elective and nonessential surgeries and procedures. The order will be in effect from March 23 to April 14, with the exception of rural and critical access hospitals.
As of Wednesday, March 18, Colorado had 216 confirmed cases of COVID-19, making it the ninth hardest-hit state in the country. Experts suggest, though, the incidence of the novel coronavirus in the Centennial State is much higher, and many hospitals and health care systems in the Denver metro area are prepping for that forthcoming reality. In their attempts to “surge plan,” several Front Range medical centers are adjusting standard policies and procedures, including decreasing the number of elective surgeries—or halting them altogether. But not every health care system is ready to make that change.
Although Denver Health, SCL Health (including St. Joseph, Good Samaritan, and Lutheran medical centers), UCHealth (including University of Colorado Hospital), and Centura Health have either discontinued all nonessential procedures in the main hospital operating rooms, begun postponing some procedures to free up in-patient beds and preserve supplies, or moved previously scheduled surgeries to ambulatory surgical centers, HealthOne facilities have yet to make any of those moves.
Despite the American College of Surgeons’ March 13 recommendation that hospitals review their dockets with a plan to “minimize, postpone, or cancel electively scheduled operations” in the face of COVID-19, one of the largest providers of health care along the Front Range has continued running its ORs as normal.
“For now, we are leaving that decision for the physician and the patient to determine together,” says Stephanie Sullivan, assistant vice president of media relations and video content for HealthOne. “We still have capacity in our facilities, and we have established the necessary protocols in order to meet the highest safety precautions for patients to have elective surgery right now.”
While experts, like those at the American Hospital Association, advise that hospital systems must continue providing vital services to their communities as well as consider the increasing needs of COVID-19 patients, some metro-area physicians say they are concerned with the decisions being made at HealthOne facilities, including Sky Ridge, Aurora, Rose, and Presbyterian/St. Luke’s medical centers. With the Centers for Disease Control and Prevention cautioning that older Americans are more susceptible to complications of COVID-19, physicians 5280 spoke with on the condition of anonymity say they believe it’s irresponsible to encourage, for example, a healthy 70-year-old to leave her home to go to a hospital potentially full of COVID-19 patients for a knee replacement that could wait two months.
One veteran physician, who has worked in HealthOne ORs for years, says emails from leadership at Rose Medical Center and Sky Ridge Medical Center on March 16 did not give physicians the impression they had much leeway to postpone or cancel cases. The communique explained that the hospital had ample capacity and supplies to deal with both COVID patients and elective surgeries. It further stated that the administration did not believe postponement of nonessential operations was “necessary or advisable” at that time. As of the morning of Thursday, March 19, Rose Medical Center was still running elective surgeries at its main hospital, at least one of which the doctor deemed imprudent. “We know from what’s going on in Italy that a tidal wave is coming our way,” the veteran doctor says. “It’s so crazy to be doing elective stuff now.”
Administrators at hospitals that aren’t part of HealthOne are cognizant of the need for keeping ORs running, too, of course. Hospitals don’t want to make it difficult for people who need procedures to get them when they need them, and, crucially, health centers bring in more revenue from surgical patients than they do from other medical patients. David Hoyt, executive director of the American College of Surgeons, admits that some hospitals and health care systems across the country may be more focused on the bottom line than preparing for COVID-19. “There are those who are less interested in seeing revenue dip,” says Hoyt, “but that’s not a good excuse. We’re all feeling the economic hit—hotels, restaurants. We really hope everyone would think it through and treat this as a big public health concern.”
Certainly there might be a balance to be struck. Officials at Denver Health say they’re trying to find that equilibrium. “We’re continuing to do some outpatient procedures at Pavilion M, which is not in the main hospital,” says April Valdez Villa, spokesperson for Denver Health. “At the end of the day, we want to have the bed capacity to deal with incoming COVID patients, but we also don’t want to create a six-month backlog for surgeries. Things are changing every day. Still, it was an easy call to cancel surgeries that would require a patient to be admitted to make sure we can handle what’s coming.”