Why you still might have trouble scheduling your surgery despite relaxed coronavirus rules
When Gov. Greg Abbott announced an executive order April 17 allowing some surgeries and procedures to resume in Texas amid the coronavirus outbreak, patients immediately started to call health care providers across Tarrant County to see if their previously canceled appointments could move forward.
But the relaxed restrictions also come with a new set of requirements for health care providers to navigate. As a result, some hospital systems and clinics in Tarrant County said they are starting to reschedule procedures — but in a limited way as they assess the new caveats.
“It’s clear as mud,” said Barry Russo, the CEO of the Center for Cancer and Blood Disorders, which has locations across Tarrant County. “We were excited when we heard it was coming. We were less excited when we actually saw it, because it is still fairly complicated to get a case posted.”
Since late March, physicians have had to put procedures on hold due to Abbott’s executive order that suspended elective surgeries.
The new executive order — which went into effect at 11:59 p.m. Tuesday — allows for some to proceed, but only if doing so wouldn’t deplete hospital capacity or supplies of personal protective equipment, such as face masks or gloves.
And licensed health care facilities may also resume surgeries or procedures if they certify in writing to the Texas Health and Human Services Commission that they will reserve at least 25% of their hospital capacity for COVID-19 patients, and that they will not request any personal protective equipment from public sources.
But not all hospital systems have chosen to take that option as they balance meeting patients’ needs with being prepared to combat the novel coronavirus.
How to ramp up
Michael Boothby, an orthopedic surgeon and founder of The Orthopedic Surgery and Sports Medicine Institute in Fort Worth, said starting Monday, the institute is beginning to resume some of its urgent elective cases “in a very cautious manner.”
“It’s been a really hard situation because obviously for four to six weeks, we’ve been kind of stuck and there’s lots of patients out there who may not qualify for emergency procedure, but are still really hurting and still having a tremendous amount of discomfort and dysfunction that need to get taken care of, for their own sake,” Boothby said.
Before the pandemic, many patients had already waited three to four weeks just to get on the schedule before their surgeries were canceled due to the March 22 executive order. And determining what procedures to prioritize as the most urgent can be tricky.
Guidance this week from the Texas Medical Board said that non-urgent elective surgeries and procedures — where there is no negative effect anticipated from delaying them — should still be rescheduled unless they meet one of the order’s exceptions.
And the guidance cautioned physicians that even when determining a procedure is necessary and won’t violate the order, “documentation is key.”
If a health care facility has not certified in writing to HHSC, the guidance states “it is very important that the medical record clearly reflects why the physicians determined a surgery or procedure was urgent and necessary to prevent serious adverse medical consequences or death, as well as the impact on hospital bed availability and usage of PPE.”
Physicians at the Center for Cancer and Blood Disorders rely on hospital operating room space to conduct surgeries. And Russo said the center “can’t seem to find any hospitals that are willing to send that certification,” leaving it up to physicians to determine on a case by case basis to ensure that the procedure is both urgent and would not deplete hospital capacity to combat the coronavirus.
Jennifer Hecht, a breast surgeon with Texas Breast Specialists-Southwest Fort Worth, said that while she would like to treat her patients as soon as possible, she also has to ensure it will be safe to do so amid the outbreak.
“I want to be able to take all of them. But with the backlog of cases, we’re going to have to look at each patient and evaluate their risk and their cancer and timing,” Hecht said.
All three providers said they’ve seen their volume of surgical cases plummet, and Boothby and Russo said loans from the Paycheck Protection Program have helped them avoid furloughs of their staff for now. Boothby aims to tentatively see more patients in the office by May 4, and Russo said he’s hopeful surgeries can resume by May 18.
“It’s not going to be easy for anybody, but we’re doing our very best,” Hecht said. “Eventually I have hope that it’s all going to go back to normal. It just may take a little while. And in the meantime, we’re going to keep checking in and making sure our patients are doing OK.”
DFW hospital systems
Diana Brodeur, a spokeswoman for John Peter Smith Hospital, wrote in an email Thursday that while plans are being put in place, changes are not being made at this time.
Meanwhile, starting Monday, Cook Children’s Medical Center plans to incrementally resume medically-necessary procedures that were postponed since March due to the restrictions, Kim Brown, a spokeswoman for the hospital, wrote in an email Friday.
“We are focused on medically-necessary procedures rather than elective surgeries at this time and have not sought any exemptions from Texas Health and Human Services,” Brown wrote.
Stephen O’Brien, a spokesman for Texas Health Resources, wrote in an email Friday that starting Monday appointments will be scheduled for the week of May 4 on a case-by-case basis for “time-sensitive procedures where a delay in care would result in a worse disease outcome for the patient and the risk of the procedure is minimal.”
“This includes surgical care and procedures within interventional cardiology, urology, endoscopy and interventional radiology,” O’Brien wrote.
Methodist Health System is developing a phased approach to beginning non-essential surgeries “to ensure we have the appropriate number of tests, as well as the correct amount of PPE, to mitigate as much risk as possible for our patients, physicians, and staff,” Ryan Owens, a spokesman for the system, wrote in an email Thursday.
Baylor Scott and White Health has already begun contacting patients to reschedule procedures and surgeries, while ensuring it remains prepared for an influx of COVID-19 patients, Susan Hall, a spokeswoman for the system, wrote in an email Friday.
“We are confident we can safely care for patients who meet the criteria set forth in the executive order — patients who need biopsies for potential cancer diagnoses, for example — as soon as this week, while maintaining an adequate supply of personal protective equipment. And we will continue to evaluate this balance daily,” Hall wrote.
Medical City Healthcare’s hospitals and ambulatory surgery centers in Collin, Denton, Parker and Tarrant counties have resumed elective surgeries, and elective procedures can take place “as clinically appropriate in the outpatient and inpatient settings,” Janet St. James, a spokeswoman for the system, wrote in an email Thursday.
“Medical City Healthcare is adhering to the requirements set forth by the Texas Medical Board and local and state agencies regarding elective surgeries including maintaining adequate PPE and bed capacity,” James wrote. “At all times, the supply of PPE, hospital and intensive care unit beds, and ventilators will be taken into consideration, even in areas that are not currently managing COVID-19 infections.”
Regardless of which route, health care providers said they’re taking extra precautions, from testing patients ahead of time for COVID-19 to requiring self-quarantine 48 hours ahead of a surgery.
This story was originally published April 27, 2020 at 5:30 AM.
