Some surgeries placed on COVID-hold could return in May at area hospitals

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At a time when early projections suggested Ventura County could be swamped by COVID-19 patients, a surplus of available beds and operating rooms mean area hospitals could soon resume some surgeries that had been placed on hold.

Ventura County Medical Center in Ventura, Adventist Health Simi Valley and Los Robles Health System in Thousand Oaks have penciled in plans to perform in May some essential scheduled procedures postponed or canceled to preserve space and resources for COVID-19. Other hospitals are still finalizing timetables.

"We're looking at May 4," said Dr. Todd Flosi, chief medical officer of Ventura County Medical Center, of opening one operating room for some previously scheduled, medically necessary surgeries. That plan could change if a flattened curve of COVID-19 patients begins to climb again.

"We would have to back off," he said.

The planning comes in the wake of Gov. Gavin Newsom's announcement last week he is opening the door for hospitals to again perform essential surgeries that had been put on hold during the pandemic.

“Thanks to the work our health care delivery system has done expanding hospital capacity and reducing the rate of spread of COVID-19, hospitals and health systems can consider resuming medical care that residents have delayed during this crisis," Newsom said, listing procedures like heart valve replacements, angioplasty and tumor removals.

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Coronavirus surge has not happened

In Ventura County, a once projected surge of COVID-19 patients has not yet materialized with public health officials crediting the community's adherence to social distancing measures. The governor's announcement triggered planning at area hospitals and, in some circles, cautious optimism.

"We are all excited about the idea of getting back to the work we were doing prior to preparing for the pandemic and providing services we know will benefit patients," said Flosi.

Leaders at area hospitals said surgeons never stopped performing some procedures — ranging from cancer operations to emergencies like a burst appendix or severe injuries caused by a car accident. Now, they're considering the next tier of procedures — previously scheduled surgeries that can't be indefinitely delayed.

California Department of Public Health officials issued more guidance on Monday, directing facilities considering the resumption of services to weigh factors including the possibility of further spread of COVID-19, availability of protective gear and staffing levels.

Officials at Adventist Health Simi Valley have said that on May 1 they hope to resume surgeries that shouldn't be put off for more than 60 days.

"No elective cases will be scheduled at this time," they said in a written statement Thursday, echoing the assertion made by Newsom that any performed surgeries would have to carry significant medical need.

Adventist Health officials said patients in any resumed surgeries would be tested for COVID-19. As with county officials, they suggested plans could change if COVID-19 cases climb again.

Officials at Los Robles Health System are also defining what they called the hospital's "new normal." Spokeswoman Daphne Yousem said Los Robles hospital leaders will slowly begin to schedule surgeries in May with priorities based on urgency and severity of a patient's condition.

Safety protocols

The hospital is also intensifying safety protocols.

"Our goal is to reassure patients that they can safely return to our care environments for testing, procedures, surgery, and other critical services," Yousem said in a written statement.

People's concerns about the safety of facilities caring for COVID-19 patients is an issue hospitals face.

In a written statement on Saturday, Adventist Health Simi Valley president Jennifer Swenson said many beds are empty and the number of patients being treated for heart attacks, strokes and chest pain is down.

Similar trends are emerging in hospitals everywhere, she said.

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"As much as we'd like to believe it's because people are not suffering from life-threatening conditions, we know that's not the case," she said. "Across the communities we serve, loved ones, including the elderly and medically vulnerable, have been delaying or avoiding care out of fear of coming to the hospital during a pandemic."

Swenson said some patients may also delay care because they're worried about using resources that are needed for COVID-19.

"Our hospitals are safe," she said, urging people not to delay emergency care. "We should never let fear get in the way of receiving needed medical care. If we allow it to, then this pandemic will have indirectly claimed more lives and wreaked more havoc than it should have."

Economic impacts

Postponed procedures also carry economic impacts.

"The cancellation of surgeries and other non-urgent appointments was a major financial hit to hospitals and private medical practices," said leaders of the California Medical Association in a recent tweet, noting some offices "temporarily closed or laid off staff, including physicians, due to the decline in patients and revenue."

Resuming more scheduled surgeries could carry a financial boost, said Gary Wilde, CEO of Community Memorial Health System and board chairman for the California Hospital Association.

"Yes, there will be a financial boost to hospitals when elective procedures resume," Wilde said in an email. "Hospitals want to be sure the benefits clearly outweigh the risk and that it is safe to proceed."

Wilde said Monday morning his system's hospitals were waiting for more guidance from the state before finalizing a plan for resuming surgeries.

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St. John's hospitals in Camarillo and Oxnard are also still planning an exact timeline but plan to gradually increase the scope of scheduled surgeries, starting with those most essential to the patient's health, said Dr. Lynn Jeffers, chief medical officer at St. John's Pleasant Valley in Camarillo.

Other factors that will be considered include staffing levels, supplies including personal protective equipment and the availability of beds and ventilators.

Jeffers emphasized the hospitals never completely stopped surgeries.

"We have performed those surgeries that needed to be done and delayed those that could safely be delayed," she said.

Flosi, chief medical officer of two county-run hospitals, said some scheduled medically necessary surgeries could also be rescheduled in May at Santa Paula Hospital. He said calculations being used to determine how many surgeries can be performed could change in an instant, just like the pandemic.

"If there was an outbreak in a skilled nursing facility, that would change the math somewhat," he said.

It's impossible to know when electives surgeries that can be indefinitely postponed will be rescheduled, said Flosi. He cited the unpredictability of the pandemic.

"If all continues to go really well, it could be back to purely elective cases within two or three months," he said.

Many of the state's outpatient surgery centers have either closed during the pandemic or significantly limited services, said Beth LaBouyer, executive director of the California Ambulatory Surgery Association.

The surgery centers are waiting for more guidance from the state regarding when they can resume more procedures, she said Monday morning.

The state guidelines issued that same day suggested resumption of outpatient and in-patient surgery would have to be phased in and evaluated based on a series of factors including medical need and time sensitivity.

Tom Kisken covers health care and other news for the Ventura County Star. Reach him at tom.kisken@vcstar.com or 805-437-0255.

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