Surgery Delayed? Hospitals Calculate Which Procedures To Reschedule
Hospitals across the country are delaying elective procedures to preserve personal protective equipment to fight COVID-19. But what qualifies as elective isn't clear cut.
A few months ago, West Rutland resident Russell Green had an MRI, which revealed he had prostate cancer, and it was growing rapidly. On March 9, the 63-year-old financial advisor met with his doctor at Dartmouth-Hitchcock Health for a biopsy.
“That's when the aggressive cancer was determined to be there,” Green said. He and his doctor agreed: Green would have the cancer surgically removed on April 22.
“He said that was the next available surgery,” Green said. “I'd actually asked him. I said, ‘I'm supposed to be in a performance mid-July. You know, can I wait till mid-July?’”
Green said his doctor told him to not postpone the surgery, even for “Shrek: The Musical,” which Green’s son is directing at the Paramount Theater in Rutland in July, and which Green and his wife are performing in.
“And he said, ‘I absolutely would not do that. No, not with what I've seen here, and your history. I would get it out as soon as possible,’” Green said.
"I think, well, this isn't elective. It's aggressive cancer. And you want to get rid of the thing, that's not elective. And then I'm told, 'Well, yeah, it's sort of not — they're rescheduling things.'" — Russell Green, West Rutland
So Green put the surgery in his books for April 22, the earliest date he could get it. Then the coronavirus hit, and Dartmouth-Hitchcock put a hold on elective surgeries, including, it seemed, Russell Green's cancer surgery.
“I hear this. And I think, well, this isn't elective. It's aggressive cancer,” Green said. “And you want to get rid of the thing, that's not elective. And then I'm told, ‘Well, yeah, it's sort of not — they're rescheduling things.’”
Dr. Ed Merrens is Chief Clinical Officer for Dartmouth-Hitchcock Health, and he said about a week and a half ago, Dartmouth-Hitchcock did pause many elective procedures and surgeries.
“You know, the most important thing to understand is that things are so fluid right now, that we are revising our understanding, our recommendation, our planning on a daily basis,” Merrens said.
UVM Medical Center also paused non-urgent elective procedures, along with other hospitals nationwide. Gov. Phil Scott later ordered the suspension of those surgeries, a policy the Trump administration has supported.
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“We are really short on the protective equipment needed to evaluate, test and treat patients with COVID-19 right now,” Merrens said. “And the protective equipment we use in procedures and in surgeries is the same equipment. And if we can pause doing some of these elective procedures for a period of time ... while waiting for additional shipments to come in – we're hoping that works.”
Merrens said the hospital asked medical leadership in all areas to identify elective scheduled procedures that could be delayed to preserve protective equipment. And they did that. But he said they’re now easing back just a bit.
“And then we've gone back and said, ‘Can you look more at that middle area? There might be some people that really are more semi-elective that we would like to be able to do,’” he said.
Merrens said now departments are assessing how to proceed with more urgent elective procedures, while reducing the number of staff and equipment they use. But, he said, it’s a balancing act.
"There might be some people that really are more semi-elective that we would like to be able to do. At the same time, we're talking about this impending tsunami of this novel coronavirus and the impact on a pretty limited health care system in northern New England." — Dr. Ed Merrens, Dartmouth-Hitchcock Chief Clinical Officer
“At the same time, we're talking about this impending tsunami of this novel coronavirus and the impact on a pretty limited health care system in northern New England,” Merrens said.
Russell Green said he doesn’t blame hospital staff: They have to play the cards they’ve been dealt.
And since Green complained to his doctor and the hospital, he said the April 22 date appears to be back on the books. But, Green said, his doctor recently told him: Don’t count on that date. It's all subject to change.