Sonoma County hospitals begin rescheduling elective surgeries

Hospital officials, physicians and their patients received a flash of good news this week - the anticipated surge in coronavirus patients has been successfully suppressed for now in Sonoma County.

New computer modeling showed that with the proper public health measures in place, local hospitals would need fewer beds than projected for county residents with COVID-19, the disease caused by the new virus.

Countless canceled and postponed elective surgeries - which generate crucial revenue for hospitals and their affiliated physicians - could once again be rescheduled. But more importantly, patients waiting weeks for such things like hip replacements or hernia operations, some of them in pain, could be put on a path to relief.

“We know today that we have the capacity and capability to create a safe environment to go back and do some of these surgeries,” said Chad Krilich, chief medical officer for St. Joseph Health, which runs both Santa Rosa Memorial and Petaluma Valley hospitals.

“We know that to be true, based on data,” Krilich said. “There’s no large spike being projected by public health (officials) as previously projected.”

Last week, Gov. Gavin Newsom gave the green light for hospitals to begin conducting elective surgeries, which for weeks had been canceled or postponed to free up hospital beds for coronavirus patients. During his daily coronavirus briefing on April 22, Newsom echoed what’s become a growing concern among local health care providers: Putting off some non-urgent surgeries could become emergencies in the near future.

“These are surgeries that, yes, are scheduled but also are essential - tumors, heart valves,” he said. “If it’s delayed it becomes ultimately denied. ... That fundamentally is a health issue beyond just the issue of the virus.”

On Thursday, during her daily press briefing, Dr. Sundari Mase, the Sonoma County health officer, said it was “perfectly reasonable” for hospitals to begin scheduling elective procedures, many of which are necessary for health reasons even if they aren’t emergencies.

Hospitals, she said, “are going to start doing some of the surgeries that are going to include quality of life for our patients now.”

Weeks before the first confirmed case of coronavirus was detected in Sonoma County on March 2, local hospital officials began planning for a surge in patients, freeing up beds, canceling surgeries and converting areas of the hospital, such as outpatient units, for COVID-19 use.

At Kaiser Permanente Medical Center, patients who saw their procedures delayed are currently being reassessed to determine which cases are a priority.

“We fully understand our patients’ anxiety and concerns regarding elective surgery during this unusual time,” Dr. Stephen Parodi, associate executive director of the Permanente Medical Group, said in a statement. “We look forward to resuming these services as soon as feasible while assuring the safety of all of our patients and staff.”

Dr. Bill Isenberg, chief quality and safety officer at Sutter Health, said the health care giant plans on resuming surgeries in a “phased, safety-first approach” for patients eager to have their procedures rescheduled.

“We will proactively reach out to our patients with details soon,” Isenberg said in a statement. “At the same time, we continue to care for suspected and confirmed COVID-19 patients across all our care settings and anticipate caring for patients with respiratory symptoms and/or COVID-19 for at least the next several months.”

Canceling surgeries and setting aside so many beds has been a tremendous financial blow to local hospitals. Large health care systems like Sutter Health, St. Joseph Health and Kaiser Permanente have been able to weather the financial blow better than smaller hospitals.

But Healdsburg District Hospital, which was forced to furlough at least 38 of its 387 health care workers, has reported losing nearly $2 million in March, with more losses expected in April. Resuming elective surgeries means crucial dollars, but more importantly it begins to address “pent-up demand” among the local patients, said Dr. Joseph Tito, the hospital’s chief of surgery.

“The primary consideration is the patient and what they’re going through,” Tito said, adding that canceled procedures have created a “backlog of patients calling in and saying, ‘Hey, when can I get my procedure done?’”

The hospital, which closed to elective procedures in ?mid-March, has remained open for emergency surgeries and procedures. Even before Newsom’s announcement last week, the Healdsburg hospital district created a task force to examine the opportunity of performing semi-urgent and necessary surgeries.

The committee, which includes Tito, the emergency department director, chief of anesthesia and others, meet regularly via Zoom to discuss each surgery request. They conduct a risk assessment to determine the benefit of surgery over the risk. Doctors fear patients will turn to additional and stronger medications to relieve severe pain if the problem cannot be corrected through surgery or other treatments.

“Someone with a very badly deteriorated joint, that person is living with increasing pain,” Tito said. “We don’t want to come out of this with a bunch of folks addicted to opioids.”

Beginning Monday, everyone undergoing an elective surgery at Healdsburg District Hospital will have to be “COVID-19 negative,” Tito said. The requirement is recommended by the American College of Surgeons and patients will be tested days in advance of their surgery.

The requirement does not apply to those in need of emergency surgeries for life-threatening conditions, he said.

Similarly, St. Joseph Health is also offering COVID-19 testing for surgery patients where appropriate, said Krilich.

As the county’s highest-level trauma center, Memorial Hospital has continued to perform urgent and emergency surgeries and procedures, Krilich said. In looking to restart elective surgeries, Krilich said St. Joseph is adhering to recommendations by the American College of Surgeons. Hospitals must make sure they have adequate personal protective equipment and lab supplies, and that they are not currently practicing crisis-level care or placing elective surgery patients in ICU beds.

Krilich said it’s too early to determine the impact of delaying so many surgeries.

“That being said, heart disease didn’t go away, diabetes didn’t go away,” Krilich said.

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter ?@pressreno.