BUFFALO — Gov. Andrew Cuomo Tuesday announced that some hospitals can resume elective outpatient surgical procedures under certain conditions — but not in Albany, Rensselaer and 17 other counties.
Whether and when a hospital can resume procedures will depend on a three-part consideration of how bad the COVID-19 infection rate is in that area and how many COVID patients that hospital has.
As the COVID-19 crisis worsened in March, state officials asked and then ordered New York hospitals to halt all nonessential procedures to conserve supplies and manpower for the coming wave of patients that would need to be hospitalized for treatment of the virus.
A month later, many hospitals are experiencing significant financial hardship, deprived of this key source of revenue. In some cases, the hospitals have take the ironic step of laying off or furloughing employees during the worst public health crisis in living memory.
Three Capital Region hospitals told The Daily Gazette on Tuesday that community health is suffering because of public misconception that they can’t get treatment at hospitals — or shouldn’t, because hospitals are COVID hotbeds.
The fear is misplaced, people are at greater risk of infection in a supermarket than in a hospital, Ellis Medicine’s Dr. Nicholas Montalto said Tuesday. Ellis Hospital — where 30 COVID patients were spread across multiple units on Tuesday — has reams of protocol on keeping diseases from spreading within its walls and decades of practice.
Saratoga Hospital’s Dr. Richard Falivena said patients with appendicitis are waiting to come in until the appendix ruptures, and they develop life-threatening peritonitis. Meanwhile, there were 12 patients on ventilators in intensive care Tuesday, only three of them with COVID-19. The other nine — an unheard-of number — are cardiology and pulmonology patients who stopped getting routine care.
Hospitals are eager to get back in the business of treating the general population. How easy that will be remains to be seen.
The crushing surge of COVID patients is easing downstate and never happened upstate, so Cuomo is allowing some resumption of these procedures upstate.
The relaxation of the ban on elective procedures is slight and is conditioned on multiple circumstances. The ban stands in 19 counties, from the obvious downstate hot spots (New York City, Long Island, etc., where thousands are still hospitalized with COVID) to such remote upstate locations as Schuyler and Yates counties, confirmed case count seven and 10, respectively.)
Individual hospitals in the other 43 counties may be allowed to do resume elective procedures, based on how many empty beds they have, what percentage those beds comprise of the total number of beds in the county, how many COVID patients they have and how many COVID cases there are in the county. And only if the prospective patient tests negative for COVID. And only on an outpatient basis — with no overnight hospital stay.
It’s a complex rule. Albany Medical Center, the largest hospital in the region, declined comment Tuesday until it could get further clarification from the state.
Cuomo delivered his daily briefing Tuesday in Buffalo, and noted that he has been heavily focused on the downstate region, where 95 percent of the COVID cases have been confirmed. (Ironically, Erie County is one of the 19 counties where elective procedures will remain banned; it has the state’s highest death toll outside of the New York City metro area.)
He said the move to allow elective procedures is in response to upstate hospitals not seeing the surge of patients initially feared.
“You have many hospitals that are very quiet,” Cuomo said. “Some hospitals are actually laying off people, believe it or not, in the middle of this because they have no patients.”
- Ellis Medicine is the latest to trim staff: It said Tuesday it will furlough 60 of its roughly 3,300 employees and cut the hours worked by 53 others.
- Saratoga Hospital has furloughed about 200 of its 3,000 employees and reduced the hours of 200 more. Some are part-time or per-diem workers; the full-time equivalent works out to about 350 people.
- Glens Falls has furloughed more than 300 employees.
Furloughs are the preferred option because the workforce will be within reach when needed again, and because furloughed workers can continue to receive health benefits while collecting unemployment.
Albany Medical Center has done neither layoffs or furloughs, but is having some staff stay home while collecting full pay, with instructions to be ready to return to work within 24 hours to relieve exhausted colleagues.
The financial impact to hospitals has been substantial.
- Ellis Medicine couldn’t readily quantify the cost but said it canceled more than 6,500 visits and procedures in the last two weeks of March alone. That was partially offset by increased telemedicine visits but will represent a major loss of revenue when the accounting is complete.
- From March 18 through April 21, Glens Falls Hospital has seen a 75 percent reduction in surgical volume and a 50 percent drop in revenue, even as it was spending more to stockpile in COVID-related equipment and supplies. On Friday, it announced a fund-raising campaign to cover COVID costs.
- Saratoga Hospital is $15 million to $16 million short on the $33 million to $35 million in revenue it records in a typical month.
“It has been severe and swift,” Saratoga Hospital CEO Angelo Calbone said of the impact on the bottom line. “That translates across the board. Urgent care, ER, elective, admissions.”
He said the hospital is looking forward to reading, understanding, and implementing the framework for resuming elective procedures while still caring for COVID patients.
“We have invested weeks of time now in preparation and planning,” he said. “Our staff is unfortunately now fairly well experienced in managing this situation. I think whatever those conditions turn out to be, we are going to manage it very very well.”
Harder to predict, Calbone said, is whether the public is ready to return to hospitals while the pandemic still holds sway. People have been staying away unnecessarily, and in some cases suffering.
Dr. Falivena, Saratoga Hospital’s chief medical officer, put it bluntly:
“We are confronting a completely new and unexpected consequence of COVID-19,” he said. “In many respects, we are experiencing an epidemic of avoidable complications. Patients are avoiding coming to the hospital for an important medical need out of fear of being exposed to the virus. This is leading to numerous cases that would have been routine now becoming a serious threat to health and life.”
Dr. Nicholas Montalto, medical director of operating room services at Ellis Medicine, is a practicing gynecologist who has taken on additional administrative duties as his own patient load diminished.
He said Ellis has found some wiggle room in the state ban on elective surgery over the last month by using the word “essential” instead of “elective.”
Fixing a medical condition that is not life-threatening would generally be an elective or non-essential procedure, unless it became unbearably painful, at which point it is essential.
As an example, Montalto said he has seen a number of patients with endometriosis — a disorder of the uterus that can be accompanied by mild to severe pain. Some of these women have found relief with nonsurgical options, but two did not — one found herself in the emergency room repeatedly, another was sliding toward overuse of opioid painkillers.
Both were brought in for surgery.
That’s one of Montalto’s jobs now, deciding what is essential and non-essential.
“For me it’s been incredibly busy figuring how we’re gong to scale down the OR, and being the gatekeeper for what surgeries we’re going to do,” he said.
Montalto said he doesn’t know what the next step looks like, with restrictions on elective surgery loosened.
“We are beginning those meetings now to consider how to reintroduce those procedures to the OR,” he said. “Just because the governor says we can do elective surgeries doesn’t mean we can open the gates.”