AMSTERDAM — More Capital Region hospitals have gained approval to resume elective surgical procedures, which were ordered halted statewide for nearly two months to conserve resources for the COVID-19 pandemic.
Albany Medical Center and Glens Falls Hospital were the first to announced they’d been approved for waivers Wednesday and Thursday. St. Peter’s and Samaritan hospitals were next, along with St. Mary’s Healthcare. Ellis Hospital was still awaiting word Friday on its application for a waiver.
Gov. Andrew Cuomo announced April 21 that elective surgery could resume April 28, but only in certain counties and only at hospitals that met multiple conditions. Saratoga Hospital was the only hospital in the Capital Region that met the conditions and was not in a county on the blackout list.
The ban on elective surgery affected both the finances of hospitals, which rely heavily on revenue from these procedures, and patients suffering from medical conditions that they couldn’t get fixed.
St. Peter’s Health Partners, for example, has done about 520 procedures in the last 30 days vs. 1,600 in a normal month. It plans to resume elective procedures May 12.
St. Mary’s Hospital was gratified to receive its waiver.
Chief Medical Officer Dr. William Mayer categorizes surgery as emergent, urgent and non-urgent.
“I wouldn’t use the word ‘elective’ like it’s cosmetic or removing a tattoo or something,” he said.
Emergent surgeries — broken bones, internal injuries — have continued through the COVID crisis. The others have not.
“These are non-emergent in most cases but they’re not something you’d want to postpone forever either,” Mayer said.
The first wave of non-emergent surgeries at St. Mary’s after the waiver was granted were gallbladder, hernia and orthopedic procedures. The hospital limited itself to five surgeries, and will gradually increase the number performed daily and the medical specialties involved.
Many hospitals have laid off or furloughed staff during the COVID-19 crisis. St. Mary’s did not, but it reassigned some people away from operating and recovery rooms. They now need to be brought back together as the hospital ramps back up to normal.
“I think it’s been challenging for our patients,” said Trish Sanders, the hospital’s incident commander during COVID crisis. “These people have had to wait and we’re working to get them all scheduled now.”
She said the hospital doesn’t know how many people were put on hold during the surgical moratorium. It will have a rough tally after it checks their status and schedules them for the procedures they need.
Like most hospitals, St. Mary’s has been heavily focused on COVID-19 while it wasn’t doing elective procedures. The danger isn’t over, and there could be a second wave of the pandemic, but the caseload has eased and the staff can look back with a sense of accomplishment, Sanders said.
It lost only two COVID patients — one of them a very elderly person with do not resuscitate/do not intubate orders in place. Everyone else has recovered or is on the road to recovery, including one who was on advanced life support a remarkable 37 days.
“We got ahead of this very early on and started taking action,” Sanders said.
Even after St. Mary’s accepted patients transferred from the New York City area, it never approached the crisis level seen in downstate hospitals, Mayer said, and it was able to stay on top of the situation. So there’s a sense of satisfaction.
“Absolutely. We put a lot of time, energy and effort into doing the best we can,” he said, “and the effort paid off.”
Saratoga Hospital met all the conditions that Cuomo set and is within an approved county so it was able to resume elective surgery April 28.
Chief Medical Officer Dr. Richard Falivena said Friday the surgical staff is hearing relief from their patients, some of whom had painful and disruptive conditions such as gallbladder disease and osteoarthritis.
“They tell me their patients are expressing gratitude,” he said.
Saratoga and other hospitals could do surgery for cancer and bone fractures and other acute conditions all through the moratorium. It was the less-urgent procedures that were delayed — those for conditions that cause mild to moderate suffering but not major short-term problems.
The restart has been slow, as supplies were stockpiled and post-surgical recovery nurses were brought back from critical care units where they’d been sent to help care for COVID patients.
“Obviously when we turned the surgery on we did it thoughtfully and step by step,” Falivena said. “We’re only now about 60 percent of our full volume. The goal is to be 100 percent by Memorial Day.”
Doctors are starting to return to normalcy, as well. Those that could best adapt their practices to telemedicine kept busy, Falivena, said. Those who rely on in-person visits, such as to tell with their fingertips how big a hernia is or how deformed a joint is, didn’t see as many patients.
The hospital faces another challenge even as the state allows it to return to normal operation, Falivena said: The community is not back to normal. Too many people are afraid to go to a hospital, he explained. Emergency departments are seeing too many people with conditions that have advanced to a dangerous point because they delayed coming in. Albany Medical Center reported Friday morning that it’s seeing 40 percent fewer heart attack patients.
Which is not to say 40 percent fewer heart attacks are happening; more likely, at least some heart attack patients aren’t going for help when they need it.
“These are all scary, scary things,” Falivena said, repeating the message all hospitals have had to broadcast in some form: Hospitals are safe for staff and patient alike, you won’t catch COVID-19 there.
Saratoga Hospital is down to five COVID patients, none of them in intensive-care settings. As with St. Mary’s Hospital, which has had zero known transmissions of COVID within its walls, there are extensive precautions and protocols in place to prevent the spread of the virus.
Looking forward, Falivena suspects there will be further COVID infections to treat in the Capital Region but hopes there won’t be a surge. The possibility of transmission increases with people getting out in the warm weather and decreases with them taking the universally advised precautions — hand washing, mask wearing, social distancing.
“I’m hoping it’s not a wave, it’s a blip,” he said.
“One thing I would say is we have demonstrated that if you have the right leadership and take the right steps you can really, really reduce the impact of the disease.”