For weeks, the operating room at Good Samaritan Medical Center in West Palm Beach, Florida was nearly empty—a casualty of restrictions on elective procedures that the majority of states have implemented to stop the spread of the coronavirus. But that all changed this week, when Florida Gov. Ron De Santis lifted his state’s ban on elective surgeries. By Monday, an employee in the surgical department told The Daily Beast, the Good Samaritan operating room was back to three-quarters of its pre-pandemic capacity. And not everyone was happy.
The employee, who asked to remain anonymous for fear of professional retaliation, said the hospital was still running low on basic medical supplies, like syringes and surgical jackets. Four boxes of sanitizing wipes were being split between the hospital’s eight operating rooms. Hospital policy allotted the employee one N95 mask per shift, he said, during which he could easily be in the operating room with six or more patients. As of this week, a new policy dictated that the masks would be sanitized and reused over multiple shifts.
“We’re all concerned,” the employee said. “You don’t know who’s positive, who’s not positive. If we are low on the supplies, it’s just increasing our risk of getting infected.”
Hospitals around the country say they are ready to reopen for elective procedures—a term generally used for non-emergency procedures like knee replacements, tonsillectomies, and even some cancer surgeries. Patients and providers alike are anxious to restart the operations, which can greatly improve patients’ quality of life and are a key source of income for most hospitals. A spokesperson for Good Samaritan said the hospital had invested in rigorous infection prevention protocols and rapid testing capabilities and was “ready to safely provide this care to our community again.”
“We follow PPE conservation practices as recommended by the CDC and can safely and appropriately care for our patients with the necessary and appropriate PPE, cleaning supplies and medical equipment,” the spokesperson said.
But the decision to restart these procedures also means increased risk, for both patients and providers. Most states have yet to see a steady two-week decline in COVID-19 cases—the benchmark recommended by the American College of Surgeons for resuming elective surgeries. And personal protective gear continues to be an issue: None of the health-care workers across four states who spoke to The Daily Beast said their hospitals supplied adequate protective equipment.
“It's a constant battle for the proper PPE,” said Alexandria Culter, a dietary services worker at the University of Pittsburgh Medical Center (UPMC). “We need more masks, we need more gloves, we need more cleaning supplies.”
“There’s a possibility that these patients can come in for a surgery for one thing and leave with another,” she added.
Thirty-five states issued some sort of restriction on elective procedures in March, following guidance from the U.S. Surgeon General and Centers for Medicare and Medicaid Services. In mid-April, a coalition of national surgical groups issued guidelines for slowly increasing these services, which included an adequate supply of PPE and a preoperative coronavirus testing process for patients. A majority of governors loosened their states’ restrictions shortly thereafter.
Some hospitals started performing elective procedures even before the restrictions were lifted. Administrators at UPMC told doctors to increase their elective caseload last month, more than a week before the Pennsylvania governor loosened the ban. In communications first reported by the Pittsburgh Post-Gazette, administrators said they wanted to reach pre-pandemic surgical capacity within six weeks, and instructed doctors to use words like “urgent,” “cancer,” and “unstable” to justify doing the procedures.
Cutler, the dietary services worker at UPMCS, said she was shocked to hear the hospital wanted to add more patients to its schedule. She said the kitchen staff at one of her hospitals still did not have basic cleaning supplies like sanitizing wipes, and were making due by budgeting tablets of cleanser dissolved in water. She said coworkers were also reusing surgical masks so long as they changed colors.
“We have to kind of pick and choose what we clean, when it should be clean, and how clean it should be, and it shouldn’t be like that,” she said.
The decision to increase the number of elective cases, she added, was “risking [our patients’] lives and ours.”
“We’re all working to keep these patients safe, and UPMC is working against us by doing all these things from the comfort of their homes while we’re out here on the frontline,” she said.
A spokesperson for the hospital said all staff, including dietary workers, were given masks to wear at the start of each shift. The spokesperson said UPMC facilities and staff were “safe and well-equipped to properly care for patients,” and that care was provided in accordance with guidance from CMMS and in compliance with public health authorities.
“Our return to essential care has happened against the backdrop of declining numbers of new COVID-19 cases in our hospitals, communities and statewide,” the spokesperson said. “We always prepared for the worst, cared for those who needed care, and used our experiences across UPMC to guide us.”
The lack of PPE has been a national issue since the early days of the pandemic. Skyrocketing demand and a disrupted supply chain left many hospitals scrambling for equipment and providers getting by with reused masks or DIY face shields. Nurses at Good Samaritan raised the alarm about PPE more than a month ago, telling the South Florida Sun Sentinel, “We are short-staffed, short-supplied, and you can see the effects of poor management.”
Despite national task forces and executive orders, the situation on the ground has not markedly improved. In a survey conducted last week of more than 200 nurses in North Carolina, nearly half said they still did not have adequate protective gear. More than a quarter said the amount of PPE was less available than it was a month earlier. Still, hospitals in the state reopened for elective procedures last month.
Health-care workers’ unions from Massachusetts to Minnesota have pushed back on plans to begin elective procedures in their states, fearing it will put added strain on PPE reserves.
“Throughout the pandemic… too many hospitals have been incapable of making prompt, appropriate decisions in the best interests of their staff and patients,” the Massachusetts Nurses Association wrote in a May 4 letter to Gov. Charlie Baker. “We fear the desire to generate revenue through elective procedures could override the need to ensure proper protections are in place before resuming these procedures.”
A nurse at Eastern Maine Medical Center told The Daily Beast that she and her coworkers had been advocating for weeks to get access to a single N95 mask per shift. Instead, she said, the hospital told nurses to stay six feet away from patients when they were being intubated or extubated. When that didn’t work, the hospital told them to stay out of patients’ rooms during the procedures—a policy the nurse said could put patients at risk. So she was confused when she learned the hospital planned to restart elective procedures this month.
“We’ll be using more PPE to open and we already don’t seem to have what we need, so that’s concerning,” she said.
“I have to wonder, if it was my family member, if I’d want to send them in for surgery right now,” she added. “Because I feel like we’re cutting a lot of corners.”
A hospital spokesperson said the limited number of people in each room was part of a plan to “safely conserve” resources, and added that emergency N95s were located outside of all operating rooms in the event that a nurse needed to enter.
“We are prioritizing patients who have a medically necessary, time-sensitive need and have plans in place to pause these efforts, and even reduce services again if we have any indication that the safety of our staff or patients are at risk,” the spokesperson said.
In Iowa, where the number of COVID-19 cases is still increasing, Gov. Kim Reynolds eased the restrictions on elective procedures nearly two weeks ago. A nurse practitioner at the University of Iowa Hospitals said her department was already back at 100 percent of its usual caseload, and was considering adding in extra procedures on weekends to make up for the backlog. But hospital workers, she said, were still asked to sanitize and reuse their N95 masks for multiple shifts. (A hospital spokesperson said the sterilization procedure was among those approved by the CDC, and that the hospital was at 65 percent capacity overall.)
The nurse said her coworkers had tried to convince her that the risk of transmission was lower at the hospital than at the grocery store, but the assurances rang hollow.
“When the patient is like my mother, who hasn't even been going to the grocery store... for those kinds of people, how can you justify that increased risk?” she asked.
In many cases, however, it is the patients who are advocating for the resumption of elective procedures. One liver transplant candidate told NBC News that having his surgery postponed was akin to a “death sentence.” Cancer patients in Texas told the Texas Tribune they were terrified when their tumor removal surgeries were put on hold. When several states tried to put a hold on abortions, providers sued on behalf of their patients, claiming ending a pregnancy was not an elective procedure.
Some health-care workers are also eager for the procedures to restart. Elective procedures account for a sizable portion of most hospitals’ incomes, and some hospitals have posted hundreds of millions of dollars in losses amid the pandemic. According to Beckers Hospital Review, more than 200 hospitals across the country have furloughed staff due to the budget constraints.
The workers who spoke to The Daily Beast said they knew that continuing to pause elective surgeries would eat into their hospitals’ profits, and possibly affect their own pay. The Good Samaritan employee, who has several children to support, said he has already seen his hours cut back. He’s had to put his mortgage, credit card payments, and car insurance payment on hold because he can no longer afford to pay them. But he said he would rather lose more income than be forced back into a dangerous situation.
“Health comes first—above anything at the moment,” he said. “It would not make sense to rush to work and become sick, or risk other peoples’ lives.”
“It’s safety over profits,” Cutler, the dietary worker at UPMC, added. “I would rather be dealing with these economic troubles than be diagnosed with COVID-19.”
The nurse at the University of Iowa said she understood there were risks to both delaying and restarting elective surgeries—she just wanted her hospital to be more transparent about what those were.
“I understand the situation that we’re in but I wish there was more transparency about what that situation really is,” she said. “This is not the best practice, this is just practice we have right now.”
