April 11, 2021

DCTRS

Damascus Center for Theoretical and Civil Rights Studies

Hospitals delay surgeries, warn of rationed care amid COVID

Kaiser Permanente is postponing non-urgent and elective surgeries and procedures throughout California as its hospitals — like healthcare systems statewide — continue to reel from an overwhelming onslaught of critically ill COVID-19 patients.

The pause will remain in effect through Jan. 10 in Kaiser’s Southern California region, and Jan. 4 in Northern California, according to statements from the healthcare consortium.

In Southern California, Kaiser is also not scheduling any new elective surgeries through the end of January.

Pushing back less pressing procedures is necessary, officials said Monday, “to respond to the current and forecasted increases in COVID-19 cases” and free staff up “to concentrate on supporting COVID-19 care.”

Cancer-related surgeries will continue, as will procedures in “any situation in which postponing surgery would have a negative impact on the patient’s medical condition, including pain,” officials added in a statement.

“We understand and recognize the potential for patient concerns, but believe these necessary steps will help us ensure we can continue to have the capacity and staff available to provide high-quality care to our members, while also meeting the current needs and preparing for the ongoing increases in the number of COVID-19 patients during this surge,” the statement from Kaiser Permanente Southern California said.

Delaying procedures is one of the tools healthcare providers have at their disposal to de-stress their systems.

The latest, virulent surge of COVID-19 is applying more pressure than ever before.

“Sixteen of our 36 hospitals are already above 100% occupancy in our ICUs,” Greg Adams, chairman and chief executive of Kaiser Permanente, said during a news conference last week. “We’re struggling to add capacity for COVID patients as we speak.”

Along with putting off some procedures, hospitals statewide have already been forced to take other steps to contend with the crush of COVID-19 patients — such as keeping patients on ambulances for hours until space is available and moving some patients who would typically be in the ICU to other areas of the hospital.

However, those measures can go only so far, and healthcare officials warn that capacity is limited not just by physical space but by the scarcity of trained staff.

“As the hospital bed count continues to dwindle, we simply will not be able to keep up if the COVID surge continues to increase,” Adams said.

Should the medical system become too overwhelmed and overtaxed, officials warn there may not be sufficient staffing or resources to provide critical care to all who need it, which would significantly increase the chances of patients dying.

In extreme circumstances, hospitals could be forced to ration care — with doctors no longer pulling out all the stops to save a life and instead strategizing about where to most effectively use resources and equipment.

Huntington Hospital in Pasadena is now warning of that grim possibility in an information sheet for patients and their families.

Should the situation “reach a point where our hospital faces a shortage that will affect our ability to care for all patients,” officials wrote, then a clinical committee consisting of doctors, a community member, a bioethicist, a spiritual care provider and other experts “will review the cases of all patients who are critically ill” and “make necessary decisions about allocating limited medical resources based on the best medical information possible and will use the same decision criteria that is being used nationally and throughout California on all patient cases.”

“This unburdens bedside staff from making any decisions about triaging care when resources are scarce, and instead delegates those to a committee who will follow an ethical framework for decision-making,” hospital officials added in a statement Monday. “Importantly, no one person will make a caregiving decision, and the committee will be given no information about patient race, ethnicity, religion, citizenship, insurance or any other information unrelated to the patient’s health.

“We are committed, as always, to providing compassionate care to all and wholeheartedly thank our frontline healthcare workers, physicians and staff members who help run our hospital,” the statement continued.

The worst wave of the coronavirus pandemic is walloping all corners of California.

As of Sunday, the most recent day for which complete data are available, there were 19,766 coronavirus-positive patients hospitalized statewide — an all-time high and 45% more than two weeks ago.

Of those patients, 4,228 were in intensive care, also a record.

In the face of already unprecedented numbers of COVID-19 patients, health officials fear a surge of infections stemming from Christmastime travel and gatherings.

The COVID-19 patients who are in the hospital now reflect coronavirus cases diagnosed two weeks earlier. That means hospitals are still expected to see increasing demand into the new year because of infections that took place in early December.

Any fallout from Christmas will take weeks to fully assess, but officials have warned that the healthcare system cannot contend with another surge the likes of which happened after Thanksgiving.

“Given the very, very high rate of hospitalization that we’re already at — where hospitals are already strained and overwhelmed — it is a situation that could easily become catastrophic in January if we have this surge upon a surge,” said Dr. Christina Ghaly, director of health services for Los Angeles County, last week.

The wave of new coronavirus cases has continued to crest despite the state’s imposing strict limitations on businesses and activities earlier this month in hopes of blunting the rampaging surge.

Four of the state’s five defined regions — Southern California, the Bay Area, San Joaquin Valley and Greater Sacramento — are under a stay-at-home order and subject to restrictions such as reduced capacity at retail stores; the closure of some businesses including hair salons, nail salons, card rooms, museums, zoos and aquariums; and a prohibition on most gatherings, hotel stays for tourism and outdoor restaurant dining.

Those orders, which are put into place when a region’s ICU availability falls below 15%, have a mandatory three-week lifespan. After that, they can be lifted, depending on a region’s expected hospital conditions in the near future.

Southern California and the San Joaquin Valley hit their three-week minimum Monday. However, since both regions have languished at zero availability in their intensive care units for more than a week, officials have said they fully expect those orders to be extended.