UPDATE: Gov. Ralph Northam announced Wednesday, April 29 that hospitals and dentists will be allowed to resume non-emergency procedures as of midnight Thursday, April 30.
In March, elective medical procedures were banned under Public Health Order Number 2, signed by Northam and State Health Commissioner M. Norman Oliver. This was done to preserve personal protective equipment during the COVID-19 pandemic, and to allow hospitals to focus resources on COVID patients, said the release.
Northam said at today's press conference that non-emergency procedures can resume because social distancing and other measures have slowed the spread of the COVID virus.
He said the administration is working closely with hospitals and dental practices to ensure they resume operations safely, use necessary PPE and follow all CDC guidelines.
Dr. Michael P. McDermott, president and CEO of Mary Washington Healthcare and the chairman of Virginia Hospital & Healthcare Association's board of directors, also spoke during today’s news conference. He said, "As we consider the current situation, and the other medical needs of Virginia patients, we now believe the time is right to chart a path to begin providing non-emergency, scheduled procedures to people who need that care in inpatient and outpatient settings to improve their health outcomes.
"Virginia hospitals have more than 5,000 available beds to meet patient needs and continue the care for those impacted by COVID-19. Access to expanded testing continues to be an area of focus for the governor and for health care providers, as are PPE supplies.
"... we will continue to work closely with Gov. Northam and his administration to monitor the number of patients hospitalized for COVID-19 and other conditions, to track testing and PPE supplies and to protect the safety of our frontline caregivers as we work to slow the spread of this disease."
UPDATE: An April 23 press release from Gov. Ralph Northam announced that the governor has extended the current ban on elective surgeries by one week, until May 1. The order was set to expire tomorrow.
The press release said that the ban on elective surgeries "will continue while the governor and state Health Commissioner M. Norman Oliver, MD, MA continue to evaluate, in conjunction with hospitals and other medical facilities, how to safely ease restrictions on non-essential medical procedures..."
Northam said in the release, “We have increased our supply of personal protective equipment, but before we allow elective surgeries to resume, we must first be assured that the doctors, nurses and medical staff who are fighting this virus or conducting emergency surgeries have the necessary supplies. We are working with medical facilities on plans to ensure that we can resume elective surgeries safely and responsibly.”
ORIGINAL STORY: The Virginia Hospital & Healthcare Association sent a letter to Gov. Ralph Northam on Thursday, April 18, asking that he allow the Order of Public Health Emergency Two to expire on April 24. The change would allow hospitals in the commonwealth to offer non-urgent services, like elective surgeries.
VHHA president and CEO Sean Connaughton wrote in the letter, “As this crisis has evolved, we have gained a better understanding of our capacity to meet the needs of COVID-19 patients. We believe we have the capacity to treat these patients now and as the disease progresses, while at the same time safely providing care for Virginians in need of non-urgent, but medically necessary care unrelated to COVID-19.”
Fauquier Hospital CEO Chad Melton said Thursday that he agrees with the VHHA request. He said, “We are prepared if the governor lets the executive order expire tomorrow. A plan has been in the works for many weeks, and [we are] currently working with our medical staff to start elective cases in a safe and organized manner.”
He explained, “It will be a phased approach to ensure the safety of our patients and team. We don’t expect to be back to 100% until a month or two down the road; there are too many variables to give an exact timeframe.
“It will be a day-to-day call on performing elective cases, with guidance from administration and medical staff leadership.”
Melton clarified that many of the precautions in place today will remain in place for the foreseeable future. He said, “The hospital, clinics, outpatient locations and our emergency department are safe environments to provide care, due to the precautions we’ve put in place the past two months.”
All Fauquier Health entities are operating under a zero-visitor policy, with entrance to the hospital available only through the front lobby and emergency department until 7 p.m. and only through the emergency department after 7 p.m. and on weekends. Visitor screening precautions are still in effect. Internally, all staff is screened, temperatures are taken, and they are asked the same screening questions that visitors are asked. (For a complete list of steps Fauquier Hospital is taking to minimize the risk of spreading COVID-19, see https://www.fauquierhealth.org/coronavirus-covid-19-preparedness-information.)
VHHA letter to the governor
The VHHA’s letter to the governor lays out Connaughton's view of the current situation. “Significant progress has been made in combating the COVID-19 pandemic and treating those afflicted with the virus… we have distributed personal protective equipment to frontline health care workers, expanded the commonwealth’s capacity for testing suspected COVID-19 patients, increased capacity to treat COVID-19 patients and modeled projected surge at our hospitals. These efforts, combined with … directives on social distancing and Virginians’ commitment to staying home, have helped stem the impact COVID-19 has had on the commonwealth.”
The letter continues, “Another hallmark of our efforts was Virginia’s hospitals’ voluntary agreement on March 18 to stop all non-urgent medical procedures. This decision was advanced further when on March 23, the Virginia Disaster Medical Advisory Committee requested the issuance of an executive order to prohibit non-urgent medical procedures by all providers. You subsequently issued Order of Public Health Emergency Two on March 25, which prohibited all inpatient and outpatient surgical hospitals licensed under 12 VAC 5-410, freestanding endoscopy centers, physicians’ offices, and dental, orthodontic and endodontic offices from providing procedures and surgeries that require PPE, which if delayed, are not anticipated to cause harm to the patient ...”
Connaughton wrote that the executive order has led to a “tremendous availability of beds at our hospitals. There are almost 6,000 open beds at our hospitals, along with 2,200 unused ventilators.”
He added, “There are currently 1,301 COVID-19 patients (confirmed and pending test results) hospitalized across Virginia. Only 21% of the 2,865 ventilators available are in use by both COVID-19 and non-COVID-19 patients. Critically, these numbers have remained consistent since the end of March.”
In an accompanying document titled “Framework for reopening Virginia’s Health care System,” the VHHA claims that staffing is not a significant issue, stating, “Only one of 115 hospitals ... have indicated potential challenges staffing their facilities over the next 96 hours.”
And the document pointed out that the restrictions imposed by the executive order are contributing to medical staff being out of work. “Given the prohibition on non-urgent procedures, many hospitals have furloughed staff not engaged in urgent care and treating COVID-19 patients,” the document said.
In the letter to the governor, Connaughton further explained his reasoning for allowing hospitals to resume non-urgent services: “… it is estimated that 60,000 Virginians have had their non-urgent inpatient and outpatient medical procedures canceled over the past month and 15,000 procedures will be canceled every week going forward…
“We are concerned that continuing to delay their care while we have available capacity to address and/or stabilize their conditions will have long-term negative impacts on health across the commonwealth.”
Melton agreed, “The VHHA did a nice job outlining the variables and flowcharting the process.”