Hospitals and patients making tough decisions on elective surgeries during COVID-19 surge

BOSTON — As the number of patients with COVID-19 increases, hospitals face a looming crisis as resources will be stretched to the limit once again.

Field hospitals can help, but hospitals will still need enough staff and enough revenue to treat all their patients.

That revenue portion can be tough especially if the numbers get high enough where the state has to cancel elective surgeries again. Sometimes, those elective surgeries aren’t unnecessary surgeries, but ones that may not be needed right away. Maybe the patient can get by on some antibiotics or just deal with the pain for a few weeks, but that could make things worse.

Hospitals have to make tough decisions right now and so do patients.

“It is painful and it hurts to go to work every day actually, but I’m not going to die from it,” said Brittany K. Bankhead-Kendall, MD MS of CovidSurg.

The surgeon tore her hip labrum this summer and may now need surgery, but says she won’t do it until the pandemic is over.

“Not only is there a hospital capacity problem that could surge at any moment, but there’s also staffing problems, there is a PPE problem and quite frankly as a patient, if I catch COVID, even after the fact within 30 days, my prognosis is worse,” said Bankhead-Kendall.

While doing her fellowship training at MGH, she was part of a global COVID-19 study that looked at surgeries at hundreds of hospitals and found higher numbers of deaths and complications.

“In those who had a COVID-19 diagnosis, the study found that anyone from all surgeries, all types, eye surgery, belly surgery, orthopedic surgery that people were having worse outcomes 50% of the time,” said Bankhead-Kendall.

Numbers like that have kept many people from going through with their elective surgeries. Even those who wanted to could only do so once the state lifted the ban a couple of months ago. Still, for hospitals, the damage was done.

“With COVID-19 hospitalizations on the rise, Massachusetts hospitals and healthcare organizations remain laser-focused on treating every patient in need of care this fall and winter,” said Catherine S. Bromberg, MBA of Massachusetts Health & Hospital Association. “At the same time, they continue to navigate highly unstable financial circumstances, having lost over $5 billion during the initial wave in Massachusetts. We are grateful for the efforts of our state and federal leaders, who secured the relief our providers needed to stabilize and survive. This support will continue to be vital as we prepare for what will be yet another challenging season for our healthcare system.”

Continued state and federal support is now vital as cases are starting to go up again.

“A month ago we had typically about ten patients in and then we quickly went to thirty and now we are at sixty as of today,” said CFO of UMass Memorial Healthcare Sergio Melgar.

Doctors say at the rate we’re going, it may not be long before our 650 hospitalizations turn into the nearly 4,000 we saw in April

“The numbers can double in a matter of literally one to two weeks,” said Melgar. “So if they began to double over a thirty-day period of time you could very quickly exhaust the capacity in the system to help all of these patients.”

The potential for rapid growth is what’s forcing every hospital to make tough decisions.

“There’s a socio-economic issue of major hospital corporations not having the influx of money sure, but it’s also people who have colon cancer and gallbladder cancer and soft-tissue cancers that the longer you delay their surgery, the farther along their prognosis is,” said Bankhead-Kendall. “It is worse just by waiting a few months and it’s a really it’s a really tough call and I don’t think anyone has the right answer yet as to who we should be still operating on and who shouldn’t be and where that fine line is.”

Hospitals lost money from fewer elective procedures and outpatient services but also the increase in equipment costs.

[ 25 Investigates: Furloughed nurses concerned hospital money problems will impact care ]

UMass Memorial was losing about $30 million per month but was able to recoup much of that with state and federal funding.

Now that Governor Baker said field hospitals will be in play again, Boston 25 News asked Melgar if they would be used more, if needed, in an effort to keep elective surgeries going.

“Field hospitals are important so hospitals can concentrate COVID patients in one place, doesn’t mean, you can’t have COVID patients in the hospital,” said Melgar. “Once patients are positive and can recover, they can all be put together in a field hospital. So that helps hospitals, one, maintain a cleaner space in the hospital and two, figure out that balance to keep revenue going with a safe amount of surgeries.”

Follow Wale on Facebook: WaleAliyuTV Twitter: @WaleAliyu or Instagram: WaleAliyuTV

Download the free Boston 25 News app for up-to-the-minute push alerts