LITTLE ROCK, Ark. — State health leaders say they are monitoring health care providers who continue to perform surgeries to make sure they are in compliance with directives to postpone as many procedures as possible during the COVID-19 outbreak.
“It is important that people who need surgical procedures either to save life or limb or where they’re very time-sensitive, that they receive those surgical procedures,” said Dr. Nate Smith, the Arkansas Secretary of Health and the point-man for Governor Asa Hutchinson in the virus fight.
The Arkansas Dept. of Health issued a directive March 21 that called for procedures, tests and office visits that could be safely postponed to get rescheduled. It put off routine dental and eye care visits, but it allowed “emergent, urgent and time-sensitive care” to continue.
Dr. Smith spelled out who gets to make the decision over exceptions.
“Our directive is not designed to replace a physician’s judgment on that,” he said Monday.
That case-by-case process between doctor and patient is being relied on at Arkansas Surgical Hospital. The physician-owned facility says it is abiding by the guidance from both the state and the Centers for Disease Control (CDC).
“It’s a very difficult decision and one that I am definitely not qualified to make,” said CEO Brian Fowler. “It is critical that we continue to provide care to people with emergent and urgent conditions. When we do, we’re keeping people out of ER’s, and we’re limiting the amount of opioid prescriptions being filled.”
Fowler said what might be an elective surgery to one patient could be an urgent procedure to another. He says all of the doctors at the facility are fully going over the risks and potential complications with each individual patient.
But several health care workers outside the doctor-patient relationship think the risk is too great for them to keep performing surgery in cases that appear to be routine.
“They were doing business as usual,” said one health care worker who asked not to be identified for fear of reprisal. “They are using valuable [personal protective equipment] and bringing in more patients. It makes patients and staff more susceptible to coming in contact with people that might be carriers and asymptomatic.”
Fowler said procedures have been severely curtailed, noting that during normal times the facility handles about 100 surgeries a day. Most of the parking lot was empty on Monday except for the Emergency entrance and a pain management clinic.
Other health care networks, including Baptist Health, have furloughed workers as clinic visits, testing and elective procedures have stopped. But doctors who practice in outpatient clinics within those networks may still continue to perform surgeries if they meet the criteria set out by the state.
Dr. Smith indicated physicians who overdo it will be dealt with.
“If we receive notice that people are going ahead and scheduling cases that are clearly not time-sensitive, and potentially either putting that patient at risk,” he said. “We would go ahead and take action.”
The health department oversees hospitals, while the state medical board oversees ambulatory surgical centers. A representative from the board did not return a call asking about how they are monitoring those facilities.
The state directive also excludes small, rural hospitals with fewer than 60 beds but they are “strongly advised to follow this guidance to maximize resources.”