Go Ahead and Schedule That Hip Replacement: Elective Surgeries Okay on May 1

Arizona Governor Doug Ducey announced a small loosening of one of his coronavirus restrictions today. Elective surgeries may resume May 1, with some caveats.
State of Arizona
Arizona Governor Doug Ducey announced a small loosening of one of his coronavirus restrictions today. Elective surgeries may resume May 1, with some caveats.
With pressure coming from all sides to ease coronavirus restrictions responsibly, Governor Doug Ducey took the first step on Wednesday in loosening the lockdown.

Health care providers can resume elective surgeries beginning May 1, if they demonstrate that they have enough personal protective equipment (PPE), he announced at an afternoon coronavirus update.

The news was a source of relief for Arizona hospitals and health care providers, which have been decimated financially since Ducey's March 19 executive order banning the surgeries.

Elective surgeries are a key source of revenue for hospitals, especially rural ones. They also provide a livelihood for untold numbers of specialty doctors. Similar coronavirus restrictions on surgeries across the country have cost providers billions of dollars. On Monday, for instance, Banner Health announced it would furlough up to 3,000 of its 43,000 Arizona employees, pause hiring for some positions, and make other cost-cutting moves to deal with its revenue crisis.

Ducey's general stay-at-home order, which went into effect on March 31, and other executive orders related to the coronavirus emergency, remain in effect. But the governor said he and his health care experts are observing the situation carefully and will lift more restrictions as time goes by, if doing so doesn't result in a surge in COVID-19 cases.

"I hear the calls from people saying turn it back on as if it were a light switch," Ducey said, adding that the correct analogy would be more like a "dimmer switch." Lifting the restriction on surgeries will be a "slight tick" of the dimmer.

Ann-Marie Alameddin, president and CEO of the Arizona Hospital and Healthcare Association - ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION
Ann-Marie Alameddin, president and CEO of the Arizona Hospital and Healthcare Association
Arizona Hospital and Healthcare Association
A new executive order published today on the governor's website establishes the rules for restarting the elective surgeries. The first step will be for the Arizona Department of Health Services (DHS) to set up "minimum criteria" for privately owned, on-site PPE for frontline health care providers and surgery patients. Among other things, providers must request an exemption from the March 19 order that includes detailed information about its PPE supply (they need at least a 14-day supply), its bed space, its ability to test personnel and patients for the novel coronavirus, and enhanced cleaning for patient and waiting areas.

Providers receiving an exemption would no longer be eligible to request or receive state- or county-distributed PPE.

Ducey said he expected the order to help the health care system's bottom line.

Will Humble, director of the Arizona Public Health Association, said while re-establishing revenue for urban and rural health care providers is key, "to me, it's more about the quality of life people have been missing out on" because they haven't had their surgeries.

"These aren't cosmetic surgeries (usually)," Humble said. Electives are often important procedures like hip or heart valve replacements, or surgeries on slow-growing cancers, he noted.

Humble supported the March 19 order, as well as an additional order on March 26 for hospitals to ramp up bed space by 50 percent by April 24. But earlier this month, a slowdown in COVID-19 cases showed there was no need for such an increase in bed space, and Humble believes there should be expedited surgeries for some people that could start before May 1.

"People are going to suffer for another week unnecessarily," he said.

Across the state, hospitals and providers lost an estimated 30 to 40 percent of normal revenue since the March 19 order, or about $430 million to $575 million a month, said Ann-Marie Alameddin, president and CEO of the Arizona Hospital and Healthcare Association. At the same time, hospitals faced a large increase in expenses due to the March 26 order. The association and its members are "very pleased" with the loosening of the elective surgery ban, she said.

"There is a significant backlog of cases now and hospitals are going to have to prioritize," she said, adding that some of the cases will have moved from elective to "more urgent" in the past month.

Alameddin acknowledged that hospitals will need to be vigilant about establishing policies to make sure COVID-positive patients are not coming in to infect health care workers. But today's order was clearly a step in the right direction, she said, because the state needs a strong health care system and infrastructure for the "marathon" of a pandemic, much of which still lies ahead.

Despite problems with PPE supplies, as reported by Phoenix New Times, a representative of Banner Health said the company is "confident" it can meet all the necessary requirements by May 1.

"While we are eager to meet the needs of patients who have been waiting for care, we have not identified a specific date to resume elective surgeries at Banner Health," said spokeswoman Becky Armendariz. "Personal protective equipment and testing will be critical factors in our decision to resume surgeries. Internal planning is already underway; Banner leaders are working closely with our physician partners to ensure a safe environment to restart elective procedures."

Banner will share more information with the community once a decision has been made, she said.

Ducey and Dr. Cara Christ, director of the state DHS, outlined several pieces of good news in their press conference. While the state has recorded about 5,500 COVID-19 cases as of today and 229 deaths, current data shows that coronavirus cases won't overwhelm Arizona's health care system. The number of available beds, ICU beds, and ventilators all appear to be more than adequate for the remainder of the current wave of cases. (Experts still don't know if a second wave of cases will appear this fall.)

The state also keeps upping the number of coronavirus tests it can perform, he said, and in concert with the University of Arizona, 250,000 people in the state will receive coronavirus antibody tests that can tell if a person has had the virus.

With all that good news, does Arizona need to extend Ducey's restriction deadline of April 30? He's already been beat by Georgia Governor Brian Kemp and others who have announced that many restrictions for businesses will end in a week or so. On Sunday and Monday, Trump supporters and lockdown protesters besieged the State Capitol, demanding an end to the lockdowns. The state, like much of the country, is in dire economic trouble because of the restrictions.Yet the restrictions seem to have averted an epic tragedy of far more COVID-19 cases and deaths.

Making decisions to go forward with the restrictions was very hard, Ducey said, and he doesn't want to make decisions now that he might have to "come back and reverse."

Arizona's economic reopening will be gradual and responsible "as we restore confidence in our economy at the appropriate and safe time," he said.