Austin-area doctors warn that local hospitals are ill-prepared for an influx of coronavirus patients, accusing government and hospital officials of failing to require all health care workers to wear masks while at work and being slow to obtain protective equipment.
They also say nonurgent surgeries have required beds that should be reserved for an increasing number of coronavirus patients and have needlessly exposed medical personnel to a greater number of people who could be carrying the virus.
Several doctors and health care professionals — who work at St. David’s HealthCare; Ascension Seton, which operates Dell Seton Medical Center; and The Hospital at Westlake Medical Center — said they fear that without policy changes, those on the front lines of combating the virus will continue to face unnecessary risks.
There are now 58 confirmed cases of COVID-19, the illness caused by the new coronavirus, in Travis County. Health officials announced 17 fresh cases on Friday evening.
“St. David’s (and its operating company) is not only grossly irresponsible to disregard ... firm recommendations that all elective cases in hospitals and ambulatory surgery centers be placed on hold indefinitely,” a St. David’s physician said earlier this week, “but more concerning, they are putting patients and health care workers at risk by potentially exposing them to asymptomatic patients that have no fever, cough and don’t know they’re sick, but are still actively shedding virus and infecting anyone they come in contact with.”
As of Friday morning, elective surgeries still were occurring across the Austin area. But after this story was initially published online, St. David’s officials sent a letter to employees saying that all elective procedures would be postponed starting Monday in accordance with federal recommendations, according to a doctor who received the notice.
Health care professionals who spoke to the American-Statesman asked to remain anonymous for fear of retaliation by area hospital officials. Hospitals have asked employees to limit their comments to the media and have designated public relations personnel to direct messaging.
Officials at Ascension Seton, St. David’s and Baylor Scott and White declined requests for interviews. Multiple calls to the Westlake hospital were not answered.
Ascension Seton and St. David’s officials instead provided a joint statement.
“We are confident in our preparedness efforts, our protocols, which are continuously evolving based on CDC guidelines, and our ability to care for this community, even as COVID-19 spreads,” according to the statement signed by St. David’s chief medical officer Ken Mitchell and Samson Jesudass, chief clinical officer of Ascension Texas. “Patients who test positive for COVID-19 who do not require inpatient care are sent home to self-quarantine, per CDC guidelines. If a patient requires inpatient care, we have infection prevention procedures in place, and they are isolated in the hospital away from other patients.”
Concerns by doctors come as St. David’s on Wednesday announced that a physician working there was diagnosed with COVID-19 and that patients could have been exposed to the virus. The potential exposure was not the result of a breach in hospital protocol, Mitchell said in a news release.
More than 250 doctors have signed an open letter asking Austin and Travis County officials to help hospitals, clinics and medical offices obtain more protective equipment, improve access to testing and implement mandatory lockdown measures in the city.
One doctor who works in several area hospitals said the flow of people going in and out of the Dell Seton emergency room has slowed in recent days, but he still worries about what he considers insufficient protective measures.
“There is no one wearing even a paper mask in the hallways of Dell Seton,” the doctor said.
Elective procedures
The U.S. Surgeon General, the federal Centers for Disease Control and Prevention and national physician groups have recommended the suspension of such nonurgent procedures as knee replacements, colonoscopies and hernia repairs. Vice President Mike Pence on Wednesday also called on hospitals to delay such procedures.
Some Texas hospitals have followed the guidance, but others haven’t, with the support of American Hospital Association, which has pushed back against the recommendations.
As of Friday, St. David’s and at Baylor Scott and White had not canceled all elective surgeries, leaving it up to physicians to decide.
Ascension Seton spokeswoman Danielle Hall said the hospitals had canceled all “nonessential, elective surgeries,” but the Dell Seton doctor who spoke to the Statesman said that elective surgeries were not scheduled to stop until the end of work Friday.
“Because every patient encounter is unique, individual care decisions are made on a case-by-case basis between caregivers and patients. Ascension Seton providers will continue to provide compassionate, personalized care and procedures when it is safe to do so for urgent and emergent procedures. If an Ascension Seton provider needs to postpone a procedure or appointment, patients will be notified to reschedule,” Hall said in a statement.
Physicians who oppose doing elective surgeries at this time believe that across-the-board cancellations will preserve beds and medical equipment for COVID-19 patients and reduce the risk of coronavirus exposure to other employees and staff. They fear becoming infected by patients.
The Dell Seton doctor said he is concerned that anesthesiologists who often contract with hospitals and are essential to most surgeries might feel forced to scrub into procedures to avoid losing the business.
“The more procedure-oriented hospitals are, that’s how they make their money,” said another Austin physician, who is calling on Gov. Greg Abbott to cancel elective procedures. “Are they going to be strapped for money during these tough times? Yes, everybody will be. But it’s no excuse.”
In the letter sent to employees Friday, Mitchell with St. David’s said that elective surgeries would be postponed until at least after May 15. He also notes in the letter that all elective surgeries might not be truly optional and doctors must submit information ahead of time for procedures that they believe are medically necessary.
The St. David’s and Ascension Texas officials said in the joint statement to the Statesman that the hospital systems are doing their best to protect health care providers.
“We are taking every possible precaution to protect them. We need to support our caregivers as they selflessly show up each day to care for our patients. ... The community can be assured that we have alerted anyone potentially exposed, including caregivers, and we will continue to do so,” according to the statement.
It’s scary’
Seton and St. David’s hospitals are working to conserve masks amid a national shortage. They also have locked up protective equipment, the statement said.
But doctors said not requiring all hospital employees to don masks shows that hospitals recognize that protective equipment could be in short supply if the coronavirus continues to spread.
“Additionally, St. David’s is saying that they are currently adequate on the supplies on hand to care for all COVID-19 patients, using this a rationale for why it’s OK to continue elective cases,” the St. David’s physician said. “Unfortunately, what they aren’t mentioning is that they are requiring all staff to use only regular surgical masks and not the recommended N95 masks when taking care of all patients for elective surgery.”
The fear of limited protective equipment extends to nonhospital settings.
“We’re in a sub-ideal situation and the medical community is just trying to work through it with what we have,” said Luke Padwick, chief executive officer of Austin Emergency Center, a free-standing emergency room.
Padwick and the Dell Seton physician also would like a more robust increase in testing.
“Ideally, all patients coming into nursing facilities need to be tested,” said the Dell Seton physician, adding that he works with a lot of elderly patients. “It’s scary. We know that it will be bad, and I’m most concerned about the geriatric population.”
The doctor added that the Dell Seton intensive care unit has about 30 true ventilators and that the emergency and operating rooms have their own. He estimates that the breathing machines within the intensive care unit could handle more than 110 patients.
Because the coronavirus can cause severe respiratory issues, ventilators are essential in helping those with more severe cases battle the disease.
Partnering with private labs and relaxing of federal requirements have allowed for increased testing in the state, according to the Texas Department of State Health Services.
“There have been a few things that have allowed us to increase the number of people we’re able to test at the state lab in Austin from 26 when we started a couple of weeks ago up to a max of 150 people per day now: CDC changed from requiring two swabs per person (nasal and oral) to just one (nasal). And we got federal approval to begin using automated equipment for part of the testing process,” said Chris Van Deusen, state health department spokesman.
Padwick noted that if a patient shows up at a free-standing emergency room, a hospital or a clinic, they won’t immediately be tested for the coronavirus.
Padwick said an Austin Emergency Center patient who appears to be at high risk for COVID-19 would be treated that way. A test might be done a couple of days later, but the patient would immediately go into self-quarantine, or in more serious cases, into a hospital for treatment.
“The bottom line is that our federal government, the administration has let us down,” he said. “The vast majority of patients that come in and ask for tests cannot be tested. ... At this very minute you can’t just show up at a free-standing clinic and ask for tests, but we can evaluate you.”
Update: This story was updated to include that Ascension Seton hospital officials have said that elective surgeries have ended.
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