Statewide Elective-Surgery Ban is Medical Malpractice

The impact of COVID-19 is uneven across Virginia. If its jam-packed parking lots Monday at noon were any indication, Henrico Doctors Hospital in Henrico County (owned by HCA) is feeling no economic pain. Furloughs are widespread at other Virginia hospitals.

by James A. Bacon

The Carilion Medical Center in Roanoke is the largest hospital in Virginia west of the Blue Ridge Mountains. It was staffed for 663 beds in 2018, according to Virginia Health Information, and it admitted roughly 40,000 patients a year. Twelve days ago, reeling from the drastic decline in admissions caused by Governor Ralph Northam’s emergency statewide ban on elective surgery,  Carilion Clinic announced a wave of furloughs, reduced hours, and pay cuts for senior administrators as the health system.

The Governor enacted the prohibition to ensure that there would be enough hospital beds, ICU units, ventilators, and personal protective equipment to handle the influx of COVID-19 patients. On Friday, he extended the ban for another week.

The number of COVID-19 patients at the 663-bed Carilion Medical Center Sunday night: two. Let me repeat that: Two. That’s according to an informed source whom I will not divulge because he/she may not have been permitted to release the information.

Similar reports have dribbled out for other hospitals. Kerry Dougherty writes in her column today that she was given a copy of a “medical staff update” distributed last Thursday at Sentara Norfolk General Hospital. The largest hospital in Hampton Roads, with 538 staffed beds, had nine COVID patients in regular rooms, two in the ICU, and none on ventilators.

Clearly, Northam’s statewide ban on elective surgery is a sledgehammer which may be appropriate for the hardest-hit parts of the state but is wildly inappropriate for others. That policy is directly responsible for thousands of delayed medical procedures, hundreds of furloughs, and millions of dollars in lost revenue. In sum, the statewide aspect of the edict has been calamitous for many, with no offsetting gains for public health.

How typical are the Carilion and Sentara stories? We don’t know. The Virginia Department of Health and the Virginia Hospital and Healthcare Association COVID-19 dashboards do not allow visitors to drill down to see what’s happening in individual hospitals.

(Update: I received this communication from Marvin Gilliam, who served on the Board of Trustees of the 116-bed Johnston Memorial Hospital in Abingdon. Citing a daily briefing from the administrator, he writes, “They have dedicated one floor to Covid19 (I think 17-25 beds available) and, to date, have only had one bed occupied for about one week.”)

As Kerry Dougherty asks in her column today, why the secrecy? There is no excuse for not providing that information, she argues. No one’s medical privacy is being protected.

The experience at Carilion Medical Center may or may not be common, but it clearly shows the how unnecessary the blanket ban has been in at least one part of the state. According to the VDH COVID-19 dashboard, the three localities of the Roanoke Valley — the city and county of Roanoke, and the city of Salem, an area with a population exceeding 200,000 — have reported a grand total of 88 COVID-19 cases and, more germane to our discussion here, a grand total of seven hospitalizations. As of yet, there have been no deaths reported in the Roanoke Valley.

Roanoke is not Henrico County, where nearly 50 residents have died in a single nursing home. (My neighborhood hospital, Henrico Doctor’s Hospital appears to be doing a booming business, if its jam-packed parking lots are any indication, as seen in the photo atop this post.) Neither is Roanoke Arlington County (a locality with roughly the same population), where 157 patients have been hospitalized and 32 have died. Or Fairfax County, where 555 patients have been hospitalized and 114 have died.

The next two maps, taken from the VDH dashboard, show how the COVID-19 virus is having a radically different impact around the state. The map below tracks the number of deaths per 100,000 population. You can see there are large swaths (mostly rural) where there are zero deaths.


The second map shows hospitalizations per 100,000 population. By this measure, some rural areas are as affected as urban areas. Still, the impact varies geographically by orders of magnitude.

Subjecting all parts of the state to the same blanket policy is medical malpractice. Thousands of Virginians outside the epidemic epicenters are being denied medical treatment for no legitimate reason.

Further, when Northam does relax the ban and patients can reschedule their procedures, some hospitals could be financially crippled. The federal government is helicoptering tens of billions of dollars upon the U.S. hospital industry, but nobody knows at present whether the money will flow to those who need it the most or whether it will arrive in a timely manner. Inevitably, when that much money is shoved through an institutional pipeline unprepared to handle it, billions will be misallocated. It is impossible to say at this point which Virginia hospitals will rise from the wreckage.

Governor Northam has indicated that he may scrap the ban on elective procedures by the end of the week. One can only hope that he will recognize that other economic shutdown measures similarly might be appropriate for some parts of the state and entirely unsuited to other parts. The Governor can’t be blamed for the virus, but he can be blamed for needless economic devastation that results from his actions.

Update: Reports to the Associated Press, “Virginia Gov. Ralph Northam said Monday he is open to the idea of opening businesses in southwest Virginia before the rest of the state as he weighs when coronavirus restrictions can be lifted. Northam said at a press conference that the situation in the border city of Bristol illustrates why a regional approach might be necessary.”

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45 responses to “Statewide Elective-Surgery Ban is Medical Malpractice

  1. One size must fit all…

  2. The Post and the rest of the MSM has given Northam a perpetual pass. It’s awfully arrogant of BR not to respect its betters and do the same. If the factual situation is different in the Greater Roanoke Area, why not tailor restrictions accordingly?

  3. “The Post and the rest of the MSM has given Northam a perpetual pass.”

    Of course, they would, Blackface is a Democrat.

    Might Roanoke have too many Republicans? Is that reason for Governor’s torture of and financial assault on Roanoke’s prime economic engine, its hospitals, on which so many people in that region rely for their health and money. Did they talk about joining West Virginia!

  4. Continuing to accuse the Govt of bad faith is mind-numbingly monotonous and just plain wrong IMHO.. and if it actually came from people who were not prior/continuing critics of the govt/Northam, it might have some import but in the current context, it’s just more of the same “anti” conspiratorial blather that flows continuously from that “loyal opposition” these days.

    • I’m not saying the Governor is acting in bad faith. I’m saying he’s made a disastrous error in judgment by enforcing a blanket policy statewide.

      Your dogged defense of Northam makes me laugh. Not once have you offered a substantive refutation of my argument. Your defense consists entirely of assailing the biases of his critics — the critics are biased, therefore they have no credibility. Yeah, like you’d ever adopt that logic to dismiss the criticisms of Donald Trump by people who literally hate him.

      Regarding Northam, you’ve got nothing. You’re shooting blanks. When you adopt a rhetorical strategy of deflection, I know I’ve won the debate on the substance.

      • I think you HAVE accused him of bad faith AND bad judgement and your argument is more along the lines of “why do you beat your wife” than anything substantiative.

        It IS a judgement call of which is not inconsistent with other states also and we’re talking about DAYS upon which we characterize as DISASTROUS. In days, it’s disastrous?

        In terms of Northam – what I’ve said is how does he compare to other Govs on these issues? Is he out of line? way out from others?

        How do you justify your criticism if he is not?

        If you were an objective person in the middle on these issues, your criticism would have import but you are not – it’s a drumbeat…one thing after another… admit it! 😉

    • I have to wonder how many people would want to get elective surgery at the moment. I know someone who had to have minor but emergency surgery, and she was absolutely terrified of being exposed to Covid. If she had been able to postpone it, she would have.

      My suspicion is that, like restaurants and retail and travel and conventions, the demand side is not going to be even close to normal until either we get good treatments or a vaccine.

      And demand is going to be even lower if we see a rebound in infections.

    • This is the first COVID-19 criticism I’ve made of Northam. It’s hardly made in bad faith but, rather, based on a failure to apply reason to a factual situation that seems to differ substantially from factual situations in other parts of the state.

      Moreover, my statement about the Post and the rest of the MSM giving Northam political cover is 100% accurate. No Republican or even Independent office holder who as an adult, ready to graduate from medical school, who admitted to appearing in blackface when caught, but denied the next day, would have his conduct ignored by the media. Northam is a dishonorable man who owes his continued political existence to a biased media with the integrity of Joseph Goebbels.

      • yadda yadda : Northam and the left and WaPo … bad bad bad..

        must be a real trial and tribulation to have to live in NoVa where the leftists and liberals run amok, eh?

  5. And in other news…
    “Fifth District manufacturing activity declined sharply in April, according to the most recent survey from the Richmond Fed. The composite index plummeted from 2 in March to −53 in April, its lowest reading and largest one-month drop on record. ”

    https://www.richmondfed.org/research/regional_economy/surveys_of_business_conditions/manufacturing

  6. So why doesn’t the Governor allow the Roanoke area hospitals to resume elective surgeries when the data indicates that they have the capacity to do so and they aren’t seeing many COVID cases? What data supports keeping them closed? Is it the whole equity and fairness thing run amok? If others can’t open, Roanoke doesn’t get to? Is it just because Northam is governor and no one opens until he “says so”?

    • Much of the reason is fear of exposing people to Covid while they’re in the hospital. Particularly since much elective surgery is in older or sicker people.

      Healthcare workers are more likely to have been exposed, and asymptomatic transmission means you can’t easily be certain. Increasing testing would help.

      • I would imagine there would be a lot of concern with respect to whether the patient was infected or not AND whether the rooms where procedures are done are infection-free.

        I think there are going to be issues.

        I know right now, there is thinking that you don’t go to an ER unless you have no choice and if you do go there, you’re NOT going to sit in a waiting room with 20 others waiting to be seen.

        The world we were used to has changed. It’s no ones fault. Blaming it on someone is just futile and a little bit ignorant.

  7. My dentist recently confirmed an early May routine visit, not emergency, an appointment made long ago. They have been told the medical restrictions lift this weekend. This is here in Richmond, not another part of the state.

    • The dentist is probably a good example. Totally aside from what the Govt might say – take a small Dental practice and what would happen to them if some of them got COVID 19. It’s not like they have replacements.

      So how would Dental practices proceed? My guess is that they’re probably going to NOT have you wait in a waiting room and that they WILL use a temperature and/or other probes AND that in that room, they’re going to be dressed up in HazMat type equipment AND they’re going to having to totally clean the room after you are in there AND you’re gonna pay for whatever extra they have to equip with.

      This is just one small type of business that will have to figure out how to re-open – and my guess is that if there ARE some govt rules – they’re probably going to be based on what the Dental industry is advocating.

  8. Re: Steve H. I cracked tooth this weekend. My regular dentist is closed. I called the emergency number (not a real emergency) and was told my regular dentist reopens Monday so I have an appointment next day

  9. There are MOMENTOUS changes occurring in the economy not the least of which is how public education – both K-12 and Higher Ed will work and yet the folks like Jim who have, seemingly forever, expressed their dissatisfaction with K-12 and Higher Ed are not looking ahead to the opportunities but instead focused on, essentially, blame.

    Perhaps this is one of the differences between those dastardly leftists and libertarian/Conservatives?

    Now, it could well be that a miracle will happen and a real vaccine will short-circuit all this kerfuffle but geeze – right now, at the least, the “disrupters” actually have a significant opportunity for change and yet they choose to squander it on feckless attacks on a Governor who cannot run for re-election.

    What Gives? Right now, today, we hear that if Colleges cannot open with regular campus/dorm operations that some of them will “fail”.

    Well Hells Bells… isn’t this the gift from heaven for Conservatives to preside over the crash and burn of those overpriced and corrupt institutions?

    It’s almost as if they prefer sniffing their armpits… figuratively speaking of course

    Come on Jim B – let’s hear it for how to disrupt higher Ed and K-12 public Ed!

    Cat got your tongue?

    • James Wyatt Whitehead V

      You made some good points Mr. Larry. I saw an education report that seems to support no major gains in the Common Core/SOL era. Isn’t now the time to reimagine education? I do think this will be a truth for the remainder of Mr. Northam’s term: an empty treasury will produce a limited government. I also think we should lay off Mr. Bacon. He is alright with me and I appreciate the work he puts into “the Rebellion”.

      • James – ideas, yes! NOW is the time to get those ideas on the table about how to do education better!

        In terms of laying off Mr. Bacon… did he put you up to this?

        The man does need some looking after here.. he’s basically good-hearted but tends to go off the rails on his ideology – like a cat to catnip sometimes…. He apparently feels compelled to support the really wretched ideology of the rancid right…. I know it’s a challenge…

        but just for you… I’ll not print my next comment… ! 😉

    • Now that it’s obvious that education can be done remotely and from a distance it’s time to tear down Virginia’s lack of school choice. Students might still go to a physical facility but the curriculum, subjects, teachers and teaching styles can be chosen by the parents.

      If the school districts downstate can’t afford sufficient salaries to hire the best teachers then don’t hire the best teachers. Let the best teachers instruct over the internet with the equivalent of tutor / study hall monitors physically in the schools.

      Seems like distance learning is being “proven in” during the lockdown. We should be able to simultaneously increase the quality and decrease the cost of K-12 education through the now proven approach of distance learning.

      • Ripper – have you been reading the stories about parents trying to function as teachers to their kids?

        I’m hearing that some kids are now up for adoption and others in danger of abuse!

        But seriously – how about you start the ball rolling on what the opportunities are for K-12 and Higher Ed.

        We need a break from the relentless Blame Northam Blather…

        • Don’t fool yourself Larry – the elites are going to war on homeschooling now that a lot of parents have figured out that they can make homeschooling work.

          https://nypost.com/2020/04/23/elites-go-to-war-on-homeschooling-just-when-everyones-doing-it/

          Why should a good teacher be limited to teaching 20 students at a time when they can use the internet to teach 2,000? Of course, that would mean needing fewer teachers. If those video-teachers can reach homeschooled kids over the internet maybe the parents of the homeschooled kids should get a voucher since they are not in the physical school and cost less to educate.

          Never waste a crisis. It’s not just for libtwits anymore.

          • I don’t put much stock in the Post – it’s sorta like those tabloids in the super market!

            But I DO agree with you – why not have a teacher teach 200 not 20?

            But why are you STILL “blaming” when it’s out of the hands of those dastardly “elites” now?

            Of course, I would expect you to continue to call for standards, transparency and accountability, right?

            But here’s one for you:

            Some parents giving up on distance learning (FOX)

            ‘It Was Just Too Much’: How Remote Learning Is Breaking Parents
            For the adults in the house, trying to do their own jobs while helping children with class work has become one of the most trying aspects of the pandemic. (NYT)

            Distance Learning Isn’t Working
            Instead of trying to move classes online, schools should support parents in educating their children. (Atlantic)

            Fairfax temporarily cancels face-to-face video instruction, retains law firm to review botched debut of online learning (WaPo).

            Now I know you are want to blame… those terrible “elites” but what does this problem sound like right now?

            Are teachers REAL professionals or what? All this time, we’ve heard that they are glorified babysitters protected by unions and elites.

            Right?

            But how about a Post? None of the other authors in BR including Jim seem to have the cojones to do it!

      • James Wyatt Whitehead V

        Mr. DJ that is an interesting proposal. A school where the curriculum, subjects, teachers, and styles are chosen by parents. It would literally be a customized education. Distance/virtual learning could be the bridge to this sort of Shangri La. I wonder what that would look like and does this have the potential for better educational outcomes?

        • So , THIS is the KIND of discussion I was hoping would occur in BR now that we are at this juxtaposition.

          Is DJ actually advocating an end to standards and instead let each parent decide what level of education they want for their kids?

          or what?

          I’m looking for some specifics not the usual anti-K-12 blather…

  10. Ripper. Ha ha. Go got me!

  11. ” … Carilion Clinic announced a wave of furloughs, reduced hours, and pay cuts for senior administrators as the health system.”

    So, Northam’s inept policies are causing needless layoffs.

    How many of Virginia’s state employees have been furloughed or laid off? For example, what do the VDOT employees who work in the now closed “service” centers do these days?

    I did some internet searches around Virginia state employees & furloughs or layoffs and didn’t find anything. Well, that’s not exactly right …

    I found a story about how Chesterfield County furloughed 500 employees.
    I found a story about how Pennsylvania froze the paychecks of 9,000 employees.
    I found a story that 2,900 Michigan state employees have been notified that they will be laid off.

    Of course, millions of private sector employees have been laid off.

    How many layoffs or furloughs among Virginia state employees?

    We’re all in this together, right?

    • Don, you’ve really got it in for VDOT employees. FYI, maintenance crews are still out doing maintenance, cutting grass, replacing pipes, etc. Construction projects are still in full swing, inspectors and project managers are still going hard since its entering prime construction season. The customer service centers are still working, VDOT is getting more complaints than ever. Engineers are still designing future projects. Those who work on the land development side are still working with developers since they’re still working. Inspections of newly constructed streets and coordination with local governments to bring them in is still occurring. Who exactly do you want laid off?

  12. Geeze, I had no idea that Northam was responsible for Chesterfield employees, Pennsylvania and Michigan………

    Good Lord – sounds like herpes… or some such.

    • Try to follow the bouncing ball. If localities and other states are laying off and putting employees on furlough – are we doing the same? Or are we still following Northam and Money Train Layne’s hallucination of a $2b revenue shortfall over two years? Families, private companies and well run states and localities are aggressively belt tightening now. Other states are laying off and putting on furlough employees who can’t work because of the lockdown. Why? To reduce the financial fiasco to come. Are we?

      • Is Northam doing different than other states?

        You’re advocating that Northam lay off state employees?

        Are you advocating that Virginia stop funding K-12 in the localities?

        Are you advocating that Virginia lay off State Police or the localities their public safety?

        what are you advocating? what employees do you think should be laying off?

        That bouncing ball has to have something more than just “bounce”.

  13. Malpractice would be injecting them with Lysol, or perhaps not injecting them with Lysol before exposing them to SARS-COV2.

  14. Pingback: COVID-19 roundup | Overlawyered

  15. This is “malpractice” going on – for sure – but mostly at the Federal level that should be taking the lead on establishing uniform testing standards and contact tracing procedures.

    People do not stay in one county or one state. And that is one of the significant issues in opening up regions and localities. People travel across state lines, across couunty lines and asserting that each state should set up their own standards is tantamount to malpractice in my view.

    The states have to do the actual testing, no question, we do not want or need the Feds doing that. States and localities know best where they will test and what populations to test but unless we have uniform standard and approach, we end up with the chaos that we have right now with various tests of varying quality, being used in ways that actually do not expand surveillance and finding the infected quickly and isolating them before others are infected.

    The military knows what to do. They are testing every single person on some ships. Not once but many times.

    Prisons and meat packers – you have to test everyone and quickly find who is infected and remove them from the others or else everyone in that facilities will be at risk.

    Colleges and Universities and K-12 cannot re-open until we figure out how to do so safely and it will surely involve wide-spread testing. Instead of a Federal standard, we are leaving it up to the state and individual institutions – each of which has their own plan.

    Students from all over the country attend schools in other states than their own – what’s the procedure for testing for them? Do they get a test in their home state then carry the results to school? Once they are at that school, do they get tested again especially if COVID19 is detected on campus?

    MeatPackers have closed down on their own – no govt edict told them to close and now, in fact, the govt is forcing them to re-open without really setting standards for testing and protecting the workers. Is that going to be company by company or state by state or what?

    Are we going to force people to work in meat-packing plants? Hows that for draconian govt?

    NOT Having a National approach to testing to reopen is Malpractice far, far worse than a 5 day delay in elective surgeries…

    • But… USMA will gather their graduating class for a commence address by Trump… reminds me of something… a word keeps trying to come to mind… mal… malady… Ah ha! MALMEDY!

  16. Early 1990s. Cohort lost his wife after an elective surgery. Along with 13 other patients at Riverside hospital, she died of a still-unknown respiratory disease contracted in the hospital.

    Raise your hand if you never thought, or don’t believe, that doctor’s waiting rooms and offices, hospitals and their ERs, and Doc-in-a-Box urgent care centers are NOT Petri dishes.

    • Yep. Don’t be surprised if a lot of people who need elective surgery are going to put it off until they are convinced the facilities are safe and will not end up going to places where they fear they might get infected.

      And here’s a prediction. Like the meat packers, the elective surgery folks are going to overtly or covertly seek immunity to liability and it’s probably already in the fine print of the papers you will sign when you admit.

      As soon as they do that or as soon as people realize that they’re doing that , the elective surgery business ain’t going to be what some folks think it will.

      • Removing your right to remedy one business at a time.

      • I’ve been banned

        • Odd.. this comment got posted but not this one… could be the multiple links

          and is an excellent link – probably needs it’s own separate blog post.

          Comment:
          Found this Harvard/Mass General website. It’s a first order linear ordinary differential equation model of the infection spread in each state. It models six states of infection from healthy to dead or recovered. The parameters are set via data fitting. It allows investigations of mitigation policies by state and nationally

          https://www.massgeneral.org/news/coronavirus/COVID-19-simulator

          covid19simdotorg

          might need to provide a laymans explanation of what a first order linear ordinary differential equation model of the infection spread….

        • multiple links are held and moderated… I think… Try
          one link per… or use the title of the webpage and have people
          google for it.

          • I’ll repost under one of Jim’s chart of the day pieces. It would make more sense there.

  17. Medical malpractice? Sledgehammer? Talk about hyperbole!

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