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.”