Despite Wolf’s request, UPMC continues elective surgery
Health care workers fear job loss, infection
Defying Gov. Tom Wolf’s request that hospitals shut down elective surgeries, UPMC on Friday said — unlike other hospitals in southwestern Pennsylvania — that it would continue to do some elective surgeries. In part, that’s because health system officials believe regional COVID-19 case activity does not yet warrant taking that step.
The move has many of the Pittsburgh health system’s employees upset over the risk to their health, patients’ health and the use of resources that might be needed in the coming weeks.
“It’s a huge deal,” said a UPMC surgical nurse who asked not to be identified because, like a dozen UPMC employees who spoke with Pittsburgh Post-Gazette reporters this week, the individual was worried about losing their job.
“It’s causing massive stress around everyone,” the nurse said, “just because everyone who is still working now realizes we don’t have all the resources we need now, and when [COVID-19] becomes a massive deal, there won’t be enough resources then.”
At a news conference Friday morning, UPMC officials cited their own in-house “surveillance” research that found little COVID-19 activity in the region. More would typically be seen with “widespread community transmission,” said Dr. John Williams, chief of the division of pediatric infectious diseases at UPMC Children’s Hospital of Pittsburgh, who is leading that research.
The health system’s research is based on 950 samples from people who came to its facilities over the last month complaining of cold or flu-like symptoms — not specifically for treatment of possible COVID-19. Just five of those samples tested positive for the disease.
That testing is separate from what UPMC is doing for people being tested at its new South Side
collection site. That was set up specifically for those who have COVID-19 symptoms and either travel or possible contact with someone with the symptoms.
“This data is incredibly valuable to us to know that this is not northern Italy; we’re not Wuhan right now,” Dr. Graham Snyder, UPMC’s medical director of infection prevention, said Friday, referring to the hardest-hit region in the world and the Chinese city where the virus originated. “In Pittsburgh, this is an area of relative calm compared to where outbreaks are happening.”
That conclusion is small comfort to many employees who describe hospital staff reluctantly coming to work in fear — for their health and their jobs — and being told that even if they have COVID-19-like symptoms, they won’t be tested unless they can prove exposure to someone who already tested positive.
“People are very scared,” said another UPMC surgical nurse. “I saw a couple nurses sobbing today.”
The health system is not testing patients before surgery either, the nurse said.
Protective equipment
The allocation of protective equipment for operations has also been a concern among employees.
For example, UPMC has a supply of the sought-after N95 masks that can help prevent hospital staff from breathing in aerosolized infected droplets, but several staffers said they are kept under lock and key — given out only after administrators OK their use. Some employees have taken to asking neighbors and friends on social media to donate N95 masks to hospital staff.
There’s a reason for limiting use of such items, said Dr. Don Yealy, UPMC’s chief of emergency medicine.
“We’re beginning right now to make sure we deploy this very important protective equipment smartly,” he said at the news conference, “so that we do not go through equipment when it’s not optimally protective.”
“It’s very easy to interpret that as ‘Aha! There isn’t enough!’” he said. “That isn’t the reality. The reality is we want to be smart about this on day one, so this isn’t a problem and we’re not having this discussion in two weeks or two months.”
‘Inaccurate’ perception
Despite concerns that UPMC hasn’t pulled back enough on elective surgeries, Dr. Yealy said the health system has canceled some after doctors and patients conferred about the risks.
And though UPMC has not yet “broadly” canceled elective surgeries, he said: “We are and we will rapidly adjust our service and our plans based on the science and the facts.”
“We’ve had lots of cases that have already been deferred,” Dr. Yealy said. “The perception that nothing has changed at all is inaccurate.”
Employees reported that Thursday at UPMC Mercy Hospital, a full schedule of elective surgeries continued despite a Pennsylvania Department of Health recommendation as far back as
Tuesday and reinforced Thursday by Mr. Wolf that hospitals postpone nonemergency operations.
The Uptown hospital’s schedule of medical procedures — some scheduled months ago — included screening colonoscopies, cataract operations and hernia repair, according to a person familiar with the list. Such cases comprised about 60% of Thursday’s surgical schedule at the Uptown hospital.
UPMC officials reject assertions that the health system is not handling things properly.
“UPMC has a measured, clinically appropriate approach to continuation of elective procedures,” spokesman Paul Wood wrote in a statement Friday. “If our physicians, in consultation with the patient, believe it is not medically responsible to delay, then we’ll proceed.”
Statewide push
On Tuesday, the state Health Department asked hospitals to review all scheduled elective admissions and “develop a plan to postpone those admissions, surgeries and procedures if they haven’t done so already,” spokesman Nate Wardle said.
Mr. Wolf said Friday that the number of COVID-19 cases was rapidly spreading in Pennsylvania, where 268 cases were reported by noon Friday. And Allegheny County’s case count jumped one-third in just one day from Thursday to Friday, growing from 18 to 28 positive cases.
“We are in an unprecedented crisis,” Mr. Wolf said. “The number of positive cases is growing exponentially every day.”
Asked if the state could force UPMC to shut down its elective surgeries, Mr. Wardle wrote: “We are hoping all of our partners are willing to assist in ensuring the entire state is prepared to address
COVID-19, and are taking all steps to prepare.”
Allegheny Health Network, Excela Health, Heritage Valley Health System, St. Clair and Washington Hospital have announced cancellation or postponement of medical procedures that were not emergent.
UPMC staff say the directive to continue doing elective surgeries came from the administration, not from surgeons.
Meanwhile, members of UPMC’s medical staff said there have been mixed messages or no clear direction from the administration about how to protect staff from the new coronavirus. Doctors and nurses have been left to develop individual protocols and practices, based on guidelines issued by the Centers for Disease Control and Prevention and other sources.
“We’ve been asking, ‘What are we going to do? What are we going to do?’ ” one UPMC employee said about precautions to be taken with COVID-19 patients.
A UPMC physician said the health system earlier this week did give some guidance, seemingly putting the decision to perform a surgery or not in the hands of the surgeons themselves.
But in that guidance, the physician said, “Rather than encouraging cancellations, UPMC highlighted reasons providers might decide not to delay care.”