Checking Up On Health: June 14, 2021

Medical Monday: A (mostly) weekly post of healthcare- and technology-related policy news, views and commentaries.

At a conference last week in Idaho, we had some down time and took a shuttle boat from the lakeside hotel to lunch at a nearby restaurant. The return trip included a group from a fly-fishing class, and I eavesdropped as the conversation turned to the upcoming Independence Day holiday and fireworks.

One described how a relative, former military, loaded up on fireworks for his display, spending up to $5,000 for a couple of pallets of the stuff every year.

“Any injuries yet?” asked a companion.

None, he responded, although his wife, a registered nurse,  sees many around such holidays … fingers blown off and the like.

“I know what you mean,” his companion responded. “I’m an ER nurse.”

He went on to recount a horrific tale of a patient at his hospital’s emergency room just the day before.

The patient had had a run-in with the circular saw he was using and sliced off four fingers. Two looked like they could be reattached; the other two were “iffy,” and they began prepping the man for surgery.

Then his pre-op rapid-test COVID-19 results came back positive.

“He’s 25. He’s asymptomatic. We can save at least some of his fingers. But now the question becomes do we take down an operating room for hours, for his surgery and post-op sanitizing the contaminated room afterward, or do we tell him we can’t re-attach his fingers and he’s going to have to live without them?”

The boat ride came to an end before I overheard what had been the hospital’s decision.

I’m haunted now by the thought of how many hospitals and physicians had to make life-altering decisions like that about their patients in the past 15-16 months of the pandemic. Many hospitals focused only on admitting patients struggling to overcome COVID-19 and canceled “elective” surgeries.

Elective surgeries are non-emergency, or scheduled, surgeries. They’re not unnecessary surgeries. It could be removing that precancerous polyp. It could be a mastectomy, colonoscopy or an organ donation. It could be a tonsillectomy or a hip or knee replacement.

When the pandemic hit and hospitals postponed and canceled elective surgeries, it made so much sense to divert many to ambulatory surgery centers, known as ASCs. You’re not staying overnight, so that reduces your risk of infection from other patients.

And yet, even after Gov. Brian Kemp’s March 2020 executive order to suspend certificate of need regulations during the public health emergency, Georgia’s Department of Community Health rejected every one of 14 ASC certificate-of-need applications in the first 45 days of the pandemic. As an article for the Georgia Public Policy Foundation noted

Despite the obvious and overwhelming need, every ASC application was turned down. A common DCH response was that ASCs had not proven local hospitals could not handle patient loads on their own, this at a time when hospitals were overrun by COVID-19 patients and most were not scheduling elective surgeries.

It’s worthwhile patients asking whether decisions about their health and wellbeing are based on their diagnosis and prognosis or the inconvenience to a facility. And, of course, the more medical quality facilities available instead of being prohibited by outdated regulation, the less the risk you’ll lose a body part because someone’s concerned that cleaning up behind you might take too long.

In other news …

Rural hospitals that close inpatient beds and revamp as standalone emergency rooms may receive more funding under a proposal buried in the almost 6,000-page stimulus act signed late last year, Bloomberg reports. Rural hospitals with fewer than 50 beds can apply for the designation, which takes effect in 2023.

A federal judge dismissed a lawsuit brought by 117 employees of Houston Methodist over the health system’s COVID-19 vaccination mandate for workers, marking the first decision of its kind by a court regarding such a requirement at a health system. The lawsuit argued that the mandate is illegal and forces workers to get an experimental vaccine to keep their jobs. The judge ruled the health system did not violate state or federal law or public policy with its requirement, saying “This is not coercion. … It is a choice made to keep staff, patients and their families safer.”

Almost 144 million Americans have been fully vaccinated, or 43.4% of the country’s population, according to the Centers for Disease Control and Prevention. Georgia ranks 45th among the states and the District of Columbia, with about 34% of the population fully vaccinated. Source: Becker’s Hospital Review

Suspected suicide attempts spiked 31% last year in the 12-17 age group compared with 2019, based on the proportion of mental health–related ER visits, according to the CDC. Among girls, suspected suicide-attempt ER visits increased 50.6% during February 21–March 20 compared with last year while it increased 3.7% among young males.

Compiled by Benita Dodd, vice president of the Georgia Public Policy Foundation.

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