Detroit hospitals resuming surgeries, procedures after weeks of red ink

For the first time in a month, Henry Ford Health System resumed outpatient surgeries in specially designated operating rooms at its five hospitals, senior vice president Dr. Steven Kalkanis revealed Thursday. 

Other health systems, including Detroit Medical Center and Michigan Medicine, said they are also easing into more surgeries. 

The announcements follow a dispiriting series of layoffs and furloughs of doctors, nurses, administrative staff and other hospital personnel across metro Detroit in the past week, which hospital administrators had blamed largely on their inability to generate revenue from medical procedures unrelated to the coronavirus crisis.  

"Today marks the first day where Henry Ford Health System is launching a portal of opportunity for patients to have surgeries for non-COVID, but still time-sensitive cases," Kalkanis said in a call with reporters. 

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"We understand that cancer and transplants and heart disease and so many other afflictions don’t get to wait," said Kalkanis, who also is CEO of the Henry Ford Medical Group and chief academic officer for the Henry Ford Health System.

Henry Ford suspended many types of non-emergency surgeries March 16 in response to the fast-spreading novel coronavirus. Four days later, Gov. Gretchen Whitmer issued an executive order prohibiting non-essential medical and dental procedures to reduce the strain on the health care system as the virus began to infect more and more Michiganders.  

Kalkanis said Henry Ford identified one or two operating suites in each of its five hospitals that are designated specifically as non-COVID-19 operating rooms, and the teams assigned to those rooms will work "only and specifically" in those rooms.

"There's an entire testing and sterilization process, both for the patients and for the staff who are working in those rooms to make sure we can prioritize these patients and get these cases as quickly as possible," he said.

Kalkanis said Henry Ford has begun with outpatient surgical procedures that involve patients with a low likelihood of needing an overnight stay or admission to the intensive care unit.

Such surgeries could include cancer biopsies, procedures required before a patient gets a transplant, or treatments to prevent blood clots or strokes.

Kalkanis said the health system hopes to expand those surgeries to more complex procedures, but for the next few days, "we're starting with those ambulatory cases."

For Kalkanis, resuming surgeries comes as the health system reaches a plateau in the coronavirus pandemic and it is "hopefully the beginning of a recovery situation. That doesn’t mean we’re out of the woods, it also does not mean that there's a complete drop off in the number of cases," he said.

"If you need a diagnostic procedure or surgery, which if delayed would risk impairing your health, function or well-being, we have made our hospitals safe for this care," said Dr. Donald Weaver, specialist in chief, surgery, at the Detroit Medical Center, in a statement. "This includes our emergency departments, imaging departments, cardiac labs and operating rooms.

"In this challenging time, we also recognize that patients continue to require medical attention for conditions other than those due to COVID-19. Chronic diseases, medical emergencies, new or worsening symptoms, childbirths and ongoing conditions like cancer do not stop for COVID-19, and neither can their care," Weaver said.

In addition, Michigan Medicine, the Ann Arbor-based health system affiliated with the University of Michigan, also has been performing "essential cancer surgeries throughout the pandemic,” said Mary Masson, a spokeswoman for the health system.

“We’ve been able to gently increase our surgery volumes for time-sensitive procedures, even now, for patients for whom further delay would create harm," she said.

While Whitmer did issue an executive order prohibiting purely elective procedures, Masson noted that it doesn't prohibit essential care.

"Essential care includes cancer and cardiovascular procedures in individuals for whom delays would be detrimental,” she said. 

Michigan Medicine, she said, is in “active planning stages” to expand the surgeries and procedures it can provide to patients who are at highest risk for disease progression.

“As always, we would protect our patients from any infectious disease with careful procedures that are always in place,” Masson said. “Throughout this pandemic, safety has been a top priority and we have taken many steps to minimize the spread of disease.”

Henry Ford's Kalkanis, meanwhile, said he is pleading for the public to know that Henry Ford's emergency rooms, and emergency rooms at all the major hospitals around Detroit, are safe and sterilized.

"We want people who have life-threatening emergencies to not be afraid to come in," he said, noting a 20 percent  drop in emergency room volume from a year ago. "We're concerned that many patients are saying to themselves, 'I’ll just wait it out.'

"We need to get the message out that if someone is having chest pain or any kind of emergent problem, stroke symptoms, and so forth, that they get to an emergency room."

Beaumont Health also issued a statement Thursday saying that its emergency medicine specialists are concerned about people waiting too long to go to get help because they're afraid of being exposed to coronavirus at the hospital. 

“We’ve taken extra precautions to ensure our emergency centers are disinfected, clean and staffed to assist patients with non-COVID-19 medical emergencies,” said Dr. James Ziadeh, chief of emergency medicine at Beaumont Hospital, Royal Oak. 

“Those experiencing chest pains, stroke symptoms or any other medical emergency should not hesitate to call 911, or visit one of our emergency centers. We are concerned some patients might be experiencing medical emergencies and may be reluctant to seek care, which could potentially put their lives in danger.”

Beaumont emergency rooms are open at hospitals in Dearborn, Farmington Hills, Grosse Pointe, Royal Oak, Taylor, Trenton and Troy. Its emergency center in Canton also is open. 

At Michigan Medicine, Dr. Valerie Vaughn, a hospitalist who also is an assistant professor at the U-M Medical School, said emergency surgeries never stopped,  but now "we’re starting to do more of those semi-urgent surgeries, the cancer surgeries. We’re in the process of talking about doing those now because that also hurts people if we're having to delay those things.”

Although hospitals are starting to ease into more surgeries, Vaughn said that doesn’t mean it's a good idea to loosen all the restrictions Whitmer has put in place to slow the spread of the virus.

“If we just open up the state immediately, a lot more people are going to die,” said Vaughn, who was the co-medical director in converting a regular hospital unit into Michigan Medicine’s negative-pressure Regional Infectious Containment Unit to help handle the COVID-19 surge.

“We can't just reopen society, bam, on May 1. If we did that, our hospital would be overwhelmed again,” she said.

“When we were initially planning without social distancing, we were estimating that between 2,000 and 5,000 patients would need to be hospitalized at the University of Michigan. Instead, ... about two weeks after social distancing went into effect ... our curve stopped being exponential and started flattening. And I'm telling you, we breathed the collective sigh of relief.”

That’s when the university put on hold plans to open a field hospital at its indoor track to handle a rush of COVID-19 patients.

“We were talking about putting 500 to 1,000 beds in there, and it just was overwhelming,” Vaughn said. “I never want to have to see that building come to fruition. If we reopened the entire state on May 1, we would need that plus more to cover the number of people that need to be hospitalized.

“Luckily, I don't think our governor is going to let that happen, where the entire state opens up at once.

“But I do foresee some sort of phased reopening, and I think what is going to be necessary is widespread testing capacity. We've developed our own internal test here at the University of Michigan and increased our capacity to test both our patients and nursing homes.

“But we need more than that. We need to be able to do widespread testing of asymptomatic people. We need to … figure out how many people have antibodies — asymptomatic carriers of the disease who therefore are most likely to be immune.

“If we can get to that stage, we can really start to think about how to reopen in small ways to help the economy while not overwhelming our hospitals again. Because we are by no means out of the woods.”

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