Dominican Hospital in Santa Cruz.
(Kevin Painchaud / Lookout Santa Cruz)

Santa Cruz County halts elective surgeries as hospitals face surging COVID-19 demand

County Health Officer Gail Newel signed off on the order Tuesday, which dictates that hospitals and ambulatory surgery centers forego certain surgeries and procedures, starting at 5 p.m. Thursday.

Santa Cruz County health officials are suspending elective surgeries and procedures starting Thursday evening as local health care systems and hospitals face staffing shortages and surging demand due to the coronavirus pandemic.

County Health Officer Gail Newel signed off on the order Tuesday, which applies to hospitals and ambulatory surgery centers countywide starting at 5 p.m.

“This Order is issued in response to critical shortages of staffing, overall bed capacity and Intensive Care Unit capacity due to surging demand on the healthcare systems in the County of Santa Cruz as a result of the COVID-19 pandemic,” the two-page order states. “These shortages have led to near crisis-care status in the County’s hospitals.”

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Hospitals and ambulatory surgery centers in the county will have to categorize all elective surgical procedures by tiers using the Elective Surgery Acuity Scale. Tier 1 and Tier 2 surgical procedures will have to be delayed until the order is rescinded. Those run the gamut from colonoscopies and carpal tunnel release to non-urgent spine surgeries.

“Dominican Hospital has stopped elective surgeries consistent with the County of Santa Cruz Health Services Agency order,” Dominican Hospital President Dr. Nanette Mickiewicz said in a brief statement to Lookout Thursday.

Failure to comply with the order is a misdemeanor punishable by fine, imprisonment or both. The order requests that the Santa Cruz County Sheriff’s Office and all chiefs of police in the county “ensure compliance with and enforce” it. It will be in effect indefinitely, until it is “extended, rescinded, superseded or amended.”

Dr. David Ghilarducci, the county emergency medical services director, said the local decision was “based on our extremely overloaded hospitals in Santa Cruz County,” calling it an “unprecedented situation.”

“While our local hospitals have been doing a good job of delaying cases that could potentially require hospitalization, and the few cases that have been happening have not required hospitalization, we now need ALL healthcare staff and equipment to be reassigned to dealing with this disaster situation,” Ghilarducci wrote in an email to Lookout.

“This is not a decision we take lightly, we understand the inconvenience to patients and the financial strain this places on health providers, but this is an unprecedented situation.”

He wrote that San Francisco and Santa Clara “have significantly limited elective surgery some time ago already, and continue to do so” and San Benito is under a state order to suspend them.

“Other (Association of Bay Area Health Officials) counties are considering mirroring the States’, as we have done,” Ghilarducci added.

The local mandate comes on the heels of a similar order issued by state of California officials Tuesday.

The state’s order — issued by Dr. Tomás J. Aragón, California Department of Public Health Director and State Public Health Officer — applies to a county when it “is in a region under the Regional Stay at Home Order that has zero percent ICU availability (0%) and the CDPH calculation of the ICU availability for that county is ten percent (10%) or less.”

Under the state’s order, hospitals and ambulatory surgery centers “operating under the hospital license or hospital based clinic” in the county shall delay Tier 1 and 2 surgeries for as long as the state order remains in effect in the county.

The state’s order also says that ambulatory surgery centers “still performing surgical procedures shall coordinate with local hospitals to ensure the hospitals where post-surgery admissions are usually referred to have capacity to accept any possible post-surgery admissions prior to performing any surgery or other invasive procedure.”

Santa Cruz County has been below 0% capacity for more than two weeks now, according to Ghilarducci.

“Our larger neighbors to the north have a small reserve of ICU beds but that is not the case locally,” he wrote. “We feel strongly that the State Public Health Order, while important, does not adequately address the situation in our small county.”

Last week, the county’s ICUs were at 123% of capacity, with overflow in non-ICU areas and Emergency Departments, Ghilarducci said. On Thursday, that number hit 100%.

While the state is releasing updated data by midday Thursday, Ghilarducci said the Bay Area region is now reporting 3.5% reserve ICU beds, and 7.4% yesterday.

He wrote that “if this trend continues I would expect that elective surgeries in the Bay Area region will be suspended by state order by Friday.”

The situation at hospitals and in ICUs has turned dire in areas across the state. Coronavirus hospitalizations have increased 17% in the past two weeks, while ICU admissions have increased 21% in the same time.

The counties impacted by the state order issued Tuesday include:

  • In the San Joaquin Valley area: Fresno, Kern, Kings, Madera, Merced, San Benito, San Joaquin, Stanislaus.
  • In Southern California: Imperial, Los Angeles, Orange, Riverside, San Bernardino, San Diego.

Aragón, the CDPH director and state public health officer, said in a news release Tuesday that if the state continues “to see an alarming increase of COVID-19 patient admissions at hospitals statewide, some facilities may not be able to provide the critical and necessary care Californians need, whether those patients have COVID-19 or another medical condition.”

He continued: “This order helps ensure that patients continue to receive appropriate medical services by better distributing available resources across the state to prevent overwhelming specific hospitals, counties and regions. As we continue to see the effects of holiday travel and gatherings in our emergency rooms and ICUs, we cannot underscore enough how critically important it is for Californians to stay home, wear masks and avoid getting together with people outside their immediate households to slow this alarming surge of hospitalizations.”

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