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Patients in pain as omicron wave leads to surgery delays

‘It’s a bona fide mess right now’: Coronavirus cases and staff shortages force hospitals to close beds

Robert and Kimberly DeMoss at home on Jan. 16. After waiting two months for an operating slot, Robert’s neck surgery was postponed indefinitely last week. (Amy Lynn Powell for The Washington Post)
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Two years ago, Robert DeMoss fell at his home in rural Ohio and hit his head on a bucket of paint. He got a black eye and, worse, ruptured a cervical disk. After seven months in a neck brace, eight months waiting to see a specialist and another two months waiting for an operating room slot at a hospital 47 miles away, a surgeon was finally scheduled to repair his neck last week.

Then the coronavirus foiled the plan.

The omicron surge has exacerbated a national health-care staffing crisis, forcing medical workers with coronavirus infections to isolate (even those without symptoms) and hospitals to close beds. The staff shortages and bed closures in turn are forcing hospitals to cancel surgeries that require overnight stays. For procedures to alleviate pain or correct non-life-threatening conditions, postponements have become routine.

“I’d say it’s a bona fide mess right now,” said Kenneth Kaufman, chairman and founding partner of Kaufman Hall, a Chicago-based health economics and strategy consulting firm with numerous health-care clients, including the American Hospital Association.

“We seem to be back to square one,” he said. “Omicron has significantly compounded staffing shortages in a very profound way.”

Mercy Health-St. Rita’s Medical Center in Lima, Ohio, last week indefinitely postponed DeMoss’s surgery, one of the thousands of medical procedures delayed as hospitals across the country experience a surge in infections fueled by the omicron variant and acute staffing shortages.

“I’m upset,” said DeMoss, 65, who said his neck pain frequently reaches a 12 on a scale of 1 to 10. After waiting so long, he said, “now I don’t know when I will have my surgery.”

Doctors, hospital officials and patients and their family members described a deep sense of dismay, frustration and worry about delayed surgeries, overflowing emergency rooms and hospital beds that have been taken out of service because of a lack of staff.

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Coronavirus surges have hammered hospitals in varying ways. Early in the pandemic, a dearth of personal protective equipment (PPE), fear of the virus’s spread and maxed-out intensive care units led to blanket suspensions of routine surgical procedures in most parts of the country.

Now, hospitals have enough PPE, and most hospital staff members are vaccinated against the virus. But infections from and exposures to the omicron variant require vaccinated staff members to stay home for days, even if they exhibit no symptoms.

Those absences on the front line — already under strain from the high number of unvaccinated patients who have fallen ill — are compounding the effect of longer-term staff shortages caused by pandemic-related burnout and attrition. Intense competition for health-care workers also is enticing nurses to quit and take more lucrative jobs as traveling nurses.

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DeMoss, a retired machinist and Navy veteran who served on the USS Kitty Hawk, doesn’t blame St. Rita’s, which is the closest major hospital to his home in the western Ohio community of Haviland. He doesn’t blame his doctors.

He blames the unvaccinated, who are filling hospital beds in yet another coronavirus wave.

“Get vaccinated,” he said.

Mercy Health said it is continually evaluating caseloads and surgeries to see which procedures can be added back to the schedule. It urged people to socially distance, wear masks and schedule appointments for immunizations.

“We have recently seen our highest levels of covid-19 hospitalizations since the start of the pandemic across our organizational footprint, including in the Lima, Ohio, area,” Mercy Health spokeswoman Maureen Richmond said in an email.

Doctors said in interviews that calling patients to advise them their surgeries are being postponed has been among their hardest tasks during the pandemic. Hospitals, doctors and administrators have been learning over the past two years how to triage surgical cases to manage increasing infections and resource shortages.

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They said the term “elective surgery” can be misunderstood by the public to mean something like cosmetic surgery when it applies to a broad range of critical procedures.

If a patient is not an urgent case and delaying a procedures does not put them at risk of dying or getting sicker, then their surgeries may safely be postponed. Still, doctors said, they anguish about prolonging suffering.

Some patients waiting for hip surgery, for instance, experience intense pain just sitting and standing, said Wayne J. Sebastianelli, an orthopedic surgeon who is the medical director at Penn State Sports Medicine and associate dean for clinical affairs.

“Some of these patients who need a joint replacement, they can’t sleep, they can’t dress appropriately, and they can’t [use the] toilet if they have a hip problem. It’s really hard. They get bed-bound or chair-bound,” he said. “I have patients who have been rescheduled three or four times.”

In Detroit, hospital administrators at the Henry Ford Health System set up an incident command operation that allows doctors and other staff members to access computer models of pandemic caseloads, measure emergency room demand and monitor bed availability daily. Robert G. Riney, president of health-care operations and chief operating officer, said he has never experienced a level of crisis like the coronavirus pandemic in his four-decade career at the Henry Ford Health System.

“Detroit’s gone through some incredible periods of challenge — [the city’s] bankruptcy, the health-care economic hit when auto companies were struggling in 2008, the Balanced Budget Act — and none of them come even close to what it’s been like to go through the last two years,” Riney said.

“To think that we’re now in the fourth surge, with very little lull periods in between the surges, is incredibly tough,” he said.

As of Jan. 10, Henry Ford had 87 beds temporarily closed because of staffing challenges: 64 at Henry Ford Hospital, 22 at Henry Ford Wyandotte and one at Henry Ford Allegiance Health, the system said in a news release. That represents about 4.3 percent of the system’s 2,000 beds. Defense Department personnel arrived to help ease staff shortages.

Like systems in other states, Henry Ford has worked to move as many surgeries as possible to outpatient, ambulatory settings.

“We’re moving those that are not time sensitive, that are not going to put the health of a patient in jeopardy,” Riney said.

Hospital officials are urging people who think they are infected but not experiencing serious symptoms to consult with a primary-care physician online instead of coming to the emergency room. Hospital leaders nationally are running into the same problems, Riney added.

“Because there’s a lack of inpatient beds, there are patients in emergency rooms all over the place, so the emergency room is running an inpatient service,” he said. “But those patients aren’t in a private setting, and it’s certainly more stressful for them.”

At University of Utah Health in Salt Lake City, hospital leaders this month closed 50 beds to deal with omicron-related absences among staff and huge emergency room volume. After a major wave of the delta variant that began last summer and lasted through the fall, the hospital had returned to something approaching normal operations in December, said Robert E. Glasgow, the interim chairman of its surgery department.

“Around Christmastime and the week after Christmas, we didn’t have to reschedule any operations for a period of three weeks, until January 1st. Then the wheels came off,” he said. The hospital has learned how to handle influxes of patients, but the number of staff members infected by the omicron variant crippled the system, he said. Vaccination rates among hospital employees are well above 95 percent, Glasgow said.

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“But as we know, people who are triply vaccinated are coming down with mild covid symptoms and testing positive. And you can’t have a nurse come in and care for patients who is testing positive, even if they are not sick,” he said. So beds closed and surgeons started calling patients to tell them the bad news. About 20 percent of surgeries have been postponed, Glasgow said.

“I’ve been screamed at. I’ve been yelled at, and with some words that I haven’t heard in a long time. But everybody understands,” he said.

Last week, doctors at the hospital learned they could squeeze in six more surgeries for the Tuesday after Martin Luther King Jr. Day. That set off a scramble the Friday before the long weekend to identify priority patients who could get to the hospital on short notice.

“How can we find six cases that are most in need and are most able to come?” he said.

In Pontiac, Mich., Nelson Case, 90, is waiting in his room at an assisted-living facility for surgery to repair a wound in his abdomen. His son, Bryan Alexander of Manassas, Va., said he was told Jan. 11 that the surgery would have to be delayed. Doctors gave him antibiotics to prevent an infection while he waits.

“I’m worried about his pain and anxiety,” Alexander said. “I can’t do anything about it. I can’t build a new hospital or fly him to some place that isn’t experiencing this. There’s nothing that can be done.”

Alexander said he was astonished to learn his father could not receive basic medical care for such an obvious need as repairing a hole in his body. He noted “the weirdness of it. This is not something I have experienced in the United States in my lifetime.”