Local health-care providers are turning away business for safety reasons during the COVID-19 crisis — but not all are ruling out non-emergency procedures as they balance health risks and surge preparations against patients' medical needs and financial considerations.
Working closely with authorities but without mandates on which treatments to delay, some hospitals and clinics are being stricter than others about when to postpone procedures versus move forward with medical care that could prevent health complications later.
Some facilities report being as busy as ever: Diabetic Foot and Wound Center at 1408 Commercial Way said it extended its operations to seven days per week during the pandemic to help chronic-disease patients who are trying to avoid a trip to the hospital.
Others local health-care providers have established a policy of delaying all non-emergency treatment, though they emphasize that patients' changing conditions can mean that someone who didn't qualify for an inpatient procedure one day may suddenly deteriorate and be brought in for an overnight hospital stay.
Often it comes down to a judgment call by a doctor working in consultation with a hospital that has its own view of how to best serve its community.
The president and CEO of Bakersfield Memorial, Ken Keller said Wednesday his hospital is "still open for business” during this stage of the pandemic.
He said visitor access has been limited, steps have been taken to protect patients and personnel and telemedicine is used whenever appropriate. But Memorial does perform elective procedures when circumstances call for it, he said.
With patient volume down generally these days, he acknowledged long-term financial considerations do come into play.
"We’re here for the long term for the good of the community," he said.
Elective surgery is generally defined as a procedure that can be scheduled in advance. That ranges from hernia repair to kidney stone removals to cancer treatments.
On March 14, U.S. Surgeon General Jerome Adams asked that hospitals and health-care systems consider halting elective procedures during pandemic. Four days later, the federal agency that administers Medicare issued guidance limiting "non-essential adult elective surgery and medical and surgical procedures, including all dental procedures."
Since then, business is down overall as local medical facilities remain on alert for an expected surge in coronavirus patients.
Nevertheless, hospitals still deliver babies, mend broken arms and provide emergency medical attention because "that's what we do day to day," said California Hospital Association spokeswoman Jan Emerson-Shea.
There's no question hospitals are doing fewer procedures in order to help contain the spread of COVID-19, she said, adding there's a price to be paid for their restraint.
"We are going to have some very serious long-term problems as a result of this, because that is where we make our revenue," Emerson-Shea said.
Finances are not an overriding concern at Omni Family Health, said Dr. Grace Tidwell, a Bakersfield family practice physician who has helped coordinate the organization's response to the pandemic.
While Omni doesn't perform surgeries as an operator of outpatient centers, she said all non-essential treatments are being postponed. Instead, more care including visual assessments of things like wounds and rashes are being handled by videoconferencing.
"What we’ve done is we really agree that people should stay home," she said. "I think that is our best defense against coronavirus.”
When medical treatment cannot be put off, she explained, medical providers make sure to wear full protective gear.
Bakersfield Heart Hospital said it continues to operate its wound care center and 24-hour emergency department. But it has closed its cardiac rehab and women's heart centers and is staggering any visits that cannot be postponed.
Patient volume is down overall but CEO Michelle Oxford said the hospital is standing firm.
“Bakersfield Heart Hospital would love to be doing elective surgeries but until we receive direction that we can do them, we are not,” she said by email.
The chief medical officer at Adventist Health Bakersfield and Tehachapi said patients should never delay care if they experience chest pain or have stroke-like symptoms. Postponing care in such cases can be dangerous and complicate later treatment, he said.
Complex decisions on when a patient's condition becomes urgent or an emergency are largely left up to surgeons in consultation with hospital staff, Dr. Ronaldo Reynoso said, adding that such judgments are fluid.
"Any procedure at a given time can go from elective to urgent or emergent depending how things are happening with the patient,” he said.
Availability of face masks and other personal protective equipment is not as big a concern as it was weeks ago and doesn't generally influence whether procedures are delayed, Reynoso said. And while the need to generate revenue can be a factor in deciding whether to move forward sooner with treatments, he said, it's not necessarily a primary factor.
Kern Medical Center declined to say whether it is performing elective procedures during the coronavirus crisis.