Anchorage

Elective procedures become a flashpoint in the debate over Anchorage’s hospital capacity

Elective surgeries have come under scrutiny as hospitals in Anchorage face an unprecedented strain on staffing and resources due to the current COVID-19 surge and the city’s mayor sows doubt about whether health care facilities are truly in crisis.

Alaska providers say the term “elective procedures” — which can include everything from life-saving heart surgeries to hernia repair — may be a misnomer because they’re vitally important for many patients. And some elective surgeries have continued uninterrupted during the latest surge because they are outpatient procedures that don’t take up precious intensive-care bed space.

As they grapple with hard choices surrounding patient care, health care facilities in Anchorage and Mat-Su also report receiving a barrage of angry and harassing phone calls from the public in recent days.

At an Anchorage Assembly meeting Monday night where public testimony over a proposed mask mandate was being heard, Mayor Dave Bronson said, “Of the 46 surgeries done today at Providence, only one was an emergency surgery; the rest were elective. If there was a crisis, would they be doing something else?”

Bronson, who has a history of making inaccurate claims about the pandemic, opposes the mask ordinance and COVID-19 mandates in general. His remarks about Providence Alaska Medical Center’s elective procedures Monday follow earlier instances where he’s taken aim at the Anchorage hospital during Assembly meetings, in particular over its vaccine requirement for staff.

As virus spread in the municipality has worsened in recent weeks, he’s continued downplaying the seriousness of the pandemic and continued to avoid recommending mask wearing or endorsing vaccinations, which are both proven to help curb the spread of the virus and lessen the risk of severe illness.

When Anchorage hospitals are under stress, impacts ripple throughout the rest of the state. Twenty health care facilities across Alaska have activated crisis standards of care, giving them the option to prioritize care for patients most likely to survive if scarce resources make that decision necessary. In practice, that means hospitals around the state are evaluating what they have the capacity to do each day and, in some cases, are postponing some “elective” care.

By definition, an elective surgery is one that can be scheduled in advance. It can include open-heart surgeries, lung surgeries, mastectomies and kidney stone removals — procedures that might not officially be considered an emergency but still are urgent.

Since Bronson made his remarks, statewide virus hospitalization numbers as of Thursday had decreased slightly from near-record levels. A top state health official said it’s possible infections and hospitalizations here may be peaking, though that remains to be definitively seen.

Procedures delayed for heart patients

The heart surgery program at Providence, the state’s largest hospital, has been particularly affected by delays to procedures, according to Dr. Tony Furnary, a cardiothoracic surgery specialist. That’s because most heart surgeries require ICU bed space and longer hospital stays, and many of the delayed “elective” procedures are both urgent and life-saving, he said.

Right now, due to a lack of available ICU beds and staff, “the only operations that we can possibly do are imminently, life-threatening operations — like, someone’s about to die in the next six hours,” he said. “And so, care is being massively delayed.”

Furnary said that as of Thursday, there were 43 patients on a waiting list to have heart surgery — far above a typical count of 10 to 12. The majority of those patients would typically get treated immediately because they are at risk of heart attacks, heart failures and other negative health outcomes.

“We cannot do life-saving heart surgery because the ICU is so full,” he said. Not all life-saving operations are emergencies, he explained. “People can die at home waiting for heart surgery.”

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Last week, Furnary had a patient whose aortic valve was severely leaking. That meant that blood ejected from his heart into his aorta, the main artery in his body, was gushing back into his heart.

The patient waited at another hospital for four days before arriving at Providence and getting placed on a waitlist. Even though he was first on the waitlist, it took another five days before an ICU bed became available, Furnary said. While the patient waited for a bed, his heart efficiency decreased from 50% to 20%, and he went into severe congestive heart failure.

“We almost didn’t get him out (of surgery) alive,” he said. “One more day, he would have been dead. And so that’s the kind of tough decision that we’re having to make.”

Hospitals face harassment

At the same time that doctors are having to make difficult choices about patient care, some hospitals are also reporting an unheard-of deluge of angry and harassing phone calls. Officials at Providence and Mat-Su Regional Medical Center near Palmer this week say they’re fielding angry phone calls from the public, according to the Alaska State Hospital and Nursing Home Association.

The calls are coming from family members berating providers for not administering ivermectin — an unproven COVID-19 treatment endorsed by Mayor Bronson — to patients, and also from people just calling to yell at whoever answers the phone, hospital officials say.

The calls seem to be an offshoot of the tense atmosphere of the ongoing Anchorage Assembly meetings where the proposed citywide mask mandate is being debated, said Jeannie Monk, senior vice president of the Alaska State Hospital and Nursing Home Association.

The in-person audience for Assembly meetings on the mask mandate has been heavily anti-mask and anti-vaccine, and much of the public testimony against the ordinance has been filled with misinformation and debunked claims from Bronson’s supporters — many of whom applaud when he makes pointed remarks about Providence. The meetings have been punctuated with cheers, jibes, insults and worse, reaching a moment of reckoning last Wednesday when a testifier called a gay Assembly member a homophobic slur and Bronson defended the appropriation of Holocaust imagery by mask opponents wearing the Star of David. The mayor later apologized after outcry from Jewish leaders locally and nationally.

In response to the negativity and harassment directed at health care workers, the Alaska State Hospital and Nursing Home Association recently launched a “notes of gratitude” program that allows Alaskans to send encouraging messages to health workers via an online form.

“The harassment issue is real, and it is really making it more difficult for hospitals to take care of patients in the best way they can,” Monk said. “To have health professionals feeling threatened and harassed is really inexcusable right now.”

Callers are asking why hospitals are doing “elective” procedures, which Monk called a misnomer. That doesn’t mean plastic surgery, she said.

Sometimes it means deciding which heart patients are most likely to die if they don’t receive care.

“Having to triage one person over another when everyone has a life-threatening condition is a tough thing to do. It’s like, you’re almost weighing the value of life,” Furnary said. “There are just crazy decisions that are having to be made right now.”

Juggling patient needs and hospital resources

Most of the larger hospitals in Alaska are not carrying out procedures that would require an overnight stay unless it’s an emergency, Monk said.

At Alaska Regional Hospital in Anchorage, “we are continuing to review our surgery schedule daily to prioritize the urgency of the procedures, and critical cases continue,” spokesperson Kjerstin Lastufka said Monday.

The majority of the procedures that Providence continues to perform, even with limited resources and staffing challenges, are “surgeries that can be done on an outpatient basis,” spokesperson Mikal Canfield said in an email early this week. That’s because outpatient surgeries don’t require hospitalization and, as a result, don’t affect inpatient bed availability at the hospital, he explained.

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For example, of all the surgeries conducted Tuesday at Providence, more than half did not require an inpatient bed and just one inpatient case was an emergency that required an ICU bed. Still, more than 20% of these cases were considered urgent, according to Canfield.

Some examples of elective procedures that don’t require overnight stays include tonsillectomies, hernia repair, kidney stone removal and mastectomies. There are also a number of non-elective procedures the hospital continues to do that cannot be postponed, including C-sections.

To determine which procedures to move forward with, Alaska’s hospitals are evaluating what procedures are scheduled and whether or not they will end up involving overnight stays or intensive care unit space, as well as staff availability and the urgency of the procedure, Monk said.

Some doctors have changed their practices to protect hospital bed capacity. Some patients that normally would have spent the night in the hospital post-procedure — like elderly patients from out of town getting a pacemaker put in — are being sent home the same day, said Dr. Steve Compton, president of the Alaska Heart and Vascular Institute.

Monk said hospitals are trying to juggle patient needs, which includes having the capacity to deal with emergencies but also not postponing procedures that could impact a person’s health.

“If you have a cancer diagnosis, and surgery is recommended, maybe waiting a couple of weeks or months is OK,” Monk said. “Or maybe it’s not, it’s a hard call. And from the patient’s perspective, if you have a cancer diagnosis, you want to get your treatment as soon as possible.”

Daily News reporters Morgan Krakow and Zaz Hollander contributed reporting.

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