UPMC defends decision to continue with some elective surgeries

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UPMC on Monday defended its policy of continuing to perform elective procedures on a case-by-case basis amid the COVID-19 outbreak, even as nearly 300 doctors urged the health system to cancel such procedures across the board.

In a letter to UPMC administrators signed by 291 of its resident physicians, fellows and attending physicians, the doctors argued that continuing to perform elective procedures and allow outpatient visits would lead to further spread of the novel coronavirus to healthcare workers and patients alike and would use up crucial supplies at a time of national shortages.

"If we do not do this, we face the possibility of shortages of ventilators, oxygen, personal protective equipment, and other resources that are life-saving for both patients and healthcare workers," the letter said. "If we do not do this, we face the possibility of confronting horrific triage scenarios in which we, the healthcare workers on the ground, must make difficult decisions regarding who gets treatment and who does not."

Pittsburgh-based UPMC responded in a statement Monday that it's not always clinically safe to delay procedures. The health system provided the examples of cancer care, heart valve replacements and hernia repair. UPMC said it will continue to serve patients whose procedures are not medically responsible to delay.

"Balancing our patients' ongoing clinical needs with the avoidance of unnecessary exposure requires a nuanced approach—not an across-the-board canceling of clinics and procedures," the statement said.

The conflict emerged at a news conference on Friday when reporters told UPMC administrators they had spoken with employees who said they did not feel safe given the continuation of elective procedures and outpatient visits. The employees spoke to reporters on the condition of anonymity.

Dr. Donald Yealy, UPMC's chair of emergency medicine, said at Friday's news conference that UPMC's protocol aligns with the request from Pennsylvania Gov. Tom Wolf and the state health department that hospitals stop performing elective procedures. He said the governor did not request that "necessary" procedures be canceled.

Instead, Yealy said doctors and their patients are assessing whether procedures can safely be delayed.

"We have lots of cases that have been deferred or canceled," he said. "So in fact, the perception that nothing has changed at all is inaccurate."

UPMC's position aligns with that of the American Hospital Association, the Federation of American Hospitals and other groups that asked the U.S. Surgeon General to clarify his recommendation that hospitals stop performing elective procedures to prevent the spread of COVID-19. Leaders with those groups argued that not all so-called elective procedures can be delayed. Federation CEO Chip Kahn called such a directive "dangerous."

Cynthia Hundorfean, CEO of UPMC's neighbor in Pittsburgh, Allegheny Health Network, told Modern Healthcare last week her system would "never" cancel all scheduled procedures.

"In clinical medicine, you wouldn't think of it that way," she said, giving the example of a breast biopsy to diagnose cancer.

As of Friday, 28 UPMC patients had tested positive for COVID-19, and four of them were currently hospitalized, Dr. Graham Snyder, the health system's medical director of infection prevention and hospital epidemiology, said at the news conference. Thus far, he said the virus has had minimal impact on the health system.

"This is not northern Italy," Snyder said. "We are not Wuhan right now. In Pittsburgh, this is an area of relative calm compared to where outbreaks are happening. That should give us a measure of the risk and response that we need to take."

UPMC has more than 5,500 hospital beds across its system, including 750 that can serve as intensive-care beds. Last week, the health system had the capacity to test 80 COVID-19 specimens per day. It plans to double that capacity this week, Snyder said.

Snyder said on Friday that UPMC is not testing asymptomatic individuals, including its own employees, to preserve critical supplies. He said that includes "mundane" supplies like the swabs and vials used in testing.

Administrators at Friday's news conference said UPMC is not experiencing any shortage of the personal protective equipment necessary to treat COVID-19 patients.

However, the open letter from residents said the health system has reported its mask use is more than 200% the typical level. The letter also said that those who work in operating rooms across the system have reported limited supplies of surgical gowns and blue towels used in surgeries. The letter emphasized the need to preserve "critical resources" of hand sanitizer, soap, N95 masks, gowns and towels.

While UPMC is a large, 40-hospital system that reported $20.6 billion in revenue last year, the academic health system has operated on slim margins. In 2019, UPMC's operating margin was just 0.1%—or a 0.6% loss margin including income tax and interest expense—down from 0.5% in 2018.

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