01/06/2021

State Issues Public Health Order Ensuring Distribution of Health Care Resources across the State to Ensure Patients Get Life-Saving Care as ICU Capacity is Strained

State Issues Public Health Order Addressing Elective Surgery

Tuesday evening, January 5^th, 2021, the California Department of Public Health (CDPH) issued a new public health order to reduce pressure on strained hospital systems and redistribute the responsibility of medical care across the state so patients can continue to receive lifesaving care. This order takes effect immediately.

To preserve services for the sickest patients, the public health order requires some non-essential and non-life-threatening surgeries to be delayed in counties with 10% or less of ICU capacity under the Regional Stay at Home Order where the regional ICU capacity is at 0%. Examples of procedures that may be delayed include carpal tunnel release and non-urgent spine surgeries. Surgeries for patients who have serious and urgent medical conditions will continue. Examples of procedures that will continue include serious cancer removal and necessary heart surgeries. The order will remain in effect for at least three weeks and will continue until rescinded.

The order requires

1. All hospitals and ambulatory surgery centers shall categorize all elective procedures by Tier using the Elective Surgery Acuity Scale (ESAS) from St. Louis University and suggested by the American College of Surgeons.
2. All hospitals and ambulatory surgery centers operating under the hospital license or hospital based clinic in the county shall delay ESAS Tier 1 and 2 surgical procedures for at least as long as this Order remains effective in the county.
3. All 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.

As of January 5, 2021, the following counties are impacted by the order:

San Joaquin Valley: Fresno, Kern, Kings, Madera, Merced, San Benito, San Joaquin, Stanislaus.

Southern California: Imperial, Los Angeles, Orange, Riverside, San Bernardino, San Diego.

In the press release by CDPH, Tomás J. Aragón, M.D., Dr. P.H. Director & State Public Health Officer states, “When hospitals are overwhelmed and overflowing, they are no longer able to provide the traditional standards of care we expect, but if health care resources are available elsewhere, we should ensure Californians can receive appropriate care, we must ensure our entire health care system does everything it can to prevent our hospitals from shifting to crisis care standards for people who are seriously ill with COVID-19 or other critical medical conditions. California is committed to an equitable California for All approach to health care access and standards of care.”

As each individual county responds to the current COVID-19 surge, ASCs should continue to reach out to their county health department and their Medical Health Operations Area Coordinator (MHOAC) to ensure you are included in regional planning and aligned with their COVID-19 response as the state addresses this pandemic.