PHOENIX — The state’s largest hospital network is operating over capacity at several of its facilities and is turning away surgery that is not medically necessary.
And Dr. Marjorie Bessel, the chief medical officer for Banner Health, said Tuesday she expects things to only get worse in the next month. That, in turn, will result in even more instances of people with non life-threatening conditions having their surgeries delayed.
Bessel said that, for the moment, Banner is not anticipating having to do what has occurred in some other states where the National Guard has been called out to help set up facilities outside of hospitals. She also said the hospital is not yet using a “triage” system to turn away patients whose illnesses or injuries are not considered severe enough, or where their chances of survival are so low as to not merit care.
But it does not look good.
“Inpatient volumes are at their highest levels since the start of the pandemic, with several Banner hospitals operating above capacity,” Bessel said.
And that's just now.
“If the forecasted trends continue, we will soon be unable to meet the health care needs of Arizonans,” she said.
“Banner’s predictive modeling tools show no sign of letting up,” Bessel continued. “We expect volumes will continue to increase throughout December and into the beginning of next year before peaking around the middle of January.”
And even that, she said, does not account for the emergence of the Omicron variant which now is present in Arizona. Bessel said while it appears to be highly transmissible there is still a lot to learn about how severe it is and whether those who contract it will need to be hospitalized or, more problematic for hospitals, put into already overburdened intensive-care units.
But Bessel, who repeatedly emphasized the importance of getting vaccinated and wearing masks to help deal with the problem, declined to call on Gov. Doug Ducey to use his emergency powers to mandate either.
“I’m asking the community to assist us in preserving health care capacity for all of you,” she said. “I believe that each one of us can make a personal decision to do our part.”
Her comments come as the state on Tuesday posted another 203 deaths from COVID-19, bringing the total since the beginning of the pandemic to 23,243. There also were another 2,168 cases.
It’s not just a question of having beds, both in the intensive-care units as well as standard care. Bessel said it’s having the staff to provide the necessary medical care.
“We are more stretched now than we have been since the start of the pandemic,” she said, saying many “core team members” deciding to retire, seek another position within the hospital that does not involve face-to-face health care — or get out of the profession entirely. All that, Bessel said, is due to “prior surges and the enormous physical and mental impact the pandemic has had on them.”
There is a significant difference, though, in what is causing the current overcrowding problem at hospitals.
In January, when more than 90% of intensive-care beds were occupied, COVID patients accounted for about two thirds of that. Now, those with COVID take up about 40% of all ICU beds.
But Bessel said the balance of patients are a direct result of the pandemic.
“We know that individuals throughout the pandemic have, very unfortunately, because of the scenario that we have been experiencing, (been) delaying care,” she said.
“Some of them delayed preventative care,” Bessel continued. “Some of them are presenting after having symptoms over a protracted period of time and presenting late in the course of their disease or illness.”
The bottom line, she said, is that Banner has more patients now than it has had since the beginning of the pandemic.
All that goes to the question of whether patients will be able not only to get into the hospitals but even how quickly they will be able to get care at Banner clinics.
It starts with crowding in emergency rooms.
Bessel said that those whose injuries and illnesses are not life threatening are instead being referred to primary care clinics. But that, in turn, means those clinics will be giving priority to established patients who are sick.
“As a result, patients may experience an increased wait for non-urgent primary care physician appointments that can safely be delayed, such as routine follow-ups, ‘well visits’ and new patient visits,” she said.
As to surgical care, Bessel said Banner hospitals and surgery centers are continuing to offer “medically necessary” procedures, though each facility makes its own scheduling decisions on a day-by-day basis depending on available staffing resources and capacity.
But … what’s medically necessary?
“They include things like mastectomies for breast cancer, gall bladder removal for stones, and hip replacement for those who are in pain,” Bessel said.
One key to deciding whether to allow a surgery, she said, is whether if it were significantly postponed, might become emergency procedures. And that, said Bessel, creates problems of their own.
“Emergency surgeries often have a longer recovery and worse outcomes, which can then require hospitalization and ICU-level of care,” she said.
The good news, Bessel said, is that most scheduled surgeries do not require a stay in the already overcrowded intensive-care units.
“And many can be performed on an out-patient basis,” she said.
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