Some nonessential medical procedures are back on—with conditions

Restrictions on nonessential medical procedures were rolled back today per an executive order issued by Gov. Greg Abbott.

Some surgeries will be allowed to resume, as long as health care facilities certify that they will not deplete hospital capacity or the personal protective equipment (PPE) needed to respond to the COVID-19 pandemic.

The ban on nonessential procedures dates back to last month, when the governor issued an executive order to contain the spread of the coronavirus and free up medical resources.

The original order did not specify which procedures were allowed, instead leaving it up to physicians to decide if a procedure was "immediately medically necessary" to prevent serious adverse consequences or death. Failure to comply ran the risk of a fine or jail time.

"There was no clear-cut distinction as to how we were to interpret the rule," said Dr. Shaun McKenzie, a surgical oncologist who works at Texas Oncology's North and South Austin locations. The original order significantly impacted some of his patients, whose cancer surgeries were not considered essential.

"You just have to imagine a patient who has a life-threatening illness [and] who has a potentially curative surgery scheduled being told, 'Well, it's not going to happen,'" he said.

As a result of the initial order, many private practices and hospitals saw their revenue drop precipitously, and groups—including the Texas Medical Association and all 31 state senators—called on the governor to reconsider.

"Many doctors and nurses have been sidelined because of the need to postpone nonessential medical procedures," Abbott said during a press conference on Friday announcing the restrictions would be loosened. "It is time to allow those doctors and nurses to return to work."

Specifically, under the order issued Friday—which is in effect until May 8—nonessential surgeries and procedures may be performed at licensed health care facilities that have certified in writing that they will reserve at least 25% of capacity for COVID-19 patients and they will not request any PPE from public entities for the duration of the pandemic.

TMA President Dr. David Fleeger commended the governor's decision last week to allow for nonessential surgeries but expressed concern about the continued shortage of PPE and testing.

According to a TMA survey conducted earlier this month, nearly two-thirds of physicians practicing in non-hospital settings reported they had less than one week's supply of the most critical PPE supplies.

Tom Banning, CEO of the Texas Academy of Family Physicians, echoed this concern, saying the conditions could prove problematic. But he added that until state regulatory agencies issue their guidance the true impact is unknown.

"Having the ability to allow doctors to use their clinical discretion or professional judgment to determine whether a service is needed or not is really what's most important," Banning said. "And it would appear that the governor's executive order would allow for that professional discretion, assuming that other key components, like sufficiency of PPE … and bed capacity is met."

Dr. McKenzie is optimistic about the regulatory change. Texas Oncology has assembled a COVID task force, which has ensured adequate PPE supply across its 210 locations. "The reality is I think that we positioned ourselves very well," he said.

For hospitals treating COVID patients, PPE might be a bigger issue, and the decision to resume elective surgeries may be more fraught.

"The concern … is that if we have a surge and we start requiring more inpatient care for our COVID population that the hospitals are positioned to meet that demand," Dr. McKenzie said. "And so the hospitals have to take ownership of saying they have the resources to do these elective surgeries."