NASHVILLE, Tenn. (WTVF) — Hospitals are trying to save critical supplies by canceling elective surgeries, but inside one local facility there were rumblings about people still going on the operating table.
Still, on Friday, one of the top doctors at Saint Thomas Hospital told NewsChannel 5 Investigates that their message is clear: facilities must cut back on procedures to prepare for what may be ahead in the COVID-19 crisis.
"We started looking very early at that, and we started having conversations probably about two weeks ago internally," said Dr. Brian Wilcox, president of Saint Thomas Medical Group.
Wilcox said that, as the coronavirus spread in other countries, the potential shortage of personal protective equipment became a top-of-mind concern.
That's why he insisted that, at the Saint Thomas Hospital for Specialty Surgery, surgeons were already looking at canceling elective surgeries.
NewsChannel 5 Investigates asked, "Elective surgeries, by definition, are surgeries that could be postponed?"
Wilcox answered, "Well, yes."
"Elective for us, medically, means we have the ability to often delay, postpone or reschedule safely," he explained.
"And yet that's where the decision for doing elective or non-elective operations is really hinged right now. What can we do safety for patients in terms of delay, postponement or rescheduling - and yet what do we actually need to do right now because there's risk to the patient or part of their care plan?"
It's an issue surgeons have been debating.
On Friday, March 13th, the American College of Surgeons recommended that medical facilities should "minimize, postpone or cancel electively scheduled operations"
The next day, the U.S. Surgeon General tweeted, "Please consider stopping elective procedures"
On March 15th, the federal Centers for Medicare and Medicaid Services issued guidance that facilities should "limit all non-essential planned surgeries and procedures ... until further notice."
But, then three days later, the chief nursing officer for the Saint Thomas Hospital for Specialty Surgery emailed staff, "At this point we will continue with all elective procedures."
Wilcox said he wasn't aware of that email.
"As part of the leadership team here at Saint Thomas, we've been really clear with our hospitals, our medical staff and our surgeons what our expectations are," Wilcox said.
"What we've allowed surgeons to do, what we've asked hospitals to do is sit down together and figure out what comprises elective and non-elective - or what we can do safely and what we need to delay."
On Monday, the governor ordered that all elective surgeries should be canceled, but patients were still showing up early Tuesday morning for procedures.
Internally, some staff worried that some might be considered elective.
An internal email, sent Thursday, said the facility had "immediately canceled all joint replacement surgery" -- which was specifically mentioned in the governor's order.
But it wasn't until Tuesday - the day NewsChannel 5 started asking questions - that physician staff met and outlined temporary policies
Now, "any scheduled surgical procedure will be reviewed by a committee."
Wilcox said healthcare leaders have been "fire-hose drinking, so to speak, in terms of policy, procedures and directives."
"We're building processes literally every day that change in response to what we know today that we didn't know yesterday," he added.
NewsChannel 5 asked, "So it's been hard to keep up in this environment?"
"Well," Wilcox said, "I would say the good news is: there's 24 hours in every day, and we're using almost all of them."
The doctor said that what one surgeon sees as elective, another equally qualified doctor may see as medically necessary.
That's why all those decisions will be run through a committee to decide what is in the patient's best interest.
