It was all over the media on Friday, April 17th. Governor Abbott said he was going to open the State of Texas back up, in stages. Certain types of surgery would be allowed. That made for great headlines, but as usual, it’s the details that count. And so far, the details aren’t very clear. Let’s do a quick review of laws governing surgery in Texas during COVID19…
On March 22nd Governor Abbott issued Executive Order GA-09. That mandated all licensed doctors and facilities “postpone all surgeries and procedures that are not immediately medically necessary to correct a serious medical condition of, or to preserve the life of, a patient who without immediate performance of the surgery or procedure would be at risk for serious adverse medical consequences or death, as determined by the patient’s physician.”
One day later, Texas Attorney General Paxton followed up on that with an edict stating that failure to comply with an executive order issued by the governor related to the COVID-19 disaster can result in penalties of up to $1,000 or 180 days of jail time. So, that ended essentially all surgery in Texas. Even cancer cases. No surgeon wants to spend 180 days in jail for doing something that someone else arbitrarily might later say was not absolutely necessary.
I do a lot of breast cancer reconstruction. The breast oncology surgeons have been forced to stop doing surgery on women who have been newly diagnosed with certain breast cancers. Large numbers of women with early stage breast cancer are now being placed on pills rather than undergo surgery for their cancer. There is no data to know if this will be effective or if this will be harmful in the long run for them. Once the State mandate is lifted, these will be able to undergo their cancer surgery.  But not until then.
On April 17th, Governor Abbott signed Executive Order GA-15. News outlets across the country reported the “loosening of restrictions” on surgery in Texas. That sounds great to me! Breast cancer patients actually getting to have their cancer surgery and their reconstruction? That has been the standard of care for decades. But, let’s not get ahead of ourselves. Here are the two conditions that need to be met before these types of surgery are to be allowed, verbatim:
- any procedure that, if performed in accordance with the commonly accepted
standard of clinical practice, would not deplete the hospital capacity or the
personal protective equipment needed to cope with the COVID-19 disaster; or - any surgery or procedure performed in a licensed health care facility that has
certified in writing to the Texas Health and Human Services Commission both:
(1) that it will reserve at least 25% of its hospital capacity for treatment of
COVID-19 patients, accounting for the range of clinical severity of COVID-l9
patients; and (2) that it will not request any personal protective equipment from
any public source, whether federal, state, or local, for the duration of the COVID
19 disaster.
It’s this last condition (I added the italics) that may be what slows everything down. Since we don’t know how long the “COVID 19 disaster” will be, and there’s no way to know how bad it could be in December, this is a difficult thing for a hospital to say. I’m not sure that Texas Health Resources (Harris hospitals) or the Baylor Scott & White system will state that they will not ever request any PPE from any public source before the end of this COVID19 event.
In my office we are actively looking into all of this on a daily basis. We communicate frequently with the hospitals and surgery centers. We monitor national, state, and local media for updates. We look to the Texas Medical Board for guidance on what is and is not allowed.
We are eager to get back to doing what we do. And that’s taking care of you. With compassionate, professional people with high ethical and outcomes-oriented standards.
Let’s go, Texas! Let’s be the first state to get past this!
