COVID-19

OKLAHOMA CITY – Hospitals are poised to bear the brunt of the state’s newly revised medical surge plan if Oklahoma can’t figure out how to slow its growing COVID-19 hospitalization numbers.

The same COVID-19 Hospital Surge Plan unveiled late last month, meanwhile, does not propose any mask mandates or consequences for other sectors of the economy that could be contributing to the spread of coronavirus and the increasing number of sick Oklahomans ending up on hospitals’ doorsteps.

When hospital leaders quickly drafted the new surge plan, they recommended mask mandates and limiting congregations. However, those didn’t make the final public plan, said LaWanna Halstead, vice president of quality and clinical initiatives with the Oklahoma Hospital Association.

Hospital officials never suggested executive orders banning elective procedures. When Gov. Kevin Stitt released his final version of the plan that proposed potential bans or reductions, that came as “a complete surprise,” she said.

The plan notes that he’d consider issuing executive orders reducing elective procedures by 50% statewide if there are at least 1,079 COVID-19 hospitalizations. And, he noted he’d consider banning all but emergent surgeries if there are more than 2,212.

This week, hospitalizations reached a record 1,055.

“That’s not the language that we wrote,” Halstead said. “It’s very devastating for hospitals to not be able do surgeries.”

Oklahoma County, meanwhile, entered the “Tier 3” stage this week, meaning 20-39% of staffed beds held COVID patients. Much of western and central Oklahoma, meanwhile, was classified as “Tier 2,” meaning 15-19% of staffed beds held COVID patients. Hospitals that land in Tier 2, 3, and 4 all potentially face bans or limits on elective procedures, under the state’s revised plan.

“We have been told that the governor does not want to cancel elective surgeries because that’s hard on the public,” Halstead said. “That’s hard on your family if you have your care delayed.”

Hospitals, though, are frustrated, she said.

“The population is not showing personal responsibility in trying to curb the virus, and it all lands on the hospital,” she said. “That’s where the rubber meets the road, is the hospitalized patients because that’s who’s most sick. The frustration is the public is doing nothing to curb this.”

The goal of hospital surge plans is to protect Oklahomans, ensure the stability of the health system and aid hospital systems as they manage patient care, said Travis Kirkpatrick, Oklahoma State Health Department deputy commissioner.

“These recommendations are in place to assist hospitals, and were developed in conjunction with the Oklahoma Hospital Association and hospital partners,” he said. “The tiered interventions are optional, and OSDH is empowering hospitals to take the lead in how best to control their capacity.”

Kirkpatrick said he’s aware that hospitalizations are trending high.

“There is no reason to believe this trend is going to change without Oklahomans significantly altering their behaviors,” he said.

The surge plan is designed as a resource for hospitals, so the potential interventions listed on the document specifically relate to hospital operations, Baylee Lakey, a spokeswoman for Stitt, said in an email.

“There are always other options under consideration that do not tie directly to hospital operations,” she said.

“We have learned throughout the course of this pandemic that there are many variables that can affect the situation, and it is difficult to rely on one specific metric to guide actions,” Lakey said. “The governor will continue to consult with OSDH and medical experts on any additional measures that may be needed, but we also need all Oklahomans to do their part to protect their families and neighbors by washing their hands frequently, watching their distance and wearing a mask around others.”

State Rep. Monroe Nichols, D-Tulsa, said the state doesn’t just need hospital surge plan, it also needs a plan to reduce the number of people ending up in hospitals.

He said a statewide mask mandate is the only way to relieve pressure on the hospitals and to keep the economy humming uninterrupted. Temporarily reducing dine-in restaurant capacity is probably also a smart move to stabilize the medical system, Nichols said.

“(Hospitals) are there to help people who get sick,” he said. “None of us should get sick on purpose. Stopping the spread of COVID is the responsibility of all of us. When it comes down to it, the governor has enormous power and influence in that area. The burden (to slow) the spread rests largely, but not solely in the Governor’s Office. It’s not hospitals’ responsibility to stop the spread.”

The state stands on the brink of the health care system having to get rid of elective surgeries, a “really strong revenue” source that will have a crippling effect on Oklahoma’s economy, Nichols said.

“This shouldn’t be happening,” he said.

Janelle Stecklein covers the Oklahoma Statehouse for CNHI's newspapers and websites.

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