Gov. Doug Ducey took the first step in reopening the state's economy during the COVID-19 pandemic with his signing of an executive order on Wednesday allowing Arizona hospitals to resume elective surgeries.

While the order lifts restrictions to allow many cash-strapped hospitals to perform non-emergency surgeries, hospital leaders say patients shouldn't expect to undergo just any operation immediately.

Elective cases prioritized by necessity

Dr. Ross Goldberg, a general surgeon at Valleywise Health, said hospitals will have to prioritize delayed procedures by necessity.

Goldberg explained that elective procedures fall under a broad array of operations ranging from cancer treatments to cosmetic alterations. Those with potentially life-threatening or debilitating conditions will take priority since most hospitals are still operating with limited resources during the global pandemic.

"The cancer operation is quite medically urgent compared to a cosmetic (surgery), which is purely elective," Goldberg said. "So first you have to determine the need and necessity to get this done and the timing of getting it done."

Quality of life is also a key factor in prioritizing procedures, Goldberg added. For example, a person with a hernia who infrequently experiences minor discomfort likely wouldn't be as much of a priority as someone with a hernia that causes excruciating pain every day.

Goldberg said Ducey's executive order also requires hospitals to test all patients for COVID-19 before an operation whether they're symptomatic or not. He said the measure was necessary as symptoms from COVID-19 could potentially appear after a surgery when the patient was initially asymptomatic.

"It's a stress to the body," Goldberg said about surgeries. "You don't want (the patient) to kind of have a double hit, especially you don't want to have someone who's asymptomatic and has (COVID-19) — then you do this to the body and people are no longer asymptomatic because you've kind of triggered things on top of it, which is another concern."

Dr. Raman Dhaliwal, chief medical officer for Banner Health's Arizona hospitals, said department chairs for various fields of medicine — such as cardiology and oncology — are responsible for determining how necessary a procedure is while weighing patient risk.

"Somebody comes in with a heart attack — they need to be taken care of," Dhaliwal said.

Mitigating spread of COVID-19 within hospitals

Goldberg said that, although there's a risk to visiting a hospital during the pandemic, Valleywise has employed measures to reduce exposure to COVID-19.

"We really kind of mapped things out pretty quickly and aggressively to maximize as much protection as we can," Goldberg said. "We're isolating people out — even for the elective surgeries where we're talking about ramping that back up. If these people need to stay in the hospital, we're keeping them away from any COVID presumed positive patient."

Goldberg said physicians will have to weigh risks — such as whether their patient is old or immunocompromised — when deciding whether the risk of a hospital visit outweighs that of suspending a medical procedure.

Physicians are contacting their respective patients to reschedule procedures as best they can, but encouraging people who haven't yet been contacted to be proactive about reaching out. That said, Goldberg cautioned against flooding a hospital's phone line every day if an answer isn't immediately available.

He recommended patients seeking clarification on their respective treatment plans should feel comfortable reaching out to their doctor for an answer.

Reach the reporter Perry Vandell at 602-444-2474 or perry.vandell@gannett.com. Follow him on Twitter @PerryVandell.

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