A growing number of hospitals in Michigan are taking the U.S. Surgeon General's advice and canceling or reducing elective or nonessential surgeries to free up staff, beds and units to prepare for an expected surge of incoming coronavirus patients.

Hospitals including those of Beaumont Health, Henry Ford Health System, Detroit Medical Center, Ascension Health, Trinity Health and the University of Michigan Hospitals have reduced non-essential surgeries, including postponing a range of cardiology, cosmetic, bariatric and orthopedic elective procedures.

The internal decisions weren't easy and sometimes led to debates between medical staffs and hospital administrations before final decisions were made.

For example, while DMC officials confirmed Wednesday they implemented a policy on Tuesday that would allow doctors to decide themselves to delay or cancel non-essential surgeries or procedures, three DMC surgeons who requested anonymity told Crain's that hospital administration was reluctant to curtail certain lucrative operations and pressure is still being applied to meet volume targets.

But Brian Taylor, DMC's chief spokesman, said DMC is being as clear as it can be with its medical staff and patients. He said next steps for each case will be determined by individual physicians in consultation with their patients.

"The DMC continues to closely monitor the CDC's COVID-19 guidance and adjust measures in place to ensure the safety of our patients and staff," Taylor said in an email to Crain's.

"We have developed guidelines for elective care given new guidance from authorities. All emergent and urgent procedures and diagnostics will proceed as scheduled. We seek to balance the needs for care for those with chronic or other illnesses that require health care diagnostics or procedures and where delaying it could cause them to require emergency care a few weeks from now, at a time when COVID-19 cases might be ramping up. We trust that doctors and patients will use their judgment on which cases should proceed as scheduled."

In a statement from Ascension Health Michigan, spokesperson Melissa Thrasher said its 13 hospitals in Michigan started on Tuesday to defer "all elective procedures" for the next 45 days. She said the decision was to help protect the health and safety of our patients, families, health care staff and providers from the spread of COVID-19.

"Elective procedures are those that have options in terms of timing/level of urgency to be completed, or are determined non essential at this time," Thrasher said in an email. "We recognize that each case is unique, so processes are in place to review requests for procedures that might be considered elective to determine issues of optimal timing and resource support."

A surgeon at St. John Hospital and Medical Center in Detroit said the curtailment is being done across many clinical specialties. The doctor, who asked for anonymity, said hospital medical staffs have insisted on reductions to protect caregivers from infection and patients who may be asymptomatic at the time of surgery but turn out to test positive later while in a weakened condition.

In a March 16 memo to Beaumont cardiologists, George Nahhas, M.D., chief of cardiology, said all nonessential cases in the cardiac catheter lab, the electrophysiology lab and other routine tests was postponed as of Tuesday. He said non-essential cases mean outpatient elective cases that are stable and can wait for elective procedures, but will exclude patients who need to undergo a procedure or require inter-hospital transfers.

"They should be rescheduled by the cardiologist after April 1," Nahhas said in the memo. "Any patient who is not responding to medical therapy can undergo the necessary procedure. ... Please help us to avoid this national emergency by conserving the hospital resources in case of overflow of ill patients."

At Henry Ford, Adnan Munkarah, the six-hospital system's executive vice president and chief clinical officer, said the decision to reduce elective surgery was made over the past several days in consultation with its medical staff.

"Our concern is to keep patients safe and free our hospital for some capacity for coronavirus patients," Munkarah said. "We will divide and prioritize surgeries two weeks at a time. We have four categories" to determine whether surgery can be delayed.

The four categories are as follows: procedures will proceed if the patient is already in the hospital and not performing it could endanger health; if outpatient surgeries on patients for cancer, heart problems or other needs have been scheduled and a delay could make the condition worse; if any procedure or surgery could be safely rescheduled over the next four to six weeks and not impact wellness or health; finally, if other surgeries or screenings such as a colonoscopy can wait two to three months, Munkarah said.

"We will also cut down and deactivate our ambulatory surgery centers for a couple weeks," Munkarah said. "We want to preserve equipment and staff, and redeploy them. We will reassess in a couple weeks."

Munkarah said Henry Ford is not laying off employees at the five surgery centers, some of which are connected with one of the system's 40 outpatient medical centers. He said employees will be redeployed to medical centers or hospitals. They also could be used to supplement virtual visit appointments, which have been increasing the past two weeks.

Examples of elective or non-essential surgeries include cosmetic or plastic surgeries, hip and knee total joint replacements, peripheral vein treatments, hand surgery, carpal tunnel, bariatric, hysterectomy for benign issues like fibroids and surgery for incontinence, Munkarah said.