Coronavirus Response Newsletter

State Revises Health Order on Hospital Surge

The state has revised its Jan. 5 State Health Officer Order as a result of advocacy efforts by CHA. The original order prohibited some surgical procedures and allowed the state to direct the interfacility transfer of patients to avoid overwhelming some hospitals. The revisions include:

  • The only procedures that must be delayed are “ESAS Tier 1 and 2 surgical procedures as triaged by the clinical judgment of the physician” in impacted counties (children’s hospitals are exempted). Although all hospitals and ambulatory surgery centers are required to categorize all elective procedures by tier using the Elective Surgery Acuity Scale (ESAS), the California Department of Public Health (CDPH) has clarified that this step is intended only to prompt the physician to at least consider postponement in a highly impacted county. Only inpatient ESAS Tier 1 and 2 surgical procedures are required to be postponed. This new language also emphasizes the importance of the physician’s clinical judgment in determining which inpatient surgical procedures must be postponed.
  • The Jan. 5 order required a hospital to notify its Medical and Health Operational Area Coordinator (MHOAC), local health officer, and CDPH when it reached crisis care. The revised order instead requires hospitals to notify these entities when hospital leadership determine/declare the following (these determinations/declarations are within the discretion of hospital leadership):
    • Declares an internal disaster
    • Determines it is transitioning from contingency care to crisis care
    • Determines it is operating under crisis care standards
  • The state can require a hospital that has made the above notification to transfer patients to other facilities. The state can also require a hospital to transfer patients when the MHOAC determines the hospital is transitioning from contingency care to crisis care, even if hospital leadership has not reached this determination.
  • The MHOAC may not make a unilateral decision that a receiving hospital has the capability to accept a transfer patient. Both the MHOAC and hospital leadership must agree that the receiving hospital has this capability. CDPH has told CHA that the availability of a physician to accept the transfer patient and adequate nurse staffing are integral to the determination of a hospital’s capability to accept a transfer patient.
  • CDPH will post on its website a list of counties that are required to delay inpatient elective surgeries – that is, counties experiencing less than 10% ICU capacity in regions with 0% ICU capacity. CHA will inform members when this list is available. The order to delay inpatient elective surgeries will take effect at 11:59 p.m. (PT) the day after CDPH makes the determination that a county meets this criterion.

The revised State Health Order is effective through at least Jan. 26 unless earlier terminated.