News

Medical clinics strip services to the 'essentials' during the COVID-19 pandemic

Facilities are canceling elective surgeries, routine procedures

Palo Alto Medical Foundation, Kaiser Permanente and Stanford Health Care are canceling routine and "nonessential" procedures, including elective surgeries, to protect workers and make them available to care for coronavirus patients as the need arises. The medical centers are also offering alternative options for patients to receive care, such as car clinics and virtual visits.

Sutter Health, which includes the Palo Alto Medical Foundation, on Tuesday began postponing elective procedures such as mammograms, minor surgeries and vaccinations that can be safely rescheduled at its hospitals. "This decision was made to help preserve capacity to address critical needs as they arise," the health care company said in a statement.

Sutter Health began calling patients in the last couple of days and sending emails to cancel services such as routine testing and vaccination clinics, Dr. Rob Nordgren, area CEO of Palo Alto Medical Foundation and Sutter Health Peninsula Region, said by phone on Wednesday.

"We're trying to keep patients as safe as possible, and keep staff and clinicians healthy, and we are efficiently using resources like gowns, gloves and masks," he said.

The clinics are better able to manage safety-equipment resources by cutting back on the nonessential visits. People will receive diagnostic procedures and treatments in person for chronic and suspected conditions such as cancers, he said.

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Sutter is triaging patients through a variety of means before sending them to see a clinician, including through video, virtual visits and online assessment programs to actively reduce the need to come through the facilities, he said. Most patients are able to stay at home and do self-care without on-site examinations, he said.

For more serious respiratory infections, Sutter is holding "car clinics" that launched last week. Patients who are members of Palo Alto Medical Foundation and Sutter Health are referred by a clinician for an exam while sitting in their vehicle. He stressed that these clinics are not open to without a doctor's referral or to non-Sutter patients.

There are several car clinics across Sutter's network with clinicians and staff set up in a tent with exam room equipment from 8 a.m. to 5 p.m. They come out in protective gear to examine the patient in the vehicle or on a chair outside of the car, where they perform assessments such as listening to their lungs and taking temperatures. A portable X-ray machine is also on site to check for potential lung infections.

The patient is then given instructions for the next steps in their care, including if they need hospitalization.

The clinic service has ramped this week. Between 150 and 200 patients with respiratory issues per day have received care at their Palo Alto and San Carlos sites combined, Nordgren said. There have been a few hospitalizations as a result of the exams, but that is typical, he said.

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Nordgren said that staffing levels are currently adequate at PAMF. When a staff member comes into contact with a patient who tests positive for COVID-19, the staff member stays home until they have tested negative for the virus.

The shelter in place has affected other staff members, however, who have kids and have found their child care has been canceled.

"We are closely monitoring staff and making sure we have adequate staff, but it is certainly a concern if the virus spreads more," he said.

Some doctors who normally work in urgent care are being shifted to the respiratory clinic. Staff who are now much less busy in other departments because of the nonessential appointment cancellations are also being used to help as needed.

Kaiser Permanente has also canceled elective surgeries and procedures, the medical organization said Tuesday in a statement.

"The health and safety of our members, patients, employees and communities remains our priority. In alignment with recommendations from the Centers for Disease Control and Prevention (CDC) and the American College of Surgeons, Kaiser Permanente physicians are reviewing all elective procedures scheduled for this month to determine those that can be safely postponed,” the company said. Kaiser staff is contacting patients to discuss options for rescheduling appointments and to answer questions.

"We understand that this is an inconvenience, but for Kaiser Permanente and other health care providers this is a necessary step to slow the spread of COVID-19 and ensure that we continue to have the resources, capacity, and staff available to care for our members and the communities we serve.

"We are taking action to help slow the spread of COVID-19 in our communities while continuing to provide high-quality, safe care for our members. We are following the guidance of public health authorities for the safe isolation, testing, and treatment of patients suspected or confirmed to have the COVID-19 virus. While our medical centers are open and operating and are safe places to be, we are helping to support social distancing, crowd avoidance, and other techniques that help to prevent and slow the dissemination of COVID-19," the organization said.

Kaiser is offering members the option of video or telephone visits, where physicians provide guidance and make recommendations for next steps, including if an in-person visit is needed or recommended. Kaiser is also encouraging patients to use its mail-order pharmacy service to help members avoid unnecessary outings.

Stanford Health Care said in a statement that it is also limiting nonessential services.

"Stanford Medicine's operations, including Stanford Health Care, Stanford Children's Health, SHC-ValleyCare, University Health Alliance, and Packard Children's Health will remain open and available to patients. Essential therapeutic support for our patients, where cessation of the treatment could negatively impact patient outcomes, will continue with in-person visits," Stanford spokeswoman Lisa Kim wrote in a statement on behalf of the medical center.

Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and Almanac here.

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Medical clinics strip services to the 'essentials' during the COVID-19 pandemic

Facilities are canceling elective surgeries, routine procedures

by / Palo Alto Weekly

Uploaded: Thu, Mar 19, 2020, 1:19 pm

Palo Alto Medical Foundation, Kaiser Permanente and Stanford Health Care are canceling routine and "nonessential" procedures, including elective surgeries, to protect workers and make them available to care for coronavirus patients as the need arises. The medical centers are also offering alternative options for patients to receive care, such as car clinics and virtual visits.

Sutter Health, which includes the Palo Alto Medical Foundation, on Tuesday began postponing elective procedures such as mammograms, minor surgeries and vaccinations that can be safely rescheduled at its hospitals. "This decision was made to help preserve capacity to address critical needs as they arise," the health care company said in a statement.

Sutter Health began calling patients in the last couple of days and sending emails to cancel services such as routine testing and vaccination clinics, Dr. Rob Nordgren, area CEO of Palo Alto Medical Foundation and Sutter Health Peninsula Region, said by phone on Wednesday.

"We're trying to keep patients as safe as possible, and keep staff and clinicians healthy, and we are efficiently using resources like gowns, gloves and masks," he said.

The clinics are better able to manage safety-equipment resources by cutting back on the nonessential visits. People will receive diagnostic procedures and treatments in person for chronic and suspected conditions such as cancers, he said.

Sutter is triaging patients through a variety of means before sending them to see a clinician, including through video, virtual visits and online assessment programs to actively reduce the need to come through the facilities, he said. Most patients are able to stay at home and do self-care without on-site examinations, he said.

For more serious respiratory infections, Sutter is holding "car clinics" that launched last week. Patients who are members of Palo Alto Medical Foundation and Sutter Health are referred by a clinician for an exam while sitting in their vehicle. He stressed that these clinics are not open to without a doctor's referral or to non-Sutter patients.

There are several car clinics across Sutter's network with clinicians and staff set up in a tent with exam room equipment from 8 a.m. to 5 p.m. They come out in protective gear to examine the patient in the vehicle or on a chair outside of the car, where they perform assessments such as listening to their lungs and taking temperatures. A portable X-ray machine is also on site to check for potential lung infections.

The patient is then given instructions for the next steps in their care, including if they need hospitalization.

The clinic service has ramped this week. Between 150 and 200 patients with respiratory issues per day have received care at their Palo Alto and San Carlos sites combined, Nordgren said. There have been a few hospitalizations as a result of the exams, but that is typical, he said.

Nordgren said that staffing levels are currently adequate at PAMF. When a staff member comes into contact with a patient who tests positive for COVID-19, the staff member stays home until they have tested negative for the virus.

The shelter in place has affected other staff members, however, who have kids and have found their child care has been canceled.

"We are closely monitoring staff and making sure we have adequate staff, but it is certainly a concern if the virus spreads more," he said.

Some doctors who normally work in urgent care are being shifted to the respiratory clinic. Staff who are now much less busy in other departments because of the nonessential appointment cancellations are also being used to help as needed.

Kaiser Permanente has also canceled elective surgeries and procedures, the medical organization said Tuesday in a statement.

"The health and safety of our members, patients, employees and communities remains our priority. In alignment with recommendations from the Centers for Disease Control and Prevention (CDC) and the American College of Surgeons, Kaiser Permanente physicians are reviewing all elective procedures scheduled for this month to determine those that can be safely postponed,” the company said. Kaiser staff is contacting patients to discuss options for rescheduling appointments and to answer questions.

"We understand that this is an inconvenience, but for Kaiser Permanente and other health care providers this is a necessary step to slow the spread of COVID-19 and ensure that we continue to have the resources, capacity, and staff available to care for our members and the communities we serve.

"We are taking action to help slow the spread of COVID-19 in our communities while continuing to provide high-quality, safe care for our members. We are following the guidance of public health authorities for the safe isolation, testing, and treatment of patients suspected or confirmed to have the COVID-19 virus. While our medical centers are open and operating and are safe places to be, we are helping to support social distancing, crowd avoidance, and other techniques that help to prevent and slow the dissemination of COVID-19," the organization said.

Kaiser is offering members the option of video or telephone visits, where physicians provide guidance and make recommendations for next steps, including if an in-person visit is needed or recommended. Kaiser is also encouraging patients to use its mail-order pharmacy service to help members avoid unnecessary outings.

Stanford Health Care said in a statement that it is also limiting nonessential services.

"Stanford Medicine's operations, including Stanford Health Care, Stanford Children's Health, SHC-ValleyCare, University Health Alliance, and Packard Children's Health will remain open and available to patients. Essential therapeutic support for our patients, where cessation of the treatment could negatively impact patient outcomes, will continue with in-person visits," Stanford spokeswoman Lisa Kim wrote in a statement on behalf of the medical center.

Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and Almanac here.

Comments

Anonymous
Duveneck/St. Francis
on Mar 19, 2020 at 4:37 pm
Anonymous, Duveneck/St. Francis
on Mar 19, 2020 at 4:37 pm
3 people like this

It is essential that major medical services continue around the country. I am stuck out of state in a big city not only owing to Coronavirus making travel unwise, but also owing to being here for several weeks already, providing constant care to my close family member who had surgery one week ago.
Post-operative patients require followup medical care/appointments. In our case, it’s vital. Our problem is continuing to get transportation via rideshare to a major medical clinic. There are certain medical treatments that must occur. I’m sure thousands of others are in the same worrisome situation, too.
While there’s “non-emergency,” the decision on “non-essential” classification of some patients could come with lifetime consequences if intelligent people aren’t making those decisions! So far, my relative is considered an essential patient for ongoing attention from her surgeon and associates, this must continue to be the case.


TimR
Downtown North
on Mar 19, 2020 at 8:13 pm
TimR, Downtown North
on Mar 19, 2020 at 8:13 pm
6 people like this

I'd like to hear more about what these hospitals, and other big ones in CA, are doing to expand capacity, not just manage existing capacity. And that goes double for UC hospitals. They all have billions of dollars available to them, and need to really start doing more. Or maybe they are doing more, and no one's writing about it? We as CA are willing to put up with the social and business restrictions, but as time goes on, only if we know the most important issue--hospital capacity--is being fully addressed.


Online Name
Embarcadero Oaks/Leland
on Mar 19, 2020 at 8:46 pm
Online Name, Embarcadero Oaks/Leland
on Mar 19, 2020 at 8:46 pm
18 people like this

Please do a follow-up with the PAMF CEO because PAMF/ Sutter and the authorities seriously need to review their procedures, especially as regards their new Respiratory Clinic. Maybe they didn't anticipate the demand for respiratory testing when they blocked off the back courtyard and shut down much of the back garage during a cold, rainy morning?

Bottom line: It was hazardous getting to my Weds morning appointment in Lee because they had long lines of people waiting for the tests blocking the back entrances to Lee and Jambliss. People were packed in like sardines and the guard did nothing to enforce "social distancing" of the people in line and nothing to ensure they left room for patients like me trying to enter or leave the building.

It was bad going in but scary plowing through a large crowd of people with potential respiratory problems 20 minutes later because the crowd had grown and gotten impatient.

Today (Thurs.) my partner went for several tests in different parts of PAMF so he got to see more examples of bad practices: lots of unmasked staff and volunteers directing people, unmasked people handing out shared clipboards and pens that weren't sanitized between each use.



Rick
Adobe-Meadow
on Mar 20, 2020 at 9:33 am
Rick, Adobe-Meadow
on Mar 20, 2020 at 9:33 am
4 people like this

Went to the grocery store this morning. Angry at the number of people wearing N95 masks that do -them- no good, but keep the masks away from the medical people who need them. Amused and alarmed that the staff were all wearing gloves, but paying -no- heed to the fact that the -outside- of those gloves were happily transferring bacteria and virus from one customer to another. I’ll
Bet the staff was not trained on how to safely remove those gloves, so at the end of their day they get the entire viral load transferred to their hands snyway! This one store is going to me a major source of infection and I’ll bet most others are not any better.


PAMF Worker
Greenmeadow
on Mar 21, 2020 at 1:56 pm
PAMF Worker, Greenmeadow
on Mar 21, 2020 at 1:56 pm
8 people like this

CEO Rob Nordgren of PAMF is quoted saying something that is not true:

"When a staff member comes into contact with a patient who tests positive for COVID-19, the staff member stays home until they have tested negative for the virus."

I work at PAMF Palo Alto and was notified that I had a patient last week who tested positive for COVID-19. I was not told to stay home; I continue to work. I heard later through the grapevine (coworkers who also had patients positive for COVID-19) that we were supposed to be told to take our temperatures twice a day but I wasn't even advised to do that.


Online Name
Embarcadero Oaks/Leland
on Mar 21, 2020 at 2:28 pm
Online Name, Embarcadero Oaks/Leland
on Mar 21, 2020 at 2:28 pm
12 people like this

PAMF Worker, so sorry to read that and love to see some followup.

I was pretty horrified having to brave a crowd of possibly infected people and then finding that Trader Joe's Town & Country after my appointment was observing better procedures than PAMF -- separating entering customers by spraying customers' hands with alcohol and then wiping down shopping cart handles for each new customer.

We're obviously PAMF members but got NO notice about the respiratory clinics but did get about 5 confirmations each for our appointment.

PAMF quality has suffered under Sutter's continued expansion, resulting in months of delays in getting appointments and leaving some dedicated doctors coming in for Saturday appointments to try to clear the backlog. We joke about how they might clear the backlog if they cut back on the constant ads for new patients.

I've been trying with no success to report the PAMF breach to the county, to medical boards, using the new PA call center ...


PAMF Worker
Greenmeadow
on Mar 21, 2020 at 3:00 pm
PAMF Worker, Greenmeadow
on Mar 21, 2020 at 3:00 pm
8 people like this

Hello Online Name - Thanks for the feedback. Would be happy to provide followup. What would you like to know? I certainly agree that Sutter management has cheapened the PAMF brand considerably. Sutter Health is a Sacramento based, marketing driven, health care holding company. Sutter has had to settle many, many lawsuits related to its unethical business practices. PAMF's handling of the coronavirus crisis has changed from day to day. I think local health care workers are doing the best they can under the circumstances, but this threat is not something any of us have seen before. I've been extremely careful with infection control, but like you, I am alarmed that some of my coworkers are not as careful as they could be - of course this describes the general public too.


Online Name
Embarcadero Oaks/Leland
on Mar 21, 2020 at 3:44 pm
Online Name, Embarcadero Oaks/Leland
on Mar 21, 2020 at 3:44 pm
7 people like this

PAMF Worker -- Thanks. I've been reading about the "many, many" lawsuits and yes, it's alarming that some of your co-workers AND the general public are not as careful as they should be. I was shocked that a Palo Alto crowd that should be smart and aware could so blithely be crowding and pushing each other in front of the Lee entrance. I didn't envy the poor guard. One would expect more from educated people.

I'd like to know with whom to file a complaint at PAMF, at Sutter and, more importantly, at the appropriate state and county medical boards. I'm sure I'm not alone. I want to do so in a way that discourages retaliation. (If you want to connect with me personally, Palo Alto Online has volunteered to connect individuals here by writing to the moderator and to Bill Johnson, the publisher, and requesting it.)

I'd also like to know when PAMF will follow Kaiser and Stanford in offering virus testing. how much it will cost and when they'll inform PAMF members.

Thanks much!


PAMF Worker
Green Acres
on Mar 22, 2020 at 11:31 am
PAMF Worker, Green Acres
on Mar 22, 2020 at 11:31 am
7 people like this

Online Name:

The CEO of Sutter is Sarah Krevans. Sutter is based in Sacramento. The CEO of PAMF is Liz Vilardo. I believe she is based at PAMF Mountain View. I'm guessing they're a little busy right now.

PAMF is doing limited testing. The respiratory clinics are designed to decide who gets tested based on history and symptoms, given that tests are a limited resource. Their tests are sent out to Quest Diagnostics and turnaround time is 3-5 days. Stanford has its own test and I've read the turnaround is 1 day. Keep in mind PAMF is not a research institution or a hospital and has less resources to develop tests.

Obviously we would all like to get a test on demand but the inability to do so is a nationwide problem, not a local problem.

Stay safe!


Anon
Another Palo Alto neighborhood
on Mar 23, 2020 at 5:17 pm
Anon, Another Palo Alto neighborhood
on Mar 23, 2020 at 5:17 pm
2 people like this

Posted by TimR, a resident of Downtown North

>> I'd like to hear more about what these hospitals, and other big ones in CA, are doing to expand capacity, not just manage existing capacity. And that goes double for UC hospitals. They all have billions of dollars available to them, and need to really start doing more.

One of the articles mentioned how few hospital beds there are now in SCC. Recently, I read that Seton is supposed to close due to lack of funding. Web Link. Amazing that this is under consideration considering that it has 357 beds that are, at the moment, highly needed. Web Link


Online Name
Embarcadero Oaks/Leland
on Mar 24, 2020 at 8:41 am
Online Name, Embarcadero Oaks/Leland
on Mar 24, 2020 at 8:41 am
4 people like this

PAMF Worker, thanks for the info. I did get a response from "City of Palo Alto" to my note on NextDoor after one of their health posts. They first offered to followup and then wrote back saying "they" had conveyed their concern to "PAMF."


Anon
Another Palo Alto neighborhood
on Mar 24, 2020 at 11:45 am
Anon, Another Palo Alto neighborhood
on Mar 24, 2020 at 11:45 am
2 people like this

Follow up: The State is reserving beds at Seton and a mothballed LA hospital to keep the capacity available if needed: Web Link

It is expensive. Good for the State of California to do this.


PAMF Worker
Green Acres
on Mar 26, 2020 at 11:11 am
PAMF Worker, Green Acres
on Mar 26, 2020 at 11:11 am
5 people like this

Great article on Medscape on how health care employers are muzzling their employees from speaking out regarding the lack of PPE, etc.:


Web Link

Very consistent with how PAMF CEO Rob Nordgren is saying we are being sent home after contact with a positive C19 patient when we are not. [Portion removed.]


Online Name
Embarcadero Oaks/Leland
on Mar 26, 2020 at 2:06 pm
Online Name, Embarcadero Oaks/Leland
on Mar 26, 2020 at 2:06 pm
4 people like this

PAMF Worker, thanks for that info. Hope you and your colleagues stay as safe as you can.


PAMF worker
Another Palo Alto neighborhood
on Apr 11, 2020 at 12:26 am
PAMF worker, Another Palo Alto neighborhood
on Apr 11, 2020 at 12:26 am
3 people like this

The CEO of Palo Alto Medical Clinic is either turning a blind eye to how the clinics are run or she is behind the pure greed business model. Doctors are share holders and love referred appointments to make more money for themselves. Sutter feeds on more profit for share holder doctors. Patients are profit tools. The COVID 19 outbreak is hurting this organization's profit for doctor share holders and when shelter in place is over, watch out! [Portion removed.]


Resident
Palo Alto High School
on Apr 11, 2020 at 12:35 pm
Resident, Palo Alto High School
on Apr 11, 2020 at 12:35 pm
2 people like this

The doctors have been hunkering down and hiding out - they don't want to get sick.
Hospitals all over have cut non-essential surgeries and services. Some claim they are doing this to save supplies for Covid patients, which may be true. But who would want to go to a clinic or hospital now?
The hospitals are suffering financially. Some smaller hospitals may go under and re-direct any sick people to larger hospitals like Stanford or County.


Anon
Another Palo Alto neighborhood
on Apr 12, 2020 at 12:07 pm
Anon, Another Palo Alto neighborhood
on Apr 12, 2020 at 12:07 pm
Like this comment

Here's hoping that clinics will migrate to having facilities that clearly segregate infectious disease treatment from other treatment. Even before SARS-CoV-2, I found it annoying to have to share air space with all the influenza/bronchitis/pneumonia patients when getting treatment for anything else (dermatology, say). It makes no sense to mix them together.


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