April 21, 2020
Editor’s note: Please see the TMB’s COVID-19 Elective Surgeries and Procedures FAQs for more information. Please check these FAQs for updates often.
See also the TMA White Paper "TMB Releases Emergency Rules: Non-urgent Surgeries and Procedures." and the TMA article "Which hospitals are ready for elective surgery."
The Texas Medical Board has adopted emergency rules and released guidance about Governor Abbott’s loosened restrictions on elective procedures that take effect at 11:59 p.m. tonight.
According to the Governor’s Executive Order GA-15 released on April 17, physicians and facilities must continue to postpone surgeries and procedures as previously described, but with two exceptions.
- “Any procedure that, if performed in accordance with the commonly accepted standard of clinical practice, would not deplete the hospital capacity or the PPE needed to cope with COVID-19, or
- Any surgery or procedure performed in a licensed health care facility that has certified in writing to Texas HHSC both (1) that it will reserve at least 25% of its hospital capacity for treatment of COVID-19 patients, accounting for the range of clinical severity of COVID-19 patients, and (2) that it will not request any PPE from any public source — whether federal, state, or local — for the duration of the COVID-19 disaster.”
About those exceptions, the TMB said the following.
“What does the first exception about PPE mean?
If the procedure is performed in accordance with the commonly accepted standards of clinical practice and would not potentially deplete the hospital capacity or the PPE needed to cope with the COVID-19 disaster, then the procedure may go forward. However, if the procedure could deplete hospital capacity or the PPE needed to cope with the COVID-19 disaster, then the procedure may not go forward, unless the second exception applies, as discussed above.”
“What does this second exception about facility certification mean?
The healthcare providers must continue to determine if they have to postpone all non-urgent elective surgeries or procedures, unless the surgery or procedure will be performed in a licensed healthcare facility that has completed a written certification submitted to the Texas HHSC. The certification must state both that: 1. The facility will reserve at least 25% of its hospital capacity for treatment of COVID-19 patients, accounting for the range of clinical severity of COVID-19 patients; and 2. The facility will not request any PPE from any public source, whether federal, state, or local, for the duration of the COVID-19 disaster.”
“How do I know if the licensed healthcare facility where the surgery or procedure would be completed is one that qualifies for the second exception?
The Texas HHSC [Health and Human Services Commission] is the agency that is certifying licensed healthcare facilities that qualify for the exemption. The physician performing the surgery or procedure must verify with Texas HHSC that the facility where the surgery or procedure will be held has submitted a written certification to the Texas HHSC. This verification must be documented in the medical record.”
Please see the TMB’s COVID-19 Elective Surgeries and Procedures FAQs for further guidance.
According to the TMB, the relaxed restrictions are now possible “due to actions that resulted in increased hospital bed availability, increased supply of personal protective equipment (PPE), and enhanced supply chains for vital medical resources to address COVID-19.”
Further, the TMB reminds physicians “to be mindful of their obligations for the safety of patients, fellow healthcare providers, providing quality care, and ensuring best possible outcomes for their patients.”
- Texas Medical Association (TMA) COVID-19 Resource Center
- Texas Medical Board (TMB) COVID-19 page
- Centers for Disease Control and Prevention (CDC) COVID-19 resource page
- Texas Department of State Health Services (DSHS) COVID-19 webpage
- The Institute for Health Metrics and Evaluation (IHME) COVID-19 projections
- Johns Hopkins Coronavirus Resource Center