Overwhelmed With COVID Patients, Oregon Hospitals Postpone Surgeries And Cancer Care

Sep 16, 2021
Originally published on September 17, 2021 9:29 am

It's a bad time to get sick in Oregon. That's what many doctors are telling their patients and the public as hospitals full of COVID-19 patients have been forced to postpone some treatments of other medical conditions.

Charlie Callagan's scheduled bone-marrow transplant was postponed. Now he's waiting for a new surgery date, hunkered down at his home in Merlin, a small Rogue Valley town in southern Oregon.

Though he looks perfectly healthy, sitting in the smoky summer air on his outdoor deck, Callagan, 72, has multiple myeloma, a blood cancer of the bone marrow.

"It affects the immune system; it affects the bones," he says. "I had a PET scan that described my bones as looking 'kind of swiss cheese-like.'"

Callagan is a retired National Parks ranger. Fifty years ago, he served in Vietnam. This spring, doctors identified his cancer as one of those linked to exposure to Agent Orange, the defoliant used during the war.

In recent years, Callagan has consulted maps showing hot spots where Agent Orange was sprayed in Vietnam.

"It turns out the airbase I was in was surrounded," he says. "They sprayed all over."

On the way to the hospital, an unexpected and disappointing call

A few weeks ago, Callagan was driving to Oregon Health and Science University in Portland for a bone marrow transplant, a major procedure that requires intensive follow-up tests and monitoring for complications.

But during the drive, Callagan got a call from his doctor.

"They're like, 'We were told this morning that we have to cancel the surgeries we had planned,' " he says.

Callagan's surgery was postponed until further notice because the hospital was full. That's the story at many hospitals in Oregon where they've been flooded with COVID-19 patients.

OHSU spokesperson Erik Robinson says the hospital, which is the state's only public academic medical center and serves patients from across the region, has had to postpone numerous surgeries and procedures in the wake of the delta surge. "Surgical postponements initially impacted patients who needed an overnight hospital stay, but more recently has impacted all outpatient surgeries and procedures," Robinson wrote.

Callagan says his bone marrow transplant has not yet been rescheduled.

Such delays can have consequences, according to Dr. Mujahid Rizvi, who leads the oncology clinic handling Callagan's care.

"With cancer treatment, sometimes there's a window of opportunity where you can go in and potentially cure the patient," Rizvi says. "If you wait too long, the cancer can spread. And that can affect prognosis and can make a potentially curable disease incurable."

Such high stakes for delaying treatment at hospitals right now extends beyond cancer care.

"I've seen patients get ready to have their open-heart surgery that day. I've seen patients [who] have brain tumor with visual changes, or someone with lung cancer, and their procedures are canceled that day and they have to come back another day," says Dr. Kent Dauterman, a cardiologist and co-director of the regional cardiac center in Medford, Ore. "You always hope they come back."

In early September, according to Dauterman, the local hospital had 28 patients who were waiting for open heart surgery, 24 who needed pacemakers, and 22 who were awaiting lung surgeries. He says during normal times, there is no wait.

"I don't want to be dramatic — it's just there's plenty of other things killing Oregonians before this," Dauterman says.

Unvaccinated patients are straining medical resources

Right now, the vast majority of COVID-19 patients in Oregon hospitals are unvaccinated — about five times as many as those who got the vaccine, according to the Oregon Health Authority. COVID-19 infections in Oregon are starting to decline from a peak of the most recent delta variant-driven wave, but hospitals are still burdened with the most severe cases.

Even before the pandemic, there usually wasn't a lot of room to spare in Oregon's health care system.

"If you look at the number of hospital beds per capita, Oregon has 1.7 hospital beds per thousand population. That's the lowest in the country," says Becky Hultberg, CEO of the Oregon Association of Hospitals and Health Systems.

For a closer look at the curtailment of nonemergency procedures during the pandemic, investigators looked back at how hospitals in the Veterans Health Administration system hospitals did during the first pandemic wave in the spring of 2020. Their study found that, overall, the VA health system was able to temporarily reduce the number of elective treatments by 91%.

It showed that stopping elective procedures was an effective tool to free up ICU beds to care for COVID-19 patients. But the study didn't look at the consequences for those patients who had to wait.

"We clearly, even in hindsight, made the right decision of curtailing elective surgery," says Dr. Brajesh Lal, a professor of surgery at the University of Maryland School of Medicine and the study's lead author. "But we as a society have not really emphatically asked the question 'At what price in the long term?'"

He says they won't know that without more long-term research.

At his home in southern Oregon, Charlie Callagan says he doesn't consider his bone-marrow transplant as urgent as what some people are facing right now.

"There's so many other people who are being affected," he says. "People are dying waiting for a hospital bed. That just angers me. It's hard to stay quiet now."

He says it's hard to have sympathy for the COVID-19 patients filling up ICUs, when a simple vaccine could have prevented most of these hospitalizations.

This story comes from NPR's health reporting partnership with Jefferson Public Radio and Kaiser Health News (KHN).

Copyright 2021 Jefferson Public Radio. To see more, visit Jefferson Public Radio.

AILSA CHANG, HOST:

It's a bad time to get sick in Oregon. That is the message from some doctors as hospitals that are filled with COVID patients bump patients with other medical conditions. Jefferson Public Radio's Erik Neumann has more.

ERIK NEUMANN, BYLINE: Charlie Callagan sits outside on his deck in the smoky summer air in the small town of Merlin in southwest Oregon. Though he looks perfectly healthy, 72-year-old Callagan has multiple myeloma, basically a blood cancer of the bone marrow.

CHARLIE CALLAGAN: So it affects the immune system. It affects the bones. I had a PET scan that described my bones as looking kind of Swiss cheese-like.

NEUMANN: Callagan is a retired national park ranger. Fifty years ago, he served in Vietnam, and this spring doctors found his cancer. They're assuming he got it from exposure to Agent Orange during the war.

CALLAGAN: There's maps online that show what were the hot spots in Vietnam for the spraying of Agent Orange. And it turns out the air base I was in was surrounded by it. They sprayed all over it.

NEUMANN: A few weeks ago, he was driving to Oregon Health and Science University in Portland to get a bone marrow transplant. On the way, he got a call from his doctor.

CALLAGAN: They're like, we were told this morning we have to cancel the surgeries we had planned.

NEUMANN: Cancelled because the hospital was full. That's the story at many hospitals in Oregon, where they've been flooded with COVID-19 patients. Dr. Mujahid Rizvi leads the oncology clinic handling Callagan's care. He says delays can have consequences.

MUJAHID RIZVI: With cancer treatment, sometimes there's a window of opportunity where you can go in and potentially cure the patient. And if you wait too long, the cancer can spread.

NEUMANN: And it's not just cancer care. Dr. Kent Dauterman is a cardiologist in southern Oregon.

KENT DAUTERMAN: I've seen patients get ready to have their open heart surgery that day. I've seen patients have brain tumor or someone with lung cancer, and their procedures are cancelled that day, and they have to come back another day.

NEUMANN: The day we talked, Dauterman said at his local hospital, 28 patients were waiting for open heart surgery, and 24 needed pacemakers. He says during normal times, there wouldn't be any wait.

DAUTERMAN: I don't want to be dramatic. It's just - there is plenty of other things killing Oregonians before this.

NEUMANN: Right now the vast majority of patients in Oregon hospitals with COVID are unvaccinated. But even in non-pandemic times, there's not a lot of extra room in Oregon's health care system. Becky Hultberg is the CEO of the state's hospital association.

BECKY HULTBERG: If you look at the number of hospital beds per capita, Oregon has 1.7 hospital beds per thousand population. That's the lowest in the country.

NEUMANN: A new study on curtailing procedures looked back at how the VA hospitals did during the first pandemic wave. It found that the veterans health system was able to reduce elective treatments by 91%, and it was effective in that ICU beds were freed up to care for COVID patients. But the study didn't look at the consequences for the patients who had to wait. Dr. Brajesh Lal is the lead author.

BRAJESH LAL: We clearly, even in hindsight, made the right decision of curtailing elective surgery. But we as a society have not really emphatically asked the question at what price in the long term.

NEUMANN: He says we won't know that without more long-term research. Back on his deck in Oregon, Charlie Callagan says he doesn't consider his bone marrow transplant as urgent as what some people are facing right now.

CALLAGAN: There are so many other people that are being affected. People are dying waiting for a hospital bed, and that just angers me. You know, it's hard to stay quiet now.

NEUMANN: He says it's hard to stay sympathetic for the COVID patients filling up hospitals when a simple vaccine could have prevented most of it.

For NPR news, I'm Erik Neumann in Merlin, Ore.

CHANG: And this story comes from NPR's partnership with Jefferson Public Radio and Kaiser Health News.

(SOUNDBITE OF THE SHINS SONG, "THE FEAR") Transcript provided by NPR, Copyright NPR.