Minnesota’s Border Battles: COVID-19 edition
Last year, we released a report titled ‘Minnesota’s Border Battles‘ in which we compared the economic outcomes in Minnesota counties bordering other states with the outcomes in the border counties…
There was an unmistakable urgency to Minnesota Health Commissioner Jan Malcolm’s remarks at the May 5 Covid-19 task force briefing explaining the reasons behind Gov. Tim Walz’s executive order rescinding restrictions on so-called elective surgeries.
“We are very mindful and becoming increasingly concerned about all the other services that are being put on hold, we think dangerously and unnecessarily. That yes, it’s a matter of keeping a balance,” Malcolm told reporters.
Yet at the same time, the state’s coronavirus coordinator tried to distance the Walz administration from culpability for the decline in many surgeries for untold numbers of Minnesotans. In fact, Malcolm essentially put the onus on providers and patients who went without treatment under the governor’s previous executive order 20-09 that indefinitely postponed elective surgeries and procedures.
“We have been saying for quite awhile that we are concerned with the amount of procedures that we know are being foregone,” Malcolm said with Walz looking on. “Care that should be being sought that isn’t being sought, both out of perhaps a fear on the part of patients that the health care system might not be safe and because providers were taking this guidance very literally and very cautiously in terms of preserving the PPE (Personal Protective Equipment).”
Judging from Malcolm’s comments, at the very least there appears to have been confusion over Walz’s directive to prioritize and minimize non-Covid medical treatment in order to maintain hospital capacity for coronavirus patients and preserve masks, gowns and other supplies for medical staff.
The result in some cases was postponement of care that had serious consequences for an unknown number of patients, some of whose gut-wrenching stories were documented by the Mankato Free Press.
Larry Ballman anxiously watched the cancer on the right side of his face and neck spread from late March into the first weeks of April.
A lump of squamous cell carcinoma went from about half the size of a golf ball to an egg within a week, he said, and his discomfort grew with it.
“You’ve got cancer growing — and I’ve had cancer before — and you don’t sleep,” he said. “You wonder what in the hell it’s going to be like in two weeks.”
All of it was happening in the aftermath of the state’s late-March halt on elective procedures in clinics and hospitals, a response to the COVID-19 pandemic. The Cleveland man’s case was more emergent than elective, but delays associated with the state’s order pushed his surgery back by weeks.
Facing a tougher recovery because of it, Ballman said he feels like state leaders were calling the shots on his medical care despite his doctors pushing to move forward.
Behind the scenes, it’s clear that doctors and health care providers were a key force in pressing the state to allow patients to get the healthcare help they need and end the indefinite suspension. Yet the postponement of critical care caused by the confusion over the state’s guidelines will have long term consequences for some.
Resuming all procedures soon also won’t change the fact Ballman and other patients face harder recoveries. His surgeon, Dr. Brett Baldwin of Mankato Clinic, said he felt as if his hands were tied.
“That upstaged him from a stage 2 cancer to a stage 4 cancer due to that delay,” he said. ”It’s fairly uncommon for things to grow that fast, of course, but he was in that unlucky time and place.”
The clock on Ballman’s care delay began March 18, when his medical team explained he’d need a neck dissection to remove the cancer from his right neck and lymph nodes. The order to delay elective procedures took effect March 23.
His care team recognized his surgery shouldn’t be delayed based on guidelines from the American College of Surgeons. The surgery was initially set for April 3, but scheduling difficulties related to what procedures were prioritized pushed it back to April 17, Baldwin said.
After so many patients being on hold for weeks, it will take medical centers time to catch up and resolve the pileup in pending cases. But two months into the coronavirus response, state officials finally appear to be on the same page with health care providers.
“This is really about striking a balance to say, of course people who need a surgery or a procedure to treat something that is otherwise going to progress and become a life-threatening or function-limiting in its own right, has to be our priority as well,” Malcolm acknowledged at the May 5 briefing.