SARANAC LAKE — A new executive order from the state could possibly limit elective surgeries at Adirondack Medical Center and the Lake Placid Health and Medical Fitness Center if the health care network’s ability to staff beds dips.

Currently, Adirondack Health is safe from needing to limit elective surgeries.

When elective surgeries were cut for three weeks last year, Adirondack Health lost out on millions of dollars in revenue it relies on to sustain its services. Adirondack Health CEO Aaron Kramer recently said the hospital network was able to recover some of that revenue — the hospital was given some funding when Congress passed coronavirus relief packages last year — but has never been able to make up for that lost time.

A recent rise in COVID-19 cases has also prompted Adirondack Health administrators to limit visitations at some of its facilities again.

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Elective surgeries face potential cuts again

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Last Friday, Gov. Kathy Hochul signed an executive order allowing the state to again limit elective procedures at any hospital that sees an influx of patients and has 10%, or less, of staffed beds left open.

Hochul said she passed this executive order to keep bed capacity available if COVID-19 hospitalizations surge.

Scollin said some details of this order — like what procedures are considered elective — are not yet clear, as the order goes into effect today and the state Department of Health is supposed to issue a guidance with more details.

Currently, Adirondack Health is not below that 10% threshold, Scollin said. The state has identified 37 hospitals currently eligible for suspension of elective procedures — including Alice Hyde Medical Center in Malone, Elizabethtown Community Hospital and Champlain Valley Physicians Hospital in Plattsburgh.

Any hospital deemed eligible would have its elective surgeries reduced by an undetermined amount until Jan. 15, 2022. It is not clear in the order if a hospital could resume surgeries before that date if it rises above that 10% threshold again.

Scollin said AMC’s percentage of available staffed beds has ranged from 12 to 19% this week. That’s been close to the threshold at times, and though it’s been a busier week than normal, Scollin said with a workforce shortage in the health care industry nationally, extra staff is hard to come by.

Last week, several Adirondack Health employees resigned as a deadline for a state mandate for COVID-19 vaccination approached and those with religious exemptions were required to get vaccinated. Seven other employees resigned in September when the mandate took effect.

But Scollin said these departures have not had a “pronounced” impact on staffing.

The hospital has also been busier this week than it’s been in the past year, Scollin said. That’s in part because AMC had the most COVID-19-positive patients at one time that it’s ever had — 10 — on Monday and Tuesday.

“Oftentimes, we’ve had much more extra capacity as we have now,” Scollin said.

Scollin added that the executive order also allows the state to limit elective procedures, “as determined by the Department of Health based on regional and healthcare utilization factors.” He said it’s unclear how the DOH would reach that decision.

Scollin said this is concerning and that AMC wants to continue offering elective surgeries.

The state last suspended elective surgical procedures in March 2020, at the start of the COVID-19 pandemic.

Scollin said in this three-week window, Adirondack Health lost around $70,000 per day. He said limiting elective surgeries again would make the hospital network’s tenuous financial situation tougher.

“The vast majority of services that Adirondack Health and other rural health care facilities offer to the community are not money-makers,” Scollin said. “We count on other services to make money … and elective surgery is extremely high up on that list.”

Scollin said Hochul indicated on Thursday that this limiting of elective surgeries could be less restrictive than last time, but said they won’t know for sure until they see the guidance.

“We are really at the mercy of the guidance,” he said.

Last time, Scollin said Adirondack Health created a surgical review committee with doctors, nurses and clinical staff who would look at all possible surgeries in the coming days and decide which ones were medically urgent and which weren’t. He said the hospital could have been in big trouble with the state if it didn’t follow its rules on what was urgent and what wasn’t. This committee would be restarted if the state deems it necessary, he said.

Scollin said that regional hospitals have considered sharing patients. If one facility is overburdened, he said other facilities could take patients and ease the burden. He said this is discussed daily.

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Visitations suspended

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Due to an increase in COVID-19 cases locally and within Adirondack Medical Center in Saranac Lake, Adirondack Health is choosing to again suspend most patient visitation in hospital and active, short-term treatment settings, starting today, Scollin said.

Exceptions will be made for one support person to visit during certain cases, he said. These cases include labor and delivery; pediatric patients; people deemed essential in the care and treatment of the patient, like a caregiver to a developmentally disabled person; compassionate care in end-of-life situations, at the discretion of the medical team; family care conferences deemed necessary by the provider to facilitate significant care decisions; emergency room patients; and ambulatory surgery patients upon discharge, if deemed necessary for the ongoing care and support of the patient.

When exceptions are allowed, he said visitors will be required to wear appropriate personal protective equipment, which they will be given, and adhere to all Adirondack Health visitor requirements. All allowed visitors must be at least 18 years old, with rare exceptions handled on a case-by-case basis by the hospital and medical team, he added.

Scollin said visitations at Mercy Living Center, an Adirondack Health-run nursing home in Tupper Lake, are still allowed — despite the home being in outbreak status — because state and federal guidelines now require all nursing homes to allow indoor visitations for all residents at all times.

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Mercy update

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The latest round of testing of all residents and staff at Mercy came in on Tuesday and again turned up no new cases. The center has been on “outbreak status” for three weeks now. No new cases were found in a previous round of testing last weekend, and only one new resident has tested positive since the outbreak was first discovered — someone who had returned to the nursing home after the outbreak started and tested positive.

Scollin said the lack of spread of the virus is a positive sign and the nursing home is on course to exit “outbreak” status on Dec. 5, as long as another round of testing on Friday comes back with no new positives.

Scollin said 16 of Mercy’s 51 residents and eight of its 100-or-so staff members had tested positive for COVID-19 during the outbreak. Of the 16 COVID-positive residents, Scollin said 14 are vaccinated and two are not. He said all eight staff are vaccinated.

Two COVID-positive Mercy residents were hospitalized at Adirondack Medical Center in Saranac Lake — one was in the intensive care unit earlier this week.

There have been no deaths as a result of the nursing home outbreak.

Ten of the positive residents have been given monoclonal antibody treatments based on their medical histories, their oxygen saturation and if they have any symptoms.

Scollin said residents who were showing symptoms of COVID-19 are getting better and there have not been any more hospitalizations.

Scollin said residents are dining in their rooms. Activities are being held in individual rooms or in socially distanced spaces, but he said there are no gatherings allowed.

Staff who test positive for COVID-19 are required to test negative before returning to work.