Date: April 28, 2020

To: Medical Staff

From: Hospital and System Chief Medical Officers
RE: Medically Necessary Elective Surgery

Our top priority continues to be the safety of our patients, visitors, employees and physicians. We hope
that you and your loved ones have been safe and healthy during this unprecedented time.

We understand how disruptive this crisis has been to each of your practices. In an effort to support our
physicians, staff and community during this re-engagement period, each of our hospitals are taking
necessary steps to resume the performance of medically necessary elective, surgical and procedural
cases in the main operating rooms, ambulatory surgery centers, endoscopy, interventional, cardiac and
radiology suites.

As a community, the Southern Nevada hospitals COVID volumes and experience are consistent with the
IHME model and we continue to see a downward trajectory of both positive cases and cases requiring
ICU level care. We agreed that the following gates would need to be satisfied in order to begin adding
additional medically necessary elective surgical procedures:
 No one is operating in crisis mode
 Adequate PPE is available
 Adequate surgical equipment and supplies are available
 Adequate vent capacity – hospitals are currently at @ 40%
 Adequate staffing to care for surgical and post-operative patients, as well as other hospital
volume
 Available overall hospital capacity

The Southern NV hospitals believe that we have met the above gates and recommend beginning to
schedule medically necessary OP and low acuity inpatient cases as of May 4th. Scheduling for these cases
can begin effective immediately. The above metrics will continue to be measured and if any of the
metrics hit higher levels, we will adjust elective surgeries as required to meet the needs of the
community.

There was agreement that the following processes would be consistent across all hospitals:
 Patients scheduled for elective procedures would be tested for COVID 72 hours prior to their
procedure. Patients should remain in isolation following the test up to the time of the surgery
and take their temperature 2 times per day. Positive COVID patients and symptomatic patients
should not be scheduled for elective surgery. Tests should be performed at a certified lab and
preferably collected by the hospital performing the surgical procedure.
 Hospital staff should continue to be screened as they are currently are (not tested until there
are sufficient tests for all hospital workers) and follow guidelines for appropriate PPE
 The visitor restriction policies will remain in effect.
 Social distancing policies should remain in place for patients arriving for procedures who are
waiting for pre-admission processing or waiting to be seen.
 Post-operatively admitted surgical patients should be placed on a dedicated unit that does not
house COVID or PUI patients.

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  For surgical procedures, surgeons and anesthesiologists should follow the guidelines established
and published via the joint statement of the American Society of Anesthesiologists, American
College of Surgeons, Association of perioperative Registered Nurses and the American Hospital
Association. See attached document.

As we move forward with scheduling elective cases, each of the hospital(s) will provide each office with
specific instructions for scheduling cases at the different facilities. We truly appreciate your
cooperation. If you have any questions, please feel free to reach out to any of the Chief Medical
Officers. Thank you for your continued service to the patients of our community.

Dan McBride, MD, Valley Health System CMO, Former Governor and Past President of the Nevada
Chapter of the American College of Surgeons.

Jeffrey A Murawsky MD, Sunrise CMO

Chike Nzerue MD MBA FACP, Dignity CMO

Alex Saxena, MD, North Vista Hospital CMO

Rick Lippmann, MD, UMC Chief of Staff