On April 20, 2020, the Louisiana Department of Health (“LDH”) Office of Public Health issued Healthcare Facility Notice/Order Notice #2020-COVID 19-ALL-10 (“Notice-10”) which supersedes prior notices and lifts some of the restrictions on medical, surgical and dental procedures as well as other healthcare services beginning on April 27, 2020.  All licensed healthcare facilities and professionals in Louisiana must adhere to Notice-10.  The three areas covered by Notice-10 include: (1) medical and surgical procedures; (2) dental visits and procedures; and (3) healthcare services other than procedures.

Medical and Surgical Procedures

All medical or surgical procedures in which a delay will not adversely affect the particular patient or the underlying disease process should continue to be postponed.  Medical and surgical procedures may only be performed if the following conditions are met:

1. to treat an “emergency medical condition” which is defined as a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in:

(a) Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;

(b) serious impairment to bodily functions; or

(c) Serious dysfunction of bodily organs.

2. to avoid further harms from underlying condition or disease.

3. to treat time-sensitive medical conditions, but only if each of the following conditions/requirements are met:

(a) Each patient undergoing such a medical or surgical procedure shall undergo an appropriate pre-operative clinical evaluation to minimize the risk that the patient has COVID-19 including COVID-19 testing, if available;

(b) Each patient must comply with strict social distancing measures from the time of the pre-operative clinical evaluation through the day of the surgery;

(c) The facility and healthcare provider shall have an adequate and appropriate supply of personal protective equipment (“PPE”) to treat patients, including COVID positive patients with at least a 5-day supply on hand at the facility. The facility cannot be dependent on the state or other governmental body to meet the 5-day requirement;

(d) There is an adequate supply chain to the facility/healthcare provider for medical equipment, supplies, and medications;

(e) The facility/healthcare provider has adequate medical staff, including surgical, surgical support, recovery, and nursing staff, to meet the needs of all patients;

(f) The facility/healthcare provider shall conduct constant monitoring of hospital, regional, and state resources, as well as ESF-8 reports, indicating coronavirus burden of disease and impact.

Dental Visits and Procedures

Any dental visit, procedure, and surgery (“dental procedure”) in which a delay will not adversely affect the particular patient or the underlying disease process should continue to be postponed.  Dental procedures can only be performed under the following conditions:

1. to treat an “emergency medical condition” which is defined as a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in:

(a) Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;

(b) Serious impairment to bodily functions; or

(c) Serious dysfunction of bodily organs.

2. to avoid further harms from underlying condition or disease.

3. to treat Time-Sensitive Dental Conditions if ADA algorithms 2 and 3 and CDC Guidelines are followed for screening patients and for treating patients.

Healthcare Services, Other than Medical, Surgical or Dental Procedures

For healthcare services (other than a medical or surgical procedure or a dental procedure), all providers are directed by LDH to offer telehealth rather than an in-person visit when medically appropriate and when the same standard of care can be met. In-person healthcare services should be postponed when patient outcomes would not be compromised. LDH recognizes that there may be some legitimate and valid barriers preventing some services from shifting to telehealth.  Providers are to use their best medical judgment within the scope of their license to make the determination of whether to use telehealth on a case-by-case basis.  Providers must consider the entire clinical picture when determining if a service can be safely postponed, including the consequences to both the patient and to the healthcare system.  All providers are encouraged to follow LDH and CDC recommendations to reduce COVID-19 exposure should an in-person visit be deemed necessary.

Follow-Up Post Procedure or Visit

Within 10-14 days after a procedure or in-person visit, the provider must make contact with the patient to determine whether the patient has signs/symptoms of COVID-19 or has tested positive for COVID-19 since the procedure.  The contact with the patient must be documented in the medical record.  If the patient has signs/symptoms of COVID-19, recommendations must be made by the provider including appropriate testing. The healthcare provider must also immediately notify the Office of Public Health if any such patient has tested positive for COVID-19.

Discontinuance of Procedures and Compliance

The State Health Officer has the authority to order the immediate discontinuance of medical, surgical and dental procedures to treat time-sensitive medical conditions.  In making this determination, the State Health Officer will consider statewide or region-wide:  ventilator capacity; ICU bed availability; med surg bed availability; the number of new admit COVID-19 cases; and any other criteria deemed appropriate.

Each facility and healthcare provider that performs a medical, surgical or procedure or other healthcare service should comply with the Centers for Medicare and Medicaid Services (“CMS”) April 19, 2020 Recommendations for Re-opening Facilities to Provide Nonemergent Non-COVID-19 Healthcare: Phase I and any subsequent recommendations or guidance issued by CMS.

Any provider acting in good faith shall not be found to be in violation of the directives set forth in Notice-10.