Non-Urgent Surgeries and Procedures-Updated 4/18/20

On March 22, 2020, Governor Abbott issued Executive Order GA-09 that directed all licensed health care providers to postpone all surgeries and procedures that "are not immediately necessary to correct a serious medical condition of, or to preserve the life of, a patient who without immediate performance of the surgery or procedure would be at risk for serious adverse medical consequences or death. . . ." As licensed health care providers, nurses are required to comply with this executive order. The intent of this order is to prevent the depletion of important health care resources that might be needed in the treatment of COVID-19. Such resources include personnel and personal protective equipment. The executive order provides an exemption for procedures that may be performed without depletion of personal protective equipment.

Executive Order GA-09 is applicable to procedures that are performed in outpatient settings, such as ambulatory surgery centers, med-spas, and office practices, in addition to hospitals. The Texas Medical Board has determined that procedures including cosmetic procedures and non-surgical cosmetic procedures are considered non-urgent. Likewise, most dermatological and orthopedic procedures have also been deemed to be non-urgent. Nurses may also wish to review guidelines available from the Centers for Disease Control and Prevention.

On April 17, 2020, the Governor issued three additional Executive Orders. Among them is Executive Order GA-15 relating to hospital capacity and personal protective equipment (PPE) needed for the COVID-19 response. This order loosens restrictions on surgeries put in place by Governor Abbott in March. Beginning at 11:59pm on April 21 through 11:59pm on May 8, all licensed health care professionals and all licensed health care facilities must continue to postpone all surgeries and procedures that are not medically necessary to diagnose or correct a serious medical condition of, or to preserve the life of, a patient who without timely performance of the surgery or procedure would be at risk for serious adverse medical consequences or death as determined by a patient's physician. Exceptions now include:

• Any procedure that, if performed in accordance with the commonly accepted standard of clinical practice, would not deplete the hospital capacity or the PPE needed to cope with COVID-19, or
• Any surgery or procedure performed in a licensed health care facility that has certified in writing to Texas HHSC both (1) that it will reserve at least 25% of its hospital capacity for treatment of COVID-19 patients, accounting for the range of clinical severity of COVID-19 patients, and (2) that it will not request any PPE from any public source - whether federal, state, or local - for the duration of the COVID-19 disaster. 

Executive Order GA-15 provides that "Failure to comply with an executive order issued by the governor related to the COVID-19 disaster can result in penalties of up to $1,000 or 180 days of jail time." Either of these penalties would come from law enforcement. The Texas Board of Nursing has no authority to issue criminal fines or jail time.

All nurses are required to uphold the standards of nursing practice outlined in Board Rule 217.11. Specifically, Board Rule 217.11 (1)(a) requires nurses to know and conform to the Texas Nursing Practice Act and the Board's rules and regulations as well as all federal, state, or local laws, rules or regulations affecting the nurse's current area of nursing practice. Therefore, nurses must comply with the requirements of Executive Order GA-15. Failure to do so may result in licensure discipline.