INTERPRETIVE STATEMENT RELATED TO PROCLAMATION BY THE GOVERNOR 20-24, RESTRICTIONS ON NON-URGENT MEDICAL PROCEDURES
TO: Interested Stakeholders
FROM: Governor Jay Inslee
DATE: April 29, 2020
SUBJECT: Interpretive Statement Related to Proclamation by the Governor 20-24, Restrictions on Non-Urgent Medical Procedures
Background. On March 19, 2020 Governor Inslee issued Proclamation 20-24 with the goal of ensuring hospitals and the health system would have enough surge capacity and personal protective equipment to manage an influx of patients with COVID-19. The Proclamation applies to services delivered in hospitals, ambulatory surgical facilities, dental, orthodontic, and endodontic offices in Washington State. The Proclamation will remain in effect through May 18, 2020.
As providers across the state have significantly adjusted operations in response to the Proclamation, the need for additional guidance has been identified. The purpose of this statement is to provide that guidance.
It is the position of the State that the Proclamation allows performance of all services considered to be “emergent” or “urgent” for which delay would result in worsening a life-threatening or debilitating prognosis. Clinicians should use clinical judgment to determine performance of procedures considered to be non-urgent or “elective.”
In addition, given the evolving and fluid nature of pandemics in general, and COVID-19 in particular, clinical judgments regarding non-urgent or “elective” procedures need to be viewed through the lens of relative harm to patients of treatment versus deferment, in terms of potential patient and provider contraction of COVID-19.
The remainder of this document pertains to health care services, procedures, and surgeries falling into the non-urgent or “elective” category.
Considerations in determining “harm” to the patient. The Proclamation limits, “healthcare services, procedures, and surgeries that, if delayed, are not anticipated to cause harm to the patient within the next three months…” The Proclamation goes on to provide examples of procedures to delay, which include, “most joint replacements, most cataract and lens surgeries, non-urgent cardiac procedures, cosmetic procedures, some endoscopy and some interventional radiology services.”
The Proclamation does not provide a definition of “harm.” To clarify, the Governor leaves assessment of harm up to the individual clinician. In order to assess harm, clinicians should consider if a patient’s illness or injury is: causing significant pain, significant dysfunction in their daily life or work, or is either progressing, or at risk to progress. Additionally, clinicians should assess the risk of harm that could be experienced by a patient as a result of undertaking the surgery or procedure during the COVID-19 pandemic.
The decision to perform any surgery or procedure in hospitals, ambulatory surgical facilities, dental, orthodontic, and endodontic offices, including examples of those that could be delayed in the Proclamation, should be weighed against the following criteria when considering potential harm to a patient’s health and well-being as described above:
- Expected advancement of disease process
- Possibility that delay results in more complex future surgery or treatment
- Increased loss of function
- Continuing or worsening of significant or severe pain
- Deterioration of the patient’s condition or overall health
- Delay would be expected to result in a less-positive ultimate medical or surgical outcome
- Leaving a condition untreated could render the patient more vulnerable to COVID-19 contraction, or resultant disease morbidity and/or mortality
- Non-surgical alternatives are not available or appropriate per current standards of care
- Patient’s co-morbidities or risk factors for morbidity or mortality, if inflicted with COVID-19 after procedure is performed
Furthermore, diagnostic imaging, diagnostic procedures or testing should continue in all settings if disease is suspected, based on clinical judgement that uses the same definition of harm and criteria as listed above.
Prerequisites to performance of healthcare services, procedures and surgeries. Foundational to the performance of any healthcare service, procedure, or surgery permitted under Emergency Proclamation 20-24 is the ability to meet infection prevention and control standards, maintain
appropriate personal protective equipment supplies, as well as following Department of Health (DOH)- issued guidance on use of personal protective equipment (PPE). For permitted procedures requiring an overnight stay, hospitals will not exceed 80% of available bed (licensed and staffed beds) capacity.
Specifically, the following PPE prerequisites are required before facilities can perform procedures, surgeries, or services permitted under Emergency Proclamation 20-24:
- Facilities must provide health care workers (direct patient care and affected ancillary staff) with appropriately sized and sufficient quantities of PPE to perform essential job
- Facilities must be aligned with Washington State Department of Health’s PPE Usage Guidelines – PPE Conservation Strategies (Yellow), which says personal protective equipment is discarded and replaced when it is soiled, damaged, or hard to breathe
- Facilities must follow the Washington State Department of Health’s Guidance on Extended and Re-use of PPE by Healthcare Personnel (HCP).
- Facilities must have on-hand and in the facility 7 days of appropriate
- Facilities must report accurate counts of PPE available and in the facility daily, as well as PPE on order, to the WA Health
- Facilities must report following required DOH guidelines for PPE use and conversation to the WA Health
- Health care workers have access to COVID-19 testing and to timely notification (within eight
(8) hours of awareness) of exposure to COVID-19.
- Facilities must report on COVID-19 positive health care workers by facility and profession/position to the WA Health
Outpatient clinic visits. The Proclamation permits outpatient clinic visits, both in hospital-based clinics and other outpatient clinic settings. While not addressed in the Proclamation, the Governor encourages clinicians to weigh the benefits and risks of such visits to patients given the active presence of COVID-19 in our communities. He also encourages clinicians to use telehealth visits where possible. If a clinician determines an outpatient clinic visit is necessary, all steps possible should be taken to promote social distancing measures and reduction of infection risk by appropriate use of hand hygiene and PPE-use protocols.
Penalties and enforcement. The Proclamation states, “Violators of this order may be subject to criminal penalties pursuant to RCW 43.06.220(5),” making anyone found to be in willful violation of the order guilty of a gross misdemeanor. The department finds that documented clinical decision- making reflecting application of the Proclamation and this statement to the clinical matter(s) or case(s) under consideration will serve as evidence that performance of the health care services, procedures or surgeries was not a willful violation of the Proclamation.
We’ve had to take unprecedented actions to slow the spread of COVID-19 in Washington. Luckily, we’ve had some success, but until we have a vaccine, protecting the health of all Washingtonians will require ongoing effort. Gov. Jay Inslee and the state’s public health leaders use many factors to determine how to protect the health of all Washingtonians and begin our economic recovery.
TO READ THE MOST UP TO DATE DASHBOARD DETAILS PLEASE CLICK HERE
About this dial dashboard
This dashboard provides a high-level overview of the main data points discussed among state leaders and the level of risk experts perceive around the current numbers. It is not intended to represent the totality of all COVID-19 related data. The state is currently developing several new systems for collecting, compiling and reporting much of the data outlined below and this dashboard will link to those new systems as they are completed. In the meantime, where possible, we’ve linked to the data that is currently available or created a snapshot that summarizes the most recent information available.
This dashboard is updated weekly on Wednesdays.
- 1. Residents Should Focus on their Own Compliance First. This is a difficult time for everyone. Residents should first focus on their own compliance with the stay home order and not try to police other people’s failure to comply.
- Don’t call 911. Residents should not call 911 to report an alleged violation of the stay home order. Instead, please call the communications business line, 360-344-9779.
- Don’t call the Public Health Department. Residents should not call the Public Health Department. It does not have the resources in the current environment to police violations of the stay home order.
- Use the Governor’s Website. Residents should use the Governor’s website for complaints about businesses or people that they believe are violating the stay home order. Precious law enforcement resources must be saved for true emergencies, not for enforcing alleged violations of the stay home order by businesses. If a business is allegedly not following the stay home order, residents should go to the website the Governor created that collects alleged violations by business and fill out the on-line form. The address for the Governor’s web site is:
- Only Report to the Sheriff’s Office Individual Violations that Pose a Threat to Residents. The Governor’s web site tells people to report violations about an individual or private group not following the stay home order to their local law enforcement agency.
- The Sheriff’s Office Will Use Discretion and Persuasion to Gain Compliance. The Sheriff’s Office will weigh all the law enforcement priorities when considering whether to send deputies to respond in person to a complaint about a violation of the stay home order. The Sheriff’s Office will not arrest anyone for violating the order before first using persuasion to obtain compliance. Arrests for violation of the stay home order will be avoided because they put deputies and jail staff at risk. If persuasion doesn’t work, deputies will consult with a supervisor, who can involve the Prosecuting Attorney if necessary.
Phase 1: Low-risk construction work resumes.
Any existing construction projects complying with the points below may resume only those work activities that do not require workers to be closer than six-feet together. If a work activity requires workers to be closer than six-feet, it is not considered low- risk and is not authorized. Adherence to the physical distancing requirement and the health and safety points below will be strictly enforced.
Prior to recommencing work all contractors are required to develop and post at each job site a comprehensive COVID-19 exposure control, mitigation, and recovery plan. The plan must include policies regarding the following control measures: PPE utilization; on-site social distancing; hygiene; sanitation; symptom monitoring; incident reporting; site decontamination procedures; COVID-19 safety training; exposure response procedures; and a post-exposure incident project wide recovery plan. A copy of the plan must be available on each job site during any construction activities and available for inspection by state and local authorities. Failure to meet posting requirements will result in sanctions, including the job being shut down.
All Contractors are required to post at each job site written notice to employees, subcontractors and government officials the Phase 1 work that will be performed at that job site and signed commitment to adhere to the requirements listed in this document.
All contractors have a general obligation to keep a safe and healthy worksite in accordance with state and federal law. Failure to follow these requirements will be considered a violation of these duties and be penalized accordingly. Under RCW 49.17.060, “each employer shall furnish to each of their employees a place of employment free from recognized hazards that are causing or likely to cause serious injury or death to his or her employees and shall comply with the rules, regulations, and orders promulgated under this chapter.” The Washington State Department of Labor & Industries’ Division of Occupational Safety and Health (DOSH) is responsible for workplace safety and health, including inspections and enforcement, consultation, technical assistance, training, education and grants.
All contractors are also required to comply with the following COVID-19 worksite-specific safety practices, as outlined in Gov. Jay Inslee’s “Stay Home, Stay Healthy” Proclamation 20-25, and in accordance with the Washington State Department of Labor & Industries General Coronavirus Prevention Under Stay Home-Stay Healthy Order (DOSH Directive 1.70: https://www.lni.wa.gov/safety-health/safety-rules/enforcement- policies/DD170.pdf) and the Washington State Department of Health Workplace and Employer Resources & Recommendations at https://www.doh.wa.gov/Coronavirus/workplace:
COVID-19 Site Supervisor
- A site-specific COVID-19 Supervisor shall be designated by the contractor at every job site to monitor the health of employees and enforce the COVID-19 job site safety plan. A designated COVID-19 Supervisor must be present at all times during construction activities, except on single- family residential job sites with 6 or fewer people on the
COVID-19 Safety Training
- A Safety Stand-Down/toolbox talk/tailgate training must be conducted on all job sites on the first day of returning to work, and weekly thereafter, to explain the protective measures in place for all workers. Social distancing must be maintained at all
- Attendance will be communicated verbally and the trainer will sign in each
- COVID-19 safety requirements shall be visibly posted on each
- Social distancing of at least 6 feet of separation must be maintained by every person on the worksite at all times.
- Gatherings of any size must be precluded by taking breaks and lunch in shifts. Any time two or more persons must meet, ensure minimum 6 feet of
- Identify “choke points” and “high-risk areas” on job sites where workers typically congregate and control them so social distancing is always
- Minimize interactions when picking up or delivering equipment or materials, ensure minimum 6- foot separation.
- To the extent practical allow only one trade/subcontractor at a time on a jobsite and maintain 6-foot separation social distancing for each member of that trade. If more than one trade/subcontractor must be on the job to complete the job then at a minimum all trades and subcontractors must maintain social distancing policies in accordance with this
Personal Protective Equipment (PPE) – Employer Provided
- Provide personal protective equipment (PPE) such as gloves, goggles, face shields and face masks as appropriate, or required, for the activity being
- Masks, in accordance with Washington Department of Health guidelines, or as required by Washington Department of Labor & Industries (L&I) safety rules, must be worn at all times by every employee on the
- Eye protection must be worn at all times by every employee while on
- Gloves must be worn at all times by every employee while on worksite. The type of glove worn should be appropriate to the task. If gloves are not typically required for the task, then any type of glove is acceptable, including latex
- If appropriate PPE cannot be provided, the worksite must be shut
Sanitation and Cleanliness
- Soap and running water shall be abundantly provided on all job sites for frequent handwashing. Workers should be encouraged to leave their workstations to wash their hands regularly, before and after going to the bathroom, before and after eating and after coughing, sneezing or blowing their nose.
- When running water is not available, portable washing stations, with soap, are required, per WAC 296-155-140 2(a) – (f). Alcohol-based hand sanitizers with greater than 60% ethanol or 70% isopropanol can also be used, but are not a replacement for the water
- Post, in areas visible to all workers, required hygienic practices, including not to touch face with unwashed hands or with gloves; washing hands often with soap and water for at least 20 seconds; use hand sanitizer with at least 60% alcohol; cleaning and disinfecting frequently touched objects and surfaces such as workstations, keyboards, telephones, handrails, machines, shared tools, elevator control buttons, and doorknobs; covering the mouth and nose when coughing or sneezing as well as other hygienic recommendations by the U.S. Centers for Disease Control (CDC).
- Make disinfectants available to workers throughout the worksite and ensure cleaning supplies are frequently replenished.
- Frequently clean and disinfect high-touch surfaces on job sites and in offices, such as shared tools, machines, vehicles and other equipment, handrails, doorknobs, and portable toilets. If these areas cannot be cleaned and disinfected frequently, the jobsite shall be shut down until such measures can be achieved and
- When the worksite is an occupied home, workers should sanitize work areas upon arrival, throughout the workday and immediately before they leave, and occupants should keep a personal distance of at least 10
- If an employee reports feeling sick and goes home, the area where that person worked should be immediately disinfected.
- Create policies which encourage workers to stay home or leave the worksite when feeling sick or when they have been in close contact with a confirmed positive case. If they develop symptoms of acute respiratory illness, they must seek medical attention and inform their
- Have employees inform their supervisors if they have a sick family member at home with COVID-19. If an employee has a family member sick with COVID-19, that employee must follow the isolation/quarantine requirements as established by the State Department of
- Screen all workers at the beginning of their shift by taking their temperature and asking them if they have a fever, cough, shortness of breath, fatigue, muscle aches, or new loss of taste or smell. Thermometers used shall be ‘no touch’ or ‘no contact’ to the greatest extent possible. If a ‘no touch’ or ‘no contact’ thermometer is not available, the thermometer must be properly sanitized between each use. Any worker with a temperature of 100.4°F or higher is considered to have a fever and must be sent
- Instruct workers to report to their supervisor if they develop symptoms of COVID-19 (e.g., fever, cough, shortness of breath, fatigue, muscle aches, or new loss of taste or smell). If symptoms develop during a shift, the worker should be immediately sent home. If symptoms develop while the worker is not working, the worker should not return to work until they have been evaluated by a healthcare provider.
- Failure of employees to comply will result in employees being sent home during the emergency actions.
- Employees who do not believe it is safe to work shall be allowed to remove themselves from the worksite and employers must follow the expanded family and medical leave requirements included in the Families First Coronavirus Response Act or allow the worker to use unemployment benefits, paid time off, or any other available form of paid leave available to the worker at the workers
- Any worker coming to work on a construction site in Washington from any state that is not contiguous to Washington must self-quarantine for 14 days to become eligible to work on a job site in
- If an employee is confirmed to have COVID-19 infection, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA). The employer should instruct fellow employees about how to proceed based on the CDC Public Health Recommendations for Community-Related Exposure.
Job Site Visitors
- A daily attendance log of all workers and visitors must be kept and retained for at least four weeks. The log must include the name, phone number, and email address of all workers and
No jobsite may operate until the contractor can meet and maintain all requirements, including providing materials, schedules and equipment required to comply.
These Phase 1 COVID-19 job site safety practices are required as long as the “Stay Home, Stay Healthy” Gubernatorial Proclamation 20-25 is in effect or if adopted as rules by a federal, state or local regulatory agency. All items minus numbers 28 and 30 are subject to enforcement action under L&I’s Division of Occupational Safety and Health (DOSH).
Workplace safety and health complaints may be submitted to the L&I Call Center: (1-800-423-7233) or via e- mail to firstname.lastname@example.org. General questions about how to comply with construction safety practices can be submitted to the state’s Business Response Center at https://app.smartsheet.com/b/form/2562f1caf5814c46a6bf163762263aa5. All other violations related to Proclamation 20-25 can be submitted via at: https://bit.ly/covid-compliance.
- Red Apple – Poulsbo
- Central Market – Poulsbo
- Safeway Poulsbo
- Walmart – Poulsbo
- QFC – Port Hadlock
- Albertsons – Kingston
- Chimacum Farm Stand – Chimacum
- Port Ludlow Village Market – Port Ludlow
- No website
- For Jefferson County “Only” Grocery Locations – please visit the Local 20/20 website at:
- Fireside Restaurant at the Port Ludlow Inn: 360-437-7412 Lunch and Dinner take-out menu: https://portludlowresort.com/dining/ – Closed until further notice
- Molcajete Mexican Restaurant – Port Ludlow: 360-344-8317 Lunch and Dinner take-out menu: http://www.molcajetemexican.com
- Cucina Restaurant – Port Ludlow: 360-437-8200, Deliveries, take-out and curbside. Limited hours – 3-7:30 Mon-Fri, Sat 4-7:30 and Sunday 5-7:30. Take-out menu: http://www.cucina-italian-restaurant.com/take-outdelivery.html
- GBF Catering – Port Ludlow: 206-913-7747, pickup at the Community Center: https://gbfcatering.com, email: email@example.com
- Niblicks Restaurant at Port Ludlow Golf Course: Closed
- The Port Ludlow Village Market is also serving take-out – 360-437-9110 – hours of operation 5:00 AM to 10:00 PM – subject to change.
- Rise on Shine – Port Ludlow: 360-302-6032 – https://www.riseonshinefood.com/–https://www.riseonshinefood.com/contact.html
- Ajax Café – Port Hadlock – 360-385-1965 – http://www.ajazcafe.com/index.html – https://www.ajaxcafe.com/
- For Jefferson County “Only” Dinning Locations – please visit the Local 20/20 website at: https://l2020.org/covid-19/groceries/
Volunteer with Jefferson County Department of Emergency Management
The Department of Emergency Management is interested in volunteers with medical backgrounds (doctor, nurse, EMT, etc.), backgrounds in security (military, law enforcement), other emergency response (firefighters, Incident Command System) or other specialized skills.
More information can be found at: www.co.jefferson.wa.us/1450/VolunteerHow-to-Help
Volunteer or Donate through OlyCAP
OlyCAP offers a wide array of community service programs and can provide help to those in need or can use your help if you’d like to give back to the community.
More information can be found at: www.co.jefferson.wa.us/1450/VolunteerHow-to-Help
Help with Making Face Masks
While many people have stepped up to make face masks for community use, the demand has outpaced our supply! Jefferson County face mask volunteers have set up a Facebook page to help with locating resources. These masks are distributed to disadvantaged citizens, homeless and incarcerated persons; they are not available to the general public at this time.
If you are interested in helping with this project and need help with resources, you can find it here: www.facebook.com/groups/207602053835025/?ref=share
The face mask pattern and instructions can be found at: www.co.jefferson.wa.us/1450/VolunteerHow-to-Help
Jefferson County Department of Health has coordinated appointment-only blood donations in our area at the following locations:
Monday, April 6 – Port Townsend Elks Lodge, Room 555 Otto, 12 pm to 6 pm
Wednesday, April 8 – Port Hadlock Community Methodist Church, 130 Church Lane, 11 am to 5 pm
To make an appointment or for more information call 1-800-398-7888 or visit: www.bloodworksNW.org
|CHS Northwest Propane
9315 Rhody Dr, Chimacum, WA 98325
1473 A, Chimacum Rd, Chimacum, WA 98325
265 Chimacum Rd, Port Hadlock, WA 98339
|Murrey’s Disposal Service
2153 4th St, Port Townsend, WA 98368
|Olympic Sewer & Water, Inc
70 Breaker Ln, Port Ludlow, WA 98365
|PUD Jefferson Co
| Sunshine Propane
10853 Rhody Dr, Port Hadlock, WA 98339
- The Benji Project’s trained teachers will host a FREE one-hour session two times a week to share stress relief, connection and coping practices. Drop in to our Zoom online meetings every Tuesday at 7pm starting March 24, and every Thursday at 4pm starting March 26.
Centers for Disease Control and Prevention: Coronavirus Disease
Discovery Behavioral Healthcare
- DBH continues to provide a variety of mental health, crisis and medication management services. Please call our office at (360) 385–0321.
Jumping Mouse Children’s Center
- Or call 1-800-273-TALK (8255)
Port Townsend Police Department
- Community members seeking resources, please contact Judson Haynes LMHC, SUDP at 360-531-3445 or firstname.lastname@example.org
Volunteers of America is a national, nonprofit, faith-based organization dedicated to helping those in need live healthy, safe and productive lives. Since 1896, our ministry of service has supported and empowered America’s most vulnerable groups, including veterans, seniors, people with disabilities, at-risk youth, men and women returning from prison, homeless individuals and families, those recovering from addictions and many others.
- Or call 1-888-910-0416