Charleston Reporter

Dr. Marcelo Hochman said the COVID-19 pandemic has both revealed the level of political dysfunction in the country and provided possible remedies.

Hochman, 60, is facial plastic and reconstructive surgeon in Charleston, South Carolina, an affiliate professor at the Medical University of South Carolina and a Visiting Fellow with the Palmetto Promise Institute. 

“In general, I think the whole issue has been less than ideally managed, let’s put it that way,” he told Charleston Reporter. “There’s a lot of things that could have been done differently or should have been done differently.”

One of the major problems has been “too many mixed messages” from the start, Hochman said.

“I think there’s a lot of finger-pointing and head-nodding being done,” he said. “I think it does highlight that in many different areas, in and out of health care, we need it change the focus of things and who’s responsible for this.”

In general he believes there are “very few things the federal government should” but it needs to play a prominent role in a public health crisis, adding “that’s my general feeling.” 

There should have been far more planning and preparation, but Hochman said it’s difficult to predict when such a crisis as COVID-19 will occur. He also said there must be “great deal of responsibility on the part of individual and the private sector.”

However, Hochman said President Trump and his political opponents have confused the public with “a lot of mixed messages” and have done a great deal of harm to reliable sources.

“It’s become so politicized,” he said. “The original message was mixed and continued to be mixed.”

Hochman said he is not a fan of either major party. They are, in his view, “different versions of the same thing.”

What he favors is a well-planned public health policy that is ready for a viral pandemic, bioterrorism or some other calamity. Doctors can help bring that about.

“I hope so. And that’s one thing I’ve been saying,” Hochman said. “Be more vocal and take a leadership role. I think you’re going to see a lot more doctors speaking up on behalf of themselves as physicians and on behalf of their patients.”

He has done so by serving as president of the Charleston County Medical Society. Hochman wants the Certificate of Need law repealed in South Carolina.

Under a Certificate of Need (CON) law, a proposed medical facility must prove there is a need for its services before it can be constructed. CON laws trace their roots to New York in 1964 but became a federal law in 1974. The concept was to prevent duplication, unfair pricing and unneeded hospitalization and treatment.

The impact, Hochman said, is far different.

The federal mandate was dropped in the late 1980s, but 35 states and the District of Columbia still have such laws in place. Hochman said they are unnecessary and have dangerous consequences, as has been revealed during the pandemic.

“In South Carolina, if you want to build a facility or open a business or buy an MRI, hospitals contest it,” he said.

Sometimes legal battles continue for a decade, Hochman said, as hospitals and other medical facilities engage in turf wars before allowing a new facility to be built. In the meantime, the public is not given the options — or the health care — they want and need.

There is a lack of birthing centers, he said, and not everyone can get access to health care facilities near them. Even during a pandemic, people break their arms or grow ill, and because of CON laws, there are not enough facilities to provide needed care.

There is a “huge racial disparity” in available medical facilities, he said, and CON laws prevent that from being changed.

Hochman said the crisis that developed when a shortage of personal protective equipment was discovered. The “PPE debacle,” in his words — is a perfect example.

“Our small medical community worked together,” he said. “We took care of the problem ourselves. We created a platform and a supply chain.”

He noted that South Carolina Gov. Henry McMaster temporarily lifted a portion of the COD law to allow hospitals to add beds without seeking permission. Hochman said that was a good decision — and reveals the hurdles the law puts in the way of proper health care decisions.

“The pandemic has highlighted some legislative and regulatory issues that are so bad for doctors and their patients,” he said. “The pandemic has given us an additional argument. So many people suffered because of a lack of options. It’s better for the community.”

Hochman also wants doctors exempted from blanket non-compete clauses as condition of employment. As half of all doctors are currently employees of large health care entities, they are finding themselves restricted in widening circles by these clauses.

“As systems have gotten bigger and bigger, the radius has gotten bigger, too,” he said.

Hochman supports a tax incentive for doctors who provide pro-bono charitable medical care. All these issues will be brought before the South Carolina Legislature in 2021, and Hochman said he thinks lawmakers will be more receptive to such ideas.

COVID-19 has changed a lot of people’s thinking on many issues. He said that will continue as the country tries to return to life as we knew if before the pandemic.

Hochman said reopening the country is a complex issue, and there is no one right answer. Resuming in-classroom instruction is an issue as fall approaches,

“I think that’s a perfect example of how there’s no one solution to every situation,” he said.

Elementary school children and college students very different, he said, adding that it's unrealistic to expect 2nd-graders to sit in front of computer for several hours a day and learn that way.

They need a classroom setting. Data show children of that age face very little risk from COVID-19, he said.

“It is virtually nonexistent,” Hochman said. “There are some cases, of course, that’s the way things are. I feel very strongly that elementary and middle schools ought to be back in an in-person environment. Or at least should have the option for in-person.”

He noted that most elementary teachers are younger and healthier and face less risk. Those who are not should be provided options but schools should reopen.

“The price the young children are paying and will pay in the future, for six months to a year or very little education, is very terrible,” Hochman said.

In addition, for many students, school provides their major meal during the school week.

“That’s a real issue,” Hochman said.

He said while people quote statistics about COVID-19, they ignore that while infections are up, the death and hospitalization figures are declining. The reality remains, most of the people who are dying are elderly, and had other health issues, Hochman said.

And there are other troubling numbers.

“Child abuse is up 30 percent based on cases presented at hospitals,” he said.

Parents under stress with financial and other pressures are hurting their children. That is a result of lockdowns that must be weighed.

“I think there are a lot of very bad consequences for young students,” he said.

Many if not most students want to return to school to be around their friends and classmates. He and his wife have three children and their youngest son, “an outstanding student,” has handled the change to distance learning well. But he wants to return to school.

“His preference is to be with people and his colleagues,” Hochman said. “We actually are OK with that as long as some precautions are taken. I feel very strongly about having choices and having alternatives and just making choices you feel are best for you.”

He supports the use of masks.

“We know regardless of what you hear and read, masks are effective to some degree,” Hochman said. “We know there is a benefit. There’s no question a mask is better than no mask.”

People who refuse to wear them have to accept the consequences, he said, since businesses have every right to deny access to people who won’t put one on.

“It’s not an infringement in freedoms or liberty,” Hochman said. “It’s a public health issue.”

The nation learned this lesson from other outbreaks, as well as from countries where mask use is common. It’s similar to someone at work who is sick — they are sent home so others are not exposed.

“It’s just common sense, common practice,” Hochman said.

Should restaurants and bars be open? Yes, he said, as long as they make accommodations.

“I think so as long as they have some policy or format that they enforce,” Hochman said.

He has made such arrangements in his office. He has five employees and sees 15-20 patients per day on average.

“I’m very comfortable with my office with staff and patients,” Hochman said.

They are using ultraviolet sterilization of equipment, “aggressive cleaning,” spacing out appointments and not having people wait in the same room. Masks are required and patients fill out a triage questionnaire before being treated.

Hochman has stocked up on PPE and other needed equipment to allow him to perform elective procedures, although he said that term is a bit troubling. The theory was to prevent hospitals from being overwhelmed but his facility is fully equipped — “at great expense” — without denying hospitals access to the equipment they need.

He does have a surgical facility and patients are tested before the procedure is started. The goal is to protect the patients, the staff and their families.

“We’re doing everything that’s reasonable,” Hochman said.

Hochman, who received his medical training at Stanford University, received The Order of the Palmetto, South Carolina’s highest civilian award, in 2005. He also has been awarded the Community Service Award of the American Academy of Facial Plastic Surgery and named a Health Care Hero by the Charleston Business Journal for his charitable work with patients with congenital vascular anomalies.