As coronavirus spreads, so do reports of companies mistreating workers

https://www.washingtonpost.com/business/2020/03/31/worker-retaliation-mistreatment-coronavirus/?fbclid=IwAR1uQPecWtRM3G__toecrlhfYhszBQkDoYFkxsUrMYY_UZtKaTHpq3cblH4&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

Workers complain of mistreatment as they try to cope with the ...

From nurses to retail salespeople, workers are walking off the job and facing retribution for speaking out.

She could wear her protective mask while seeing her patients. Many were, after all, elderly, with respiratory problems, susceptible to getting severely sick from the novel coronavirus. And so Laura Moreno, a nurse in Oklahoma City, wanted to protect them — as well as herself and her 12-year-old daughter, who has asthma and a thyroid condition.

She could not, however, wear her mask in the hallways, or the cafeteria or any of the hospital’s common areas, because her supervisors told her it would scare patients. “I was told if I wanted to wear a mask, I would not be working there,” she said. “So I said I’m not willing to put my life at risk, and my contract was terminated.”

Since the viral pandemic started ravaging the country in recent weeks, workers, unions and attorneys are seeing a dramatic rise in cases they say illustrate a wave of bad employer behavior, forcing workers into conditions they fear are unsafe, withholding protective equipment, and retaliating against those who speak up or walk out.

Moreno’s case was one of many that her attorney, Rachel Bussett, and her colleagues at the National Employment Lawyers Association have been inundated with as workers grow increasingly fearful of retribution from, as Bussett said, “employers who value the economy over people.”

A handful of workers at a McDonald’s outside San Francisco walked off the job to protest the lack of safety measures. So did about 50 workers at a Perdue chicken plant in Georgia, as well as workers at Instacart and Amazon, while the companies said they were taking steps to ensure their employees’ safety and well-being. (Amazon’s chief executive, Jeff Bezos, owns The Washington Post.)

Meanwhile, employees at several major retailers have circulated petitions urging the companies to close their stores and protect workers. And some workers have said they were fired outright for speaking their minds and pushing companies to look after them.

The complaints come as the virus’s toll mounts and health officials warned that extreme measures, such as lockdowns, would continue. On Sunday, health officials said social distancing guidelines would remain in place through April, and President Trump said the nation “will be well on its way to recovery” by June 1, not Easter, as he had said previously.

“This is a situation we’ve never had to deal with before,” said Heidi Burakiewicz, a D.C. attorney and a member of the employment lawyers association. “We’re doing everything we can to help these employees — not just about protecting jobs. But people’s lives are at stake, and people should never have to be faced with questions about whether they need to risk exposing themselves and their families or losing their jobs.”

The designations for “essential” businesses can vary by state but generally include supermarkets, pharmacies, hardware stores, auto repair shops and the defense industry.

Workers at a number of large retailers — such as craft stores, video-gaming shops and office supply chains — have questioned their employers’ decision to stay open despite stay-at-home orders across the country.

“It is unnecessary and unsafe to be open during a PANDEMIC,” Staples employees wrote in a petition. “We are not an essential store and corporate is fighting and begging to stay open, claiming Staples is essential and putting employees and their families at risk. Staples should temporarily close stores and pay their employees for the time being.”

Staples spokeswoman Meghan McCarrick said the company is “an essential provider of business and educational materials and products, household goods and cleaning supplies.” She said that an intensive care unit at a Baltimore hospital recently purchased ink and toner for a printer at Staples, while a hospital in Virginia bought webcams to set up remote telemedicine offices.

Last week, the Federal Bureau of Prisons turned away employees who said they had taken pain medications such as Advil, Tylenol or Motrin within four hours of reporting for work. That meant guards with balky hips or bad backs were forced to take sick leave, even if they had no fever or other symptoms of the virus, union officials said.

“You have unqualified people asking questions that are medically related,” said Sandy Parr, a union official. “They’re sending people home just because they took Motrin, which is decreasing the staff available to work — and that increases the danger.”

After guard workers complained and The Post inquired about the measure, the Bureau of Prisons said last week that it was discontinuing the practice.

Across the country, some health-care facilities are hoarding masks, goggles and gloves — forcing some workers to bring in their own, use the same equipment again and again, or go without.

“It’s in cabinets locked away, collecting dust while people need it now,” said Rebecca Reindel, the safety and health director of the AFL-CIO, who said the union has raised the issue “in every avenue we can.”

Moreno’s concern wasn’t the availability of the equipment — only her ability to use it. A contract nurse at Select Specialty Hospital, she felt she needed to wear a mask at all times, especially given that the patients she was treating were particularly susceptible to the worst effects of the virus. The hospital’s website says it provides “specialized care for patients with acute or chronic respiratory disorders. Our primary focus is to wean medically complex patients from mechanical ventilation and restore independent breathing.”

The state is under a “safer at home” order, which directs people over 65 and those with underlying medical conditions to stay home and limits gatherings to no more than 10 people, among other restrictions.

On Wednesday, however, Moreno was told her contract was being terminated because the hospital did not want her wearing a mask in common areas of the hospital, she said. But by the next afternoon, after The Post had contacted the hospital, she said hospital officials “had completely changed their tune” and decided to allow nurses to wear masks throughout the hospital and not just in patient rooms.

On Friday, she went back to work. In an email, a hospital spokeswoman said, “The nurse is still engaged with us and her upcoming scheduled shifts have been confirmed.”

The policy change “feels wonderful,” Moreno said, “because I know I will be protected and my friends and co-workers will be protected.”

Kevin Readel, another nurse in Oklahoma City, said he was fired for a similar reason — but in his case it was for insisting on wearing a mask while with patients.

He said he was told “point blank that I can’t wear a mask” because it “could cause fear and anxiety amongst the other nurses and the patients.”

He filed a suit against the Oklahoma Heart Hospital South for wrongful termination, claiming that “the hospital was more concerned about the perception of due diligence than actually performing due diligence.”

A spokesman for the hospital said he could not comment on pending litigation but said the hospital’s “entire focus is on making sure we protect the safety of our patients and health care professionals in preparation for an expected surge in COVID-19 patients. As part of our preparation, we are strictly complying with the guidelines on the personal protective equipment set forth by the World Health Organization and the Centers for Disease Control.”

Lauri Mazurkiewicz, a nurse who lives outside Chicago, grew nervous when she was repeatedly exposed to patients diagnosed with covid-19, the disease caused by the coronavirus. “This is so contagious. It’s spreading so fast. I need an N95 mask,” she said, referring to a specialty mask worn by many health-care workers.

She happened to have an N95 and began wearing it during her rounds at Northwestern Memorial Hospital, she said, but was told the hospital was prohibiting the use of N95 masks and using regular surgical masks instead.

She sent an email warning her colleagues that those masks were less effective. She was fired shortly afterward — the result, she alleged in a lawsuit against the hospital, of her attempts to “disclose public corruption and/or wrongdoing.”

A spokesman for the hospital declined to comment on the specifics of her complaint in the lawsuit, but said it is “committed to the safety of our employees who are on the frontlines of this global health care crisis.” He added that it follows “CDC guidance regarding the use of personal protective equipment for our health care providers.”

In a statement Monday, the American College of Emergency Physicians said it was “shocked and outraged by the growing reports of employers retaliating against frontline health workers who are trying to ensure they and their colleagues are protected while caring for patients in this pandemic. … Not only does this type of retribution remove healthy physicians from the frontlines, it encourages others to work in unsafe conditions, increasing their likelihood of getting sick.”

In the retail sector, employees at Michaels crafts stores said they were told the company’s shops would remain open because they serve “people who are bored at home” and double as UPS drop-off sites, according to an employee at a Phoenix store who is awaiting results for a coronavirus test.

The worker, who spoke on the condition of anonymity, has been home with a low-grade fever, cough and chest pain but says store managers have not been supportive.

“Every time I call in sick, there’s just an incredibly disappointed sound on the other end,” she said. “This is not an essential business — nobody in the history of mankind has ever dropped dead from boredom. They need to close their doors.”

Anjanette Coplin, a spokeswoman for Michaels, said its stores provide necessary products and services for parents and small-business owners. “We want to support and remain a lifeline for the teachers, parents and small businesses who rely on Michaels and our products to enable creative learning,” she said. Michaels is offering curbside pickup and has temporarily closed locations in certain states, including California, New York and Pennsylvania.

JoAnn craft stores, GameStop, Office Depot and Guitar Center have also come under fire for keeping stores open. A spokesman for Office Depot said the company is not requiring retail employees to come to work if they are not comfortable. Guitar Center, which furloughed 9,000 workers on Monday, said it is following state and local rules regarding store closures. JoAnn and GameStop did not respond to requests for comment.

In Plain City, Ohio, workers at a TenPoint Complete call center who administer automotive surveys by phone have been instructed to report to work even after the state issued a stay-at-home order, according to one employee who spoke on the condition of anonymity because she feared reprisal.

Her work, she said, consists of calling customers to ask about their experience at the body shop.

“This is not an essential job,” she said.

TenPoint Complete did not respond to a request for comment.

Even as other department stores, such as Nordstrom and Kohl’s, have temporarily shut their doors and kept paying their workers, Dillard’s has kept locations operating where government authorities allow it, making it one of the few remaining mall-based stores to remain open despite the pandemic, employees say.

That has sparked concern from employees, social media outrage by community members and a petition drive urging it to close that alleges, “Unlike other retailers who care about the safety and well-being of their employees and the guests they serve everyday, Dillard’s is choosing to run a blind eye in order to keep money funneling into their greedy pockets.”

Some employees who work for the company expressed fear about the stores remaining open, saying that they have been offered no assurances of pay if their stores close and that they had to pay more for their health insurance as their hours were cut.

One full-time Dillard’s employee based in Colorado, who requested anonymity to preserve her job, said that before her store closed in the middle of last week, she tried to use the vacation time she has accumulated to take off two weeks, but was told she couldn’t because the store was short-staffed. Her store has since closed because of local restrictions for nonessential businesses, and she said they were not being paid during the closure, other than for earned vacation leave. They have received little clear information about whether they would get their jobs back when the stores reopened, she said.

An employee in her 60s based in southwest Florida said she has not yet accumulated any paid time off, so if she were to get sick, she would have no paid leave. “They say you’re more than welcome to stay home, but that’s, of course, without pay,” at least for her.

She said the company has done little to directly encourage social distancing from customers making purchases. “They’re just telling us to relay to customers — politely — to stand back,” she said, but not putting up signage or tape to mark where customers should stand. “They are providing us at each register with a little small bottle of hand sanitizer. Mine has about a quarter of it left.”

In an email, Julie Johnson Guymon, a company spokeswoman, said “direct communication” with associates began Monday. In an earlier statement, she said Dillard’s is “fully cooperating with any government directives in our markets and promptly closing under those guidelines. Importantly, we are strictly following CDC guidelines for the safety of our associates and the customers who choose to visit us where open. No associate who is uncomfortable working is required to do so. We believe continuing to operate using current safety standards is the best thing we can do long term for our associates and for the economy.”

 

 

 

Amazon, Instacart Grocery Delivery Workers Strike For Coronavirus Protection And Pay

https://www.npr.org/2020/03/30/823767492/amazon-instacart-grocery-delivery-workers-strike-for-coronavirus-protection-and-

Amazon, Instacart Grocery Delivery Workers Strike For Coronavirus ...

Amazon warehouse workers in Staten Island, N.Y., and Instacart’s grocery delivery workers nationwide plan to walk off their jobs on Monday. They are demanding stepped-up protection and pay as they continue to work while much of the country is asked to isolate as a safeguard against the coronavirus.

The strikes come as both Amazon and Instacart have said they plan to hire tens of thousands of new workers. Online shopping and grocery home delivery are skyrocketing as much of the nation hunkers down and people stay at home, following orders and recommendations from the federal and local governments.

This has put a spotlight on workers who shop, pack and deliver these high-demand supplies. Companies refer to the workers as “heroes,” but workers say their employers aren’t doing enough to keep them safe.

The workers are asking for a variety of changes:

  • Workers from both Amazon and Instacart want more access to paid sick time off. At this time, it’s available only to those who have tested positive for the coronavirus or get placed on mandatory self-quarantine.
  • Amazon workers want their warehouse to be closed for a longer cleaning, with guaranteed pay.
  • Instacart’s grocery delivery gig workers are asking for disinfectant wipes and hand sanitizer and better pay to offset the risk they are taking.

Workers at Amazon’s Staten Island facility have said that multiple people at the warehouse have been diagnosed with COVID-19. Some of them plan to walk off the job on Monday to pressure the company to close the warehouse for an extended deep cleaning.

At Amazon, which employs some 800,000 people, workers have diagnosed positively for COVID-19 in at least 11 warehouses, forcing a prolonged closure of at least one warehouse in Kentucky. The company says it has “taken extreme measures to keep people safe,” including allowing unlimited unpaid leave time for employees who feel uncomfortable working.

Amazon says its decision on whether to close a warehouse for cleaning or for how long depends on where the sick workers were in the building, for how long, how long ago and other assessments. The company has also temporarily raised its pay by $2 an hour through April.

Instacart’s army of grocery delivery workers are not employees, but independent contractors. They say the company has not provided them with proper protective items like disinfectants, hazard pay of an extra $5 per order and a higher default tip in the settings of the app.

Instacart on Sunday said it would distribute supplies, including hand sanitizer, to more workers and that it would change some tipping settings, but did not address paid sick leave for its contractors.

Actions speak louder than words,” Instacart worker Sarah Polito told NPR. “You can tell us that we’re these household heroes and that you appreciate us. But you’re not actually, they’re not showing it. They’re not taking these steps to give us the precautions. They’re not giving us hazard pay.”

 

 

 

 

Nurses Die, Doctors Fall Sick and Panic Rises on Virus Front Lines

Nurses Die, Doctors Fall Sick and Panic Rises on Virus Front Lines ...

The pandemic has begun to sweep through New York City’s medical ranks, and anxiety is growing among normally dispassionate medical professionals.

A supervisor urged surgeons at Columbia University Irving Medical Center in Manhattan to volunteer for the front lines because half the intensive-care staff had already been sickened by coronavirus.

“ICU is EXPLODING,” she wrote in an email.

A doctor at Weill Cornell Medical Center in Manhattan described the unnerving experience of walking daily past an intubated, critically ill colleague in her 30s, wondering who would be next.

Another doctor at a major New York City hospital described it as “a petri dish,” where more than 200 workers had fallen sick.

Two nurses in city hospitals have died.

The coronavirus pandemic, which has infected more than 30,000 people in New York City, is beginning to take a toll on those who are most needed to combat it: the doctors, nurses and other workers at hospitals and clinics. In emergency rooms and intensive care units, typically dispassionate medical professionals are feeling panicked as increasing numbers of colleagues get sick.

“I feel like we’re all just being sent to slaughter,” said Thomas Riley, a nurse at Jacobi Medical Center in the Bronx, who has contracted the virus, along with his husband.

Medical workers are still showing up day after day to face overflowing emergency rooms, earning them praise as heroes. Thousands of volunteers have signed up to join their colleagues.

But doctors and nurses said they can look overseas for a dark glimpse of the risk they are facing, especially when protective gear has been in short supply.

In China, more than 3,000 doctors were infected, nearly half of them in Wuhan, where the pandemic began, according to Chinese government statistics. Li Wenliang, the Chinese doctor who first tried to raise the alarm about Covid-19, eventually died of it.

In Italy, the number of infected heath care workers is now twice the Chinese total, and the National Federation of Orders of Surgeons and Dentists has compiled a list of 50 who have died. Nearly 14 percent of Spain’s confirmed coronavirus cases are medical professionals.

New York City’s health care system is sprawling and disjointed, making precise infection rates among medical workers difficult to calculate. A spokesman for the Health and Hospitals Corporation, which runs New York City’s public hospitals, said the agency would not share data about sick medical workers “at this time.”

William P. Jaquis, president of the American College of Emergency Physicians, said the situation across the country was too fluid to begin tracking such data, but he said he expected the danger to intensify.

“Doctors are getting sick everywhere,” he said.

Last week, two nurses in New York, including Kious Kelly, a 48-year-old assistant nurse manager at Mount Sinai West, died from the disease; they are believed to be the first known victims among the city’s medical workers. Health care workers across the city said they feared many more would follow.

Mr. Riley, the nurse at Jacobi, said when he looked at the emergency room recently, he realized he and his colleagues would never avoid being infected. Patients struggling to breathe with lungs that sounded like sandpaper had crowded the hospital. Masks and protective gowns were in short supply.

“I’m swimming in this,” he said he thought. “I’m pretty sure I’m getting this.”

His symptoms began with a cough, then a fever, then nausea and diarrhea. Days later, his husband became ill. Mr. Riley said both he and his husband appear to be getting better, but are still experiencing symptoms.

Like generals steadying their troops before battle, hospital supervisors in New York have had to rally, cajole and sometimes threaten workers.

“Our health care systems are at war with a pandemic virus,” Craig R. Smith, the surgeon-in-chief at NewYork-Presbyterian Hospital, wrote in an email to staff on March 16, the day after New York City shut down its school system to contain the virus. “You are expected to keep fighting with whatever weapons you’re capable of working.”

“Sick is relative,” he wrote, adding that workers would not even be tested for the virus unless they were “unequivocally exposed and symptomatic to the point of needing admission to the hospital.”

“That means you come to work,” he wrote. “Period.”

Arriving to work each day, doctors and nurses are met with confusion and chaos.

At a branch of the Montefiore hospital system in the Bronx, nurses wear their winter coats in an unheated tent set up to triage patients with symptoms, while at Elmhurst Hospital Center in Queens, patients are sometimes dying before they can be moved into beds.

The inviolable rules that once gave a sense of rhythm and harmony to even the busiest emergency rooms have in some cases been cast aside. Few things have caused more anxiety than shifting protocols meant to preserve a dwindling supply of protective gear.

When the pandemic first hit New York, medical workers changed gowns and masks each time they visited an infected patient. Then, they were told to keep their protective gear on until the end of their shift. As supplies became even more scarce, one doctor working on an intensive care unit said he was asked to turn in his mask and face shield at the end of his shift to be sterilized for future use. Others are being told to store their masks in a paper bag between shifts.

“It puts us in danger, it puts our patients in danger. I can’t believe in the United States that’s what’s happening,” said Kelley Cabrera, an emergency room nurse at Jacobi Medical Center.

An emergency room doctor at Long Island Jewish Medical Center put it more bluntly: “It’s literally, wash your hands a lot, cross your fingers, pray.”

Doctors and nurses fear they could be transmitting the virus to their patients, compounding the crisis by transforming hospitals into incubators for the virus. That has happened in Italy, in part because infected doctors struggle through their shifts, according to an article published by physicians at a hospital in Bergamo, a city in one of the hardest-hit regions.

Frontline hospital workers in New York are now required to take their temperature every 12 hours, though many doctors and nurses fear they could contract the disease and spread it to patients before they become symptomatic.

They also say it is a challenge to know when to come back to work after being sick. All medical workers who show symptoms, even if they are not tested, must quarantine for at least seven days and must be asymptomatic for three days before coming back to work.

But some employers have been more demanding than others, workers said.

Lillian Udell, a nurse at Lincoln Medical Center, another public hospital in the Bronx, said she was still weak and experiencing symptoms when she was pressured to return to work. She powered through a long shift that was so chaotic she could not remember how many patients she attended. By the time she returned home, the chills and the cough had returned.

“I knew it was still in me,” she said. “I knew I wasn’t myself.”

Christopher Miller, a spokesman for the Health and Hospitals Corporation, said the agency could not comment on Ms. Udell’s claim, but said its hospitals had “never asked health care workers who are sick and have symptoms of Covid-19 to continue to work or to come back to work.”

There is also the fear of bringing the disease home to spouses and children. Some medical workers said they were sleeping in different rooms from their partners and even wearing surgical masks at home. Others have chosen to isolate themselves from their families completely, sending spouses and children to live outside the city, or moving into hotels.

“I come home, I strip naked, put clothes in a bag and put them in the washer and take a shower,” one New York City doctor at a large public hospital said.

Because the pathogen has spread so widely, even medical workers not assigned directly to work with infected patients risk contracting the disease.

A gynecologist who works for the Mount Sinai hospital system said she had begun seeing women in labor who were positive for the coronavirus. Because she is not considered a front-line worker, she said, restrictions on protective gear are even more stringent than on Covid-19 units. She said she was not aware of any patients who had tested positive after contact with doctors or nurses, but felt it was only a matter of time.

“We’re definitely contaminating pregnant mothers that we’re assessing and possibly discharging home,” said the doctor, who spoke on condition on anonymity because her hospital had not authorized her to speak.

Mount Sinai said in a statement that it had faced equipment shortages like other hospitals, but added the issues had been solved in part by a large shipment of masks that arrived from China over the weekend. The hospital “moved mountains” to get the shipment, the statement said.

This week, the Health and Hospitals Corporation recommended transferring doctors and nurses at higher risk of infection — such as those who are older or with underlying medical conditions — from jobs interacting with patients to more administrative positions.

But Kimberly Marsh, a nurse at Westchester Medical Center outside New York City, said she has no intention of leaving the fight, even though she is a 53-year-old smoker with multiple sclerosis and on a medication that warns against getting near people with infections.

“It almost feels selfish,” she said, though she acknowledged that with two years before retirement she could not afford leave if she wanted to.

Even so, she said, the fear is palpable each time she steps into the emergency room. A nurse on her unit has already contracted the virus and one doctor is so scared he affixes an N95 mask to his face with tape at the beginning of each shift. Ms. Marsh said she sweats profusely in her protective gear because she is going through menopause and suffers from hot flashes.

“We all think we’re screwed,” she said. “I know without any doubt that I’m going to lose colleagues. There’s just no way around it.”

 

 

 

What health care is getting out of the stimulus package

https://www.axios.com/health-care-hospitals-coronavirus-stimulus-package-c49bd0cc-05a0-479a-a83d-d4455bd0e7bd.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Senate passes $2 Trillion coronavirus economic stimulus plan, it ...

Congress’ big stimulus package will provide more than $100 billion and several favorable payment policies to hospitals, doctors and others in the health care system as they grapple with the coronavirus outbreak.

The big picture: Hospitals, including those that treat a lot of rural and low-income patients, are getting the bailout they asked for — and then some.

The cornerstone provision is a no-strings-attached $100 billion fund for hospitals and other providers so they “continue to receive the support they need for COVID-19 related expenses and lost revenue,” according to a summary of the legislation.

  • It’s unclear how that money would be divvied up. One lobbyist speculated the funds would go to the “hardest-hit areas first and those areas that are next expected to get hit,” but that has not been clarified.

The bill provides many other incentives for the industry.

  • Hospitals that treat Medicare patients for COVID-19 will get a 20% payment increase for all services provided. That means Medicare’s payment for these types of hospital stays could go from $10,000 to $12,000, depending on the severity of the illness.
  • Employers and health insurers will be required to pay hospitals and labs whatever their charges are for COVID-19 tests if a contract is not in place. By comparison, Medicare pays $51.33 for a commercial coronavirus test.
  • Medicare’s “sequestration,” which cuts payments to providers by 2%, will be lifted until the end of this year.
  • Labs won’t face any scheduled Medicare cuts in 2021, and won delays in future payment cuts as well.

What’s missing: Patients who are hospitalized with COVID-19 could still be saddled with large, surprise bills for out-of-network care.

  • There also are no subsidies for COBRA coverage, which employers wanted for people who lost their jobs. However, people who are laid off are able to sign up for a health plan on the Affordable Care Act’s marketplaces or could qualify for Medicaid.

 

 

 

 

Hospitals consider universal do-not-resuscitate orders for coronavirus patients

https://www.washingtonpost.com/health/2020/03/25/coronavirus-patients-do-not-resucitate/?utm_campaign=wp_post_most&utm_medium=email&utm_source=newsletter&wpisrc=nl_most

Image result for Hospitals consider universal do-not-resuscitate orders for coronavirus patients

Worry that ‘all hands’ responses may expose doctors and nurses to infection prompts debate about prioritizing the survival of the many over the one.

Hospitals on the front lines of the pandemic are engaged in a heated private debate over a calculation few have encountered in their lifetimes — how to weigh the “save at all costs” approach to resuscitating a dying patient against the real danger of exposing doctors and nurses to the contagion of coronavirus.

The conversations are driven by the realization that the risk to staff amid dwindling stores of protective equipment — such as masks, gowns and gloves — may be too great to justify the conventional response when a patient “codes,” and their heart or breathing stops.

Northwestern Memorial Hospital in Chicago has been discussing a do-not-resuscitate policy for infected patients, regardless of the wishes of the patient or their family members — a wrenching decision to prioritize the lives of the many over the one.

Richard Wunderink, one of Northwestern’s intensive-care medical directors, said hospital administrators would have to ask Illinois Gov. J.B. Pritzker for help in clarifying state law and whether it permits the policy shift.

“It’s a major concern for everyone,” he said. “This is something about which we have had lots of communication with families, and I think they are very aware of the grave circumstances.”

Officials at George Washington University Hospital in the District say they have had similar conversations, but for now will continue to resuscitate covid-19 patients using modified procedures, such as putting plastic sheeting over the patient to create a barrier. The University of Washington Medical Center in Seattle, one of the country’s major hot spots for infections, is dealing with the problem by severely limiting the number of responders to a contagious patient in cardiac or respiratory arrest.

Several large hospital systems — Atrium Health in the Carolinas, Geisinger in Pennsylvania and regional Kaiser Permanente networks — are looking at guidelines that would allow doctors to override the wishes of the coronavirus patient or family members on a case-by-case basis due to the risk to doctors and nurses, or a shortage of protective equipment, say ethicists and doctors involved in those conversations. But they would stop short of imposing a do-not-resuscitate order on every coronavirus patient. The companies declined to comment.

Lewis Kaplan, president of the Society of Critical Care Medicine and a University of Pennsylvania surgeon, described how colleagues at different institutions are sharing draft policies to address their changed reality.

“We are now on crisis footing,” he said. “What you take as first-come, first-served, no-holds-barred, everything-that-is-available-should-be-applied medicine is not where we are. We are now facing some difficult choices in how we apply medical resources — including staff.”

The new protocols are part of a larger rationing of lifesaving procedures and equipment — including ventilators — that is quickly becoming a reality here as in other parts of the world battling the virus. The concerns are not just about health-care workers getting sick but also about them potentially carrying the virus to other patients in the hospital.

R. Alta Charo, a University of Wisconsin-Madison bioethicist, said that while the idea of withholding treatments may be unsettling, especially in a country as wealthy as ours, it is pragmatic. “It doesn’t help anybody if our doctors and nurses are felled by this virus and not able to care for us,” she said. “The code process is one that puts them at an enhanced risk.”

Wunderink said all of the most critically ill patients in the 12 days since they had their first coronavirus case have experienced steady declines rather than a sudden crash. That allowed medical staff to talk with families about the risk to workers and how having to put on protective gear delays a response and decreases the chance of saving someone’s life.

A consequence of those conversations, he said, is that many family members are making the difficult choice to sign do-not-resuscitate orders.

Code blue

Health-care providers are bound by oath — and in some states, by law — to do everything they can within the bounds of modern technology to save a patient’s life, absent an order, such as a DNR, to do otherwise. But as cases mount amid a national shortage of personal protective equipment, or PPE, hospitals are beginning to implement emergency measures that will either minimize, modify or completely stop the use of certain procedures on patients with covid-19.

Some of the most anxiety-provoking minutes in a health-care worker’s day involve participating in procedures that send virus-laced droplets from a patient’s airways all over the room.

These include endoscopies, bronchoscopies and other procedures in which tubes or cameras are sent down the throat and are routine in ICUs to look for bleeds or examine the inside of the lungs.

Changing or eliminating those protocols is likely to decrease some patients’ chances for survival. But hospital administrators and doctors say the measures are necessary to save the most lives.

The most extreme of these situations is when a patient, in hospital lingo, “codes.”

When a code blue alarm is activated, it signals that a patient has gone into cardiopulmonary arrest and typically all available personnel — usually somewhere around eight but sometimes as many as 30 people — rush into the room to begin live-saving procedures without which the person would almost certainly perish.

“It’s extremely dangerous in terms of infection risk because it involves multiple bodily fluids,” explained one ICU physician in the Midwest, who did not want her name used because she was not authorized to speak by her hospital.

Fred Wyese, an ICU nurse in Muskegon, Mich., describes it like a storm:

A team of nurses and doctors, trading off every two minutes, begin the chest compressions that are part of cardiopulmonary resuscitation or CPR. Someone punctures the neck and arms to access blood vessels to put in new intravenous lines. Someone else grabs a “crash cart” stocked with a variety of lifesaving medications and equipment ranging from epinephrine injectors to a defibrillator to restart the heart.

As soon as possible, a breathing tube will be placed down the throat and the person will be hooked up to a mechanical ventilator. Even in the best of times, a patient who is coding presents an ethical maze; there’s often no clear cut answer for when there’s still hope and when it’s too late.

In the process, heaps of protective equipment is used — often many dozens of gloves, gowns, masks, and more.

Bruno Petinaux, chief medical officer at George Washington University Hospital, said the hospital has had a lot of discussion about how — and whether — to resuscitate covid-19 patients who are coding.

“From a safety perspective you can make the argument that the safest thing is to do nothing,” he said. “I don’t believe that is necessarily the right approach. So we have decided not to go in that direction. What we are doing is what can be done safely.”

However, he said, the decision comes down to a hospital’s resources and “every hospital has to assess and evaluate for themselves.” It’s still early in the outbreak in the Washington area, and GW still has sufficient equipment and manpower. Petinaux said he cannot rule out a change in protocol if things get worse.

GW’s procedure for responding to coronavirus patients who are coding includes using a machine called a Lucas device, which looks like a bumper, to deliver chest compressions. But the hospital has only two. If the Lucas devices are not readily accessible, doctors and nurses have been told to drape plastic sheeting — the 7-mil kind available at Home Depot or Lowe’s — over the patient’s body to minimize the spread of droplets and then proceed with chest compressions. Because the patient would presumably be on a ventilator, there is no risk of suffocation.

In Washington state which had the nation’s first covid-19 cases, UW Medicine’s chief medical officer, Tim Dellit, said the decision to send in fewer doctors and nurses to help a coding patient is about “minimizing use of PPE as we go into the surge.” He said the hospital is monitoring health-care workers’ health closely. So far, the percentage of infections among those tested is less than in the general population, which, he hopes, means their precautions are working.

‘It is a nightmare’

Bioethicist Scott Halpern at the University of Pennsylvania is the author of one widely circulated model guideline being considered by many hospitals. In an interview, he said a blanket stop to resuscitations for infected patients is too “draconian” and may end up sacrificing a young person who is otherwise in good health. However, health-care workers and limited protective equipment cannot be ignored.

“If we risk their well-being in service of one patient, we detract from the care of future patients, which is unfair,” he said.

Halpern’s document calls for two physicians, the one directly taking care of a patient and one who is not, to sign off on do-not-resuscitate orders. They must document the reason for the decision, and the family must be informed but does not have to agree.

Wyese, the Michigan ICU nurse, said his own hospital has been thinking about these issues for years but still is unprepared.

“They made us do all kinds of mandatory education and fittings and made it sound like they are prepared,” he said. “But when it hits the fan, they don’t have the supplies so the plans they had in place aren’t working.”

Over the weekend, Wyese said, a suspected covid-19 patient was rushed in and put into a negative pressure room to prevent the virus spread. In normal times, a nurse in full hazmat-type gear would sit with the patient to care for him, but there was little equipment to spare. So Wyese had to monitor him from the outside. Before he walked inside, he said, he would have to put on a face shield, N95 mask, and other equipment and slather antibacterial foam on his bald head as the hospital did not have any more head coverings. Only one powered air-purifying respirator or PAPR was available for the room and others nearby that could be used when performing an invasive procedure — but it was 150 feet away.

While he said his hospital’s policy still called for a full response to patients whose heart or breathing stopped, he worried any efforts would be challenging, if not futile.

“By the time you get all gowned up and double-gloved the patient is going to be dead,” he said. “We are going to be coding dead people. It is a nightmare.”

 

 

 

 

Everybody wants a piece of the stimulus

https://www.axios.com/newsletters/axios-vitals-a411a6cb-fd41-45d9-9dcb-da9136c68ea6.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Image result for axios vitals Everybody wants a piece of the stimulus

Lobbyists are racing to grab a piece of the stimulus package lawmakers are still trying to hammer out on Capitol Hill, Bob writes.

Driving the news: Hospitals and physicians want at least $100 billion and significant Medicare payment hikes, partially because they’ve had to cancel lucrative elective procedures.

  • Hotels, airlines, restaurants, casinos, manufacturers and other service industries that have been battered by the coronavirus spread are angling to get hundreds of billions in loans and other funding.
  • A coalition of major employers is lobbying Congress for payroll tax credits and coverage subsidies for people who lose their jobs.

The intrigue: The chance for federal bailouts has motivated small players to make bigger investments, and some nontraditional parties are spending their first lobbying dollars.

 

 

 

 

“We’re looking at a tsunami”

https://mailchi.mp/a3d9db7a57c3/the-weekly-gist-march-20-2020?e=d1e747d2d8

Yesterday we spoke with a senior healthcare executive leading the COVID-19 response for a regional health system on the West Coast. Their area is now experiencing exponential growth of new cases, with the number of local diagnoses doubling every couple of days. In all likelihood, they’re less than two weeks from having the number of cases seen in harder-hit areas like San Francisco, Seattle and New York City. She said the “anticipation of what is about to happen” is the scariest part of the around-the-clock work they are doing to prepare.

But that two-week lead time has given them precious time to organize, and she generously shared key elements of their action plan. Their preparation work—surely similar to what hundreds of health systems around the country are doing—impressed us not only with its breadth, depth and comprehensiveness, but also the level of energy and confidence conveyed by the hundreds of actions and decisions, large and small, the system is making every day. Here are some of their important learnings so far:

  1. Even though the surge of patients has yet to begin, staff are “worried and scared”. They are concerned about PPE shortages and personal safety and stressed at home with schools and daycare closed. Detailed and regular communication is more critical than ever—and they’re trying to answer every inbound concern or question from associates directly. They are funding and expanding childcare options for staff, through partnerships with community organizations and daily stipends for home-based care.
  2. As the system works through worst-case scenario planning, they anticipate the need for critical care nurses, respiratory therapists, and emergency physicians will be the worst bottlenecks, and they are working to cross-train adjacent clinicians and build new staffing models to increase capacity. While most providers are deeply dedicated to providing care for COVID-19 patients, a small number have already “called off” and refused to report—creating unanticipated questions around how to manage these difficult situations.
  1. As they prepare to implement new surge staffing models, the system is now navigating through a period of downtime. With elective procedures cancelled and some ambulatory sites closed, they currently need fewer nurses and clinical staff than a month ago, and are creating policies, like allowing staff to go negative into PTO, to maintain income while they wait for the surge. Staff who must work in-person are working variable shifts to reduce crowding. They are also working to credential nurses and staff furloughed from local ambulatory surgery centers, so they have them ready to deploy when needed.
  1. IT staff are working nonstop to quickly make it possible for all eligible employees to work remotely, and to enable staff to safely gain access to the system’s intranet while guarding against new cybersecurity threats. The system is training and enabling hundreds of doctors to deliver care virtually, including affiliated independents.
  1. Guidelines for coronavirus patient management and recommended PPE practices change daily; it’s a full-time job for clinical leaders to keep up. Doctors are eager to try novel and creative treatments for very sick patients. (For instance, one doctor is developing a 3-D printed device that will allow one ventilator to be used for four patients simultaneously.) This eagerness to “do something” is understandable but creates a bit of chaos as leaders work to create policies around how to best manage patients.
  1. While leaders communicate with other health systems and local and state authorities daily, the vast majority of decisions are made internally, on the fly. For instance, the system is connecting with now-empty local hotels and universities to provide options for low-acuity patient capacity, but leaders hope that parallel efforts at other organizations can be brought together into a more unified regional response. For now, however, coordination would likely create unacceptable delays.
  1. Long-term health and stamina of staff is top among the system’s concerns. “If I borrow worry from the future”, this leader said, “I am worried that we are facing years-long trauma, both emotional and financial, and I’m not sure how we will sort it out”. For now, efforts to support staff and provide moments of relief and joy, are critical, and very appreciated by front-line team members.

We left this conversation emotionally overwhelmed ourselves, and with a huge sense of gratitude for clinicians and health system leaders. Americans can take comfort in the amount of work that is taking place even before critical patients begin to appear—and that doctors, nurses and hospitals are truly dedicated to providing us the best possible care under circumstances they have never faced before. If you know about creative approaches or new ideas organizations are putting in place to contend with the current situation, please let us know. We’re eager to share great ideas!

 

 

 

We may need retired doctors and nurses

https://www.axios.com/newsletters/axios-vitals-57b7c8cf-bfca-4900-845a-7a841790f39d.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Image result for axios We may need retired doctors and nurses

Hospitals are asking retired doctors and nurses to come back and help with operations as they prepare for a rush of severe coronavirus cases, Axios’ Bob Herman reports.

The bottom line: Retired clinicians likely won’t be placed in intensive care units or coronavirus testing stations, because older adults are at higher risk of falling ill and dying from the virus. But they could help stabilize hospitals that will need as many hands on deck as possible over the coming months.

Where it stands: The Association of American Medical Colleges floated this idea last week with hospitals and federal agencies.

  • “The question is: How can we bring people up to speed and bring them in?” said Janis Orlowski, a physician and executive at the AAMC. “They will … [likely] backfill in areas where it’s not direct patient care.”

What they’re saying: Some retired clinicians are willing to take on other necessary care, while residents and other doctors funnel into coronavirus cases.

By the numbers: 41% of doctors are 55 or older, according to American Medical Association data provided to Axios, and 38% of nurses are 55 or older.

 

 

 

COVID-19 threatens to overwhelm hospitals. They’re weighing how best to ration care.

https://www.healthcaredive.com/news/covid-19-threatens-to-overwhelm-hospitals-theyre-weighing-how-best-to-rat/574489/

The coronavirus outbreak is forcing the U.S., a nation largely unaccustomed to scarcity, to have tough conversations about how to allocate limited medical resources as hospitals warn its only a matter of time before they’re inundated with COVID-19 patients.

Across the country, hospital officials are discussing ethical dilemmas and attempting to draft policies about rationing care when patients needing ventilators and other resources dwarf the supply, several hospital ethicists told Healthcare Dive. In addition to issues of mortality, questions also are being raised about whether medical workers can opt out of treating patients with COVID-19, particularly if they don’t have the right personal protective equipment.

“They are having these conversations at the policy level,” Kelly Dineen, director of the health law program at Creighton University and a member of COVID-19 Ethics Advisory Committee at the University of Nebraska Medical Center​, told Healthcare Dive.

Ethical dilemmas are usually tackled by a hospital’s ethics committee, which, in an ideal scenario, encompasses a variety of workers from across the hospital, including clinicians, ethicists and social workers. 

No federal mandate exists requiring hospitals to have such committees. However, many do to meet accreditation standards that require facilities to have some sort of mechanism for ethics conflicts and decision making. Many choose to meet that standard by having an ethics committee, though not all do, according to one expert.

Hospitals are at risk of not having the capacity to care for a surge of COVID-19 patients if an outbreak similar to Wuhan or Italy occurs here. New York Gov. Andrew Cuomo has pleaded with the federal government to allow the Army Corps of Engineers to build back-up facilities as the COVID-19 rapidly spreads through areas of the hard-hit state. Similarly, California Gov. Gavin Newsom has requested a Navy hospital ship and two mobile hospitals to address a surge in patients.

Federal officials are urging Americans to do their part by retreating to their homes to socially distance themselves from others in an effort to hamper the disease’s reach. CMS also last week urged hospitals to put off non-essential elective surgeries to prepare for an onslaught of cases. Years of culling hospital beds in a shift to outpatient care has the nation’s facilities short of meeting expected demand under some prediction models.

The concern about scarce resources is not unfounded. Italy’s healthcare system has been pushed to the brink and many see parallels in terms of the trajectory of the spread. Overwhelmed with sick patients, Italy’s society of anesthesiology and intensive care published recommendations on how to prioritize patients and not just serve the first in the door.

China, the first country to report cases of the disease, feverishly began building hospitals to meet demand.

And the U.S. has far fewer hospital beds per 1,000 residents than China or Italy.

It’s important facilities across the country start having conversations about allocating resources now before clinicians are pushed to their limits, ethicists said.

“Any time you have that kind of pressure and load … it’s going to be hard to also be thinking about all of the ethical implications and what that means in a way that might otherwise not be so hard,” Dineen said.

The struggle will be effectively communicating those policies throughout a system or hospital, Erica Salter, associate professor and program director of the doctorate program for healthcare ethics at St. Louis University, told Healthcare Dive.

“It’s wise to anticipate failures of communication and protect against those,” Salter said.

Ultimately, those policies will vary by institution, though ethicists said it’s important to be proactive rather than reactive. And hospitals should also be prepared to be held to account for decisions that are made, Dineen said.

Patients and their loved ones will want to know there was a process and that it was fair, not arbitrary. 

“There’s no reason we can’t be prepared with a process, even if we don’t necessarily have a better answer,” she said.

Still, despite the most well-intentioned plans it will always be the doctor’s call, Arthur Caplan, head of the division of medical ethics at NYU School of Medicine, told Healthcare Dive.  

“You’re going to see variation in what is decided floor to floor, doctor to doctor, hospital to hospital,” Caplan said.

Still, some hospitals are hesitant to issue overly broad guidance because of the liabilities that might come later. However, depending on the state, emergency orders issued during a pandemic may help shield providers or systems from liability as standard of care decisions were made during a unique situation.

And, though Americans may struggle to talk about the end of life and mortality, the medical profession is used to tough conversations about scarce resources.

For example, when dialysis machines were first developed, the technology was not widely available for everyone with end-stage kidney failure. A decision had to be made about which patients were granted access to the lifesaving treatment and which ones were not. It’s a conversation that continues today for those needing transplants.

“The principles guiding these decisions are not new,” Salter said. “We’ve been dealing with issues of scarce resources for many decades.”

 

 

 

 

Hospital leaders plead for financial help, warn of closures, missing payroll

https://www.healthcaredive.com/news/hospital-leaders-plead-for-financial-help-warn-of-closures-missing-payrol/574625/

Hospital executives from across the country sounded the alarm Saturday about the dire need for federal financial aid as their cash on hand continues to erode amid the coronavirus pandemic.

“We’ll exhaust all avenues to make payroll in the next few weeks,” Scott Graham, CEO of Three Rivers and North Valley Hospitals in rural Washington said of Three Rivers during a call with reporters Saturday morning.

The American Hospital Association is urging lawmakers on Capitol Hill to consider deploying at least $100 billion to aid hospitals fight against the outbreak of the novel coronavirus. The relief package would fund medical personnel, supplies and infrastructure, and expenses related to COVID-19, Rick Pollack, CEO of AHA, told reporters.

Without a relief package, Pollack warned it “could mean that many hospitals won’t survive.” The pleas came as Congress debates a stimulus package this weekend.

American life has ground to halt as experts urge the public to distance themselves from others in an attempt to slow the spread of the virus. Many states closed bars and restaurants with virtually all group events canceled. Likewise, hospitals have been asked — or required in some locales — to halt all elective procedures to free up resources for an expected surge of patients.

But hospitals rely on those typically lucrative procedures to drive revenue. Some hospitals are starting to wonder how they’ll keep the lights on after facing the reality of canceled procedures and the need to increase staff and supplies to combat the pathogen.

On top of that, hospitals are unable to get much needed supplies as some vendors are requiring payment on delivery, funds they do not have.

There is no time to waste, hospital leaders warned, citing less than two weeks cash on hand.

“We need to get this done now,” Pollack said of an emergency funding package from the federal government.

Despite the dire financial strain, hospitals are still preparing to increase capacity to meet a surge in demand. It’s unclear whether they will be reimbursed for all expenses related to increasing the amount of beds, capacity and supplies.

Some areas were already facing a shortage of nurses and physicians before the outbreak and anticipate that to become worse.

“In spite of our existing financial challenges, we are planning to increase capacity because that is what we must do,” LaRay Brown, CEO of One Brooklyn Health System in New York, said Saturday. One Brooklyn​ operates three hospitals, nursing homes and community health centers in New York, serving about 2 million.

Brown said all hospitals in New York were asked Friday by state health officials to submit plans for the upping of capacity by 50% of existing bed count.

Brown anticipates receiving some support from the state of New York but seemed wary of the state’s future financial footing as it battles the pathogen as well, and with a weakened tax base as businesses have shuttered.

“This is why I’m on this call,” Brown said. “We need immediate cash relief from the federal government.”