NUrses at the Alta Bates Summit Medical Center were at the forefront as early as March, when patients who had tested positive for Covid-19 began showing up in areas of the hospital that were not set aside to take care of them.
The Centers for Disease Control and Prevention had advised hospitals to isolate Covid-19 patients to limit staff exposure and help maintain high-level personal protective equipment that has been in short supply.
Nevertheless, Covid patients continued to be spread through Oakland Hospital, according to complaints to the California Department of Occupational Safety and Health (Cal / Osha). Areas of concern included medical unit on the sixth floor where veteran nurse Janine Paiste-Ponder worked.
Covid patients on this floor did not live in their rooms, either because they were confused or uninterested in the rules, according to Mike Hill, a nurse in the hospital’s intensive care unit. Hill, who is also the hospital’s chief representative for the California Nurses Association, said staff did not receive highly protective N95 respirators.
“It was just a matter of time before one of the nurses died on one of those floors,” Hill said.
Two nurses became ill, including Paiste-Ponder, 59, who died of complications from the virus on July 17.
The California Nurses Association has filed complaints to Cal / Osha, the state’s workplace safety regulator. Similar concerns have swept across the United States, according to interviews, a review of government safety complaints and inspection reports on health facilities.
Covid patients are mixed with others for various reasons. Limited testing has meant that some patients carrying the virus were only identified after they had already exposed others. In other cases, they had false negative test results, or their facility was dismissive of federal guidelines that carry no legal force.
As recently as July, a National Nurses United survey of more than 21,000 nurses found that 32% work in facilities that do not have dedicated Covid devices. By that time, coronavirus had reached all but 17 U.S. counties, data collected by Johns Hopkins University shows.
Federal occupational safety and health officials have closed at least 30 complaints about patient mix at hospitals nationwide without issuing a referral. They include a requirement that a hospital in Michigan keep patients who tested negative for the virus in the Covid device in May. An upstate New York hospital also kept Covid patients in the same unit as those without infection, according to a closed complaint to the Federal Occupational Safety and Health Administration.
Federal health and human services have urged hospitals to notify them daily of whether a patient who came in without Covid-19 but developed an apparent or confirmed case of Covid-19 within 14 days. Hospitals submitted 48,000 reports from June 21 to August 28, although the number reflects a double or additional count of individual patients.
At Alta Bates in Oakland, hospital staff made it clear in official complaints to Cal / Osha that they wanted administrators to follow the state’s unique law on aerosol-transmitted diseases.
The rules require that patients with viruses such as Covid-19 be moved to specialized units – or to a specialized facility – within five hours of identification.
Initially, in March, the hospital equipped a Covid unit with 40 beds, according to Hill. But when a wave of patients could not realize, this device was paired to 12 beds.
Since then, a steady stream of virus patients has been recorded, he said, and many tested only positive days later – and after they had been in ordinary rooms in the facility.
From March 10 to July 30, the Hills union and other eight lodged complaints with Cal / Osha, including allegations that the hospital did not follow isolation rules for Covid patients, some of whom were placed on the cancer floor.
So far, regulators have done little. Gov. Gavin Newsom ordered workplace safety officials to “focus on … supporting compliance” instead of enforcement except on “the most serious violations”.
Government officials responded to complaints by contacting telephone and telephone to “ensure that the correct virus prevention measures are in place”, and two investigations are underway, according to Frank Polizzi, a spokesman for Cal / Osha.
A third study related to transport workers without N95 respirators moving confirmed or possible coronavirus patients at a Sutter Health facility near the hospital resulted in a $ 6,750 fine, Cal / Osha records show.
The string of complaints also says the hospital did not provide staff caring for virus patients with the personal protective equipment (PPE) required by state law – an N95 respirator or something more protective.
Instead, Hill said staff on floors with Covid patients received lower-quality surgical masks, a problem reflected in complaints lodged with Cal / Osha.
A spokesman for Sutter Health said the hospital took allegations, including Cal / Osha complaints, seriously and that its highest priority was to protect patients and staff.
The statement also said that “co-ordination” or the practice of grouping virus patients is a tool that “should be considered in a larger context, including the patient’s sharpness, hospital count and other environmental factors”.
CDC guidelines are not strict in keeping Covid patients separate, noting that “facilities could consider designating entire units within the facility with dedicated [staff]“To take care of infected patients.
This approach was successful at the University of Nebraska Medical Center in Omaha. A recent study reported “extensive” viral contamination around patients with Covid-19 there, but noted that with “standard” infection control techniques in place, staff caring for infected patients did not get the virus.
The hospital set up an isolation unit with air pumped away from halls, limited access to the unit and trained staff to use well-developed protocols and N95 respirators – at least.
What worked in Nebraska, however, is far from standard elsewhere.
In Southern California, leaders of the National Union of Healthcare Workers filed an official complaint with state hospital inspectors about the risks associated with mixed Covid patients at Fountain Valley Regional Hospital, which is part of Tenet Health. There, according to the complaint, patients were not routinely tested for Covid-19 at admission.
A nursing assistant spent two consecutive 12-hour shifts caring for a patient on a general medical floor who required supervision. At the end of the second shift, she was told that the patient had tested positive for Covid.
The worker had only worn a surgical mask – not an N95 respirator or any kind of eye protection, according to the complaint to the California Department of Public Health. The nursing assistant was not offered a Covid test or quarantined before her next two shifts, the complaint said.
The Department of Public Health said it could not comment on a pending inspection.
Barbara Lewis, ward clinic for the hospital ward in Southern California, said Covid patients were kept on the same floor as cancer patients and postoperative patients who walked into the halls to speed up their recovery.
A spokeswoman for the hospital, Jessica Chen, said the hospital “quickly implemented” changes instructed by state health authorities and places some Covid patients in the same care unit as non-Covid patients under surges. She said they were placed in single rooms with closed doors. Covid tests were given after medical treatment, she added, and employees could access them elsewhere in the community.
This contrasted, Lewis said, with high-profile examples of the precautions that could be taken.
“Now we see what happens to baseball and basketball – they are tested every day and treated with great care,” Lewis said. “Yet we have thousands and thousands of health workers who have to work in a very scary environment.”
KHN (Kaiser Health News) is a non-profit news service covering health issues. It is an editorially independent program from KFF (Kaiser Family Foundation) that is not affiliated with Kaiser Permanente