Honesty From Hospitals/Governments During the Coronavirus--June 2020

 

(Photo by John Carroll)

All over the world people have lost trust in their leaders. And this is a big problem during the novel coronavirus pandemic. 

Health care workers, especially those on the frontline, have identified problems fighting Covid-19, but some have found out that speaking publically about their concerns is dangerous for their careers. 

In recent weeks in the United States, clinicians and nurses have spoken out on social media and in the press about unsafe working conditions and shortages of personal protective equipment (PPE) as they and their colleagues provide care to patients.

From Medscape Medical News—

“Some of those clinicians have been reprimanded or even fired for speaking out. And many other healthcare professionals have said they feel they can’t tell their story for fear they too will face disciplinary action from their employer.” 

Dr. Ming Lin is an Emergency Medicine physician who was practicing in Bellingham, Washington. Dr. Lin worked at PeaceHealth St. Joseph Medical Center for 17 years. St. Joseph is a Catholic not-for-profit in a large chain of hospitals owned by PeaceHealth. 

In March, when worried that St. Joseph Medical Center was doing too little to prevent the spread of coronavirus, Dr. Lin took his concerns to his administrative superiors. And not satisfied with their answer, he turned to social media, and in a series of posts over 11 days, he called for greater protections for doctors, nurses, and patients at St. Joseph Medical Center. 

“I do fear for my staff,” he said in a video recorded March 26 on YouTube. “Morally, when you see something wrong, I think you have to speak out.”

The next day Dr. Lin was fired. 

(A spokeswoman for St. Joseph said that Lin did not work for the hospital and referred questions about his dismissal to TeamHealth, the medical staffing firm that employed him at the hospital.)

So what did Dr. Lin say that was so egregious to his administrative bosses that resulted in his termination? 

In mid-March, in a letter to a superior that he shared on Facebook, Lin wrote that the medical center was “…so far behind when it comes to protecting patients and the community, but even worse when it comes to protecting the staff.”

He called for drive-through testing for the coronavirus, faster turnaround of test results, and screening of patients and staff as they entered the facility.

Subsequent posts said that nurses were given gowns offering little protection and that some had been told not to wear masks.

Dr. Lin also said the hospital lacked an area where workers could disinfect to avoid carrying the virus back to their families and the community.

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And in Chicago at Northwestern Memorial Hospital the Chicago Tribune published this article. 

“A nurse is suing Northwestern Memorial Hospital, saying she was fired after warning fellow employees the masks provided by the hospital would not properly protect them against the coronavirus.

“Lauri Mazurkiewicz alleges that Northwestern required staff to wear a type of mask “less safe and less effective” than the N95 model. In fact, she says, staff were specifically not allowed to wear the N95 mask on hospital grounds.

“Mazurkiewicz said she raised concerns when the hospital began treating patients for the coronavirus this month and she was exposed to people diagnosed with the highly contagious and sometimes fatal disease.

“Mazurkiewicz said she sent an email to about 50 fellow employees last Wednesday, warning them that the N95 face masks were “safer and more effective” than masks provided by the hospital. The next day, Mazurkiewicz said she wore an N95 mask to the hospital and was fired.”

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So what is going on? 

In the middle of April, NPR reported the following:

“Nearly 9,300 U.S. health care workers contracted COVID-19, and 27 have died. A majority of those who tested positive (55%) think they were exposed while at work.”

It seems that Dr. Lin and Nurse Mazurkiewicz were correct with their warnings regarding the transmissibility of the virus to health care workers. But both were fired from their hospitals. 

Hospital administrators can be very punitive with their response to “whistleblowers” because they are very afraid of any embarrassment the hospital may have if the public realizes their shortcomings. They are also afraid of any lawsuits that may arise if their hospitals do not protect their patients and staff. And so hospital administrators can be very quick to censor what is said by its employees. 

Also, at the end of the day, hospitals know that patients are money and cash flow trumps hospital medical ethics. 

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In Haiti, things are no better regarding leadership during this pandemic. Haitians do not trust their government to do the right thing. Why would they? 

Many Haitians believe that the virus is not in Haiti and that their government has just made this up to secure international funds. In Haiti on a good day, it is almost impossible to social distance and many Haitians ignore their government’s health care precautions because of mistrust of their government. 

Haiti Support Group Blog–

“In recent months Haitian healthcare workers have staged numerous walkouts, protesting a lack of essential supplies and abysmal sanitary conditions in Haitian hospitals. Unsurprisingly, hospitals in Port are reporting they are utterly unprepared to face the looming pandemic.”

Like the Haitian population, Haiti’s doctors and nurses do not trust their government to provide them adequate PPE to care for patients if they start flooding the public hospitals. Consequently, some doctors and nurses are refusing to come into work and risk their lives in such conditions. 

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I have a personal interest in physicians and nurses who speak out to attempt to improve care for patients. 

In September 2001, after multiple unsuccessful attempts on my part to have meaningful discussions of ER crowding at the departmental level, I sent an email to the CEO at OSF-Saint Francis Medical Center in Peoria regarding Emergency Room crowding. We were seeing thousands of more patients each year in the ER than it was designed to see. And sick elderly patients of mine in the ER were signing out after waiting long times to be admitted. 

I was put on probation the following day. 

Over the next few months, I met with the CEO multiple times regarding my concerns over ER crowding. However, he did not seem to be concerned about overcrowding or with my elderly patients being “boarded” in his ER. To my face, he metaphorically referred to me as a “malignancy” in the ER and told me things like “fear amongst employees is a good thing”.

I was fired in December 2001. 

Since that time it has been shown that keeping patients in the ER for prolonged periods of time prior to admission is associated with increased patient morbidity and mortality. 

From January 2020 EM:RAP, Rick Bukata, MD had a post called “The Moral Problem of ED Crowding”:

“Throughput issues in the emergency department can lead to increased morbidity and mortality, increased medical errors, compromised privacy, and provider moral distress. 

“Crowding (in the Emergency Department) creates competition for scarce resources such as space and time. The moral distress of caring for multiple patients without adequate resources is debilitating and this has prompted scholars to define and promote moral resilience.

“Provider moral distress is being placed in a situation where you feel you are unable to do the job as you would like.

“There are multiple potential fixes such as improving staffing, improved throughput, increasing capacity, observation, physician in triage, point-of-care testing, etc. They assert that ED crowding makes it difficult for emergency physicians to meet their moral obligations to patients.”

Bukata continues:

“Hospital administration should focus on solutions to ED throughput issues. The CEO and executive medical committee can fix the problem. They just need to want to fix it. Getting an ED that treats patients and clinicians as we want to be treated is not hard. The CEO and chief of staff need to walk down to the ED when it is a mess and say they will fix it.” 

These were my thoughts in 2001 and was the reason my email went to OSF’s CEO. However, he was clearly not under the impression that boarding sick and fragile elderly patients in his ER was his moral dilemma. 

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Conclusion—

The world needs honesty from its leaders at the local and national levels. (In this post I purposefully left out the United States federal government response to the coronavirus.)

Health care workers need to be able to advocate for their patients and themselves without fear of retaliation from their hospital administration.

When we cannot trust our leaders at the hospital level or at a governmental level, the problems dealt out by the coronavirus (or any other medical problem) are all the more deadly. 

 

John A. Carroll, MD

www.haitianhearts.org