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Hospital policies questioned after employees are infected

Staff wonder if wearing masks and changing policy sooner could’ve reduced exposure

Maui Memorial Medical Center is pictured on April 1, the same day the hospital announced it had its first COVID-19 patient. Employees are questioning whether policies on protective equipment could’ve helped reduce exposure after 15 workers tested positive. The Maui News / MATTHEW THAYER photo

A state health official expressed concerns Wednesday that issues over equipment and infection protocols at Maui Memorial Medical Center might have contributed to a cluster of 15 employees who tested positive for COVID-19.

State Department of Health Director Bruce Anderson said that hospitals across the country and the state are taking steps to keep COVID-19 and other infections under control. People are being checked for a fever before entering the hospital. Anyone with a cough or respiratory illness has to wear a mask, “and there are lots of extraordinary steps being taken at most of our hospitals.”

“Maui Memorial has, I think, had some issues there, and I think that might’ve contributed to the outbreak,” Anderson said during a news conference on Wednesday. “Having said that, they are certainly at this point highly, acutely aware of the need for respiratory protection. That applies not only to COVID-19 patients but to virtually everyone in the hospital.”

Anderson said the state is working with Maui Memorial to make sure they have the protective equipment they need “so that doesn’t become an issue, and certainly we’re expecting them to implement those measures.”

Maui Health did not respond to questions on Wednesday about protective equipment and whether wearing masks might’ve prevented the outbreak.

State Department of Health Director Bruce Anderson speaks Wednesday during a news conference on Oahu. Anderson expressed concerns that issues over protective equipment and protocols “might’ve contributed to the outbreak” of 15 Maui Memorial Medical Center employees who tested positive for COVID-19. Photo courtesy Joint Information Center

However, employees at Maui Memorial also questioned Wednesday whether Maui Health’s policies on protective equipment and wearing masks could’ve helped reduce exposure, especially if they’d been reversed sooner.

“Had they been allowed to wear their own masks, we could have reduced numbers or limit the exposure,” said Rasa Priya Thom, a respiratory therapist at Maui Memorial.

Staff members in multiple departments, who spoke anonymously out of concern for their jobs, said they knew of employees who had tested positive after treating a COVID-19 patient but hadn’t been wearing proper protective equipment because the person wasn’t positive, and administrative policies discouraged them from wearing masks if they weren’t sick.

“They would not provide us with a mask if we were healthy or if we wanted to protect ourselves,” said one employee. “The only time they said if you can wear a mask is if the patient is coughing or if we are suctioning the patient, or risk getting any type of sputum on us.”

Before Maui Health changed its policies, some staff were admonished by other employees or management for wearing masks in common areas. And, masks became increasingly harder to access. They were no longer provided in rooms were they were once available to use on patients. Supplies were instead stored in a supervisor’s office and workers had to request them.

In the days before the first patient tested positive for COVID-19 on Maui, employees believed they would get the chance to wear masks based on a March 24 email from Greg Adams, chairman and CEO of the Kaiser Foundation Health Plan Inc. and Hospitals. Adams said that “the general use of masks in the health care setting may contribute to stopping the spread of coronavirus,” and that clinicians and staff could use masks from home in the work setting. They also would be allowed to use personal masks “in nonclinical areas and areas where staff has patient and member-facing encounters.”

However, the Kaiser-affiliated Maui Health that runs Maui Memorial told employees that Maui Health would “not be revising our current mask policy related to usage by clinical and nonclinical staff or use of nonhospital supplied masks.”

“Thank you for your conservation efforts of PPE (personal protective equipment) supplies and following our current policy of mask usage,” Maui Health CEO Michael Rembis said. “Your efforts allow us to provide hospital masks, as deemed appropriate by our policy.”

On March 31, Rembis reversed course, allowing staff to use their own masks while caring for non-COVID-19 patients and/or while in clinical areas where masks are not required, as well as in nonclinical areas and during encounters with non-COVID-19 patients.

But by that time, some employees had already treated the hospital’s first COVID-19 patient, which the hospital announced the day after changing its policy. Many employees questioned the timing.

“Because it’s not a controlled experiment, I can’t say that the people that are positive would’ve been negative had they had masks on,” said one employee. “I think their chances of getting it would’ve been reduced for sure. . . . It definitely feels a little reactive instead of proactive.”

Employees said that they understand the hospital faces the same issues as the rest of the country, including a shortage of equipment and testing. However, they said that going forward, the hospital could improve safety and a level of trust by being more transparent with workers. Many said they were slow to find out, both about the cluster and about possible exposure to patients or coworkers.

“It’s all kind of like word of mouth that we’re finding out who’s positive, who’s not,” said one employee. “We’re all face to face with each other for 12 hours sometimes, and if one of them is positive, I would think management would notify us.”

Thom also said he found out about the cluster from the news, rather than from leadership.

“I think right now there are some trust issues, the way several of us found out this information,” he said.

Thom said he believed “that the CEO is doing the best he can,” and that management is relying on collective data to make decisions. But, he added, “that process has proven to be ineffective.”

One employee said that “we’ve won the battle with the masks,” and that “the new battle as I see it, is getting transparency on PPE.”

“We are being told repetitively that we have the masks, we have plenty (of equipment),” the employee said. “But the reality is we’re not finding it when we need it.”

And, ultimately, employees want testing to be more widespread. ICU nurse Aaron Bear said it’s “baffling” to him and his coworkers that they haven’t been tested en masse. Until the hospital starts testing more people “that are walking around and are looking fine, this is just going to be a vicious cycle,” he said.

The ICU is housing the hospital’s COVID-19 patients, and Bear said that while some are very sick and require ventilators, others “look and almost feel totally normal.” That’s the problem with the virus — there could be carriers throughout the hospital who just aren’t showing symptoms, he said.

“There’s nobody supporting this concept of testing everybody that looks healthy,” Bear said. “The only places that are doing it are places that are in total crisis. And I think in this community, like I said, with the size of it, we could really prevent a lot of the trouble by swabbing people and sending them home for a couple of weeks and reswabbing them before they come back to work.”

* Colleen Uechi can be reached at cuechi@maui news.com. Melissa Tanji contributed to this story.

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