Staffers at Tacoma hospital with COVID outbreak work while awaiting surveillance test results
Workers at CHI Franciscan’s St. Joseph Medical Center are reaching out to their unions and calling for rapid change in procedures at the hospital after a COVID-19 outbreak has spread among patients and staff.
On Oct. 22 the hospital first publicly announced it had confirmed COVID-19 cases in two patients and one worker after the patients had previously tested negative. The cases were tied to the seventh floor, a pre-surgical wing.
By Oct. 26, the numbers had grown to seven employees and four patients.
And, by Oct. 30, news spread among hospital employees that more cases were being identified, with the total as of Friday at 18. Four new cases among staff are in other parts of the hospital separate from the seventh floor cluster of 10 employees and four patients.
Amy Clark, media representative for SEIU Healthcare 1199NW, told The News Tribune via email on Friday that union members were getting messages that the health department “is requiring workers on other floors to be tested since cases are coming up beyond the seventh floor.”
SEIU represents service workers and LPNs at the site.
The union and the Washington State Nurses Association have both been in communication with hospital officials. The hospital officials say they are following local and federal guidelines in responding to the outbreak.
SEIU sent a letter to Sharon Royne, senior vice president of Human Resources at the hospital, seeking changes in how the hospital has been handling the outbreak.
According to the letter sent Oct. 26: “Many of our members are frightened for their safety and the safety of their families, as well as their patients and community. It is troubling that we have been raising concerns about personal protective equipment, notification of exposure, and other safety issues for many months before this outbreak occurred.”
A WSNA representative concurred in a separate interview with The News Tribune.
“With the flu season approaching and the potential for another surge of COVID-19, we really have to get these issues solved now,” Jayson Dick, WSNA’s associate director of labor advocacy, told The News Tribune.
WSNA represents more than 1,200 registered nurses at St. Joe’s.
Dick said it had been a “whirlwind” since his office learned of the outbreak from its members.
“We’ve had several nurses report that they were tested last Friday, the 23rd, and still have not seen results,” he told The News Tribune on Oct. 30. “As of today, some of our nurses are turning to outside testing facilities to get the results faster within a 24-hour period.”
This is in contrast to the hospital’s remarks. In a Friday afternoon update it announced that “All results from this first round of testing have been received.”
With the spread of cases this week, he said, WSNA met with members Friday who work in the affected areas of the hospital.
“Hospital managers must listen to our nurses and other front line workers and make changes our members need to see so they can feel safe coming to work,” Dick said.
Working with health department
The hospital is working with Tacoma-Pierce County Health Department case investigators to find the source of the spread.
Dale Phelps, COVID-19 communications lead for the Tacoma-Pierce County Health Department, said the department was made aware of the outbreak Oct. 20 by CHI Franciscan.
“We’ve been working with them via phone. They have done everything we’ve asked them to do,” Phelps told The News Tribune earlier this week. “The investigation is still ongoing.”
The source of the spread hasn’t been identified.
“In many investigations we are unable to determine one,” Phelps said.
SEIU’s letter listed issues relating to previous terms of agreement not being honored or standard of care issues that needed immediate improvement.
At the top of the list was a call for rapid COVID test results for workers, contending that now it can take three to five days to get results, while patients receive the rapid tests for quick turnaround.
“We expect these test result lag times to improve immediately,” the letter stated.
It also called for eight-hour written notification of any potential exposure, “as outlined in our existing Memorandum of Agreement dated March 15. … We remind you that the agreement has not been altered or amended by the presence of an outbreak.”
Cary Evans, vice president for communications and government affairs, CHI Franciscan, defended the hospital’s testing and notification practices in response to questions from The News Tribune.
“We are preserving the two- to four-hour turn-around tests for our patients so we can appropriately place them and assign their isolation status and ensure the staff have the appropriate PPE on as soon as possible after admission,” Evans responded via email. “As with all hospitals, we typically receive test results within three to five days for employee testing from several different providers, including the University of Washington.
“Fortunately, the majority of the results are coming back in 24 to 48 hours. All positive results are immediately flagged and Employee Health works with the employee individually.”
The answers were also posted on the hospital’s update posted Friday.
Dick maintained that changes needed to be made in the protocol.
“One of our directors has reached out and been in conversations about what can be done and what agreements we can reach to help get rapid testing and timely notification of exposures. This is a circumstance where it just took too long for members to learn about this,” he said.
As far as notifications, Evans said: “The Infection Prevention team needed to do the tracing to see if there were connections between the cases to determine if they were related or not.
“As with all hospitals, there have been positive cases throughout the pandemic, and we must engage in contact tracing and investigations to determine the source of the infections before public health makes a determination.”
Evans described the sequence of the events leading to notifications.
“We notified public health about the first single case on Oct. 20. On Thursday, Oct. 22, a team met with TPCHD to review two additional positive patients and one positive employee,” Evans said. “We were instructed to begin the process to assess employees and patients for a potential outbreak. The notification to the staff and public was made that day.
“In general, we have processes in place to ensure prompt notification of known exposures. In this situation, we expanded notification and informed employees, using several communication mediums, of the outbreak and potential for exposure.”
Dick said the process needs improvement.
“No nurse should ever have to find out about COVID-19 outbreaks at their hospital on their unit where they work from the news media, and in this particular case, that’s what happened for a lot of nurses,” he said.
Paid time off, COVID award
Both SEIU and WSNA also seek paid administrative leave for workers following a COVID test until receiving results and during any quarantine.
“We have heard that workers are being required to work while waiting for test results,” SEIU’s letter stated.
Dick of WSNA added, “Nurses placed on leave or in a quarantine status shouldn’t have to take a financial hit. Our members have been showing up and working on the front lines of COVID-19 crisis for months, putting themselves and their families at risk. Now when there’s an infection control lapse at their hospital, they’re being told to use up their own PTO and that’s not right.”
According to Evans: “Any employee who is identified as experiencing a workplace exposure is connected with the Employee Health department and participates in a risk assessment with a nurse.
“We follow CDC guidance to the letter, which says if employees have been exposed to an individual known to be infected for more than 15 minutes, and during that time the provider and the patient were not wearing a mask, they fall into a category of higher risk and they will be sent home to quarantine.”
Evans added, “An employee directed to quarantine by the Employee Health nurse is provided paid leave for up to 14 days of quarantine.”
Additionally, the SEIU letter called for adequate PPE, safe staffing levels and equitable distribution of a new award for COVID caregivers.
The letter described a scenario where workers put at risk in the latest outbreak had earlier been deemed ineligible for the award:
“The outbreak this month is a direct case in point of why this exclusion is divisive and angering to our members. The very same week that hundreds of caregivers across St. Joe’s received a $1,000 COVID Caregiver Award, workers on the seventh floor were directly exposed to a COVID outbreak — and yet had been excluded from the award because management did not consider the seventh floor to be a ‘COVID floor.’”
Evans told The News Tribune: “Employees working in designated roles and departments that provided regular care to COVID patients received a Caregiver Award earlier in the month and before the situation occurred on the seventh floor.”
One worker’s story
Alisha Colyer works as a dietary aide delivering meals to patients at St. Joseph and works in the kitchen.
Colyer told The News Tribune in an interview Tuesday that she was waiting for her COVID-19 test results after learning she was potentially exposed delivering at least one meal to the seventh floor, the epicenter of the outbreak.
She said her co-workers were just returning from a previous COVID-19 situation in the hospital’s dietary office, essentially a call center that takes meal orders from patients. The hospital had to switch to basic “house trays” for patients rather than offering a full menu for a week as a result of those workers being sent home to quarantine.
For those potentially exposed to the cases tied to the seventh-floor, Colyer said, testing started shortly after the initial announcement.
“The testing started on Friday, I believe, and we were told that we were to go take a test and then come back to work. We weren’t to quarantine. And that was a little bit troublesome to a lot of us, including myself because for one, I just felt like just a few days ago, we quarantined five co-workers because they were exposed,” Colyer said. “And they had to be taken off the schedule, immediately sent home right in the middle of their shift. So why, a couple of days later, it’s business as normal and just continue working? All of us, if we potentially have it, we could be potentially exposing ourselves to other people.”
Evans explained the difference between the two incidents.
“The dietary office was not an outbreak but rather a specific known exposure to someone with COVID-19. With any known exposure, we remove employees from work for 14 days per CDC guidelines,” Evans said. “For the seventh floor, we are conducting surveillance testing recommended by the health department.
“With this type of testing, there is no known exposure, so employees are allowed to continue working per health department directives. We have investigated each positive patient and staff member to identify any staff who may have been exposed and must leave work per CDC guidelines.”
Dick told The News Tribune on Friday; “Nurses have reported being asymptomatic or with mild symptoms that they might attribute to allergies or something like that and later tested positive. Several nurses have already reported to us that they initially tested negative and then subsequently tested positive.”
Colyer also expressed concern that doors to patient rooms labeled isolation on the seventh floor were being left open so patients could be monitored.
“I noticed that all of the rooms were wide open, all the doors are open (to rooms) that have isolation COVID patients in there,” Colyer said. “And part of the isolation protocol for those patients is that the doors are supposed to remain shut, which to me means that you’re putting more of a potential risk to the staff.”
Evans, when asked about the doors, responded: “We are working with the team on the seventh floor and their leaders to ensure all doors that need to be closed are kept closed.”
Colyer also said the nasal swab tests for workers were self-administered, and she’s not sure it was done correctly.
“The nurses that are there are only opening the container and allowing us to grab the (swab) ourselves and having us administer the test to ourselves,” Colyer said. “They’re the trained medical professionals, and I just work in the dietary department.
“I don’t feel like that’s the way it should be handled.”
She compared the experience to an earlier test she took this year at the Tacoma Dome, where it was administered to her, and she recalled it being painful.
“I couldn’t imagine anybody being able to do that to themselves,” Colyer said. “I’m more worried that people are going to have false negatives if they don’t do it the correct way. And you know the patients in the hospital can receive a rapid test, get back results in a couple hours. Why can’t the staff?”
Colyer eventually received her test result: Negative.
PPE and new fears
The recent outbreak isn’t the first time St. Joseph has come under scrutiny for COVID safety practices.
In March, a complaint was filed with the Department of Labor & Industries related to “the lack of access to personal protective equipment, including N95 respirators and surgical masks,” according to Tim Church, media representative for the department.
Additionally, lack of fit testing for PPE was included in the complaint.
“We performed an inspection and found no violations. It was completed in late August (Aug. 26),” Church told The News Tribune.
The letter sent from L&I to St. Joseph as a result of the investigation was similar to ones received by MultiCare Indigo clinics as a result of complaints filed with the state by employees over lack of PPE. L&I stated the CDC had issued guidelines for “limited use and reuse of PPE. Under normal circumstances, following these guidelines would not be allowable occupational health practices.”
Another union, UFCW21, in August warned of the potential for a future hospital outbreak in Pierce County after another CHI Franciscan property, St. Michael Medical Center in Bremerton, faced a large outbreak.
The list of complaints were the same as now: shortage of PPE, employees risking asymptomatic illness and a lack of transparency from CHI Franciscan in communicating information on everything from supplies to outbreak updates to workers.
The situation hasn’t improved much, Dick told The News Tribune on Friday.
“Many nurses are reporting that (St. Joseph) is having them wear simple surgical masks and protective eye goggles when treating confirmed COVID patients,” he said. “This is directly out of compliance with the September 2020 hazard alert that was jointly issued by Washington state Department of Health and the Washington state Department of Labor, which states that all hospital employees who enter rooms that have a patient with suspected or confirmed COVID 19 must use a properly fitted N95 respirator.”
Evans of CHI Franciscan countered that PPE supplies were fine.
“We are well-stocked with all PPE, including N95 masks, eye protection and CAPRs. No employee should be using anything less under these circumstances and needs to inform their leader if they have questions about appropriate PPE usage,” Evans said.
Colyer said PPE for her department has improved.
“We have now been told we have enough PPE, so that we can now go get a new mask, if our mask becomes soiled … we can go get a new one,” Colyer said. “Prior to that we were only allowed one mask a day for eight hour shift.”
Friday’s news of new cases renewed fears of exposure.
Colyer told The News Tribune via email she didn’t directly receive the latest alert and was told Friday its release was limited “to the staff they felt were affected.”
“Not very reassuring if you ask me,” she added.
Clark of SEIU said Friday evening: “I am now hearing that members might be getting some inconsistent guidance from management on testing. Workers may have been told that they don’t have to retest for COVID if they were tested last week, even though there is a new outbreak in another area of the hospital.”
All of it, said Dick, proves change needs to happen now.
“I know I said it before, but we have got to get these issues solved now. Because if this is the level of response, we’re going to be in for another hard hit, and it’s going to grow,” Dick said Friday.
“If we can’t say that we’re not OK, and just be honest, then denial is not a strategy to get our members, patients and communities through this safely.”
This story was originally published November 1, 2020 at 7:05 AM.
