When Kaiser Permanente ran out of replacement shields for its powered air-purifying respirators — a hooded garment that protects health care workers from airborne biological hazards — it allegedly scrambled to make its own using electrical tape and sheets of plastic.
“That's the garbage they handed us to use,” said Amy Arlund, an intensive care nurse at Kaiser’s Fresno Medical Center and board member with the California Nurses Association.
Arlund says it’s just one example of the health system’s lax record on protecting its employees and patients during the coronavirus pandemic. The Fresno facility had an outbreak in March that resulted in 10 nurses testing positive for COVID-19. One of them, Sandra Oldfield, died in late May due to complications from the disease.
The California Nurses Association says Kaiser bears responsibility for Oldfield’s death because it failed to provide adequate protective equipment.
Kaiser rejects this claim and argues it has provided the necessary protective gear throughout the pandemic.
Employees at the health system have been vocal about their concerns, holding multiple demonstrations in recent months. They’ve also filed many coronavirus health and safety complaints with the California Division of Occupational Safety and Health, or Cal OSHA.
Of the 2,599 total complaints received by the state from February to late May, nearly 120 were about Kaiser. That’s substantially more than any other health system in California, and appears to be the most among any company in the state.
The health system operates 36 hospitals and hundreds of medical offices in California; the Fresno facility, where Oldfield worked, was the subject of eight complaints. Employee complaints include a range of allegations: claims they were not provided adequate protective equipment, were instructed to recycle single-use masks and were not informed about contact with individuals who tested positive for coronavirus.
Diane McClure, a registered nurse at Kaiser’s south Sacramento facility, says the situation has improved in recent weeks, but the health system is still cutting corners. She says that’s especially alarming as California sees a surge in coronavirus hospitalizations.
Kaiser says it takes these complaints seriously, and that the safety of employees and patients is its highest priority.
“Throughout this pandemic, we have taken action to protect the health and safety of our employees and physicians, so they can care for the health needs of our members and communities,” wrote Dr. Stephen Parodi, an infectious disease physician and executive vice president of external affairs at Kaiser, in a statement.
The health system declined an interview request.
Parodi acknowledged there has been a learning curve to managing and acquiring protective equipment.
“During the initial phase of the pandemic, the entire healthcare community was striving to learn how best to manage the virus, protect health care workers, and deliver the best care,” he wrote. “Throughout this crisis we have and continue to face worldwide shortages of masks, gowns, and other equipment needed to protect the health of our workforce and patients.”
Masks A Key Concern
While other health systems in California have had their share of safety complaints during the pandemic, Kaiser has faced substantially more.
Cal OSHA received 46 complaints about Dignity Health and 37 complaints about Sutter Health. CapRadio reviewed complaint data and matched facility names and addresses with their parent health systems, as some complaints did not list business names.
Other companies with large footprints also had substantially fewer complaints than Kaiser. The state received about 20 complaints each for Amazon and Walmart, which both have facilities around the state.
CapRadio obtained records of workplace coronavirus complaints and summaries of complaints against Kaiser through Public Records Act requests to the state Department of Industrial Relations.
More than 100 complaints against Kaiser were deemed “valid” by the Cal OSHA. About half the cases have been “closed,” meaning the department believes the issue has been addressed.
Parodi says the health system received no citations as a result of the complaints.
“We understand the concerns raised during this unprecedented time,” he wrote. “And we agree it is paramount that our caregivers have the right level of protective equipment. Our policies and actions demonstrate commitment to ensuring our staff and physicians’ safety.”
Over three dozen complaints filed by Kaiser employees are specifically about masks, according to summaries provided by Cal OSHA.
Many claim nurses and staff were provided surgical masks instead of respirator N95 masks; the latter provides a greater level of protection against highly infectious diseases such as coronavirus. Some complaints allege staff had to reuse surgical masks, while others say staff were prohibited from wearing masks altogether during contact with patients.
Over two dozen other complaints discuss a general failure to provide adequate personal protective equipment.
McClure says the lack of protective equipment was most apparent during the first two months of the pandemic. That is reflected in the complaint data: more than 80 complaints were filed in March, and the number declined in the following months.
She says nurses at Kaiser’s south Sacramento facility are now provided N95 respirator masks, but are told to reuse them. She says the health system sanitizes the masks, but nurses are skeptical that it’s effective.
“The manufacturer actually recommends they are single-use only,” she said. “So, these masks should be thrown out after.”
National Nurses United, the parent organization of the California Nurses Association, has called for a halt to the practice of sanitizing and reusing respirator masks, citing research suggesting decontaminated masks don’t meet safety standards.
Arlund in Fresno says her facility has started distributing N95 masks, but their availability is limited. As a result, she says, nurses are buying masks out-of-pocket on secondary markets to ensure their personal protection.
“They're terrified they're going to come to work one day and be told: ‘Hey, sorry, we're just out. Tough luck.’”
Beyond the cost-burden of health care workers buying masks out-of-pocket, it could pose a safety risk. N95 masks are only effective if properly fitted to users. They also may be poor quality without the necessary certification.
Several complaints against Kaiser claimed the health system failed to fit-test staff for N95 masks to ensure effectiveness.
Parodi says the health system investigates and responds to each complaint filed with Cal OSHA.
“Throughout the ongoing pandemic, our policies and procedures have met and continue to meet occupational safety and health regulations and the extensive guidance issued by expert public health agencies,” he wrote.
Hospital Patients Surge
Positive coronavirus cases are on the rise in California, and so too are hospitalizations.
As of Monday, hospitalizations jumped 50% over 14 days. During the same period, admissions to intensive care units rose 39%.
Gov. Gavin Newsom has repeatedly said hospitals have adequate bed capacity statewide.
But some are starting to strain.
“Our facility has the highest number of COVID-positive patients in the region, and it's jumped enormously,” said McClure in south Sacramento. “So, I definitely feel the surge.”
She says Kaiser claims to have acquired enough protective equipment, but it continues to ration masks and then reuse equipment that should be thrown out after a single use.
“I understand that we need to be — as Kaiser would call it — good stewards of PPE [and] responsible about using it,” McClure said. “But we shouldn't be doing that to the point where we're unsafe.”
Parodi says controlling distribution of protective equipment is necessary for the health system’s preparedness.
“Conservation measures for PPE, adherent to public health authority recommendations, is a critical component to this response,” he wrote.
State officials say California has an inventory of 232 million procedure masks and 46 million N95 masks. On Wednesday, Newsom said California has given away over 15 million masks to other states, including Washington, Arizona and Oregon.
But employee concerns go beyond protective equipment. McClure says some nurses are tasked with providing care for COVID and non-COVID patients in a single shift, which could spread the virus.
She also criticized Kaiser’s system for contact tracing, which is the process of determining who an infected person crossed paths with. McClure says contact tracers don’t bother tracking people if contact with an infected person lasted less than 15 minutes.
The U.S. Centers for Disease Control and Prevention says the risk of transmitting the virus during brief interactions is lower, but it’s still possible.
Parodi’s statement did not specifically address concerns about Kaiser’s work shifts or contact tracing system.
Arlund claims contact tracing is essentially non-existent at the Fresno facility.
“Many of us who have had exposure to positive patients have never been called to follow up,” she said. “We've not been instructed on what we should do to monitor ourselves.”
Arlund says another outbreak among nurses may be unfolding at the Fresno Medical Facility. She says she’s aware of two nurses who tested positive after contact with an infected individual, and at least several more who had exposure to the same source.
“They need to know that nurses are not expendable,” she said. “I will not have one more nurse die in my facility because Kaiser has chosen not to protect us.”
Editor's note: Sutter Health is a major donor to CapRadio.
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