TRANSFORMING HEALTH — The state’s largest nurses’ union says health-care workers don’t have essential face masks, access to testing, and other safety measures, even as hospitals push to restart elective procedures and some lawmakers try to speed up Pennsylvania’s reopening.
The union also claims the state “is being misinformed about the situation on the ground from hospitals.”
In a letter to Health Secretary Rachel Levine, the Pennsylvania Association of Staff Nurses and Allied Professionals said hospitals are sitting on stockpiles of industry standard N95 respirators, while leaving nurses to risk their lives with inadequate, lower quality masks.
“It’s not about the quantity of [personal protective equipment] locked away in a closet, but whether the hospitals are handing out the PPE to staff,” Mark Warshaw, co-executive director for PASNAP, wrote in the letter, which was obtained by Spotlight PA and WITF.
The state has tasked the Hospital and Healthsystem Association of Pennsylvania — a member organization and registered lobbyist for hospital chains — with a number of responsibilities, including enforcing “mutual aid” agreements to share supplies and making sure workers have what they need.
Warshaw said in the letter the hospital association is telling state officials protective equipment “is not an issue at the moment,” while failing to mention that hospitals “have resorted to severe rationing of PPE.” The union represents 8,400 nurses across the state, with many of its leaders working in Philadelphia and surrounding counties that have been hit hard by the virus.
A spokesperson for the state health department declined to respond to whether officials were being misinformed, but said Levine “appreciates the concerns raised in this letter.”
A spokesperson for the Hospital and Healthsystem Association of Pennsylvania did not address the claims raised in the letter, but said hospitals are following the state’s guidance on safety measures and sharing supplies with one another when facilities face a shortfall.
“Early in the COVID-19 response, hospitals received shipments of personal protective equipment to help equip staff for dealing with presumed and confirmed COVID-19 patients,” spokesperson Rachel Moore said. “While we have seen some improvements in the supply chain, some areas remain under strain as additional cases continue to spread and the wider global market supply continues to trail demand.”
Since March 6, the state health department has required hospitals to report, three times a day, “the expected number of days remaining N95 respirators will last, the expected number of days remaining other PPE will last, and the number of employees unavailable for work,” spokesperson Nate Wardle said in an email. “Each of these reporting items are so the department can assist those facilities in need.”
The letter does not contend that facilities lack supplies or that they aren’t following Centers for Disease Control and Prevention pandemic guidelines. But those “crisis mode” standards “have given hospitals an excuse and enabled them to ignore basic protections and safety standards for health-care workers, and we are the ones suffering,” Warshaw said.
“Pennsylvania health-care professionals are scared, exhausted, starting to get sick, and some are dying,” he wrote in the letter. “These frontline warriors read the guidance that hospitals receive from your department and believe that [it is] written solely to protect hospital interests at the expense of their health and safety.”
Gov. Tom Wolf began shutting down the state’s economy and ordering residents to stay home in March to keep hospitals from becoming overwhelmed with COVID-19 patients. The state has largely avoided that worst-case scenario, leading Levine to allow hospitals to perform elective procedures as long as those facilities can still help patients sick with COVID-19.
However, Levine said the state won’t give masks or other protective equipment to hospitals that start those procedures.
Until issues with PPE rationing and a lack of testing are resolved, the nurses’ union said it “vehemently opposes” hospitals restarting elective procedures — something that has been a priority for health systems because they generate 30% to 50% of revenue.
Nationwide, hospitals have suffered massive financial losses expected to total $200 billion for the four-month period from March through June, according to a recent American Hospital Association report.
Warshaw said “conditions remain unsafe for health-care professionals,” and resuming elective procedures will put further strain on limited resources.
“The action of reopening elective surgeries and procedures is a huge contradiction to the declared crisis status,” Warshaw said in the letter. “If the reason they can’t follow normal protections and safety standards is their declaration that they are ‘in a crisis,’ then they can’t reopen elective procedures.”
The nurses’ union is calling for regular in-hospital testing for nurses, mandatory notifications for health workers who have been exposed, quarantine procedures for health-care workers exposed to someone who was sick, and more protective equipment including at least one new N95 mask each day.
The health department declined to say whether it would consider these requests.
At Temple University Hospital in Philadelphia, nurses in the infant intensive care unit are making do with one surgical mask per day, according to Maureen May, a registered nurse in the unit who is also president of the nurses’ association.
Nurses are given a somewhat more protective KN95 mask after someone has tested positive for COVID-19, May said. But by that point, health workers and other patients in the hospital already would have been exposed to the coronavirus.
And those KN95 masks do not meet longtime safety standards because they are not fitted like the more protective N95 respirators, May said. Some health-care workers at Temple told The Philadelphia Inquirer these masks are falling apart as they wear them.
May recently assisted with a “stat” cesarean section where the mother was COVID-19 positive, and said she had to scramble to mold a KN95 mask to her face when every second counted and lives were on the line.
“If I were to practice what I practiced today two months ago, or pre-pandemic, I would be considered a reckless nurse,” May said. “So I’ve had to lessen my standard, and compromise what I know is the right thing to do.”
Temple University Hospital did not respond to a request for comment.
Nurses are being told that they need to accept the lower safety standards because the hospital is “in crisis mode,” May said. At the same time, she said, health systems are telling state officials that everything is under control.
A lack of face masks isn’t the only problem. Another nurse in the unit recently got sick with COVID-19 and ended up in intensive care, May said, and none of the nurse’s coworkers were notified — even though they all had been in close contact. May and her colleagues only learned the nurse was sick when that nurse notified them.
“I believe we have lost faith in any system that is around us,” May said. “The federal government has failed us. The state has failed us.”