UC Davis nurses fear COVID-19 patients have infected employees. ‘Absurd’ to think otherwise
When he announced that employees of the UC Davis Medical Center in Sacramento had tested positive for coronavirus, health system CEO David Lubarsky cast blame on the outside world as “very likely” responsible.
He noted the hospital’s own infection-control regime for nurses, doctors and other medical staff, and said, “We simply can’t be protected outside of work.” Lubarsky said he expected many more infections among his employees in the days to come as the COVID-19 pandemic spreads.
Now, some employees of the healthcare network that employs 11,310 full- and part-time workers are pushing back. They contend it’s preposterous to suggest that UC Davis Medical Center employees haven’t been infected by contact with patients at the facility.
For one nurse — who believes she recently got sick after coming in contact with a COVID-19 patient — the reluctance doesn’t make sense given where they work.
“I mean that’s just absurd. We’re working around the highest-risk people in the whole entire community,” said the nurse who was at home sick Wednesday with symptoms of the novel coronavirus, although she hasn’t yet been tested. “So to tell us, ‘Well, you’re just going to catch it from the community, so sort of don’t worry about what we’re doing at the hospital.’ That’s a cop-out.”
She requested anonymity out of concerns she’d get fired. Another nurse who spoke to The Sacramento Bee on Tuesday expressed similar concerns after she tested positive for COVID-19. That nurse, who also requested anonymity out of fear of retaliation, said she believed she contracted the disease after coming into contact with a patient who had come in from a skilled nursing facility. Hospital officials disputed her claim.
Hospital spokesman Charles Casey said administrators are confident in saying staff members are being infected outside the hospital because UC Davis Medical Center has a dedicated “Infection Prevention team” that monitors and tracks all communicable diseases among patients and their interactions with staff members.
“This is becoming increasingly more difficult as COVID-19 increases in the community,” Casey said in an email. “All of the employees who have tested positive to date have been most likely community-acquired infections. We say ‘most likely’ because we can’t definitively state what happens to people outside the hospital.”
Casey said that “inside the hospital, we have only been able to connect one of the few positive-testing employees” as having had contact with “any of the few COVID-19 patients we’ve cared for in the past month.”
Casey said the positive-testing employee had worn proper protective equipment around the patient. He said the hospital has dedicated staff members who double-check to make sure equipment is worn properly, further minimizing the likelihood of the infection spreading.
Ordered not to investigate cases
Employees of the medical center have been threatened with job termination if they attempt to investigate on their own if a patient they had treated later tested positive for the virus, according to an internal memo obtained by The Bee. The hospital’s executives said it would violate patient privacy laws.
“Workforce access to patient information must always be for a work purpose. Inappropriate access is not tolerated and will be punished with disciplinary action up to and including termination,” Shara Rasmussen, UC Davis Health chief compliance and privacy officer, said Monday in the email to staff.
The announcement came Monday after Lubarsky, CEO of UC Davis Health, alerted hospital employees on Friday that some of their colleagues had been infected, and he warned that dozens more would get sick in the coming weeks as the infection spread through the community.
“While we practice contact/droplet precautions here at work,” he said in another email to staff obtained by The Bee. “We simply can’t be as protected outside of work.”
Some hospital employees say they found Lubarsky’s assertion that workers likely weren’t catching the virus inside the hospital baffling.
For one, they said, the medical center has done limited testing on staff and patients, especially for people seeking treatment who may not have symptoms of the disease. The concern is asymptomatic patients could be spreading the virus when they come to the hospital for other ailments.
“The *whole* point is that we don’t *know* which patients are positive!” UC Davis Radiologist Dr. Thomas Loehfelm wrote Wednesday on Twitter. “30% of cases are asymptomatic. For every case you found assume there are 10 more unidentified- asymptomatic or presymptomatic- among our patients, Drs, staff.”
In response to Loehfelm’s Tweet, Charles Casey, a hospital spokesman, said that the U.S. Centers for Disease Control and Prevention says people who are most contagious are those showing symptoms.
“Some spread might be possible before people show symptoms,” the CDC says. “There have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads.”
Hospital says workers are notified
Some staff members also feel the hospital hasn’t been doing enough to inform workers if the patients they encounter later tested positive for the disease, a claim the hospital also refutes.
“If a health provider has treated a patient who later tests positive, our Infection Protection people team will notify those individuals who need to know so appropriate precautions can be taken,” Casey said Wednesday in an email. “Anyone with any symptoms is removed from working immediately.”
In the memo to staff, Rasmussen, UC Davis Health chief compliance and privacy officer, made it clear that healthcare workers couldn’t check on their own without clear authorization.
“I understand that in this time of fear and uncertainty, there might be a desire to access medical records to check on the status of loved ones, former patients or even colleagues,” Rasmussen said in the email to staff. “However, if that is not part of your workflow, you may be in violation of HIPAA, state law and UC Davis Health policies.”
HIPAA is an abbreviation for the Health Insurance Portability and Accountability Act of 1996, a sweeping federal law that protects patient confidentiality in healthcare settings.
Casey said that while some HIPAA requirements have been temporarily softened because of the pandemic, “our responsibilities with respect to each employee’s requirement to access, use and disclose patient health information has not.”
“It is the responsibility of our expert Infection Prevention team to conduct contact tracing,” he said. “It is not the responsibility of individual health care providers in our system. Access to patient information without a valid work purpose is a violation of federal and state law. Employees have been, and can be, disciplined or terminated for violating patient privacy.”
He didn’t say how many were disciplined for tracking down COVID-19 patients.
‘My family didn’t sign up for that’
In early March, the hospital said 89 employees who were placed on in-home isolation precautions due to COVID-19 exposure were “doing well and will be returning to work.” All tested negative for the virus. A Solano County resident who was the nation’s first confirmed case of coronavirus from “exposure in the community” was treated at the facility in February.
In the weeks since, those sorts of mass staff quarantines have stopped, and the facility hasn’t been doing enough to inform staff if patients they treated later tested positive for the disease, the UC Davis nurse who hadn’t yet been tested for COVID-19 said Wednesday.
“Because I have young children and a husband at home, I need to know if I need to come home and isolate myself,” the nurse said. “I don’t know what I could be exposing them to. I know I’m already at a high risk because I’m a healthcare worker. That’s sort of something you sign up for when you become a medical professional, but my family didn’t sign up for that.”
The risks to healthcare workers from COVID-19 is high. In Italy, which has been the epicenter for Europe’s COVID-19 outbreak, at least 2,629 health care workers have been infected by coronavirus since the onset of the outbreak in February, according to a report published last week by an Italian research group. While there’s no official tally of how many died, local Italian media reports describe several did.
The nurse said that early on, the hospital was much more aggressive about ruling out if a patient had the disease and tracking hospital staff who went in and out of a suspected COVID-19 patient’s room.
At the time, any person who went into a room with a suspected case, staff members were required to sign a form hanging on the patient’s door, she said.
“They had a list of everyone who had come in contact with the patient, including the housekeeping staff who cleaned the room,” she said. “So if they had any kind of exposure, they would know who had been in contact with this person or anything that was even in the room. They’ve stopped doing that now because it’s considered ‘community spread.’ ”
The nurse said she began showing symptoms a few days after she treated a nursing home patient brought to the hospital last week. The patient had symptoms of COVID-19 and also tested negative for the flu, but the nurse said she’s unable to learn if the patient later tested positive for COVID-19.
The nurse hadn’t been tested yet for the disease but she said Wednesday she was going to be tested in the coming days. She said she’s frustrated with her CEO’s assertion that if she does indeed have COVID-19, she likely got it outside the hospital.
“I understand that there’s always a risk we could get it from the community, but the majority of people I work with in healthcare, we know the risk,” she said. “We’re staying home. I’m not (been) taking my kids out. Not even around the block. … We (healthcare workers) don’t want to spread it to the community if we get at work, so most of us are strictly isolating ourselves.”
PR department disputes nurses account
On Tuesday, The Bee spoke with the other nurse who said she believes she got the disease on March 15 from a patient brought to the ER from a skilled nursing facility. She said she received a positive test result on Monday. Like the other nurse who requested anonymity, she was adamant she caught the virus at the hospital.
“Basically we’re walking into the virus itself,” she told The Bee Tuesday.
The hospital’s public relations department aggressively refuted her claims, saying the hospital had no record of a female nurse notifying hospital human resources she had a positive COVID-19 test result, as required under their policy.
But the hospital’s human resources department would not have known about the case, because the nurse said she notified her employer about her positive test Wednesday morning after The Bee’s story came out.
The public relations department also insisted there was no record on the date she described of the ER treating a skilled nursing home patient who tested positive for COVID-19.
“We reviewed our records from March 15th and March 16th, and no patients that were treated in the ER who came from a skilled nursing facility tested positive for COVID-19,” Casey, the hospital spokesman, said. “This means the health care worker quoted in The Bee could not have been exposed in the manner reported.”
Although the hospital was willing to provide information about patient care on those dates to refute the nurse’s claim, they were not willing to provide details. The Bee requested a list of the medical center’s COVID-19 patients, the dates they were admitted and whether they were admitted to the hospital from a nursing home. The hospital denied the request, citing privacy concerns.
This story was originally published March 26, 2020 at 5:00 AM.