Oregon Hospital Halts Most Internal Coronavirus Tracking
Tamie Cline liked to think she knew most everything going on at Good Shepherd Health Care System, the small Umatilla County hospital where she works as a nurse.
Then came the day in June when she picked up her newspaper to read that the Hermiston hospital was suffering an outbreak of COVID-19. Five of her colleagues tested positive for the coronavirus.
Cline, a negotiator for the union representing 130 nurses, fumed. How did this happen, she wondered? And why weren’t we told?
In a subsequent meeting, top brass informed Cline and others that Good Shepherd was adopting new COVID-19 procedures that would dramatically reduce the hospital’s involvement in tracking the virus. The hospital was also narrowing the circumstances under which it would notify employees of possible exposure.
The nurses were furious. Here they were working in a hospital that eventually suffered two major COVID-19 outbreaks that sickened at least 48 people. And management unilaterally decided it would adopt a new policy of, effectively, non-disclosure?
“It’s unforgivable,” said Kevin Mealy, an organizer for the Oregon Nurses Association, which represents nurses at Good Shepherd. “This policy puts everyone in our communities at risk. Workers can’t protect their patients or their families if they don’t know they’ve been exposed.”
But Good Shepherd wasn’t doing anything improper. In fact, the hospital was simply following new guidance from Oregon’s public health agency recommending that health care providers didn’t need to perform internal contact tracing that would identify potentially infected employees and inform them of their condition.
State officials defend that controversial guidance stating that it came from the U.S.Centers for Disease Control. The Oregon Health Authority issued the advice in part because it recognized the financial and practical “burden” COVID-19 posed for hospitals, said Dr. Melissa Sutton, the agency’s medical director for respiratory viral pathogens.
Contact tracing, the painstaking and expensive work of tracking the virus' spread, is no longer necessary for hospitals under the state’s guidance. That will save the hospitals money and ease fears of staff shortages. Since the virus arrived in Oregon, hospital officials have worried that they could run out of qualified employees if too many of them were forced into quarantine due to possible COVID exposure.
Many of the state’s largest health care systems say they have ignored the state’s guidance and continue to notify employees about any exposure. But other Oregon hospitals have adopted the same strategy as Good Shepherd, Sutton said, though she’s not sure how many.
The lack of disclosure offers another stark example of how the pandemic has strained the relationship between some hospitals and their employees.
Doctors and nurses working to save COVID-19 patients at considerable risk to themselves have faced pay cuts and furloughs. The state has identified more than 3,300 confirmed or suspected infections among health care or care facility workers, about 10% of total cases in Oregon.
Seven months into the pandemic, some health care workers are still fighting with management over what constitutes adequate personal protective equipment. And now some workers are frustrated their employers can stay silent even if they know workers have been exposed.
“It’s simply one more example of how hospitals are attempting to keep people in the dark,” said Mark Brenner, an economist and professor of labor studies at the University of Oregon.
Workers at Good Shepherd and other hospitals have filed multiple complaints to state regulators claiming, among other things, that management is not informing them they they’ve come into contact with a COVID-19 patients or co-workers. Officials at Oregon OSHA, the state’s workplace safety agency, confirmed it has launched an ongoing review of the matter.
Good Shepherd in particular stands out, suffering two COVID-19 outbreaks that, as of Sunday, had led to four dozen confirmed and presumed cases, according to data from the Oregon Health Authority.
That’s more than any other hospital in Oregon except for the much-larger Salem Hospital, where the number is also 48.
Patrick Allen, director of the Oregon Health Authority, said cases linked to Good Shepherd could be the result of broader spread in the community. So devoting a lot of time and resources to internal contact tracing wouldn’t capture the whole picture. Plus, he said. “we don’t have evidence in Oregon that I’m aware of that patient to provider transmission is a significant source of spread,” he said.
Allen’s agency is now putting new emphasis on preventing infections in the first place by ensuring employees are equipped with first-rate masks, gowns and other personal protective equipment.
But ending contact tracing does have a downside, he admitted. “You have to do the contact tracing to figure out who you notify” that they might have been exposed.
Good Shepherd management readily admits it has changed its COVID-monitoring program. It jumped at the chance to halt most contact tracing when the state allowed it. “With our limited resources, we thought it made senses” said Good Shepherd CEO Dennis Burke.
Burke argues the whole situation has been blown out of proportion. In certain types of exposure deemed high-risk, the hospital will continue to do contact tracing and will inform the employees. In other cases, the county health department will do the tracing.
Hermiston Is Hot Zone
Dennis Doherty, a genial former Umatilla County commissioner, is an unabashed booster of Hermiston, a small agricultural town of about 18,000 best known for its prized melons. He likes nothing better than to rib residents of archrival Pendleton about Hermiston’s latest achievement.
But on this morning, Doherty is downcast. He had just recently learned that a longtime friend who did work for him had been diagnosed with COVID-19. His friend’s wife was in quarantine.
“It’s tough on morale when you don’t have any control over your life and fortunes,” he said.
Coronavirus has hit Umatilla County, and its largest hospital, like few other communities in Oregon.
At 376 known cases for every 10,000 people, it has had more than four times the rate of infections as the state average cumulatively. About 18% of people who’ve been tested since the start of the pandemic learned they have the virus -- more than three times the state average.
Hermiston was hit the hardest. Residents in the local ZIP code accounted for 1,545 coronavirus cases since the pandemic began – more than any other ZIP code in Oregon.
At one point in late July, Oregon State University researchers estimated one in six Hermiston residents actively had the virus. Gov. Kate Brown ordered Umatilla County back into shutdown mode July 31, although she’s since lifted full restrictions after seeing progress.
It’s become clear that workplace outbreaks have fueled the virus in Umatilla County. Sprawling food processing plants, with hundreds of employees often working in close proximity, were among the first to experience large outbreaks.
The sites of the outbreaks tend to be large, manual labor jobs that can’t be done by phone and where employees work in close proximity to one another.
In all, the county has recorded more than 3,000 coronavirus cases. Workplace outbreak in the county have accounted for more than 1,300 cases alone with only a few larger than Good Shepherd’s.
Working remotely is a fine alternative for people who can make it work, said George Murdock, a current county commissioner. “But for the working poor who are working on farms or food processing plants, they have to report for work in person.”
Hospital workers need to show up, too.
Ironically, transparency and full disclosure have become buzz words in the county, Murdock said. Early on, businesses were reluctant to air their dirty laundry. But the sense of urgency has dispelled those misgivings.
“At the outset, I think there were some problems, there was probably some reluctance about coming forward,” he said, But with so many outbreaks “there’s certainly no stigma there now,” he added.
A Labor Dispute
Nurse Jessica Barnes works in Good Shepherd’s intensive care unit, which doubles as the COVID-19 ward.
She has watched many patients pass through – and some pass on.
“Sometimes they’re in for weeks or months,” she said in an interview this summer, speaking, along with Cline, as a representative of the nurses' union. “They’re alone. It’s really depressing right now.”
Nine patients have died at the hospital due to coronavirus infections, according to state records.
The nurses, with the help of their union, the Oregon Nurses Association, had been trying for months to hammer out a memorandum of understanding that would govern operations during the pandemic.
The union successfully reached similar agreements with most hospitals in the state, including Oregon Health & Science University and PeaceHealth, operator of the two largest hospitals in Lane County.
PeaceHealth, for example, agreed to “provide all nurses or healthcare workers who have been exposed to COVID-19 with notice as soon as possible. The notice will include: the date of exposure, assessment of exposure risk and the Medical Center’s decision on whether to permit the nurse or healthcare worker to work or placed on paid leave.”
Dr. Renee Edwards, vice president and chief medical office at OHSU, said a strong in-house occupational health program, which includes full transparency with employees, protects patients and OHSU’s workers.
Nurses at Good Shepherd have pushed for a similar promise from their managers. Among other things they’ve asked for a pledge from management to notify any employee within eight hours of known exposure.
Burke dismissed the workers' proposal, calling it a “non-starter.”
Negotiations sputtered and tensions rose. Management reminded employees of a “zero tolerance” media policy first issued in March. Workers who went to the press or sounded off about the hospital on social media would be “be subject to disciplinary action, up to and including termination,” according to a memo signed by Jim Schlenker, the hospital’s chief operating officer.
“We have to differentiate who speaks officially for the hospital,” Burke, the CEO, told a reporter, justifying the hospital’s threat.
Good Shepherd and the nurse’s union remain at odds.
For now, in the place of notifications to all employees exposed to coronavirus, Good Shepherd will rely on employees to self-check every day for COVID-19 symptoms.
Many employees are pleased with the hospital’s new policy, said Devin Goldman, Good Shepherd’s director of quality and infection prevention, because it reduces burdensome paperwork required under the prior system.
The hospital CEO will soon leave Good Shepherd after three decades. Burke admits that the pandemic has not allowed the smooth glide path to retirement he hoped for. But no one in Umatilla County has had it easy.
“Our employees are going through a lot,” Burke said. “Their spouses may or may not be working. They may be victims of the recession and the shut-down order. They’re all just tired of this and we certainly understand that.”
Brown, the Good Shepherd nurse, said the hospital could lower employees' stress levels if it agreed to fully disclose potential exposures.
“We are in the front lines,” she said. “They need to hear us out. It’s very exhausting. It’s tough on morale. We’re burnt out.”
David Cansler contributed to this report.
Oct 5 2020