Two of Arizona’s largest hospital systems, Banner Health and Dignity Health, are rationing masks for doctors, nurses, and other health care workers as they face shortages of critical protective gear during an unprecedented pandemic of the new coronavirus.
At Banner, mask usage has been curtailed so severely that administrators are yanking masks off workers' faces, according to private messages among Banner employees obtained by Phoenix New Times.
Banner is also telling its health care workers to disinfect and reuse certain equipment, like masks and goggles, internal directives obtained by New Times show.
Its messaging underscores the severity of shortages of gear that is critical to protecting people who take care of the community's sickest, even at some of the nation's largest hospital chains.
Not only is Banner limiting who is allowed to wear such gear, but it is reprimanding some of those now wearing it, according to one message between workers.
“Hospital admin is actually going around and writing doctors and nurses up for going against protocol for wear masking [sic], causing hysteria and physically taking them off our faces,” one hospital employee wrote to another. “I need advice [on] how exactly to fight this because I am not going to stand down.”
Hospitals around the country face grave shortages of critical protective gear for their workers, as cases of COVID-19, the disease caused by the new coronavirus, grow.
Arizona is no different.
In an executive order on Thursday evening, Arizona Governor Doug Ducey banned elective medical procedures in the state "to free up medical resources" and to "help keep critical personal protective equipment available for the fight against COVID-19."
Dignity Health has seven acute care hospitals across Arizona. It has 41 hospitals across Arizona, California, and Nevada combined, with more than 60,000 employees and 10,000 physicians.
At two of its Valley hospitals, Chandler Regional Center and Mercy Gilbert Medical Center, doctors are changing the way they take care of patients in order to save protective equipment, according to Dignity Health.
They are now potentially limiting contact with patients suspected or confirmed to have COVID-19 to hospital intensivists — physicians who generally treat only patients in intensive care.
Non-ICU doctors are having "pre-discussions" with the unit's intensivist to decide whether non-ICU doctors should see patients in the ICU who have or might have COVID-19, a spokesperson for Dignity Health told New Times via email. "They determine together whether a patient’s condition warrants additional patient contact."
Non-ICU doctors can include specialists like cardiologists, neurologists, or pulmonologists, whose medical expertise is different from those of intensivists.
"Thee decisions have been made in an effort to ensure the safety of our patients and staff and to conserve masks and other protective gear at our hospitals," the spokesperson added. "This is standard practice among many hospital ICUs nationwide."
Banner Health is Arizona's largest hospital chain, including three major academic medical centers in Phoenix and Tucson. It operates 28 hospitals across six states — Arizona, California, Colorado, Nebraska, Nevada, and Wyoming — and has more than 50,000 employees.
One of Banner’s internal guides for Arizona health care workers, titled "Usage Guide-Tier 1 Conservation" and updated Wednesday, told health care workers that they cannot wear personal protective equipment, or PPE, in hallways.
It said that N95 masks, which cover a person’s nose and mouth and fit snugly to their faces, should be worn only in airborne isolation rooms or when performing certain procedures on people with potential or confirmed COVID-19 infections.
It told workers that they could reuse protective gear under certain circumstances.
Banner said that health care workers could wear the same N95 mask as they went from patient to patient. They could do so if those patients did not have COVID-19, but they could also do so among suspected or confirmed COVID-19 patients, if the N95 mask was used behind a face shield.
“Masks, gowns, and eye protection may be worn between patients if not visibly soiled or contaminated for up to 2 hours,” it added.
Eye protection that isn’t attached to a mask “may be disinfected and reused,” it said.
In response to detailed questions from New Times, Banner spokesperson Becky Armendariz did not dispute workers’ claims that administrators were reprimanding them for wearing masks and writing them up.
She did not address specific questions about shortages of masks and personal protective equipment at Banner, or about Banner’s advice to its front-line workers that countered that of the federal Centers for Disease Control and Prevention, but she did say that hospital recommendations were to “avoid unnecessary use to preserve PPE.”
In a two-paragraph emailed statement, Armendariz wrote, “It is of the utmost importance to us that we provide a safe and secure environment for our health care workers. They are the most valuable resource for our community during the COVID-19 outbreak, and we are dedicated to keeping them healthy.”
Armendariz did not explicitly say that Banner had a shortage of supplies, but she wrote, “We are closely monitoring our stock of equipment and supplies, which include personal protective equipment (PPE) for health care workers to safely engage with patients.”
She added, “Our infection prevention experts are making use of recommendations based on evidence-based guidelines. These recommendations are intended to avoid unnecessary use to preserve PPE.”
In the text messages and emails between Banner employees viewed by New Times, one noted that health care workers were being reprimanded for donning "appropriate" personal protective equipment.
Those messages contained a palpable fear that health care workers would pay the ultimate price because Banner refused to give them — or could not provide — protective equipment.
“Ask for a Skype meeting about this. State that you don’t want any in person meetings to avoid possible disease transmission. The Skype meeting may be recorded,” one employee wrote another. “During the recorded meeting, ask them if when you die, they will take over and see your patients too, without a mask.”
“Maybe we all need to raise awareness in the lay public about this too …” one mused.
Banner’s internal memos to health care workers regarding COVID-19 also contain misleading information or make medical claims that contradict those of the Centers for Disease Control and Prevention.
For Banner health care workers who had fever or respiratory symptoms like a cough or trouble breathing — the symptoms of COVID-19 — Banner’s "COVID-19 Healthcare Worker Monitoring and Return to Work Guide," updated Thursday, laid out an unrealistic protocol.
It told them to “contact their medical provider for health-related questions.” But as several local doctors have told New Times, they are unable to see any patients with those symptoms right now, out of concern of potentially spreading or contracting the disease.
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In a set of Banner’s internal FAQs for employees, updated Thursday, one question asks, "Can an infected person transmit infection when they do not have symptoms?”
CDC guidance from Tuesday explicitly said that “there have also been reports of asymptomatic infection with COVID-19.” It elaborated, "Asymptomatic infection with SARS-CoV-2 has been reported, but it is not yet known what role asymptomatic infection plays in transmission.”
But Banner’s response said otherwise. “Although there have been reports of asymptomatic transmission, these have not been verified,” it said. “The CDC has stressed there is currently no evidence of asymptomatic transmission in the US.”
Are you a health care worker in Arizona with a story to share about the COVID-19 pandemic? Please get in touch.