These days, when "Sophia," a veteran nurse, enters the Banner hospital where she works, she files in through a single entrance along with everyone else.
“They’ve restricted the ways we can come into the hospital, so they take our temperatures as we go in,” she said.
Then, occasionally, Banner offers employees a snack from a snack cart — a demeaning and cheap reward for their cooperation, it seemed to her.
“I’d rather have a mask,” sighed Sophia (not her real name but a pseudonym chosen by the nurse), who works on a designated COVID-19 unit.
After the initial temperature check, monitoring themselves for signs of COVID-19 is left up to Banner staff, even though, as a March 20 email from Banner Chief Clinical Officer Dr. Marjorie Bessel cheerily put it, “We are here to support you!"
What Banner calls "support" starts with self-monitoring and, if a staffer falls ill, is more likely to end with the use of paid personal or vacation time than with paid sick leave. As Phoenix New Times has previously reported, Banner is limiting when employees can use personal protective equipment (PPE). Most recently, it has required them to reuse N95 respirators.
Meanwhile, staff members who are not willing to redeploy to "high-need areas," like emergency rooms or designated COVID-19 units, have been told that they can either use paid time off to take leave, or take a 30-day leave, although the job might not be there when they come back, according to internal communications.
The five Banner health care workers who spoke with New Times, all on condition of anonymity because Banner has warned staff against speaking to media without approval, have concluded that Banner Health, Arizona's largest employer and one of the biggest hospital chains in the United States, is doing as much as possible to avoid shouldering the costs of caring for its front-line health care workers during a global pandemic.
Banner maintains that "the health and safety of our team members is a top priority," as spokesperson Becky Armendariz told New Times via email.
Although on paper Banner Health is a nonprofit corporation, it or its subsidiaries own or control "hospitals, clinics, nursing homes, clinical clinical laboratories, ambulatory surgery centers, urgent care centers, home health agencies, a captive insurance company, a foundation," health plans, and “other health care-related organizations in six western states," according to an audit of its 2018 finances by the firm Ernst & Young.
It also holds majority interests in "several health care-related business ventures," the audit said.
In 2018, Banner's revenues eclipsed $8.5 billion.
In 2017, the most recent year for which its full 990 tax return is available, CEO Peter Fine took home more than $25 million. Executive Vice President Ronald Bunnell took home more than $12.7 million, Senior Vice President David Bixby took home more than $2.3 million, and Executive Vice President Kathy Bollinger more than $1.5 million. Eleven other executives listed in the return took home more than $1 million that year. Among the rest, the lowest-paid executive made $350,000 that year.
Some health care workers face greater risk than others of contracting the new coronavirus that causes COVID-19. As a result, they should be monitored differently, the Centers for Disease Control and Prevention says.
Those labeled as "high-risk" are in "prolonged and close contact" with unmasked COVID-19 patients (i.e. getting within six feet, or being coughed on) without the right protective gear. The risk drops to “medium” for health care workers who are similarly exposed to COVID-19 patients, but with more protective gear, like a face mask (which leaves gaps at the face and nose, unlike a respirator), gown, gloves and eye protection during aerosolizing procedures.
Low-risk exposure means a health care worker has had "brief interactions" with a COVID-19 patient, or wore sufficient protective equipment when they were exposed.
According to the CDC, health care workers with medium- and high-risk exposure to COVID-19 patients should "undergo active monitoring,” either through a local or state public health department or a hospital’s occupational health or infection control facility.
That means that someone else, be it a public health authority or the hospital, is checking on and communicating with health care workers who might've been exposed to the virus, ideally "at least once each day," per the CDC.
Only those with low risk of exposure should self-monitor by taking their temperatures twice a day and being quick to note symptoms like a dry cough or shortness of breath, the CDC says.
But internal documents from Banner that explain its own monitoring protocols don't seem to reference any public health authority or its own occupational health or infection control departments.
Front-line health care workers who spoke with New Times emphasized that Banner specifically has told them to “self” monitor, and the health system's own paperwork corroborate those claims.
Banner doctors, nurses, and other health care workers are "expected to monitor themselves twice daily for fever ... and respiratory symptoms,” says Banner's “monitoring and return to work guide,” dated March 21.
An all-staff email from Dr. Marjorie Bessel, Banner's chief clinical officer, sent March 20, described in heavily bureaucratic lingo a new "5-point safety check for all team members.”
“Step 1: You self-assess via temperature check. We know you have already been doing this - THANK YOU!” it reads. Staff are supposed to "self-assess via a temperature check" at home, and if their temperatures register above 100 degrees Fahrenheit, they are supposed to stay home.
Step 2, at the Banner facility: “Enter by way of the clean, dedicated team member entrance.”
Step 3: “You initiate a safe start by acknowledging your temperature is less than 100 degrees.” If staff haven’t taken their own temperatures at home, “we will provide you the resources to do so before you begin your shift,” Bessel’s email says.
In this case, it’s not clear whether staff take their own temperatures, or if anyone is even checking that they do. Different hospitals also appear to interpret Step 3 differently.
“They have a thermometer, but it’s not mandatory,” one Banner employee in Tucson told New Times.
But Sophia, the nurse on the dedicated COVID-19 unit at a different hospital, said that someone at Banner took workers’ temperatures.
The fourth step is for employees to “continue to attest [they] are well throughout the day,” by clicking on prompts on their computers or devices.
The fifth step, "Keep it safe ... all day, everyday," is less a concrete action than an amalgam of reminders. It tells "team members" that they can check their temperatures anytime throughout their shifts. "Tables are available at the clean, designated team member entrance 24/7,” workers can stop by any time.
According to Banner’s March 21 “monitoring and return to work guide,” any health care worker who develops symptoms should tell their supervisor and go home. They “should NOT report to [Banner Occupational Health Services] but should contact their medical provider for health-related questions,” it adds.
Banner's approach to monitoring suggests that if staff get sick with COVID-19, they will shoulder the costs, not Banner — even if they contract the virus while working on the front lines of the pandemic.
In response to questions about Banner's monitoring protocols, including self-monitoring versus the "active monitoring" described by the CDC, Armendariz wrote: "We have ... implemented several measures to ensure the health of our on-site workforce. These measures include: 1) Signs posted at timeclocks verifying no symptoms are present before they clock in, 2) electronic attestations that employees must sign (roughly every 4 hours) stating that they are well and showing no signs or symptoms of COVID-19, and 3) health care worker screenings at the entrances of many Banner locations."
She did not answer a question about why Banner told employees not to report to Banner Occupational Health Services, but said that "team members" whose symptoms had resolved could contact occupational health "to schedule a return-to-work evaluation."
The Myth of Paid Sick Leave
Last week, a family physician for Banner Health was seeing a patient — a Banner nurse — via telehealth.
The nurse had had positive contact with a COVID-19 patient and had "all the symptoms," said the doctor.
But when the nurse called the internal Banner hotline, she was given the runaround. When she tried to schedule a COVID-19 test, she was told she could not get tested because first, she needed to have a telehealth appointment.
“I had to pull strings to get her in,” the doctor said. “The appropriate channels were failing her. She was incredibly frustrated. And I felt terrible for her."
That experience diverges from Banner’s description of resources available to employees if they fall ill.
According to Armendariz, health care workers have several options for medical care: "a health hotline established for our health care workers," their own primary care provider, one of Banner's urgent care centers, or Banner's "free telehealth service for employees.”
If testing is necessary, "the team member will be prioritized for testing at one of Banner's drive-thru collection sites," she said via email. Banner employees deemed to need COVID-19 testing “will be compensated up to 14 days … if test results are positive,” she wrote.
Otherwise, they’d need to take paid time off. If they didn't have paid time off (PTO), they could “borrow” PTO for up to five shifts, Armendariz said.
Several Banner employees confirmed that if they got sick, they were told that their only option was to use existing PTO or “borrow” it, putting their PTO bank into a negative balance.
They also said it was almost impossible to get tested, and therefore all but impossible to receive paid sick leave.
“They are doing the test for employees, but unless you’re basically dying, you can’t get tested,” the Tucson employee said.
Sophia said that Banner’s policies on PTO and paid sick leave had shifted in recent weeks, and in ways that contradict what Banner is telling the public about what benefits it grants employees.
An internal guide from Banner dated March 14 said that if an employee contracted COVID-19, he or she would have to take off 14 calendar days of work, but would be paid for any regularly scheduled shifts during that period. The person would also be compensated for any missed shifts if quarantined at Banner's direction.
But Sophia said she learned in a staff phone call in early April that Banner would no longer offer paid sick leave to employees who contracted the virus or had its symptoms, because the new coronavirus had become community spread.
The family physician also worried that Banner is downplaying the high rate of false negatives in COVID-19 testing, which some research suggests could be as high as 30 percent.
Although other health care institutions require two negative tests in 48 hours before allowing a health care worker back to work, the doctor said, Banner allows nurses and doctors back with just one.
Banner’s own internal documents suggest its hospitals are even more lax.
For workers who have tested positive for COVID-19, “Banner Health is utilizing the non-test method from the CDC for Return to Work,” its March 21 guidance says.
These employees can return to work only after at least 72 hours have passed since they’ve recovered (no fever, and no respiratory symptoms except a mild cough, it says) and at least seven days since their symptoms first began. The return has to be approved by Banner Occupational Health Services.
If an employee had COVID-19 symptoms but never got tested, they can call Occupational Health for a return-to-work evaluation as long as they’ve been without fever for at least 24 hours and been away from work for at least seven days since their symptoms began, an internal guidance from Banner dated March 31 shows.
Armendariz did not answer a question from New Times asking how, exactly, Occupational Health clears Banner employees to return to work.
On March 19, Arizona Governor Doug Ducey halted elective surgeries. Since then, patients to units like ORs have slowed to a trickle.
As the COVID-19 pandemic settled in, some health care workers at Banner working in departments that were losing patients — and therefore revenue — were given a choice: be redeployed to a “high-need” area, burn up PTO, or take time off and risk losing their job entirely.
“Right now, our census is really low. We’re probably at 50 percent capacity," said the Banner employee in Tucson, referring to his hospital's patient count. Even the emergency department isn’t full, he said, although he and everyone else expected that to change in the coming weeks.
It is standard for Banner to redeploy, or “flex,” nurses and technicians in units that aren’t filled with patients, according to that worker.
“If you only have 14 of the 28 patients you can handle on your unit, you’re not going to need” all your nurses, he explained. Banner might put a few nurses on hold for a couple of hours, then send them home, or push them to another unit that needs them.
In an internal Banner email in early April that went out to more than 60 employees, one administrator wrote, “As our volumes have fluctuated, we have an opportunity to utilize team members who are not filling their normal work hours.”
“Leaders will be speaking individually to team members about the redeployment effort to align your skills with the needs and demands of the system,” he wrote. He encouraged staff to fill out a “redeployment application” for possible reassignment.
He reminded them that if they weren't working, they needed to use sick time or accrued paid time off.
Another written communication was more explicit about what this “redeployment” meant.
If staffers were not willing to be moved to “high-need areas” — like emergency rooms, ICUs, and designated COVID-19 units — it warned, then they could use PTO to take time off.
Or, they could take an unpaid personal leave for 30 days, at the end of which their job might be gone, a move some saw as punishing staff for a hospital-wide slowdown that was not their fault.
"Seriously, Banner is interested in money and if they need people they don't send them away right now," one doctor at Banner told New Times, chiding Banner's COVID-19 "redeployment" strategy as COVID-19 hospitalizations in Arizona have yet to peak and the hospital doesn't know how many workers it will need.
"Insanely insensitive," the doctor added. "WTF is all I can say."
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