Hospitals must ensure staff and patient safety

While Gov. Tom Wolf and Secretary of Health Dr. Rachel Levine deserve credit for putting in place shut down orders and social distancing in an effort to safeguard the general population against the COVID-19 outbreak, they have utterly failed in their duty to protect front line health care workers. This failure has placed bedside caregivers at serious risk by allowing hospitals, nursing homes and behavioral health centers to skirt basic safety standards and protections.

The state Department of Health has given health centers a pass on safety during this pandemic. Dr. Levine has made it clear that if hospitals deem they are in “crisis mode” then they are free to ignore the basic protections and safety standards that have been in place for decades. With DOH’s blessing, hospitals have resorted to severe and unnecessary rationing of Personal Protective Equipment (PPE), have refused to notify workers of possible COVID exposure and have completely abandoned long-held infection control safety protocols. As a result we, the front line caregivers, have been paying the price. Over 3,300 health care workers around the state have tested positive for COVID-19. Many are fighting for their lives, being cared for by their co-workers, dying in the hospitals where they once worked.

We are nowhere near the end of this pandemic. Health care providers still have many weeks of working in conditions that are a far cry from normal. Weeks of having to reuse PPE in ways that violate every safety practice that we have ever been taught. Weeks of going to work constantly afraid we are going to get sick. Weeks of never knowing for sure if we’ve been exposed and fighting with our employers to get tested.

It didn’t have to be this way. Since the start of the pandemic, we have repeatedly asked been asking the governor and the state Department of Health to enact some very basic protections for front line health care workers and their patients, specifically: Protective equipment to prevent providers from contracting the disease, notification of exposure, and finally, paid quarantine and testing for those exposed. To date, neither the governor nor the DOH have issued directives mandating hospitals to implement any of these simple safety measures.

On April 27, Dr. Levine issued a directive governing the restarting of elective admissions, surgeries and procedures. When I sat down to read this directive I was filled with a great sense of optimism. Finally, the DOH was heeding the pleas of health care workers and was issuing regulations forcing hospitals to institute adequate protections for workers’ health and safety prior to reopening elective procedures. Sadly, I was sorely disappointed. Not only does this guidance fail to provide any enforceable standards or criteria for reopening elective procedures, it also allows hospitals to open without any oversight from the agency. The last paragraph says it all: “[h]ospitals do not need approval from the Department to begin allowing elective admissions or performing elective surgeries or procedures.”

Now, absent any DOH oversight or regulatory control, hospitals are beginning to restart elective procedures. Restarting these financially lucrative but nonemergent procedures without additional safety precautions in place will serve only to further increase the risks of exposure and contamination to health care providers and their patients causing unnecessary illness and possible deaths.

It didn’t have to be this way. We need only look to New York State for a model in how to safely reopen elective procedures. In contrast to our DOH, New York has protected demonstrated great concern for the safety and protection of their healthcare workers by imposing strict guidelines on when hospitals can restart elective procedures. NYS hospitals are prohibited from restarting these procedures unless they are able to operate without resorting to “contingency or crisis standards of care.” That means hospitals must have enough staff, enough protective equipment, and must follow standard protocols for infection control. Even more importantly, NYS DOH will ensure these criteria are met and if a hospital reopens without meeting any of the required benchmarks, it can be fined and its certification to operate may be suspended.

Hospitals cannot have it both ways. If the reason they can’t follow basic protections and safety standards is that they are in crisis mode, then they can’t re-open elective procedures. If, however, they decide that it is safe to re-open elective procedures then they are, by definition, no longer in crisis mode and must return to the basic protections and safety standards that were in place prior to the COVID outbreak. New York just did it and we will accept no less in Pennsylvania.