Providers still perturbed by MCSA administrators

Bennett: Hospital following CDC guidelines

Two nurses at the Medical Center of South Arkansas said this week that the hospital has not been separating patients diagnosed with COVID-19 from patients who do not have the virus, including some who they said are immunocompromised. Both are currently employed at the hospital and asked not to be named. Changing protocols

When the COVID-19 pandemic first broke out in 2020, the hospital dedicated a ward and a team of health care professionals to treating patients with the virus. The ward included specially-designed negative pressure units, which are used to prevent air from leaving rooms in the designated unit,

MCSA Chief of Staff Dr. Ezinne Nwude explained in May 2020. The technology had previously been used when patients with other infectious diseases, like tuberculosis, had presented to the hospital.

However, as the third wave of the pandemic has washed over south Arkansas, patients with COVID-19 are no longer being separated from patients who don’t have the virus, two nurses told the

News-Times this week. “They have had COVID patients up on the floor with other patients, and we’ve had at least eight or nine patients test positive for COVID that had been tested negative prior to being admitted because of the cross-contaminations,” one nurse said. “Three of the nursing staff got COVID also, and that’s been here recently.”

Another nurse said the eight or nine patients seemed to have caught COVID at MCSA in the past four or five weeks.

“When it got bad in the winter

here and we were in the second surge, it was handled appropriately. Patients were placed in a unit that was separate from the rest of the hospital, appropriately trained nurses were working in this unit and things were handled the way they were supposed to,” the second nurse said. “When we started having a third surge, that’s when new policies and procedures came down from administration that completely went against everything we were taught and learned in working during COVID.”

“Patients were no longer segregated and they were no longer just dedicated to those nurses. Nurses were being made to take care of COVID and non-COVID patients; they were no longer on an isolated wing,” the second nurse continued. “The doctors and nurses alike, we stressed and stressed and stressed the importance to keep them secluded, segregated from non-COVID (patients). … We’ve been begging them for months now to move them back to the isolated parts of the hospital for their safety, visitors’ safety, nurses’ safety.”

The second nurse said patients who came into the hospital with COVID were being placed in the third-floor stepdown unit, where patients who still need hospital-level care but not ICU-level care are held. The first nurse said surgery patients who are immunocompromised had also been kept near COVID patients.

“I think the nurses and staff, they do what they are supposed to do; we do our best to take care of our patients, but (there are) some things that are beyond our control, like telling us we have to admit a patient,” the first nurse said. “At some point, they were admitting COVID patients on the same floor as surgery patients — which, they are immunocompromised. We think you shouldn’t mix isolation patients with immunocompromised patients.”

Alexandria Bennett, executive director for business development, said the hospital is confident in its safety protocols and that the safety of both patients and caregivers is the hospital’s top priority.

“We are following CDC guidelines for the care of COVID-19 patients, and we are confident in our safety protocols, which also have been validated by the local Department of Health as well as infectious disease experts at Vanderbilt University,” she said in an email to the NewsTimes.

She noted that “it is possible to be exposed to and infected with COVID in a hospital setting,” but said that by following CDC guidelines, MCSA is lowering that risk “considerably.”

“COVID is much more likely to spread in other locations in our community and when a patient tests positive while in the hospital, the transmission of the virus is more likely to have happened in the community, prior to hospitalization,” she said.

Bennett said “non-critical COVID patients are cared for in a dedicated wing of the hospital and any critically ill patients are treated in the ICU.” She said the hospital has implemented “universal masking and use of PPE (personal protective equipment) appropriate for the patient’s status.”

Additionally, she said that medical staff discussed in July COVID protocols with a Vanderbilt University infectious disease expert, and that information gathered from that discussion and circulated among MCSA medical staff in a memo included that there was “no need to have a dedicated nursing staff for COVID vs. Non-COVID … the only exception to this would be if there was a shortage of PPE, which we are not currently experiencing.”

A copy of the memo Bennett referenced obtained by the News-Times shows that it goes on to state, “There is no list of immunocompromised patients and it is irrelevant. Other facilities are taking care of COVID patients and transplant patients on the same floor. As long as PPE is used properly, by all, spread should be minimal.”

According to the United States Centers for Disease Control, as of February 2, 2021, health care facilities “should consider designating entire units within the facility, with dedicated (health care providers), to care for patients with suspected or confirmed SARS-CoV-2 infection.”

Bed space

Last week, the News-Times reported that two MCSA nurses told the newspaper that they felt the hospital was admitting patients when there wasn’t capacity to care for them. The two nurses the newspaper spoke with this week made similar statements.

“I feel uncomfortable also because administrators tell doctors who they can and cannot admit to the hospital even if the doctors feel they don’t have the capability, as a small community hospital, to give them the care they need,” the first nurse said. “It’s like they (hospital administrators) are practicing medicine without a license. When the doctors feel they can’t adequately care for the patients, it makes nurses feel uneasy too.”

The second nurse said it’s their belief that some patients are being transferred out of the ICU before they’re well enough to be.

“The administration wants to push the transferring of the ICU patients prematurely so that we can get more patients into the ICU beds, the problem being when the patients were moved too soon under the advice of the doctors not to move these patients just to get more patients … and then there’s no bed to come to when they do have a poor outcome or something changes in their clinical condition. Then there’s nowhere for them to go,” the nurse said.

The nurse added, “A lot of them are or did get critically ill because of it (COVID-19). They had to get moved to the ICU, they had to get intensive treatment and some of them are still- some of them are very young compared to the second wave of patients and they’re literally fighting for their lives and they came to this hospital not having COVID and contracted it.”

Bennett did not answer a question about MCSA employees’ concerns about patients leaving the ICU prematurely. She noted that COVID-19 hospitalizations and cases are on the rise in the community and throughout the state.

“Our team is currently caring for 10 COVID patients,” she said. “MCSA remains prepared to care for patients needing medical care, whether for COVID-19 or other medical conditions.”

Tension

Both nurses said tensions are high at the hospital currently, as did Vicki Gilliam, an attorney representing 11 MCSA doctors who participated in June in voting “no confidence” in the hospital’s current administration. “As concerns continue to rise among doctors and other medical staff because of the lack of confidence in the current administration, the general medical staff of MCSA sent a letter this week to Regional President (Kevin) Stockton of CHS,” Gilliam said in an email to the News-Times on Friday. “In response to Stockton’s commitment to travel to MCSA and work with the Medical Staff to restructure the administration, Dr. Ezinne Nwude, Chief of Staff at MCSA, clarified and emphasized in her letter their position of having ‘no confidence’ in the top administrators in providing the leadership needed in order to maintain the standards of quality of care and treatment for patients that the medical staff need.”

CHS, or Community Health Services, is the company that owns MCSA. Following the general medical staff’s vote of no confidence, which was relayed via letter to the hospital’s Board of Trustees along with allegations to do with why the vote was held, MCSA CEO Scott Street announced that the hospital had “engaged independent counsel to conduct a thorough and complete investigation of the matters raised.”

Gilliam told the News-Times that the Tennessee-based law firm Bass, Berry and Sims had been retained by the hospital to conduct the investigation. According to the firm’s website, attorneys there have previously represented CHS in a number of legal matters.

A report on the investigation was made to the hospital’s Board of Trustees on July 29. Street on July 30 informed MCSA staff that the Board of Trustees Board of Trustees “did vote to request a new administrative structure” following their hearing the investigation report.

On Monday, Street sent a note written by Stockton to MCSA staff, informing workers there that a CHS “resource team” would be visiting the hospital last week “to help support the current administrative team.”

The News-Times reached out to CHS corporate about the visit but did not receive a response.

“According to my clients, tensions continue to rise, as the medical staff sees no action taken by CHS to efficiently remove and replace the specific Administrators, which include the CEO, Scott Street, of whom the Medical Staff have specifically expressed ‘no confidence,’” Gilliam said on Friday.

One nurse the News-Times spoke with called the hospital’s current atmosphere “toxic.”

“It’s been discouraging and difficult, you know, showing up every day and the atmosphere, due to the relationship with the administration and the medical staff, I mean, tension is super high, and it just, it creates a toxic atmosphere,” the nurse said. “We go to work, us and the doctors, every day and we fight against this administration to do the right thing for our patients.”

The other nurse said, “I believe that if we had a change in administration at the hospital, some of those nurses that were loyal, full-time and loved this community would come back to work here, but they don’t want to come back under the same circumstances.”

Bennett said the hospital stands in support of the health care workers that are employed there.

“We continue to support our clinicians and caregivers and to thank them for their work to provide safe, quality care for their patients,” she said.