Docs: BAMC’s vaccinations like ‘flash mob’
When Brooke Army Medical Center began vaccinating personnel more than a week ago for the coronavirus, two doctors say that hospital officials didn’t inform them through formal military channels or prioritize health care workers who were most likely to come into contact with people positive for the virus.
What happened, both BAMC doctors said, was a “free-for-all.”
“The way they did it is, they didn’t send out an email, they didn’t (communicate) through the chain of command, to each department chief, they didn’t do anything,” one of the doctors said. “It was like a flash mob vaccination.”
The physicians told the San Antonio Express-News that they expected better organization and a focus on the health care providers most at risk of contracting the virus,
a category called Tier 1. They say they discovered that anyone could get a shot, not just front-line health care workers — particularly those in BAMC’s Level 1 trauma center, where some personnel have been exposed to and sickened by COVID-19.
BAMC didn’t vaccinate its personnel for several days after Wilford Hall Ambulatory Surgical Center gave Air Force Maj. Andrew Gausepohl the first shot from the shipment that arrived at 9:30 a.m. Dec. 14.
Asked by media the next day about the timeline for delivering the vaccine, the hospital’s commander, Brig. Gen. Shan Bagby, said “we have a plan in place” and that he would set the BAMC start date once he and Maj. Gen. John DeGoes “are satisfied that that process is locked in.”
DeGoes commands the 59th Medical Wing at Joint Base San Antonio-Lackland, which includes the ambulatory surgical center.
A story written by BAMC’s public affairs office said Army Capt. Rebecca Parrish, an intensive care unit nurse, was the first frontline medical professional to receive the Pfizer-BioNTech COVID-19 vaccine Dec. 17 at the hospital on JBSA-Fort Sam Houston. Applause broke out in the room as she got the shot.
“The fact that we are among the first DoD sites to receive the vaccine is a testament to this team and their ability to carry out this important mission,” Bagby said in the military story. “This process took a tremendous concerted effort from our logistics, administrative and clinical personnel.”
The story said BAMC, a 425-bed hospital, would “distribute the vaccine in a phased process, based on guidance from the Department of Defense and CDC (Centers for Disease Control and Prevention)” and that “the first phase includes inpatient and outpatient health care and support personnel, emergency services and public safety personnel.” It said “the group vaccinated today comprised intensive care unit and Emergency Department staff involved in direct patient care.”
Bagby, in a lengthy statement to the Express-News on Wednesday, said, “Vaccination distribution prioritization focuses on those providing direct medical care, maintaining essential national security and installation functions, deploying forces and those at the highest risk for developing severe illness from COVID-19, before other members of the DoD population.”
He said staff was notified “using internal mass communication platforms and face-to-face leadership interaction at all organizational levels, in order to focus on those populations who are most in need of COVID protection, congruent to our limited supply.” He also said his staff is “executing the vaccination plan in compliance with DoD’s vaccination distribution prioritization.
“We started COVID vaccinations last Thursday with our highest-priority staff in accordance with DoD prioritization schema,” Bagby said. He added that leaders and staff have discretion to use “their best judgment and allow latitude to move to the next tier in response to the number of volunteers and supply available.”
Both physicians, who are not being identified because they fear they will face retaliation, sketched a far different picture of how the vaccine was given Dec. 18 at BAMC. They said there was no plan that they or superiors appeared to be aware of for vaccinating hospital personnel and no communication about it. They said there was no prioritization of hospital personnel based upon their potential risk of exposure to the coronavirus.
They also wondered why the vaccine was given first at Wilford Hall, an outpatient center, and not BAMC’s ER, the Pentagon’s sole Level 1 trauma facility and a first line of care for civilians in San Antonio and nearly two dozen other South Texas counties injured in car accidents, shootings, fires and explosions.
Those entering BAMC’s ER were not tested for COVID prior to arriving until about two months ago, one of the doctors said, adding that rapid result tests are now given to patients in the emergency room who will be hospitalized. The exposure of ER personnel to untested trauma patients dramatically raised the risk of contracting COVID.
“I think their plan was to prioritize, but nothing happened and so yesterday they actually opened it up and it was a free-for-all,” one doctor said Dec. 19. “It was literally by people just talking in the hallway that somebody figured out they were administering the vaccination up in the (BAMC) auditorium.”
One of the physicians was not at BAMC when word spread about the vaccinations. The other, who was at the hospital, said two people sat at the door leading to the auditorium as the line twisted all the way to 4 East, the world-famous burn ward, and another area called 4 West, an orthopedic ward.
“There was no rhyme or reason about prioritizing people at all, zero, zilch,” that doctor said.
Those in line wore masks but were not socially distanced by 6 feet — and couldn’t be farther apart, given the lack of space. The physician who was present said hospital workers went through a line where more than 100 people stood, asking, “‘Hey, are you guys Tier 1? We’re going to check and make sure your name’s on the list,’ but there was no list.”
He called the scene “beyond bizarre,” explaining that no one took his name or checked off names from a list. He said BAMC’s command did not send an email to staffers, as a civilian hospital system in San Antonio did in surveying employees who were interested in taking the vaccine.
In the line, the doctor said, was another physician who works in a specialty unlikely to encounter positive coronavirus patients. That physician got the vaccine. “There was a total breakdown and lack of communication between the small group of people that were in the know about receiving the vaccine and then disseminating that information in hospital provider-wide,” the doctor said.
Bagby, the hospital commander, conceded that “social distancing may not have been strictly observed, and we are addressing that. We have and will continue to stress the importance of following CDC guidance for protection against COVID, which includes washing hands, wearing a mask, and maintaining social distancing.
Wilford Hall, in a statement issued Sunday night, said the Pentagon decided to make the outpatient center the hub to supply vaccine to BAMC.
Both doctors eventually received the vaccine, despite the rollout being haphazard.
“We expected, essentially, all the Tier 1 providers to get it first, and that’s definitely not how it happened, and then finding out about it by social media — inadvertent social media, not (BAMC) putting out on social media we’re going to inoculate Tier 1s at this time — no, just colleagues posting, ‘Hey, I got my COVID shot,’” one said.
Lapses of command and control remind some at BAMC of problems with the hospital’s sterile processing department in 2017. The Express-News reported that BAMC closed more than half its operating rooms and reduced elective surgeries after it found improper sterilization of instruments in 73 cases, including 16 incidents in which fragments of organic material, such as bone, skin or blood, were left on surgical tools.
“The problem is that it all kind of gets whitewashed, and a lot of the mismanagement and poor command and control is not really discussed and … they retaliate and they penalize whistleblowers,” one doctor said.
Citing operational security concerns, Bagby declined to release statistical information sought by the Express-News, including how many doses of vaccine were received by BAMC, how many staffers received it during the initial weekend or details on the range of reactions — and if any had been serious or life-threatening. The hospital command has not released any information about COVID infections since the start of the pandemic.
“We are also unable to speak to the speculation of anonymous sources, but encourage them or anyone with ideas to work with us to improve the process,” Bagby said. “Many members of our staff function in different roles. When this occurs, we classify them at the highest level of priority they hold.”
One of the doctors said Sunday that BAMC began to offer the vaccine last week to anyone who wanted it but added that the distribution did not appear to have been done in an “organized, coherent fashion.”
There are still no guidelines for giving the vaccine first to hospital workers who are most likely to come into contact with COVID patients, he said, and some operating room nurses still hadn’t gotten their shots.