Not only do Bay Area Kaiser hospitals keep COVID-19 and virus-free patients in the same wards, but we are now learning that the nurses must also commute between the infected and the uninfected – and the patients are not being told that.
“I had two patients who were positive and two were not,” Jill Leon, a nurse at Walnut Creek told Kaiser, describing a recent shift.
Leon puts on protective clothing before entering the rooms of coronavirus patients and takes it off on departure. But, she said, she has to work a whole shift, treating people with and without the disease, while wearing the same N-95 mask. “We get one per shift,” she said.
Nurses I’ve interviewed from hospitals in San Jose, Santa Clara, Antioch, Walnut Creek, and San Rafael say they or their colleagues got a mix of COVID and non-COVID patients on the same shift. Employees at the Santa Rosa and San Leandro facilities reported similar practices in emails.
Julie Glage, a nurse in San Jose, said she raised the mixing issues with administrators “and they replied that they had no indication not to mix the patients.”
Perhaps the most troubling uninfected patients are not told that they share staff and floors with people, often in adjoining rooms, who have contracted the coronavirus. Colleen Gibbons, a nurse at San Rafael Hospital, said nurses had been warned that informing patients would violate federal medical privacy law.
Not only are assigned nurses who move between the COVID and non-COVID rooms, they are also the doctors, nurses who fill out meal breaks or provide additional assistance as needed, and assistants who often turn, clean, bathe, walk and to feed.
I reported last week that Kaiser kept patients with and without the virus in the same wards of Oakland Hospital. I heard about the practice after an elderly, immunocompromised family member hospitalized in a mixed ward of the Kaiser’s Oakland facility tested positive for coronavirus on the ninth day of her stay, after testing negative on the first, third and sixth day – suggesting she was probably infected she was there.
Kaiser declined to say how often they mix patients in the same wards or how many patients contracted the deadly virus as a result. Dr. Michael Vollmer, the regional epidemiologist for Kaiser Northern California, said in an interview Wednesday, on the condition that data would discourage patients from seeking needed treatment.
But nurses’ reports indicate the admixture is common in Kaiser’s Bay Area hospitals. And, contrary to what Kaiser suggested last week, we are now learning that nurses must take care of infected and uninfected patients at the same time.
In response to email inquiries last week, Kaiser spokeswoman Kerri Leedy wrote, “At one point, a nurse is assigned to patients with COVID-19 or to patients who don’t have COVID-19, but not both at the same time.” Questioned about this this week, Leedy wrote that the earlier answer applied only to Oakland Hospital.
It is unclear how risky the mixing practices are.
Dr. George Rutherford, a professor of epidemiology at UCSF, said his hospital is committed to keeping coronavirus patients and their nurses separate from uninfected patients. But with proper infection control, the mixing practice probably isn’t too worrisome, he said. “The problems would come with infection control breaches.”
Jane Thomason, the California Nurses Association’s lead occupational hygienist, said there is a “risk of transmission between patients and between caregivers if you have these types of mixed units.” The magnitude of that risk is difficult to determine because the hospital records are poor, she said.
It was probably inevitable that Kaiser had to resort to such mixing measures to handle the latest wave of patients ticking off many Bay Area and California hospitals. What is especially disturbing is the lack of transparency.
Patients deserve to know when they are sharing units with infected patients. Kaiser’s response to concerns about transparency is circular. When asked last week if Kaiser is warning COVID-free patients about the nearby infected people, Leedy replied, “This is certainly information available to patients and families upon request, and we don’t intend to remember it.” The catch, of course, is that they should know to ask.
But it’s not clear they would get an answer if they did. Vollmer, Kaiser’s epidemiologist in Northern California, said patients are not being told this due to patient confidentiality.
Monica Rizo, a nurse at Antioch Medical Center, said non-COVID patients sometimes inquire about the special precautions taken with the infected patients’ rooms. When nurses urged their managers to notify the patients, Rizo said, “There was no answer – nothing.”