Coughing and feeling miserable, operating room nurse Amy Niswonger worked a full shift at Penrose Hospital on March 4 — just two days before the first case of coronavirus was confirmed in Colorado Springs.
She said when she told her supervisor about her flu-like symptoms, he told her: “Well, just stay away from me.”
About two weeks later, on March 17, Niswonger said she learned from a co-worker that a surgeon she had worked with had tested positive for coronavirus — after he had operated on patients while sick on March 12.
After the surgeon tested positive, Niswonger said she was never advised by her supervisors to get tested or quarantine herself even though they knew about her symptoms. Although Niswonger tested negative for the virus on March 30, she said she was still being treated in early April for pneumonia — a condition her physician believes she developed from coronavirus.
Penrose-St. Francis Health Services’ lapse in advising Niswonger about the existence of COVID-19 within Penrose Hospital was just one of several examples of the health system failing to protect staff members from the virus, Niswonger and other employees said. Earlier this month, Niswonger filed a complaint about the lack of protection with the Joint Commission on Accreditation of Healthcare Organizations.
Thousands of similar complaints have been filed with the Occupational Health and Safety Administration against employers nationally about coronavirus exposure and a lack of safeguards, demonstrating some of the fear and frustration felt by those working during the pandemic.
In Colorado, 27 complaints with OSHA were filed between January and early April, many against employers in the Denver area, according to records obtained through a Freedom of Information Act request filed by The Washington Post and shared with The Gazette. Ten complaints were against employers providing medical care. In some of those cases, health care employees expressed concern they were not provided with proper personal protective equipment, such as respirators, leading to their exposure to coronavirus. No complaints were filed against El Paso County employers.
"Employees are potentially exposed to health hazards associated with positive cases of COVID-19 with employees having fevers/coughs," one complaint filed against an assisted living provider in Denver said.
At Penrose-St. Francis, some staff members were directed to go without needed gear in late March, while working with colleagues who were provided necessary equipment, employees there said. The directives came after employees were notified on March 10 about efforts to conserve personal protective equipment within the health system.
In an email to The Gazette, the parent organization of Penrose-St Francis, Centura Health, disputed Niswonger’s claims, saying it immediately informed all staff who worked in the same units as the surgeon about their potential exposure. Centura declined to provide a copy of the email it sent to workers about potential coronvirus exposure, citing concerns about privacy.
When asked if some staff members were asked to go without masks or other equipment, Centura said it provided proper protective equipment to employees working with patients who tested positive for coronavirus or who were suspected of having it. Chief Medical Officer for Penrose-St. Francis Bill Plauth said in late March employees were asked to use one N95 mask to work with each of their patients all day.
Niswonger said she took her concerns to the hospital’s incident command, but it was not receptive to feedback, she said.
“Nurses all over town are raising hell. … We are being pushed aside and ignored,” she said.
Other Penrose-St. Francis Health Services employees, who declined to be identified publicly for fear of losing their employment, echoed Niswonger’s concerns.
Operating room exposure
After the surgeon who worked sick at Penrose Hospital tested positive for COVID-19, Niswonger and other employees who worked with him while he might have been ill were never directly notified about their exposure, Niswonger says. The Gazette attempted to reach the surgeon for comment, but calls were not returned.
When Niswonger called in sick on March 17, she said she found out about the surgeon testing positive from a fellow staff member. On that same day, another hospital staff member said they were verbally told about the surgeon's positive test.
Niswonger said she does not believe she caught the virus from the surgeon, but thinks it’s highly likely she caught the virus at the hospital. She said that although she had been out in public, she had not attended any large events around that same time.
When she heard the surgeon had tested positive for coronavirus, she said she put herself in quarantine and tried to get tested. She eventually was tested through the hospital and her primary care doctor on March 20 — more than two weeks after her sickest day and after she likely would have tested positive for COVID-19 if she had it, she said. As of this week, she still had a cough, she said.
Centura said it informed more than 80 employees in six units about their potential exposure to the virus immediately after the surgeon tested positive. The timing of the notification may have varied based on the shifts the employees worked, the health system said. Centura did not answer a question from The Gazette asking about Amy Niswonger’s claims that she was not notified directly about her exposure, or advised to get tested or quarantine herself.
Centura said it instructed employees who may have been exposed by the surgeon to wear masks, closely monitor their symptoms and record their temperatures twice daily. Some ill employees also isolated themselves for 14 days, according to Centura.
The health system said in an email to The Gazette that it did not advise its employees to get tested because Colorado Department of Public Health and Environment guidelines at the time did not prioritize health care workers with symptoms. The only people prioritized at the time for testing were hospitalized patients, Centura said.
CDPHE said in an email Thursday that testing health care workers with symptoms has always been a high priority and there was never a point where only patients in need of hospitalization were prioritized.
“To our knowledge the provider did not knowingly expose any staff or patients to COVID-19, as there was no knowledge of the virus being in our region and initially there was no reason for anyone to suspect that the symptoms he was experiencing were COVID-19,” the health system said.
However, El Paso County Public Health announced March 6 that a resident had tested positive for COVID-19 — 11 days before the hospital announced to some staff members that the surgeon had tested positive.
Protective equipment shortages
Although hospitals across the nation have faced shortages of personal protective equipment to keep health care workers safe, Penrose-St. Francis Health Services directed some employees to go without needed gear while directing others in similar settings to wear it, Niswonger and other workers said.
Operating room anesthesiologists and nurses at Penrose in March and early April were given N95 masks to wear during surgeries, while the surgical technologists were not, a hospital employee said. An N95 mask will effectively filter airborne particles, such as bodily fluids.
Health care workers should wear protective equipment, such as an N95 mask covered with a surgical mask, during surgery to protect the worker and the patient, said Karen Hoffmann, a clinical instructor in the Division of Infectious Diseases at the University of North Carolina’s School of Medicine in Chapel Hill.
Hoffmann said health care workers need protection because they could be exposed to body fluids sent up into the air while tubes are placed down a patient's windpipe — a procedure known as intubation — and taken out of their windpipe — known as extubation.
“They should all have the same level of protection if they are in the room during intubation and extubation,” she said.
A nurse working for Penrose-St. Francis Health Services said the shortage of personal protective equipment was particularly noticeable at the end of March.
“You go on trial every time you ask for or need PPE,” she said on March 27.
In one case, she said administrators denied her the right gear to work with a patient who had coronavirus symptoms but had not tested positive.
“I, like almost every other nurse there, has been exposed,” she said.
When asked about supplying medical technologists with masks in the operating room and supplying nurses with the correct gear, Centura answered both questions with the same statement: that employees who are working with patients with COVID-19 or patients suspected of having COVID-19 are instructed to wear N95 masks and other appropriate protective gear.
As of April 14, Centura was still requiring employees to conserve N95 masks and other personal protective gear. Employees were asked to reuse the same N95 mask over a 24-hour period and return it to be decontaminated, according to the Centura's written policies.
Extended use and reuse of personal protective equipment because of the global shortage is not uncommon currently, Hoffmann said.
She said she would like to see the federal government reevaluate the nation's entire supply chain for personal protective equipment. The coronavirus is a wake-up call to be better prepared, but the country has had wake-up calls before such as the Ebola and SARS, she said.
"We don't seem to completely stay awake. ... We forget that we need to think of the worst-case scenario," she said.
In the early days of the spread of coronavirus, it was common to send hospital employees home if they were exposed, Hoffmann said. But that practice became impossible because so much exposure was going on inside of hospitals and communities; in some areas it would have left hospitals without enough staff, she said. So instead, to help prevent exposure, many hospitals required all staff to wear surgical masks and all visitors to wear cloth masks, she said.
“It’s the best way we know to contain respiratory droplets,” she said. The coronavirus spreads through droplets emitted while coughing or sneezing, according to the Centers for Disease Control and Prevention.
Prior to Gov. Jared Polis on April 3 asking everyone in Colorado to wear masks, Centura prohibited Penrose-St. Francis employees from wearing self-provided face coverings, such as cloth or surgical masks, in the hospitals while not working with patients, a nurse said.
Centura stated that it has never been against a policy of allowing nurses or any caregivers to wear personal protective equipment in hospital facilities. When Polis made his request, the health system said it adjusted its policies, as well.
However, following the governor's order, two hospital system employees said they observed many of their co-workers not wearing masks.
As of Monday, St. Francis Medical Center employees — such as receptionists, food service workers and hospital officials, were still not wearing masks, the nurse said.
“You never see them wearing masks,” the nurse said of hospital leadership.