More than 100 doctors, physician assistants and nurse practitioners who work at urgent-care facilities within the MultiCare health system went on strike Monday, as the COVID-19 pandemic worsens, to protest working conditions. 

Dozens of health care providers picketed Tacoma General Hospital. Represented by the Union of American Physicians and Dentists (UAPD), they work at 20 MultiCare Indigo Urgent Care clinics in the Puget Sound area, from Olympia to Marysville, which provide coronavirus testing.

MultiCare said in a statement Monday morning that “a majority of clinics” remained open Monday. Joe Crane, a union representative, said the strike closed several clinics.

The union has been negotiating its first contract with MultiCare for more than a year. The spread of coronavirus, as in many medical workplaces, has exposed new rifts between employees concerned for their personal safety and employers struggling to manage an unprecedented global pandemic. 

The health providers contend they sometimes work excessive hours, care for too many patients, aren’t provided the protective equipment they want and are concerned about the clinics’ infection-control practices. 

“This is last resort for us,” said Dr. Amir Atabeygi, one of those on strike. “Lately, our biggest concern and challenge is having adequate PPE [personal protective equipment] at work and feeling like we’re in as safe a work environment as possible. Our concerns are being ignored and dismissed.” 

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The providers want access to N95 respirators, plexiglass barriers in the reception areas, and for the company to discourage patients from using waiting rooms, Atabeygi said. MultiCare says it takes steps to minimize the time patients who might have the virus are inside clinics and follows “best practices” for infection control.

Atabeygi said health providers don’t have time for scheduled breaks, and often work days that stretch longer than 12 hours. MultiCare says it requires breaks.

“You’re not as mentally sharp as you would be toward the end of the day,” Atabeygi said. “What worries us is either we’ll miss something, or make an error that’s significant.” 

MultiCare, in several statements to the The Seattle Times over the past three days, said it shared employees’ frustration at the lack of progress in bargaining, including during a recent session with a federal mediator. 

“We disagree with the union’s characterization that our urgent care team members do not have access to sufficient supplies of appropriate PPE,” the statement said. 

“We are disappointed that UAPD decided to strike during a pandemic, a time when our patients need our care more than ever. Our priority remains providing the care our community needs during the pandemic. We remain committed to the negotiation process and are working hard to negotiate a fair labor contract.”

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People with mild symptoms of COVID-19 often seek care and testing at urgent care facilities. Atabeygi, who works in Thurston County, said it’s not uncommon for health care providers at Indigo clinics to see 40 to 50 patients daily, with most complaining of respiratory symptoms.

In recent weeks, the number of symptomatic patients has risen “dramatically” and Atabeygi said he worries about bringing the infection home to his family.

Infection- control measures that protect against the coronavirus have become a contentious topic dividing health care administrators and employees. N95 respirators, which have often been in short supply, are a common flashpoint.  

The Centers for Disease Control and Prevention (CDC) says respirators, or their equivalent, should be prioritized for workers performing procedures that produce infectious aerosols, such as intubation. If available, the CDC suggests using respirators when collecting swab samples from patients. The CDC considers N95 respirators the “preferred” PPE, while face masks are an “acceptable alternative.” 

Atabeygi said nasal swab samples are typically collected by medical assistants wearing face masks and shields. He said he did not understand why, many months into the pandemic, MultiCare would not provide respirators for those staffers who see dozens of potentially infected patients each day.

MultiCare said it proposed the creation of a safety committee during contract bargaining that would involve employees and further develop protocols and PPE programs along with experts.

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Ann Marie Pettis, president-elect of the Association for Professionals in Infection Control and Epidemiology, said health care systems can make employees more comfortable by allowing the optional use of N95 respirators. Pettis, who works in infection control in New York state, said installing barriers in reception areas, limiting visitors, redesigning waiting rooms and asking people to wait in their cars  rather than lobbies could also help. Ventilation is key, along with employee vigilance in masking and wearing eye protection. 

Pettis said clear communication — and open dialogue — between health care management and employees was paramount.   

“I think transparency is probably the most important thing,” Pettis said. “Fear can destroy communication pretty quickly.” 

The union’s members plan to picket again Tuesday. While MultiCare says the union represents 108 striking employees, Crane, the union representative, said he believed that was an undercount.