When James Simpson learned that teens he counseled at a Burien mental-health center had contracted COVID-19, he was nervous and irked by how his employer was handling the outbreak.

He shared his concerns with his sister, Kamaria Simpson, who advised him to find the nearest emergency room and get tested. “Don’t go back to work,” she texted him on April 1. But he had already returned to his job at the Sunstone Youth Treatment Center.

“I’ve been exposed to it,” Simpson texted back. “So I might as well keep coming to work.”

Five days later, he was sent home from work with a fever. On April 10, Simpson died at his apartment in Bellevue. He was 28 years old.

The death of Simpson – a native of Sacramento, Calif., who grew up in foster care and found a calling counseling kids – has stirred grief and anger among his family and coworkers. Several current and former Sunstone employees criticize the facility and its parent organization, MultiCare Health System, for failing to equip staff in time with the training and protective gear they needed to shield them from the virus.

Eight of the 15 teenage residents at Sunstone tested positive for COVID-19, according to internal memos reviewed by The Seattle Times – a rare outbreak among youths, with children and teens accounting for only 4% of all cases in the state as of Sunday.

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MultiCare, which declined interview requests, said in a statement that staff and patient safety was its highest priority. The organization said preventing the virus from spreading is challenging in a setting like Sunstone, where residents in psychiatric crisis are treated in groups, interact with others and don’t always comply with safety measures.

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All employees “have had and continue to have the appropriate personal protective equipment (PPE) to do their jobs safely,” MultiCare said.

Current Sunstone employees spoke on the condition of anonymity because staff have repeatedly been warned not to talk to journalists.

Some of the youths at Sunstone had low-grade symptoms before they tested positive, according to current and former Sunstone employees. Research increasingly has shown that people can transmit the virus without symptoms. As a mental-health technician, Simpson worked in close contact with residents before Sunstone began requiring staff to wear masks and other protective equipment.

More on the coronavirus outbreak

Simpson, who had underlying health conditions, died of “probable pneumonia,” according to the King County Medical Examiner’s Office. He told his sister he was tested for COVID-19 when he checked into an emergency room, but it isn’t clear if there was a result.

A funeral home has arranged for him to be tested posthumously, she said. If he was infected by the coronavirus, he would be one of the youngest known victims in Washington state, where people of color like Simpson have been disproportionately affected.

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There is no legal deadline for a facility to notify public-health authorities of a COVID-19 case, but officials in King County urge reporting within 24 hours. MultiCare did so nine days after realizing the virus had arrived on Sunstone’s campus. During that period, a current employee said, the severity of the outbreak “very rapidly began to escalate.”

An outbreak emerges

On March 25, Sunstone administrators sent a memo to staff that “a person associated” with the campus tested positive for COVID-19. “The individual did not have sustained contact with others, and the exposure risk is considered low.”

The campus at the edge of Lake Burien, operated by MultiCare subsidiary Navos, is one of five programs in the state that participate in a Medicaid-funded program for children and teenagers with severe mental illness.

Much of Sunstone’s intensive programming had halted in early March, when it began restricting visitors to reduce the risk of the novel coronavirus. Now all staff would take their temperature before starting their shift, the memo said.

Around the same time, Sunstone sent one teen resident to a health-care facility to be evaluated. A flu test came back negative, and staff treated the resident as “presumed positive” for COVID-19, according to one health-care worker familiar with the sequence of events. The resident was placed in isolation on campus.

Kelly Martin-Vegue, a nurse and social worker, left Navos’ Sunstone Youth Treatment Center in Burien after a disagreement over protective gear and training amid a COVID-19 outbreak.  (Steve Ringman / The Seattle Times)
Kelly Martin-Vegue, a nurse and social worker, left Navos’ Sunstone Youth Treatment Center in Burien after a disagreement over protective gear and training amid a COVID-19 outbreak. (Steve Ringman / The Seattle Times)

Kelly Martin-Vegue, a nurse and social worker, was alarmed by what she saw. Employees were confused about how to correctly put on and remove protective gear, she said. Some how-to illustrations didn’t correspond to the equipment that Sunstone had, another health-care worker there said.

The room where staff would put on and take off protective gear lacked a trash bin, and used gloves were discarded into a paper bag or onto the floor – a state of disarray that heightened Martin-Vegue’s concerns about training to prevent recontamination.

MultiCare said in its statement that it began educating staff on COVID-19 on March 2, and that “all staff have been instructed in proper disposal of PPE.” MultiCare acknowledged differences between its actual gear and training materials but said all PPE “meets our rigorous standards.”

Martin-Vegue had started her job at Sunstone in early February, taking a break to quarantine herself when she and others in her household became ill. She returned to work after a negative test for COVID-19.

On March 31, Martin-Vegue’s second day back, she learned that two residents had tested positive.  At a meeting that day, another employee said, staff were handed surgical masks to wear during their shifts – the first time staff not working with presumed COVID-positive patients received PPE.

The danger had become “undeniably real,” Martin-Vegue said. After raising concerns about the adequacy of protective gear and training to use it, Martin-Vegue said she was called in to a meeting with two administrators, who advised her to “seriously consider the fit.”

Martin-Vegue promptly resigned, she said.

“It was all very overwhelming, and it still is,” she said.

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“I think I’m sick”

That evening, James Simpson texted his sister Kamaria, who lives in Louisiana, with bad news.

In texts and phone conversations, Simpson confided in his older sister about his concerns that more residents could have been exposed to the virus, and that staff had only begun to use protective gear and sanitizer, Kamaria Simpson recalled.

“I am pissed,” she texted him on April 1.

“I am too,” he replied.

She reminded him not to go to work if he didn’t feel well.

“I know,” he said. “When I feel sick i will let them know.”

In its statement, MultiCare said Sunstone “immediately isolated suspected cases of COVID-19.”

James Simpson had grown up in foster care in California, and his experiences helped him identify with the youth he counseled at Sunstone, family members said. At 5-foot-9 and more than 300 pounds, he was a gentle giant, reluctant to physically restrain kids who acted out.

“He just wanted to be that voice for kids,” said his cousin Chezere Braley, “someone the kids could trust, confide in confidently without being judged.”

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On April 4, Simpson texted his sister, “I think I’m sick.” He said he would rest.

The next morning, a Sunday, a Sunstone administrator emailed staff and disclosed that eight of the 15 residents had tested positive for COVID-19. Other employees were calling in sick, some with symptoms consistent with COVID-19, putting a strain on staffing, according to the email from Kristina Schemnitzer, residential services director.

“Coverage has been challenging to say the least,” she wrote.

That day, James Simpson stopped by Braley’s home to celebrate her birthday. They danced around her kitchen, playing with her two young children, until Simpson left to work his shift at Sunstone.

“He didn’t seem sick at all,” Braley said. It was the last time she saw him.

The next day, on April 6, Simpson reported to work with a fever. He went to an urgent-care clinic but was told “they couldn’t see me because they assume that I have the virus,” he texted his sister Kamaria.

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He went to the emergency room at Overlake Medical Center, where physicians took a chest X-ray, diagnosed him with pneumonia and sent him home with a prescription for antibiotics, according to a summary of his visit.

Shock

As positive test results came in, staff regrouped to come up with a plan to separate patients with the virus. Meanwhile, patients learned that the virus had spread. Some responded by acting out. One staff member described being spat, bled and breathed on by a patient who had tested positive earlier that day.

“We’re not doing right by these kids,” the staff member said. “I cannot consciously go in there day after day and watch them escalate … [and be] put in a seclusion room for two hours. It compounds trauma. It makes me ill.”

Two residents, one who tested positive April 3 and another who tested negative, were discharged the third week of April. Until that point, they had not left the facility or seen their families, guardians or caseworkers for six weeks.

MultiCare says it allows “video visits and phone calls to ensure patients are able to stay connected to their support systems,” and that it has increased staffing at Sunstone.

By April 8, with employees continuing to call in sick, Sunstone and other Navos inpatient facilities were so short-staffed that MultiCare Chief Operations Officer Terri Card notified the rest of the health network’s employees they would be temporarily reassigned to cover empty shifts.

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Late on the night of April 10, Kamaria Simpson’s phone lit up with the number she had saved as “Brother.” It was a police officer, calling from James Simpson’s phone, to tell her he had died.

“It’s an unexplainable feeling,” Kamaria said. “It still doesn’t feel real.”

The Times first contacted MultiCare with questions about Sunstone on April 11. Three-and-a-half hours later, Sunstone staff received an email with the subject line “! Do not talk to reporters – media reminder !”

On Sunday, April 12, at 6:23 p.m., MultiCare’s president of behavioral health, Tim Holmes, emailed staff to alert them that there would likely be a story in The Seattle Times that “will question the availability of personal protective equipment (PPE) and training for its use.” Staff should not speak to the media, Holmes warned.

Barely a half an hour earlier, staff had received another email from Holmes – notifying them Simpson had died. “This news is devastating to our teams and to the people who worked with James each day,” he wrote. “We appreciate his contribution to our organization and to ensuring the patients at Sunstone were well cared for.”

Kamaria Simpson has not received any condolences from Sunstone, Navos or MultiCare, she said, and has struggled to obtain information she needs to sort out her brother’s affairs.

“He truly enjoyed working for the kids,” she said. “He was just so selfless, and he just had such a big heart.”

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