BELLINGHAM — Veteran emergency room doctor Ming Lin is in the business of saving lives, not pointing fingers. But with numbers of coronavirus patients expected to crash like a wave at Puget Sound area hospitals, he’s making a public plea for better preparation and safety precautions at his own hospital, PeaceHealth St. Joseph Medical Center.
While taking some precautionary steps, St. Joseph has lagged behind other emergency facilities in preparing for what could quickly become a crush of patients needing critical care from COVID-19 sickness, says Lin, an emergency room doctor with experience in health crises such as the 9/11 terror attacks.
And the hospital’s ongoing failure to take steps to protect staff from the virus might heighten it, he says.
Lin, an employee of TeamHealth, which contracts with PeaceHealth for emergency department personnel, went public on Facebook with a list of concerns early this week, charging that the lack of precautions at the hospital was exposing staff to a high degree of risk of virus infection. His criticism has been echoed by other hospital physicians and staff members in recent days in communications reviewed by The Times.
Lin pointed to what he called a lack of sufficient segregation at the hospital for potentially COVID-19-infected patients who come to St. Joseph’s emergency room, and, especially, the lack of protective measures, such as regular temperature checks, to screen hospital staffers for the virus.
Most of those precautions have been taken by other hospitals, including those much smaller, with more limited resources, Lin said by telephone this week from Rosebud, South Dakota, where he was maintaining frequent contact with Bellingham colleagues while working a prescheduled one-week shift at a tribal health clinic. He is scheduled to return to work at PeaceHealth St. Joseph next week.
In some ways, he said, he was alarmed to find better precautions in tiny Rosebud than in Bellingham, where the hospital is a Level II trauma center.
“We’re so close to the epicenter (King County),” said Lin, an 18-year veteran of the Bellingham emergency room. “I’m surprised we’re not screening better, or being more cautious. Bars are closed, schools are closed, this is a national emergency we happen to be in.”
Nearly 1,400 Washington residents had tested positive for the disease as of Thursday afternoon, with 74 reported deaths — 60 of those in King County. Whatcom County’s first COVID-19-linked death, a man in his 60s, occurred at PeaceHealth St. Joseph’s on Thursday, the Whatcom County Health Department said.
A spokesperson for PeaceHealth St. Joseph said plans are in place to implement some of the changes Lin called for, and said the hospital’s current practices meet industry standards.
But Lin, noting that most changes were first discussed with staff only after his public protestations, said hospital staff members still see an alarming degree of “business as usual” in practice at the hospital today.
The hospital’s assurance that it is “working on a plan” to launch measures such as outdoor pre-screening of patients is not enough, or soon enough, he maintains.
Lin also said his superiors have asked him to “retract” or “recant” his public statements, which he has refused to do.
“Unless I am terminated and not wanted I will continue to show up to work in the Emergency Room to continue to serve,” he said in a Facebook post Thursday.
Thursday morning, the doctor doubled down on his earlier protests, detailing in a Facebook post what he called the hospital’s slow response to his initial concerns:
— The hospital has announced only plans to screen temperatures of staff members but hasn’t done so at the hospital. (PeaceHealth is “beginning the process to conduct a simple temperature and verbal screening for all caregivers, providers and visitors” at all facilities, Bev Mayhew, senior director of communications for PeaceHealth, responded in a statement Thursday.)
— The hospital did seem to be moving to clear its decks by reducing elective surgeries, although other physicians told Lin that the procedures still were being performed this week.
— Administrators now say they have a plan to begin outdoor triage of incoming patients — a practice already implemented at other medical facilities in active COVID-19 zones — but have yet to put it in place, saying it’s not necessary yet.
“As with all health care facilities in our region, we are actively preparing for a surge in the number of people with acute symptoms and requiring hospitalization, but we haven’t noticed a significant increase yet; in fact, volume in our ED has been down for the last eight days in a row,” TeamHealth’s Facility Medical Director, Worth Everett, said in a statement to The Seattle Times.
That response misses the point, Lin said, which is that it only takes one incident to infect hospital staff members.
Other regional hospitals, including Skagit, Swedish, Evergreen and Wenatchee in Washington state, and others nationally, are already accepting ER patients in this manner, he added: “Why not us? Why wait?”
As the primary emergency facility for a county of 221,000 people, St. Joseph should lead the way in extensive precautions, not lagging, Lin said.
“We are at the greatest risk of spreading coronavirus,” he wrote in a Facebook missive. “We have the highest concentration of COVID and COVID-potential patients in the county.”
The hospital was awaiting results for 27 COVID-19 patient tests as of Wednesday, according to daily COVID-19 status report from the hospital’s chief medical officer, obtained by The Seattle Times. Tests already returned revealed “1 positive (in-house); one caregiver positive,” according to the memo. Positive test results initiate an investigative process about possible contact with patients or other staff, said PeaceHealth’s Mayhew.
Lin said he and other doctors are concerned about further spread, heightened by the broad shortage of masks and other protective equipment hampering treatment efforts across the country.
“We can’t do anything about the equipment,” he said Thursday. “We can control other things.”
Lin said he doesn’t like to single out his employer for lack of preparation, but he felt compelled to speak out after continued inaction because of the potential gravity of the crisis.
Like other hospitals, St. Joseph’s ability to treat and isolate COVID-19 patients has been hampered by the lack of available test kits, Lin said. Internal emails from hospital staff reviewed by the Times include frequent references to frustration with the local testing lab, Quest Diagnostics, to provide ample or timely results. Other internal emails between PeaceHealth physicians express frustration that tests are not being sent to other labs, with higher capacity and faster results.
Lin said hospital doctors have to receive PeaceHealth administrative approval for tests, because they have been told that the entire PeaceHealth Medical system, which includes 10 medical centers from Alaska to Oregon, is allotted only 50 COVID-19 tests per day.
PeaceHealth’s Mayhew did not respond to that specific claim, but said: “We see more and more tests done each day and hope the trend continues.” She maintained that the hospital is abiding by government and health organization standards in its approaches to COVID-19.
“We take the safety of our caregivers and providers very seriously,” Mayhew said in a written statement Tuesday. “In the case of the two positive COVID-19 patients that we’ve treated in house, the post-test confirmation revealed that no caregivers or providers were exposed.”
Although screening tents have yet to be erected, patients with COVID-19 symptoms are met outside the hospital by staffers wearing protective gear to be escorted inside, Mayhew noted.
As of midday Thursday, seven Whatcom County residents and at least two other people who had been commuting to work in the county from King and Snohomish counties had tested positive for COVID-19, which county health officials advise is actively circulating in the community.
The first of those cases, a woman in her 60s, spent time at PeaceHealth St. Joseph at an undetermined date before testing positive, according to the Whatcom County Health Department. The hospital followed proper procedures in that case, the department said.
The person who died Thursday at the hospital had tested positive earlier this week and received respiratory treatment, a PeaceHealth spokesperson confirmed. The county also has recorded 209 negative tests for COVID-19 and says many more are pending.
PeaceHealth, based in Vancouver, Clark County, is a nonprofit Catholic health care network employing 16,000 caregivers at 10 medical centers in Washington, Oregon and Alaska. The network treats 392,000 patients annually. Its primary facilities in Washington state are in Bellingham, Friday Harbor, Sedro-Woolley, Longview and Vancouver.