Shortly after 6:30 a.m. on a recent morning, Dr. Henry Nikicicz, an anesthesiologist in Texas, was an emergency intubation of a man in his 70s who had difficulty breathing. Then the doctor’s own problems began.
Dr. Nikicicz got out of an elevator after the procedure was completed and put his respirator back on when he saw a group of people coming down the hall – he reflexively tried to protect himself and them in case someone was infected with the coronavirus.
In the following days, Dr. Nikicicz was told that his job was at risk because the guidelines of the hospital where he worked, the University Hospital in El Paso, prohibited the use of protective masks in the hallways. “Wearing this mask is essential for me,”
After refusing to resign, Dr. Nikicicz removed from the schedule and effectively suspended him from work without pay.
As the coronavirus infection spreads – and with it the fear – hospitals are exposed to extraordinary tensions between healthcare providers and administrators. The tension comes against the background of Illness and death for healthcare professionals in China, Italy and Spain and now more than 200 sick healthcare workers in New York.
Employees and administrators often argue about masks as to whether they should be worn outside of treatment rooms and what type of masks – thinner surgical or heavier breathing masks. Should they always be worn? Only during interventions or when visiting patients? There are also some arguments about testing and isolation: who and when and who to isolate when space in bed is limited? Who should he send home when an employee has symptoms and who should he commit to work?
Some hospitals allow masks outside treatment rooms, others even make them mandatory. However, some others say that they are not always necessary and do not allow them. The guidelines of the Centers for Disease Control and Prevention have changed several times. It is currently said that medical professionals do not always have to wear masks. It also means that home-made solutions such as headscarves or scarves are fine for health workers if there is not enough protective equipment available.
On Tuesday, Dr. Anthony S. Fauci, a leading member of the Federal Government’s Coronavirus Task Force, CNN with the C.D.C. considered another change: it is reviewing its guidelines on whether the general public should wear masks.
Amidst the confusion, angry and scared, doctors and nurses say that they have to trust their own judgment. Administrators counter that doctors and nurses fearfully write their own rules.
Some doctors believe that hospital administrators are simply trying to protect the image of their facility and do not want to be seen as a facility where dangerous germs are common.
As Dr. Nikicicz insisted on wearing a mask and received an SMS from his boss, the head of anesthesia, in which he was accused of overreacting. The text read: “We wear it in a public hall. There is no WUHAN VIRUS in the halls of the hospital any more than WALMART. MAYBE LESS. “
On Monday afternoon, the hospital confirmed in a statement that “Dr. Nikicicz has been removed from his rotation / work schedule due to insubordination. “But later the day after the hospital was asked to comment, Dr. Nikicicz, his boss, had informed him that he had been reinstated and could wear a surgical mask around the hospital and an N95 for surgery.
The circumstances that lead to tensions vary across the country.
An emergency doctor Dr. Ming Lin wrote on Facebook that he was fired from his job at PeaceHealth St. Joseph Medical Center in Bellingham, Washington on Friday after publicizing his concerns about inadequate protective measures and hospital tests.
The hospital said there was no comment on Dr. Lin’s dismissal.
Administrators from another hospital in Seattle, the Cherry Hills campus of the Swedish Medical Center, threatened an anesthetist, Dr. Oliver Small to suspend indefinitely because he wore a surgical mask when he was not directly involved in patient care, such as walking in the hallway.
“He was invited to meet with the Swedish administration because they didn’t want to panic the workers, because they believed they had to wear masks to protect them,” wrote Dr. Little’s wife Jessica Green on Facebook last week. “As a precaution, he wears a surgical mask if he is an asymptomatic carrier of Covid like many people, and he doesn’t want to risk infection in uninfected patients.”
The hospital asked him to attend a meeting where the administrators Dr. Small said he could take off the mask or stop coming to work, Ms. Green wrote, adding, “What’s wrong with our health system ???? !!! ”
Dr. Small confirmed the story, but said that the hospital has since changed its position on masks and that he is “very happy” with the result. Since the incident, the hospital has allowed “universal masking” – the possibility of wearing masks in every patient area.
The hospital said there was no comment on Dr. Small. It said it changed its policy when “we learned more about this disease.”
“Despite a limited amount of evidence proving its effectiveness, and while we continue to focus heavily on reuse and preservation, we have decided to implement universal masking as a sensible strategy as long as our mask supplies allow it,” said one Email statement from the hospital.
The increasing tension falls into a broader context: in recent years, doctors have increasingly felt that they are employees of cost-cutting companies that put profits before medicine. This tension seems to have found an almost volcanic moment in the coronavirus pandemic.
“There has been a loss of autonomy and disparagement for several decades. We will need a lot,” said Dr. Christopher Garofalo, a family doctor in North Attleboro, Massachusetts, who holds several regional leadership positions in medicine, including as a state delegate the American Medical Association, “More than half of the doctors are now employed by hospital systems or large groups,” he said, a systemic change that has made doctors feel less empowered and frustrated.
Covid-19, he said, “is causing the outbreak.”
Doctors in a handful of institutions provided notices from administrators showing a meeting with doctors.
An email sent to a group of doctors by a mid-level manager at Cleveland Clinic, one of the country’s elite hospitals, warned her against becoming “villains” and wearing surgical masks in the hospital . “These are emotional times and we have to control our emotions,” it said.
Dr. Jim Merlino, a top administrator and chief transformation officer at Cleveland Clinic, said the language was “not good communication”.
He also said that although he was aware that some doctors in his facility and across the country were frustrated, he claimed that the vast majority were not.
“People are scared and we need to make the record clear: it’s okay to be scared, but let’s accept that we make the right decisions,” said Dr. Merlino. “We have to suppress fear. Otherwise we will never survive. “
He said decisions should be made based on clear scientific evidence. The Cleveland Clinic interprets this current evidence as a conclusion that it is not necessary to wear surgical masks unless it is a high-risk situation.
However, other administrators interpret the evidence differently. Long Island’s Stony Brook University Hospital has just changed its guidelines to require such masks.
“We now recommend that all nurses wear an operating mask with ear loops at work. This practice should be used in open hospital rooms, ”says the new guidelines.