All staff caring for patients at Hoag Memorial Hospital Presbyterian must now wear face masks, following the Centers for Disease Control and Prevention recommendation that everybody cover their faces in public to prevent the spread of the coronavirus — and some complaints from doctors.
The hospital updated its policy late Monday, after a couple of doctors and other workers expressed concern over the weekend that masks were allowed, but not required.
“We recognize this is a fluid situation and that recommendations from the CDC are likely to change over time as new scientific data becomes available,” a statement from the hospital said. “Although we have adequate personal protective equipment [PPE] supplies today, we are planning and pursuing additional PPE sources to ensure we are equipped for the peak of the surge.”
In a letter to staff Monday night, hospital chief of staff Michael Hurwitz, medical director Philip Robinson and president and CEO Robert Braithwaite detailed the new “mandatory policy.” Anyone directly caring for patients must wear a hospital-issued mask. But medical personnel in nursing stations, hallways, the emergency department and non-clinical areas are only “strongly encouraged” to wear one of their own.
While Dr. Steven Abelowitz of Coastal Kids pediatric medical group, who works a few days a week at Hoag, appreciates his patients will be seeing healthcare workers in masks, he said the hospital’s new policy should be even stronger.
“I believe they’re doing a disservice to the healthcare workers and the public,” said Abelowitz, who wears a mask while working at Hoag. “100%, it’s not far enough.”
Up until Monday afternoon, the hospital held a “permissive” policy, allowing employees to wear masks. Aviva Alyeshmerni, a pediatrics community doctor on-staff at Hoag, said that wasn’t enough — she and other doctors wanted administrators to take another step and recommend or mandate the protective gear.
“Every day, we’re making sick contacts and ... exposing our community, because they leave the hospital sick without knowing it,” said Alyeshmerni, who goes by Dr. Vivi and wears a mask while working at Hoag.
Other hospitals in the area have followed similar “permissive” policies, while some require the protective gear.
“We defer to and respect your right to make your own decisions about the wearing of surgical masks when seeing non-COVID patients,” Hurwitz, Robinson and Braithwaite said in an April 1 letter to hospital staff. “While Hoag is not instituting a mandatory masking policy at this time, we certainly are not discouraging the use of masks at your discretion. We wish to reassure you that masks and other appropriate PPE are available at the nursing stations in all patient care units.”
Another letter from hospital staff on April 1 said PPE was available upon request.
Still, Alyeshmerni said she was hearing on the ground that hospital supervisors had been discouraging nurses and ancillary staff from wearing masks.
“People have been told that they’re unnecessary in this last week and that they’re going to make people scared, which is just weird,” Alyeshmerni said.
On Friday, the CDC recommended everyone wear face coverings in public settings to help curb the spread of the new coronavirus.
Abelowitz agreed with Alyeshmerni’s assessment. Abelowitz said he also heard from staff last week that they were discouraged from wearing masks. In a message to Abelowitz, one person wrote she was the only nurse in the newborn intensive care unit to wear a mask.
“When we examine babies, we’re a foot away. You’re in breathing distance and droplet distance,” Abelowitz said. “My opinion is, more for the baby’s sake but somewhat for the healthcare as well, an N95 mask should be worn.”
Seeing doctors and nurses without protective gear is worrying patients, too, Abelowitz said.
“They’re seeing the nurses and other staff getting close and handling their babies without the appropriate protective measures and they’re very concerned and frightened — appropriately so,” Abelowitz said.
Abelowitz and Alyeshmerni forwarded messages to the Daily Pilot from other Hoag personnel who reiterated their concern for the lack of a universal mask policy. Other healthcare workers shared their stories on condition of anonymity, afraid they could lose their jobs if they spoke out.
Both publicly and internally, Hoag has emphasized that it is well-supplied with protective gear.
“At this time, we have adequate beds, we have adequate personal protective equipment, like masks, gowns and gloves,” said Philip Robinson, Hoag’s medical director of infection prevention in a video on Hoag’s website.
In a town hall hosted Friday afternoon for Hoag staff, which Abelowitz shared with the Daily Pilot, hospital leadership assured staff that it was “ready for the surge of patients.”
Still, in the April 1 letter, Hoag leadership cautioned hospital staff to “use these scarce resources responsibly.”
“As you are undoubtedly aware from published accounts of the crisis in New York and elsewhere, PPE, particularly facemasks, are scarce resources,” the letter read. “We don’t want to find ourselves at the peak of the surge in late April without enough to go around.”
Of the 931 cases of coronavirus to date in Orange County, 129 people are hospitalized, according to the Orange County Health Care Agency, and 75 of those patients are in intensive care.
Medical personnel at other California hospitals have protested what they called lack of preparedness to deal with the potential for coronavirus. In Modesto last week, a few dozen nurses protested at a Kaiser Permanente Hospital about inadequate stock of personal protective equipment, including masks.