Some Hospitals Are Firing Doctors for Wearing Masks
The first publicly reported case of the novel coronavirus SARS-CoV-2 was reported in Wuhan, China, December 21, 2019. According to Pro-Med International Society for Infectious Diseases,1 those first patients had clinical signs consistent with viral pneumonia.
On January 21, 2020, the first confirmed case had reached the U.S. It was an individual living in Washington state who had recently visited Wuhan, China.2 The second case appeared January 24, 2020, in Illinois;3 this was also someone who had recently returned from Wuhan, the epicenter of the SARS-CoV-2.
Since then, the number of infections has spread rapidly across the U.S. and the world. A rising number of patients entering the hospital with contagious flu and SARS-CoV-2 has put a strain on personal protective equipment (PPE) needed by health care providers to stop the spread within health care facilities.
Nearly four months later, shortages of masks, gowns, gloves and face shields have left doctors and nurses at personal risk and at increasing levels of risk for spreading viruses to those who are not infected.4 One of the most effective face masks used to protect against airborne particles is the N95 mask.
One challenge to providing PPE to health care workers has been inadequate stockpiles and N95 face masks that exceeded their shelf life. On February 28, 2020, the CDC5 announced it was necessary to test a stockpile of N95 masks manufactured between 2003 and 2013.
Although preliminary results show the masks performed as expected, it seems as if they were never expected to be used. It’s also possible the stockpile had been forgotten, left to expire and not replaced with newer masks.
Doctors Fired for Wearing Masks
Reports of doctors and nurses losing their jobs after wearing face masks in hospital hallways have been making the news. As health care workers are on the front lines of caring for highly contagious individuals, many have resorted to finding their own face mask and wearing it while at work.
NPR tells the story of one traveling physician, Dr. Neilly Buckalew, who was assigned to Saint Alphonsus Regional Rehabilitation Hospital in Boise, Idaho.6 She purchased and brought her own PPE and N95 mask to work. On her first day, she was ordered to take it off.
The reasons the hospital administrators gave kept changing, but she was told if she wore the mask she would have to leave. She refused and was terminated. Buckalew is among the few who are speaking publicly since, as she puts it, "A lot of people can't speak out because they're afraid, or they know that they'll be fired."
The events surrounding the termination of Dr. Henry Nikicicz are told in The New York Times.7 After seeing a group of individuals in the hallway at the hospital, the anesthesiologist put on his mask to protect himself and them.
However, in the following days he found his job at the University Medical Center in El Paso was at risk. After refusing to stop wearing his mask, Nikicicz was removed from the schedule and suspended without pay. As The New York Times reported, he was sent a text message from:8
“… the chief of anesthesia, accusing him of overreacting. The text read: ‘UR WEARING IT DOWN A PUBLIC HALL. THERES NO MORE WUHAN VIRUS IN THE HALLS AT THE HOSPITAL THAN WALMART. MAYBE LESS.’”
As The New York Times reporter wrote, the text message was not only inaccurate but xenophobic. In a statement, the University Medical Center of El Paso said the anesthesiologist was removed for “insubordination:”9
"The anesthesiologist was told on numerous occasions by his supervisor to not wear the N95 surgical mask while not in the Operating Room area or while not treating patients with infectious disease.”
Health Care Workers Are at Risk of Spreading Any Virus
The president-elect of the American Academy of Emergency Medicine told NPR10 she has heard multiple stories like Buckalew's from across the U.S. "We're hearing a lot of people saying that 'I'm not getting adequate PPE at my job, so I was able to buy PPE and I'm using what I buy.'"
Propublica11 highlights the dangers of health care workers who are not adequately protected in the story of Dr. John Gavin, emergency room physician in Amite, Louisiana. Gavin, 69, contracted the novel coronavirus while working in the emergency room.
When he was diagnosed March 12, 2020, and subsequently quarantined at home, he reported that the officials at Hood Memorial Hospital where he works had not yet changed any procedures to protect the doctors and nurses, nor their patients. At the time the ER did not have N95 respirator masks or gowns to protect the staff.
Because of a staff shortage, Gavin could not call in sick in the days before his diagnosis was confirmed. He showed up for work in the emergency room and treated patients, where he believes he exposed everyone he saw.
Health care workers are facing threats of disciplinary action and termination if they're found wearing masks outside of patient care areas. Megan Ranney, associate professor of emergency medicine, Brown University, told Scientific American:12
“… yes we should absolutely be able to wear procedural masks outside of patient rooms. We are all potential sources of infection and protecting our healthcare workforce is critical. Of course, we are likely to need to reuse these masks — but forbidding their use seems, to me, misguided.”
Hospital Support Personnel Without Information or Protection
Doctors and nurses are not the only workers on the front line who are short of equipment and information. One worker spoke to Vox, but didn't want to be identified for fear of repercussions from the hospital. She works in a south Florida hospital. And part of her job is to go with the doctors on rounds to see their patients. As Vox tells her story:13
“The new normal has shifted so much,” says the worker … As recently as early March, a supervisor laughed at her for wearing a mask when she was recovering from a cold. “She said she didn’t want me causing pandemonium,” she recounts. “This was a week before mask-wearing was mandatory.”
Other non-medical staff in the hospital are also at risk for contracting or passing along the virus. One working at a hospital in southern Kentucky did not want to be identified to the Vox reporter as he feared repercussions and job loss. Without adequate information about what protective measures should be taken, he asked his boss whose response was, “just wear gloves.”
His responsibilities include cleaning patient rooms and laboratories that have biohazardous waste. At the time of the report he did not have access to a mask and did not have the benefit of paid sick time. He told the reporter, “All this for 11 dollars an hour. Damned if you do, damned if you don’t.”
National Nurses United14 published a survey of 8,200 nurses from around the country. They found just 46% had information about how to recognize and respond to possible cases and 58% of employers were screening all patients for travel and exposure history as well as fever and respiratory symptoms. However, only 55% had N95 masks and 24% had enough PPE to protect the staff.
Information flow also appeared to be sparse as only 31% of the nurses knew there was a plan in place to isolate patients suspected of being infected. The lack of equipment and training within hospital facilities increases the risk health care workers and patients may be passing viruses from one to another.
Not All Hospitals Have the Same Perspective
Longtime nurse Kevin Readel spoke to a reporter from Scientific American after he was terminated for insubordination when he refused to take off a mask while inserting an IV. During a conversation with human resources he shared, “… the entire discussion we had centered around me causing hysteria by wearing a mask.”15 He spoke freely, since he has lost his job and is suing the hospital.
While some hospitals appear to have a greater concern over the appearance of protecting patients and staff rather than educating patients and protecting staff, others have a different perspective. Queen Mary Hospital in Hong Kong mandates all health care workers always wear a mask. In a six-week survey, the hospital reported no health care worker or hospital-acquired infections.16
Some hospitals in the U.S. have also taken up this strategy. Northwell Health in New York asks all health care workers to wear masks while at the hospital. Senior vice president and chief medical officer David Battinelli said:17
“We are doing this to help preserve our workforce. We can build ventilators, but we can’t build health care workers. They can’t get sick. We also want our workforce to feel comfortable and safe working.”
Massachusetts General Hospital and Brigham and Women’s Hospital announced it is mandatory to wear face masks while at the facilities. On March 24, 2020, nurses at St. Joseph’s Women’s Hospital in Florida were told they18 “should not be wearing masks or gowns if not taking care of an islocation [sic] patient. (No exceptions.).”
Within days the hospital reversed the decision, telling a news reporter the hospital expects all staff to wear a mask while working. Multiple hospitals in Florida made a similar switch from telling staff they can’t wear masks to insisting they do. Martin Peebles, representative for the National Nurses United Union, is glad these precautions are finally being implemented:19
“I really wish that a lot of these precautions would have been put forth when we first suggested it about two or three weeks ago. If they can’t protect themselves, they can’t protect anyone.”
Pandemic Agitating Loss of Physician Autonomy
According to The New York Times,20 some of the animosity between physicians and administration stems from another source. In the past several decades, doctors have moved from private practice to becoming hospital employees, losing the autonomy associated with independent practice.
This has placed the physicians as employees to companies that sometimes place profits ahead of patients. According to Dr. Christopher Garofalo, it has created an environment that leaves physicians less empowered and more frustrated.
The New York Times reports of an email from a manager at Cleveland Clinic that was sent to a group of doctors, warning them not to “go rogue” by using masks around the hospital. Garofalo is a family doctor from Massachusetts who holds leadership positions in the state and serves as a delegate to the American Medical Association. He told the New York Times:21
“There’s been a loss of autonomy and a denigration going on for a couple of decades now. We’ll take a lot" and COVID-19 "is causing it to erupt."
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