Across the country, medical personnel have expressed alarm at the lack of personal protective equipment (PPE) – masks, googles, gowns – available to them as hospitals struggle to conserve scarce supplies in the face of skyrocketing COVID-19 cases.
A similar situation came to a head here last week when a number of health workers told MauiTime about their frustration with PPE restrictions imposed by the administration at Maui Memorial Hospital. In Maui’s case, government and hospital officials have worked quickly to address health workers’ concerns.
At issue was a Maui Hospital policy that prohibited doctors, nurses, and other health care workers from wearing masks in the hospital’s “common areas,” such as hallways, nurses’ stations, elevators and in the cafeteria – even if they brought them from home. Masks provided by the hospital were for use only in “clinical” areas like the emergency room, the intensive care unit, and patients’ rooms. And those, health workers said, were being carefully rationed due to tight supplies.
The hospital had previously been muted in its public response to questions about PPE. In an interview with MauiTime on March 23, Lisa Paulson, the hospital’s director of strategic communications, maintained, “We are perfectly fine with supplies.” When it came to donations, Paulson’s response was equally dispassionate. “We do understand the community’s desire to assist. So we are allowing people to drop things off and if we find them usable, we are going to reach out to other community doctors that may need them.”
When asked about health workers’ concerns about PPE shortages during that interview, she replied, “We have a lot of people on staff who are overreacting.”
That “overreacting” had reached fever pitch by late last week. Several nurses were sent home for wearing masks in public areas. Exasperated hospital health workers told MauiTime that they were being left out of the decision-making loop. “Management is not being authentic or transparent with us,” said one nurse, who did not want to be identified because staff had been admonished not to share hospital policy. “We don’t know if they have enough masks, so we don’t understand the rationale for why we aren’t allowed to wear them in areas of the hospital where social distancing is a problem, like elevators.
“It’s crazy, I can wear a mask while I shop at the market, but not when I’m walking the hallway at the hospital.”
And, they wondered, why couldn’t they bring their own masks from home?
The situation began to change rapidly last Friday. As health workers began to talk publicly to MauiTime, members from an influential group of Hawai‘i-based doctors, which calls itself the Hawai’i COVID-19 Healthcare Providers Task Force, asked the state for recommendations on proper PPE protection for nurses and physicians. In addition, questions were raised about the mask prohibitions during Friday’s County Council meeting by Councilmember Tamara Paltin.
Friday night, the hospital released a statement to MauiTime about the situation, explaining that the hospital was trying to conserve PPE use so it wouldn’t face critical shortages when COVID-19 cases began to surge.
Lt. Gov. Josh Green told MauiTime Friday that differing rules at various Hawai‘i hospitals about the wearing of PPEs in common areas had created “conflict in the hospitals.” Green, an emergency room doctor, had been working on the problem and added, “My expectation is there will be a statewide policy by next week.”
Saturday, the doctors’ group released a letter on its HICovid.org website imploring state leadership to “provide statewide recommendations for hospital administrators to follow, as soon as possible. This would help them make these difficult ethical decisions about rationing supplies and keep the message consistent.”
The letter was subsequently signed by 1,000 doctors statewide. It recommended that hospitals institute transparent tracking of hospital inventory, that health workers be allowed to use their own regulation PPE at any given time, and that self-made masks be allowed if a shortage of regulation PPE occurred.
It quoted a statement issued that day by the president of the American Medical Association which read, “It is vital that our health care workforce is equipped with a sufficient supply of personal protective equipment, including using their own PPE in order to protect themselves…”
By Monday, hospital administrators had pivoted to a new mask-friendly stance. In a memo to staff distributed late Monday afternoon, Maui Memorial Health Center executives Mike Rembis and Debbie Walsh reversed the controversial common area policy.
“Effective immediately, Maui Health employees and providers are allowed to wear their own masks,” the memo to staff explained. “Should they choose, clinicians and staff may use their own personal masks in their work setting.” The memo added, “homemade masks that have been donated by the community will be made available in the lobby areas for clinician and staff usage for as long as there is supply on hand. Donated masks should be used at the employee’s own risk/discretion.”
The quick resolution of the escalating situation brought doctors and nurses together as well, said COVID-19 task force spokesman Dr. Kai Matthes. “We have partnered with the Hawaii Nurses Association. This will be an unprecedented example of physicians and nurses working unified as a group to help our community during the difficult times of this COVID-19 pandemic.”
Said Matthes, a Maui-based pediatric anesthesiologist, “We will always fight for our nurses and back them up. They are the backbone of our healthcare system.”
Maui Memorial spokeswoman Paulson did not return requests from MauiTime for comment on the hospital’s new mask policy.
However, her attitude toward donated PPE has warmed significantly. “We have seen a wellspring of love and support from the community, and I want to do a huge shout-out to the Maui community,” she said in a radio interview Tuesday. “As always, they come together in times of distress. So, we’re really humbled by the generosity of individuals and nonprofits.”
Those who want to donate money or supplies to the hospital can get more information from the Mauihealth.org website or by calling 808-442-5191.