Across the country, medical personnel are expressing dismay at the lack of personal protective equipment (PPE) – masks, goggles, gowns – available to them as hospitals struggle to conserve scarce supplies in the face of ever-increasing COVID-19 cases.
The situation is the same here on Maui. MauiTime spoke Friday with a number of doctors and nurses frustrated with PPE restrictions imposed by the administration at Maui Memorial Medical Center. In particular, they are upset by the policy that doctors, nurses and other healthcare workers are forbidden to wear masks in the hospital’s “common areas,” such as hallways, nurses’ stations, elevators, and in the cafeteria – even if they bring them from home. Masks provided by the hospital are allowed to be worn, and are available, in “clinical” areas like the emergency room, the Intensive Care Unit, and patient’s rooms, although staff says they are being carefully rationed.
As Maui Memorial medical workers more publicly voiced concerns Friday, the situation changed quickly. Maui Memorial Hospital administrators and state officials say they are aware of the problem, and are working to accommodate their staff’s concerns, while preserving PPE supplies in preparation for a surge in COVID-19 cases that everyone agrees is coming to the island.
Late Friday night, Maui Memorial administration released this statement to MauiTime in response to our questions about staff concerns:
“PPE (including surgical masks and N95s) are in critically short supply nationwide. States that are currently dealing with surges in COVID-19 cases are experiencing shortages that are leaving their nurses and frontline staff in dangerous positions while treating positive cases. Many of those hospitals did not properly manage PPE usage prior to the surges and that contributed to their supply being wiped out so quickly. At Maui Health, we are trying to avoid a scenario like that.
“Experts and public health officials all over the world now have confirmed that COVID-19 is spread through respiratory droplets produced when an infected person coughs or sneezes. Per this confirmation, Maui Health is using enhanced droplet precautions to treat patients with suspected or confirmed COVID-19. This is in line with CDC guidance, recommendations by the World Health Organization, and the practices of other health care providers in Hawaii and around the country.
“By enforcing strict droplet precautions that protect our staff and patients, we can ensure that PPE supplies are available to the patients and staff who need it most. Knowing what we currently have on hand, and how long it may take to receive additional PPE orders, we believe that this is the best way to protect patients and staff while preserving our critical supply of PPE for the coming months. At this point, if all staff begin to wear PPE at all times, we risk not having the supplies needed to protect staff and patients when the expected surge of COVID-19 arrives leaving our staff and patients vulnerable and unprotected when our hospitals may actually be full of positive cases.
“We have seen an outpouring of support and are especially grateful for those that are coming forward with possible solutions. Please know that we are working tirelessly to protect our employees, providers, and patients, and are looking at all options. We have heard the concerns of our staff and community and are taking everything very seriously and into consideration. We thank you for your patience as we make these tough, but critical decisions for the health and safety of our entire community.”
Lieutenant Governor Josh Green is also aware of the situation, and said Friday that differing rules at various Hawaiʻi hospitals regarding the wearing of PPEs in common areas has created “conflict in the hospitals.” Green, an emergency room doctor, has been working on the problem and added, “My expectation is there will be a statewide policy by next week.”
To the doctors and nurses MauiTime spoke with Friday, the hospital’s statement indicated a new awareness of the need to better communicate with its staff. Prior to these latest developments, many workers at told MauiTime that they felt that they were being left out of the loop about hospital policy.
“Management is not being authentic or transparent with us,” said one nurse. “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.”
UPDATE: Saturday afternoon, the task force of hundreds of Hawai’i doctors who have been writing state leaders with their concerns released a letter on its website, HICovid.org, asking for PPE protocols and the need for transparency about hospital supplies. “We implore [Hawai’i] to provide statewide recommendations for hospital administrators to follow, as soon as possible,” the letter said.
Noting that community transmission of the virus was now taking place, “it is known that patients and caregivers can spread the virus when they are pre-symptomatic.” The letter asks Hawaii leaders and the Department of Health to “implement statewide recommendations for PPE use and also a transparent tracking of statewide inventory…This would allow healthcare workers to stay informed about their resources.”
It also asks that recommendations be made on the use of “provider-owned PPE” and approved self-made equipment.