Jhonna Porter felt a duty to alert her co-workers to a potentially dangerous change on the fifth floor of Los Angeles’ West Hills Hospital. Without much notice, the administration had begun converting the floor into a COVID-19 unit on March 20.
“The rumors are true,” Porter, a registered nurse, wrote that evening in a private Facebook group used by the floor’s staff. “Be careful.”
Porter, whose department usually works with cardiac patients, didn’t think the hospital was providing staff on the newly converted floor with adequate personal protection equipment. She posted a plea for donations on her personal Facebook page on March 24.
“I’m physically ill from the mental stress,” it read. “I need anything I can get.”
Within hours of posting that, the hospital administration called Porter in for a meeting. A West Hills attorney slid a printout of her March 20 warning to the private Facebook group across the table and accused her of violating patient privacy laws.
Porter was suspended without pay while West Hills investigated.
“I’m physically ill from the mental stress. I need anything I can get.”
But the move mostly backfired. Suspending a nurse in the middle of a pandemic proved to be a public relations nightmare that sparked outrage and quickly escalated into a national news story. After 10 days, West Hills reinstated Porter and another nurse who had been suspended for a similar issue.
But the hospital had delivered its message, Porter said.
“It’s a PR thing,” she told HuffPost. “I think they’re trying to shut us up, and it worked.”
The West Hills controversy is hardly an isolated incident. Across the country, hospitals have threatened to discipline front-line health care workers who post on social media or speak with reporters about PPE shortages and dire working conditions.
Meanwhile, the latest statistics from the Centers for Disease Control and Prevention show that over 9,000 health care workers have been infected with the coronavirus, though the CDC says the true number is likely much higher because occupational data is only available for about 16% of cases.
Hospital administrators often claim they are acting to protect patient privacy rights under the Health Insurance Portability and Accountability Act, or HIPAA, and stem the spread of misinformation. But health care workers say speaking up is their best hope for pressuring decision-makers who can make changes to improve hospital conditions and save lives.
“I was hoping by using social media we can pressure hospitals to be honest and show commitment to its employees and the community,” Washington state physician Ming Lin wrote on Facebook in late March after he was fired for posting on social media about his hospital’s working conditions.
Porter and Lin’s posts led to a crowdsourcing campaign and equipment donations, though the administrations prohibited staff from using the gear because they say workers aren’t trained to use equipment not issued by the hospitals. Other health care workers hope their challenges can serve as warnings to those in hospitals the pandemic has not yet hit.
“It’s important for healthcare workers to tell their experience and stories so others can learn from it,” said Teena Chopra, an epidemiologist at Detroit’s Sinai-Grace Hospital who has regularly spoken with the media during the outbreak. “There’s nothing wrong with telling the truth to the world, as long as the information is accurate and it’s scientifically sound.”
Chopra and other doctors said they’ve received offers for assistance from experts after their names have appeared in stories. Moreover, there’s a moral case to be made for front-line workers engaged in “heroic measures” demanding a safe workplace, said I. Glenn Cohen, a Harvard University School of Law bioethicist.
“I think physicians have a right to adequate equipment, and if the only way to get it is to make a public stink, that’s ethically appropriate,” he said.
The workers also say history shows why their voices are important. Hal Weiss, a spokesperson for SEIU 121RN, which represents 9,000 nurses in Southern California, noted that it was pressure from workers that led to the state in 2009 set a new standard for measures to control the spread of transmissible pathogens like those that cause tuberculosis, measles, SARS and swine flu.
The SEIU called it “the nation’s first workplace standard designed to protect healthcare and other workers from aerosol (airborne and droplet) transmitted diseases.” It’s directly protecting workers in California’s hospitals during the COVID-19 outbreak.
“I think they’re trying to shut us up, and it worked.”
At the peak of the AIDS epidemic, hospital administrations initially resisted nurses’ demands for safer needles after several nurses contracted HIV and died due to an accidental stick. Sustained pressure from health care workers led to stricter rules throughout the 1990s, culminating with the federal Needlestick Safety Prevention Act in 2000 that requires hospitals to use safer needles that are less likely to poke health care workers and to put in place stricter safety guidelines.
“Had the union nurses who stood up during the early days of the AIDS crisis been gagged by a misuse of HIPAA, or for any reason, the Needle Safety and Prevention Act might never have come to be,” Weiss said.
‘They’re Trying To Keep Everything Hush-Hush’
Though Sinai-Grace is allowing Chopra to speak with the reporters, it fired nurse Kenisa Barkai for posting a benign video in which she discussed the PPE she wore to treat COVID-19 patients on social media. She and her attorney say the company used the post as a pretext to fire her for previously speaking up to management over PPE shortages and other dangerous job hazards.
“I just spoke out on the fact that we had some major issues that we had to address, we were scared of the unknown and we didn’t feel safe providing care for patients,” Barkai told HuffPost.
“In retaliation — and to keep all my coworkers from speaking up — they fired me and they’re trying to keep everything hush-hush.”
In New Jersey, Jersey Shore University Medical Center fired nurse Adam Witt on March 31 and barred him from entering the hospital campus after he and others posted in a private Facebook group about their fears of contracting COVID-19. Hospital administration put up flyers that Witt characterized as “Wanted” posters bearing his picture and directions for staff to contact a supervisor if he was seen on campus.
While conducting interviews for a recent piece on front-line workers in metro Detroit, reporters from HuffPost encountered dozens of staff from all the region’s major health systems who wanted to speak up about dangerous working conditions but feared retaliation from their employers.
Health care workers across the country say that administrations have updated or created policies that order employees not to speak with reporters. Some include explicit threats of discipline, while others do not. As the outbreak intensified, metro Detroit’s Beaumont Health circulated an updated media policy that an employee provided to HuffPost.
“If media shows up unannounced and you have not heard from a member of the Beaumont Media Relations team, employees must route the request to the media relations team,” it reads.
New York University Langone Medical Center took a firmer approach. It sent an email to its 30,000 employees informing them that anyone who speaks to reporters “will be subject to disciplinary action, including termination.”
But Cohen called such policies “self-defeating” for hospitals.
“The moment you fire the doctor, that becomes the story,” he said. “The reputation damage from that might be much worse than the reputation damage in the physician’s speech.”
‘There Will Be Leaks’
Hospitals, however, say they’re acting with patients’ best interests in mind.
Administrations face an extraordinarily difficult task in controlling messaging during the pandemic, said Ruthanne Sudderth, senior vice president of public affairs with the Michigan Health and Hospital Association trade group. That involves juggling staff needs, patients protections, HIPAA privacy laws and media requests.
Moreover, front-line workers don’t have a bird’s-eye view of a hospital’s supplies, so speaking up about shortages can interfere in resource allocation efforts, Sudderth said.
“There are huge impacts that come from what’s communicated to the decision makers right now, so we have to do that responsibly, and that’s why you’re seeing people being extra cautious about what’s being said about resources on the front lines,” she added.
Hospitals also don’t want employees’ comments to cause them to lose patients. And many believe that’s what’s at the heart of the hospital’s strict speech policies. They need patients to make money, and are “concerned about their reputations being harmed,” Cohen said.
That likely factored into West Hill’s decision, Porter added.
“The posts are bad PR and they’re afraid patients won’t want to come to their hospital,” she said.
Critics also contend hospitals are abusing HIPAA privacy laws to protect their images. West Hills told HuffPost in a statement that Porter violated the patient protections because she revealed room numbers where COVID-19 patients were being treated, but she and her union said the hospital was forced to reinstate her because that isn’t a HIPAA violation.
Regardless, there’s a better way for hospitals to manage their reputations, said Al Tompkins, senior faculty at the Poynter Institute for Media Studies. There’s a “huge appetite” for front-line news, which means “rogue” social media posts from health care workers carry more weight. Providing adequate access to reporters is a solution to that problem.
“The way to devalue the posts is to provide much more access to journalists so they don’t have to rely on social media posts,” Tompkins said. “You cannot long-term control access to important information. Eventually, there will be leaks and the leaks will be damaging.”