Nurses union files OSHA complaint for workplace safety hazards at HCA hospitals

National Nurses United has called on the Occupational Health and Safety Administration, or OSHA, to inspect 17 hospitals that are owned and operated by HCA Healthcare and issue citations for “willful violation” of workplace safety hazards.

The complaint filed by the nurses union claims that HCA facilities in Florida, Kansas, Missouri, North Carolina and Texas failed to notify workers when they were exposed to COVID-19 and pushed asymptomatic employees “who are or may be COVID-19 positive” to continue working, according to a press release.

“Six months into a virulent pandemic, the science has proven how unsafe conditions put frontline caregivers at extreme risk; that is the backdrop to the COVID-19 deaths of more than 1,500 health care workers, including nearly 200 RNs,” Malinda Markowitz, RN, president of the National Nurses Organizing Committee, an NNU affiliate, said in the release. “HCA’s callous disregard for the safety of the nurses and their co-workers who have put their lives, their coworkers, and their families on the line every day, is deplorable. They must be held accountable.”

The fines for willful violation could cost HCA up to $134,937 per facility, or nearly $2.3 million if all the facilities in the complaint are fined, according to the release.

Nurses unions vs. HCA

The complaint alleges that HCA disseminated a written policy that causes asymptomatic employees to work despite confirmed COVID-19 exposure. It also cited a specific example of an employee who was not formally notified of her exposure to COVID-19 and, despite her exposure, was denied a COVID-19 test because she did not exhibit a fever, shortness of breath or cough.

“HCA’s efforts to notify workers of exposure are inconsistent, at best, and negligent, at worst,” the complaint states. “Even when nurses become aware of an exposure to COVID-19 either via informal contact tracing or, in rare cases, through HCA staff, HCA refuses to test asymptomatic employees for COVID-19, further compounding the problem of COVID-19 spread in its workplaces.”

After testing positive for COVID-19 at a public testing site, the same employee was instructed to return to work after 14 days of quarantine if she was asymptomatic, regardless of whether she continued to test positive for COVID-19, according to the complaint.

A representative of HCA Healthcare told Healio Primary Care that the company complies with CDC guidance, which states that a test-based strategy for discontinuing transmission-based precautions is no longer recommended, with some exceptions, because it often results in “prolonged isolation of patients who continue to shed SARS-CoV-2 RNA but are no longer infectious.” Instead, the CDC recommends a symptom-based strategy, which allows patients who had mild-to-moderate COVID-19 and are not severely immunocompromised to discontinue precautions at least 10 days after symptom onset, at least 24 hours since fever resolution without medication and when their symptoms have improved.

The HCA representative also said that NNU is using the pandemic “as an opportunity to gain publicity by attacking hospitals across the country.”

“Since the onset of this pandemic, our focus has been to protect our colleagues — to keep them safe and keep them employed — so they can best care for our patients,” the HCA representative said. “Our frontline caregivers have shown unwavering commitment, and our efforts to protect them have included the screening and testing of our colleagues, universal masking, contact tracing and notification, and other safeguards, in line with guidance from the CDC. We’re proud of our response and the significant resources we’ve deployed to help protect our colleagues.”

Last week, Service Employees International Union–United Healthcare Workers West filed a lawsuit against HCA that claimed its hospital in Riverside, California, “recklessly facilitated the spread of COVID-19, putting patients, workers and the surrounding community at a heightened risk of infection,” according to a press release from the union. The plaintiffs include three Riverside Community Hospital workers who contracted COVID-19, as well as the daughter of a hospital employee who also became infected with COVID-19 and subsequently died.

According to the lawsuit, HCA and the Riverside Community Hospital forced employees to work without adequate personal protective equipment (PPE), forced sick employees to work despite showing symptoms of COVID-19, pressured staff not to take infection prevention measures such as frequent sanitization of medical tools and high-touch surface areas if it affected productivity, and ignored employee complaints about unsafe working conditions, including the lack of PPE and contact tracing for exposed workers as well as the “hospital management's failure to promptly notify workers who were exposed to the virus,” according to the release.

CDC’s revised testing guidance

NNU highlighted the alleged workplace safety hazards in a statement about the CDC’s revised testing guidance, which now states that people who have come in close contact with an infected patient but remain asymptomatic “do not necessarily need a test.” The CDC previously recommended testing “all close contacts of persons with SARS-CoV-2 infection.”

With this change in guidance, NNU said the CDC “is extending this malfeasance to all patients, and all individuals.”

“This recommendation deliberately ignores widespread scientific evidence of the role asymptomatic individuals play in transmission of the virus,” NNU President Jean Ross, RN, said in a press release. “Studies have documented that 40% to 50% of transmissions likely come from asymptomatic and pre-symptomatic cases. That means that the CDC’s new guidance will lead to less effective identification of infections, which will lead to increased transmission of this virus, and most likely even more deaths and long-term debilitating injuries.”

AMA President Susan R. Bailey, MD, called on the CDC to “provide a rationale for the change.”

“Months into this pandemic, we know COVID-19 is spread by asymptomatic people. Suggesting that people without symptoms, who have known exposure to COVID-positive individuals, do not need testing is a recipe for community spread and more spikes in coronavirus,” she said in a written statement. “We urge CDC and the Department of Health and Human Services to release the scientific justification for this change in testing guidelines.”

References:

• CDC. Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance). https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html. Accessed Aug. 27, 2020.
• NNU. Nurses Condemn Trump Administration Attack On Public Safety in New CDC Testing Guidelines. https://www.nationalnursesunited.org/press/nurses-condemn-trump-administration-attack-public-safety-new-cdc-testing-guidelines. Accessed Aug. 27, 2020.
• NNU. Nurses seek OSHA sanctions on HCA. https://www.nationalnursesunited.org/press/nurses-seek-osha-sanctions-hca. Accessed Aug. 27, 2020.
• Service Employees International Union–United Healthcare Workers West. https://www.seiu-uhw.org/press/hcalawsuit/. Accessed Aug. 27, 2020.