From body bags to staffing woes and furloughs, DMC CEO details coronavirus response
The Detroit Medical Center's CEO Audrey Gregory, Ph.D., spoke to the Detroit Free Press on Thursday about how the health system — which operates eight hospitals in some of the Detroit neighborhoods hardest-hit in the coronavirus outbreak — has managed in the pandemic.
Gregory, who took over leadership at the DMC in January, has had a trial by fire in her first few months on the job.
Reports of bodies being stacked in empty rooms at Sinai-Grace hospital made national headlines. At the height of the COVID-19 surge in hospital admissions in late March and early April, nurses protested and went public about what they said were unsafe patient-to-staff ratios at Sinai-Grace.
A Woodhaven nurse filed a whistleblower lawsuit earlier this week alleging she was fired for speaking out on social media about the poor conditions at Sinai-Grace. One family alleged the hospital lost the body of a loved one who died of the virus.
The health system, like others in the region has also had to compensate for financial losses as it stopped performing elective and nonemergency surgeries and procedures to brace for the pandemic.
Gregory said in a previous interview that she is among executives at Tenet Healthcare, the for-profit company in Dallas that owns the DMC, who are taking pay cuts as the company also furloughs 480 employees, including 40 managers and supervisors.
Her pay cut is 10% and will apply for the months of April, May and June.
Gregory started the interview with the Free Press on Thursday by expressing her gratitude for the health care workers.
"I really want to start the conversation ... by just really commending the staff because it has been very difficult time for them," she said. "They have continued to provide compassionate and lifesaving care to the patients. And I am very proud of the work done by the entire team."
What follows is a lightly edited transcript of the conversation:
QUESTION: How many DMC employees have tested positive for COVID-19 or have been off work because of coronavirus symptoms?
ANSWER: "In terms of the number of employees, we have had over 300 employees who have tested positive of which over 150 have returned to work, and each day more employees return to work from being quarantined."
Q: Have you had any employees die of COVID-19 or its complications?
A: "I don't know. ... I don't know yet what cause of death is for employees who have passed away. I do not have any employees who have passed away in our hospitals. And so I wouldn't be able to tell you exactly in terms of employee deaths tied to COVID."
Q: Could you please talk about the patient-to-staff ratios at DMC hospitals, including Sinai-Grace? That is where the emergency room nurses in early April said they were told to go home after they protested what they said were unsafe patient loads.
A: "I can speak to where we are with staffing. I cannot account for the past or even what the perception is of the nurses at Sinai-Grace because what was recorded is not necessarily the reality that existed and I don't want to do a back and forth with those nurses.
"What I will tell you is that we have, and always have, provided safe patient care. ... We have had supplemental staff come in. We've had nurses from across the country who have come in. We have had Children's Hospital of Michigan nurses stepping up to the plate and being retrained as adult-care nurses. We have had nurses who are not always in a traditional nursing role who have stepped up to the plate and have helped to care for patients. We have had CRNAs (certified registered nurse anesthetists) at the highest level of nursing who are taking care of critical care patients.
"So we have since the beginning had a plethora of nursing models that we have used to ensure that we can safely provide for patients and ... in the spirit of being transparent, where we are today in terms of the amount of nurses that we have ... compared to where we were a month ago in the initial surge, certainly it's different.
"I'm an ER nurse by background, so I don't even have to imagine what nurses think and feel. I'm never going to argue with the feelings of nurses. I think, a month ago, two weeks ago, things were extremely overwhelming and daunting.
"It's a novel coronavirus. This is something new for us, how we feel as providers, watching the number of patients, how sick these patients are. So I will say that I will not argue with how the nurses feel. My role is to acknowledge how they feel and do everything I can to make sure it gets better for the nurses, and also making sure that we're providing great care for the patients."
Q: Can you talk about the number of staff who have quit out of frustration?
A: "That's not a number that I have. ... We certainly have had providers, nurses who have resigned because they are afraid, or who have resigned because they themselves may have health issues.
Q: Could we talk about the situation at Sinai-Grace Hospital that was highlighted on CNN, which showed the photographs of people who died in body bags stacked in empty rooms and in a chair?
A: "Just in terms of background, Sinai-Grace sees more traffic than any hospital in metro Detroit. And just in terms of context, it is the only hospital in northwest Detroit. It also is surrounded by a large number of nursing homes.
"So, from a context perspective, we want to remember that we had around Sinai-Grace, patients who are over 65 with high rates of underlying medical conditions such as hypertension and diabetes. I want to put that in context.
"And then with the COVID-19 virus, we certainly had significantly greater than normal mortality rates and that is throughout the community. And, certainly, the result of that is that we have had capacity issues at funeral homes and morgues that are outside of the Sinai-Grace Hospital.
"But I can assure you that patients who have passed away at our hospitals, we treat them with respect and dignity. And like hospitals across the country, we are ... securing additional resources. We have used mobile refrigeration units to help temporarily manage this, increasing capacity.
"I will say, recently, we had three deceased patients that were temporarily placed in a secured non-patient care holding area before we got the additional (refrigeration) unit. ... Those patients were covered. They were temporarily placed in a secure non-patient care area, and then we were able to move them to the storage trailers when the storage trailers arrived."
Q: To be clear, that secure non-patient area you're referencing, is that what appeared to be a sleep-study room?
A: "It was in a sleep-study lab. Our patients were covered. They were in the appropriate labelled body bags and that's where we put them, in that room, on stretchers as we waited for the temporary storage unit."
Q: And what about the allegation that the body of a person who died was lost at the DMC for some time?
A: "So, we have spoken with that family member, first of all. Our hearts go out ... I cannot imagine the difficulty of losing a loved one. ... We have talked with the family. We have offered our apologies. We were able to locate our patient in our temporary trailer, and we were able to release that patient's body."
Q: The Michigan Department of Licensing and Regulatory Affairs has said it's investigating the situation at Sinai-Grace, would you talk about what that investigation process looks like from your side of it? What are you required to provide the agency?
A: "Normally, the agency will come on-site, depending on the issue. So, in this particular case, the agency came on-site. They were able to assess our morgue and temporary storage morgue areas. They have looked at our staffing patterns. They have looked at what staffing was available on which date. So those are the things that they have looked at."
Q: How about patient data with COVID? How many have tested positive or negative within the system? How many are hospitalized? How many discharged? That information has to be reported to the state, but DMC doesn't have that up on its website, and it isn't released regularly like a lot of other hospital systems do.
A: "Since we've started, actually we have seen over 3,500 patients. And so we have discharged a lot of those patients. What we're seeing is a plateau. ... In-house today, we have about 600 patients. A week ago, it was upward of 800 to 1,000. So definitely, we're seeing a difference.
"We also have had in-house testing since the beginning of April. That has certainly helped. Unfortunately, what we are seeing is that even patients who may test negative clinically are showing symptoms of COVID, and so we will treat those patients as they are presenting clinically, regardless of the test outcome."
Q: Do you think that suggests a high rate of false negatives with the tests that have been adapted in hospital labs from the U.S. Centers for Disease Control and Prevention?
A: "I am not a scientist or even the person who can answer that question, but what the evidence in the literature shows is that there is a rate of false negatives with these tests.
"... With this virus, ... when a patient tests, it really depends on where they are in the viral shedding process. . ... This is a very, I would say, a very complex virus and as you listen to the news or read, you can see that we're all trying to learn this novel coronavirus.
"It is something absolutely unbelievable. I say this without apology that we're literally building this plane as we're flying it."
Q: How many COVID-19 tests are you able to process in the DMC's labs each day?
A: "At the DMC, we can do upward of 1,000 tests in terms of the machine that we have. ... How many tests you're able to do is only a part of the equation."
The supply of testing materials has been limited, she said, and the criteria for who qualifies for testing in the state also has limited how many tests can be conducted.
The Michigan Department of Health and Human Services has followed U.S. Centers for Disease Control and Prevention guidelines for determining who should get priority to be tested.
Gov. Gretchen Whitmer announced earlier this week that the restrictions have been loosened to now include anyone with COVID-19 symptoms such as fever, cough or shortness of breath and anyone who works in a health care facility, grocery store, pharmacy, as a first responder or in other essential services, with or without symptoms.)
Q: Can you talk about why you're not regularly releasing data about COVID-19 testing, hospitalizations, and discharges like a lot of the other hospital systems?
A: "I never do anything that is dependent on what a lot of other hospitals do. We have met our obligation. ... We do report every day our data to the state. We report our information to Region 2 (Healthcare Coalition). I have really kept our focus on making sure that we're providing great care to our patients.
"And then, for our staff and physicians, we do have information on our DMC Intranet that has been openly shared with all our staff, all our physicians and all the relevant stakeholders."
Q: Where does the DMC stand on personal protective equipment for staff, and if you could detail the policy that you're using right now for determining who gets an N95 mask, how often those masks are changed or re-worn, and about gowns and face shields and those sort of things?
A: "The DMC stands, I would say, pretty good. ... If we can get up to two weeks to even longer of supplies, that is how we would prefer to stand.
"We certainly have a very rapid and intense burn rate, much more than we used to see before COVID. Our policy that we're following right now is our staff will wear their N95s for the shift. And then they get a new one for the next shift. With gowns, same thing. With face shields, we do have them cleaning and extending the life of the shield if they can.
"But we are able right now with the help of the state, Region 2 and our own internal supplies, we are able to get the supplies that we need. But we still continue to conserve because you know you can never account for how big this is going to be or how long it's going to last, even though at this point, as I said earlier, we're seeing some tapering."
Q: Doctors and nurses have told us that if they talk to the press, they'll be fired and at least one Sinai-Grace nurse has filed a whistle-blower lawsuit against the health system. What has the hospital system have to say about that and about the policy of not allowing staff members to talk publicly about the situation inside the hospital system?
A: "So I have two things to say.
"The first thing is, I'm not going to discuss personnel matters.
"But the second thing that I will say ... is this: You and I are currently talking. … One of our ER physicians was a part of the physicians who helped with Henry Ford. We have another staff member who did a donation drive to get some iPads for our patients.
"So, we are not opposed to our staff appropriately speaking to the media or whomever ... but we have a policy that governs how we interact with media or social media. That is a clear policy.
"So our expectation is that our staff would follow our policy in the same way that I am required to follow all our policies."
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