How COVID-19 catastrophe has been fueled by the drive for profit

A California hospital worker (reposted from the World Socialist Web Site)

I’m a hospital worker in California. I’m writing to share the conditions, pre- and post-pandemic, at the hospital we work at.

It’s a small hospital that serves several suburban, commuter communities. Most of the people who live here commute out of town to work, and likewise, most of the hospital workers, clinical and nonclinical alike, have to commute a good distance to get here. We are not a trauma center; severe car crash injuries and the like are transported to other hospitals. Nominally we are not-for-profit, but you know how that really goes.

One year our interim CEO was paid over $400,000. I don’t have the numbers on the current CEO at the moment. The hospital hires all sorts of “consulting” companies to better squeeze money out of patient care: our physicians are pressured to cut down inpatient admission stays to only one day, instead of two or three, because that’s “wasteful.”

Before the pandemic, we were understaffed and underequipped in all departments. Every flu season, the administration hires travelers, because they refuse to staff us adequately the rest of the year. Night crews are always skeleton crews. One pharmacy tech all alone at night; decreased staffing in ICU (intensive care unit) so patients in the ED (emergency department) are transferred upstairs only on morning shift change, when there’s actually nurses to attend them. There’s only one radiation tech at night to x-ray and CT all the patients in the hospital. On weekend nights there’s only one phlebotomist and one lab tech, as opposed to the one offset and two lab techs on weekday nights. The admitting (read: registration and billing) department is chronically understaffed, and they are constantly pressured to collect more from patients with very specific phrasing to psychologically corner patients into paying as much as possible up front. The ED at night is almost always short, especially when no one’s able to cover callouts. When the unit secretary calls out, one of the clinical workers, usually a tech, takes over.

Right before flu season a couple years ago, administration fired a dozen nurses and all the monitor techs; some of these guys had been here for over a decade. That left the remaining workers in the wards to pick up the slack and monitor the heart rhythms of up to 50+ patients. The parasites who play the stock market have sophisticated automated trading software to make microsecond decisions based on the smallest market fluctuations, and we just have one schmuck trying to keep two eyes on dozens of heart rhythms. Come flu season, administration realized they made a poor decision, and extended job offers to all the nurses they fired. Most, if not all of them, said no, having found jobs somewhere else. So, we brought in travelers, as usual.

Security is always understaffed, so when we have psych holds awaiting transfer to actual psychiatric facilities, it’s often a clinical worker watching the one patient. A tech or nurse is pulled away from all other patient care for the entirety of their shift to make sure a suicidal ten-year-old girl—and we get a lot of those—does not attempt self-harm.

About our rad techs. They image not only the emergency, surgery, and inpatient patients, but also outpatients! Two ducks running around an entire hospital, going from code, to surgery, to STAT ICU, to emergency department patients, and having to somehow, eventually, get to the patients who have actually scheduled their outpatient radiology procedures. “I got here at 10, I had an appointment at 10!” (It’s 11:40, now.) “I’m sorry, I know you came here on time for your appointment, but we were called to the ICU, then we had to assist so-and-so surgeon…” That’s right—the hospital schedules outpatient without actually having clinical staff to attend them for their appointments.

And you know how the hospital dealt with that?

They closed one of our outpatient centers. Sold it to RadNet. [Ed. note: RadNet is the largest outpatient imaging service in the United States, it reported net revenue of $1.2 billion in 2019.] Officially, the hospital is entering into a “partnership” with RadNet, who’ll give a percentage of profits to the hospital in exchange for being the exclusive service provider for the patients who go to the center. As for RadNet’s modus operandi: Imagine the mafia seizing control of all the doctor’s offices in a city, briefly offering the poor doctor a 10 percent cut of the profits before closing the joint down quicker than Speedy Gonzales running for queso Oaxaca and funneling every single patient in the city to a centralized Dr. Giancana’s office. That’s what RadNet does with radiology and imaging centers. They’ll close that outpatient center and patients will have to travel further just to get the care they need. By the way, anyone working at that outpatient center who isn’t a rad tech is out of a job now.

We don’t have a phone operator at night, so admitting department workers, the people who are trying to update your records, register your bed placement when you get admitted so the nurses can actually chart on you, and argue with your insurance company about medical necessity of inpatient stays gets to monitor all the hospital alarm panels, call codes, and take phone calls. EVS (environmental services; housekeeping) is always scrambling to clean the rooms.

Our two Bioquells (decontamination equipment) for the whole hospital are always breaking down, one or the other. Management keeps “repairing” them instead of replacing them. It takes four hours to finish Bioquelling a room, and if multiple rooms that housed C. diff patients need to be decontaminated whilst one of the machines is out of commission, it can be a long time before a room is actually ready for use. Our EKG machines have now seen eight years of use and are the most frequently used pieces of equipment in the entire hospital. The fax printers are always acting up, and we’re always joking about going Office Space on them. That might strike you as funny—and it is—but our anarchic health care infrastructure is such that faxes are the only way we can exchange medical records with other providers, e.g., obtaining the medical history of a Kaiser patient, or sending clinical data to a pediatric hospital taking a child we can’t care for. And keep in mind the times when the hospitals we’re trying to communicate with have problems with their fax machines, too. We used to have a dedicated on-call biomedical engineer to make emergency repairs to our clinical equipment, but last year they outsourced that to some center that never sends a guy at night. If something breaks at night, it’s just going to have to wait till day shift to be addressed.

This kind of horrific understaffing and underequipping isn’t exclusive to us, and we’re far from the worst. On December 8, I spoke to a traveler radtech from this huge 10-storey hospital that looks like a Marriott hotel. They had only ONE ancient portable x-ray machine for the whole hospital, to cover all ten floors. And they’re a trauma center! The hospital acquired more machines only in late November two weeks before our conversation, after said traveler “politely raised her concerns”—during a pandemic.

So: Those were our working conditions before the pandemic. Over a year since SARS-Cov-2 emerged, our staffing issues have only been exacerbated. Patients are waiting 42+ hours for their ICU beds. Sometimes the telemetry admissions are stuck in the ED for so long that they spend the entirety of their admission in the ED, never making it to the telemetry department where they were supposed to have been. This causes trouble for the ED nurses, because the process in our software to discharge a patient from the floor is different from the process to discharge from ED. They don’t know how to go about it. We’re now doubling up patients in their rooms, and our basement is ready to take a surge. Why didn’t we put patients in the basement before doubling them up on a room? I would guess (short) staffing—it is “easier” to keep one eye attending two patients in the same room, rather than hiring more nurses to look after patients in an ad hoc ward. We have a small “disaster tent” outside. Our first large one, in the parking lot, actually blew up in the first month it was set up due to an electrical issue.

Our clinical staff are starting to break. The hospitalists, the admitting physicians are not intensivists (ICU doctors). But circumstances have forced them to act in the capacity of one, especially at night—when the intensivist is on call, not on campus. One of our nightshift hospitalists broke down in tears two weeks ago, when someone asked her how one of the patients we recently admitted was faring. “I don’t know. I don’t remember how many people have died.” She called out after that night and hasn’t been back since. Regional management, meanwhile, likes to come make rounds during day shift to yell at workers for not using PPE we don’t have. “Why aren’t you using a face shield?! You’re in direct patient contact!” You didn’t give us face shields!

The on-call chaplain sometimes calls us in advance, now. “Is anyone in need of services?”

The toll on the paramedics is heavy. They have to don and doff all their PPE and decontaminate the rig (ambulance) between each patient. The local nursing homes are death traps. Those places were already horrific sites of neglect and abuse before the pandemic—we had an old lady, once we removed her pants, rose an actual cloud of human dust we couldn’t see through. She hadn’t been bathed in months. Now we get multiple runs (ambulances) from the same nursing home in the same night, and often the same crew going back for more patients. The staff at these residential care facilities are often found cowering in the corner. They don’t want to touch death. Their patients arrive blue. One of our ED physicians actually complained: “Why did you bring us a corpse?” The paramedics cry when they’re not too busy or tired to cry.