Pascaline Muhindura has seen more people than she can count die from COVID-19. From treating patients with the virus to acting as the liaison between a dying patient and their family over video chat, registered nurses like Muhindura have felt the immense stress of witnessing the human toll of the coronavirus.
“You just want to cry,” said Muhindura, who works in the COVID-19 unit at Research Medical Center in Kansas City, Missouri.
“We’re not used to seeing this many people dying.”
For Muhindura and her colleagues, the stress of working on the frontlines of the pandemic has been exacerbated by limited access to appropriate personal protective equipment and by other workplace protocols that she and other health care workers say are not strong enough to protect frontline workers. These workplace protection issues have prompted health care workers and those in other industries to file complaints with the federal Occupational Safety and Health Administration.
Standing outside the headquarters of HCA Midwest earlier this month, Muhindura and her colleagues demanded increased access to PPE and improvements in the hospital group’s current workplace protections during COVID-19. Several of these same demands were echoed in an OSHA complaint filed against Research Medical Center back in April, which outlined a lack of proper protective equipment and protocols that increased risk of exposure to COVID-19.
Research Medical Center isn’t the only local workplace to receive an OSHA complaint related to its handling of the COVID-19 pandemic. According to The Beacon’s analysis of complaints filed with OSHA that are now closed, 64 COVID-related OSHA complaints filed in Kansas were closed between March and the first week of November. In Missouri, 321 cases related to COVID-19 complaints have been closed by the agency. In the Kansas City metropolitan area, 76 COVID-related complaints have been closed with OSHA since March; so far, no penalties have been issued to any workplaces in the Kansas City metro related to COVID-19.
A “closed” case under OSHA generally means the company involved in the complaint has resolved hazards identified in an OSHA inspection or paid penalties, or that OSHA has found no hazards related to the complaint.
At a time when going to work carries possible exposure to a contagious, novel virus — and when many COVID-19 outbreaks have been linked to workplaces themselves — the complaints provide a window into the risks facing workers under a patchwork of guidelines from OSHA, the Centers for Disease Control and Prevention and government officials.
Thousands of COVID-19 complaints
In a regular year, complaints to OSHA primarily involve workplace-related injuries or violations of labor law.
But once the coronavirus pandemic began sweeping across the country, the agency began receiving more complaints and referrals specifically related to COVID-19. Many of the complaints point out a lack of PPE for workers or social distancing guidelines that are poorly enforced by employers.
Housed under the Department of Labor, OSHA acts as the oversight body for workplace protections, providing standard regulations on worker protections for employers and an avenue for employees to report unsafe working conditions.
As of Nov. 18, the federal OSHA arm has received 12,039 complaints and referrals related to COVID-19, of which 10,101 have been closed, according to a Department of Labor spokesperson. State OSHA offices, which includes OSHA-approved workplace safety and health programs run by individual states, have received 34,142 total complaints as of Nov. 22. In addition, there are 255 open complaints filed under federal OSHA, and 1,592 open complaints under state OSHA programs.
Currently, 22 states have OSHA-approved programs that cover private and public sector workers; six states’ plans only cover state and local government workers. Kansas and Missouri workplaces are governed under federal OSHA laws.
Workers can file a complaint through a written request, phone or fax. According to federal OSHA policy, which applies to Kansas and Missouri employers, workers who want an on-site inspection of their workplace must submit a written request to the agency.
When a complaint is filed via phone or fax, the agency contacts the employer to describe the complaint and then sends a follow-up via fax or letter. The employer then must respond in writing within five days, identifying any issues found and outlining the steps being taken to address the complaint. Federal OSHA will not conduct an inspection if it deems the employer’s response adequate. However, if an employee still wants an on-site inspection of the workplace, they can request one.
The most common reason an OSHA case is closed, the spokesperson told The Beacon, is if the company “abated the hazards found in the OSHA inspection and paid any proposed penalties.”
“An inspection could also be closed because no hazards are found by OSHA inspectors when responding to a complaint or conducting an inspection mandated by an employer-required report of an injury or illness or a routine compliance inspection,” the spokesperson wrote.
In response to the pandemic, OSHA published new guidelines for workplaces to prevent the spread of COVID-19. However, these guidelines do not constitute a new standard or regulation under the agency.
Health care workers among the most impacted
For Cheryl Rodarmel, a registered nurse at Research Medical Center, one of the biggest issues impacting health care workers is the reuse of N-95 masks.
“They’re asking us to reuse a single-use mask for the full shift, instead of throwing the mask out after you go in and care for your patient and then come out,” Rodarmel said. “You should be able to dispose of that mask and get another mask. … That’s what it was before COVID and has always been the practice for infectious disease patients.”
As health care facilities from nursing homes to hospitals have been at the epicenter of the pandemic, they’ve been among the industries receiving the most complaints filed with OSHA throughout the pandemic, according to The Beacon’s analysis. The OSHA complaint filed in April against Research Medical Center stated that the worker did not receive any PAPR, or powered air-supplied purifying respirators, despite caring for COVID-19 patients. According to the CDC, a PAPR creates an air flow inside a fitted facepiece or loose-fitting hood or helmet to provide higher protection and reduce the aerosols inhaled by the wearer.
“One of the three patients I cared for received a positive result during the shift, no PAPR given still, only a level 3 mask that was worn all shift, not offered PAPR for coughing PUI (patient under investigation),” the complaint says. “Lastly, on the same day I was floated from a dirty unit to a clean unit and given a neutropenic cancer patient to care for. This is unsafe practice. Should not be floated between dirty COVID unit and to a clean unit. This should never happen.”
Christine Hamele, associate vice president of public relations and community outreach at HCA Midwest, said the company has dedicated significant resources to protect workers throughout the pandemic.
“Since day one, our top priority has been to protect them — to keep them safe and keep them employed — so they can best care for our patients,” Hamele wrote in an email to The Beacon. “Our frontline caregivers have shown unwavering commitment, and our efforts to protect them have included the screening and testing of our colleagues, universal masking, including N-95s, contact tracing and notification, the assignment of a PPE steward at each hospital to ensure the proper use and fitting of protective equipment and other safeguards, in line with guidance from the CDC.”
A lack of access to appropriate, fit-tested PPE in hospitals can increase the risk of exposure not just for nurses, but other hospital staff like Tanyece Stephens, who contracted COVID-19 in early August. Working in the kitchen at Research Medical Center, Stephens delivered food to patients throughout the hospital, including patients she didn’t know were COVID-positive or had been tested for the virus.
“At that time, we were only getting level one masks and having to drop food off in the patient’s room,” Stephens said, referencing masks that provide low-barrier protection. “There were patients we didn’t know that were being tested for coronavirus because they didn’t inform us.”
For days, Stephens was bedridden with a cough and fever — at one point she thought she wasn’t going to make it. Stephens returned to work after about 10 days off, and though it’s been three months since getting COVID-19, she’s still feeling its long-term effects.
“It’s exhausting, it takes everything out of you,” she said. “It’s like somebody’s squeezing a lemon and squeezing out all the juice.”
Rodarmel said staffing shortages have also caused strain on hospital staff by increasing the number of patients assigned to each nurse. In a time where local hospitals are being inundated with COVID-19 patients, the combined lack of access to PPE and inadequate staff have exacerbated the stress on health care workers.
“Because then you’re asking nurses to pick up extra shifts beyond what they would normally commit to,” Rodarmel said. “And so if you get tired, or overstressed, then you are at a higher risk of becoming ill yourself. And so even though we’re trying to fill as many gaps as possible, there’s just not enough of us to fill all of those gaps.”
Hamele said staffing levels at HCA Midwest are “appropriate and consistent with national standards.” To further support nursing staff, Hamele said HCA Midwest recently brought on volunteer nurses from HCA Midwest’s sister hospital in New Orleans, Tulane Medical Center. The company is also incentivizing employees for referring new hires to clinical positions, according to the statement.
What action has been taken?
Though the OSHA complaint against Research Medical was filed back at the start of the pandemic, Muhindura said PPE supplies are still a major issue at the hospital. Increased supplies of proper PPE was one of the demands of health care workers during a Nov. 17 protest over workplace protections outside the headquarters of HCA Midwest in Overland Park, Kansas.
“I want my employer to enforce the same CDC guidelines that we were following before COVID-19, which was single-use masks,” she said. “I want my employer … to have enough nurses, to where nurses are not stretched to the limit.”
OSHA conducted two different inspections related to complaints filed against Research Medical Center, one on April 23 and another on Aug. 26. According to OSHA, both inspections are still considered open cases as of Nov. 23; the agency typically has six months to complete an investigation.
Only 1,414 workplaces reported to OSHA have received referrals from the federal agency so far, while 4,745 referrals have been issued by state OSHA offices. According to the Department of Labor spokesperson, OSHA has issued 232 citations related to COVID-19 nationwide, resulting in proposed penalties totaling $3,148,452 since the start of the pandemic.
Four of those citation penalties were issued to health care facilities in Missouri: $13,494 for Lutheran Senior Services in Ballwin; $2,121 for Conagra Brands in Marshall; $1,928 for Unilever in Independence; and $12,145 for Grand Manor Nursing and Rehabilitation Center in St. Louis. No Kansas facilities have received penalties so far.
The unprecedented nature of the pandemic has also caused employers and businesses to navigate changing guidelines from OSHA and the CDC.
Overland Park attorney Isaac Keppler said that his firm, Colantuono Bjerg Guinn Keppler LLC, has fielded an increasing number of calls asking for clarification surrounding COVID-19 regulation compliance in the workplace, though not necessarily from employees and employers who wish to file OSHA complaints.
“‘Can I do temperature checks? Can I require people to wear masks?’ Lots of questions like that were the first types of questions we got,” Keppler said.
Missouri Gov. Mike Parson has also considered passing COVID-19 liability protections for certain businesses during the pandemic as part of a special legislative session on COVID-19 funding, including health care providers, businesses providing PPE, schools and churches.
As Stephens continues to recover from COVID-19, she said she doesn’t want to leave her job. Instead, she wants Research Medical Center to better protect its workers.
“Give us more PPE, make it more accessible to us,” Stephens said.
“Show your appreciation to your staff. And I tell you, it’ll be so much better. Because right now, everybody’s on edge.”