By Diana Falzone
Over two weeks ago, a New York–based doctor on the front lines of the coronavirus crisis told me that her hospital was running low on personal protective equipment. Like other doctors around the country, she spoke to a shortage of N95 masks and other protective gear, not to mention critical equipment like ventilators—a situation that was nearing dire as caseloads increased. After our interview I was contacted by the hospital’s communications director, who was working from home. In contrast to the doctor’s testimony, the communications director reassured me that the hospital was well stocked in both PPE and ventilators. I hung up with the unshakable impression that the communications director was not being entirely truthful. The dissonance felt disturbing.
In the days since, more and more stories have emerged of medical workers who have been either reprimanded or fired for speaking out about COVID-19-related concerns. Samantha Houston, a Mississippi doctor, filed a lawsuit on Monday against Oxford’s Baptist Memorial Hospital-North Mississippi, alleging she was fired for a Facebook post appealing to the public for N95 masks and baby monitors to observe coronavirus patients. (Baptist Memorial Hospital said in a statement that it “has done nothing inappropriate.”) A Washington E.R. doctor, Ming Lin, claimed he was let go after he gave an interview about a lack of preparation and PPE. (Charles Prosper, the chief executive of PeaceHealth Northwest, said in a statement that the hospital where Ming worked was taking “every precaution necessary.”) And a Chicago nurse filed a lawsuit against Northwestern Memorial in which she claimed she was fired after warning coworkers that masks supplied by the hospital would not adequately protect them from COVID-19. (In a statement, the hospital said it was “reviewing” the complaint and that the “health and well-being of our patients, our staff, and our employees is our highest priority.”) According to the New York Times, “every major private hospital system” in New York City “has sent memos in recent weeks ordering workers not to speak with the media, as have some public hospitals.”
A Mississippi doctor told me he was terminated for complaining about insufficient PPE, and for using a mask and gloves against the hospital’s wishes while attending to patients. “The reason they fired me was to conceal my voice,” he said. “The hospital came after me to send a message to all their employees.… They disregarded all my suggestions, and subsequently, many of their employees were infected with COVID-19 and more than once went to the ICU.”
Other health care workers told me similar stories. One New York City doctor treating COVID-19 patients told me that accounts of doctors afraid to speak out for fear of retribution are “absolutely true on a large scale.” The doctor added, “We have specifically been told not to speak to the press without the express consent of the hospital leadership system. This is to ensure the proper messaging, even at the cost of placing their health care workers’ lives at risk.”
Most theorized that hospitals’ P.R.-first mindset has kicked into overdrive during the pandemic. “We are constantly warned not to speak negatively,” said another doctor at a New York City hospital. A New Jersey–based doctor treating COVID-19 patients added that “hospitals and their administrative staff do not want to be perceived in a negative light for any reason, let alone one addressing the treatment of staff in a time of crisis.”
“Hospital administrators are reverting to their public relations reflexes and trying to control messaging,” the New York–based doctor said. “Unfortunately, in a pandemic, nothing that any institution does will ever seem adequate; the news cycle will always be full of ‘bad news.’ Restricting this news from reaching the public does everyone a disservice.”
Another Mississippi doctor I spoke with called the effort to restrict the flow of information “very shortsighted.” While the doctor noted that hospitals may be worried about legal liability or their reputations, “the situation is so much bigger than that. The public craves hearing from experts, and now is the time that physicians should feel unhindered in educating the public about COVID-19, as well as any work safety concerns that could worsen the pandemic.”
It’s the changing nature of the hospital system itself, a New York doctor explained, that’s at the root of the problem. “Over the past 15 years, there has been tremendous health care system consolidation,” the doctor said, citing a survey conducted in 2018. “In 2012, independent physicians made up 48.5% of all doctors. In 2018, only 31.4% of physicians identified as independent-practice owners or partners.” This phenomenon means that more doctors than ever rely on big, corporate hospital systems for job security, as well operating and admitting privileges. “Independent doctors are not allowed to unionize,” the New York doctor said, “and employed doctors, for the most part, have been reluctant to do so.” As a result, hospital systems are more able than ever to mandate from on high.
The problem has been exacerbated by the COVID-19 crisis, but it’s not new. The New York doctor said there has long been a gulf between hospital administration and actual medical providers. “Administrators are not typically on the front lines of care, and they’re making decisions that seem out of touch with frontline realities to physicians,” the doctor said.
“For example: Administration wants to improve patient-satisfaction scores, so they design a two-hour mandatory course on how to improve bedside manner. For physicians the answer is simple: You can’t teach bedside manner through a two-hour presentation. If they want to improve patient satisfaction, [they should] make the hospital an attractive place for the best doctors to work. Instead hospital administrators have now burdened physicians, taken away time from patient care, and fueled burnout. This type of divide is magnified through a crisis like COVID-19. Previously the disconnect only worsened the paperwork burden or became a general annoyance...Now the ill-preparedness and refusal of administrators to listen to concerns of frontline physicians is putting patients and physicians directly in harm’s way.”
The lack of autonomy doctors have within larger hospital systems presents a challenge for those who want to educate the public without having their messaging controlled. Dr. Michael Osterholm, regents professor and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, who has spoken out extensively in light of the coronavirus pandemic, said it is wise for hospitals to be transparent, especially during an unprecedented health crisis. “People say to me, you can’t tell them that because people will panic. Have you seen riots? Have you seen cars being burned or a knife being pulled over toilet paper at a grocery store? People are scared, absolutely. [But] people will follow you if you tell them the truth. My job is not to scare you out of your wits, but scare you into them.”
Being honest about shortages now, he added, could help better prepare hospitals down the line. “We have to remind [people that] this is the first inning and the next wave is much larger,” he said. “If we deny the potential for what is coming down the pike, it’s malpractice. If half of the 320 million Americans in the country get infected, 20% will see a physician. Ten percent will be hospitalized; 5% will be in the ICU; 1% will die. At 5%, that’s 5 million people needing the ICU.”
With hospitals still insisting on controlling the narrative, however, employees might not have a leg to stand on if they decide to break the rules. Alexander Leonard, a New York employment lawyer, told me that “speaking to the media may not necessarily be protected activity...especially where the doctor/medical professional is subject to contractual confidentiality obligations.” He recommended that those who wish to do so consult a lawyer beforehand, or band together to make a joint complaint about a safety concern, a move that’s “potentially protected under the National Labor Relations Act,” as well as other state and federal agencies.
Though doing so comes at a very real risk, doctors said they’ll continue to speak up. “We want at the very least to have our basic safety needs met,” a New York City doctor told me, noting that doctors have the same priorities as everyone else: keeping their friends and family safe, and staying alive themselves. “I wish freedom of speech existed for health care workers.”