Detroit – Detroit Medical Center Sinai-Grace medical workers have been painting a grim picture of the hospital’s emergency department for the past few weeks as they rushed to treat coronavirus patients: patients dying in hallways and nurses at looking for body bags and places to put the dead.
“Going into work last Thursday was a war zone, there were patients lying everywhere,” said Jeff Eichenlaub, a daytime emergency room nurse for the past six years.
Information about conditions inside the for-profit hospital was provided to The Detroit News by five nurses and doctors – some of whom requested anonymity after a nurse was fired for posting on social media on last month – as their reports suggest that Sinai-Grace is among the toughest hospitals in Detroit with influx of COVID-19 patients.
About five patients die from the virus every 12-hour quarter, and there are not always enough body bags or refrigerators to accommodate them, said Eichenlaub de Troy.
“The three coolers are full, the morgue and the observation room next to the morgue are full and right now we are taking the bodies to the sleep lab to store them,” he said. “We first had to double the bag for each patient, but we started running out of body bags and started climbing from floor to floor to find places to take them.”
Eichenlaub said workers organized a sit-in on April 2 and told administrators “there are only 10 day nurses and we need more staff.”
“The administration has told us that we are replaceable,” he said.
The growing death toll at Sinai-Grace has drawn the attention of the federal government. Detroit Medical Center officials had a conference call with the Centers for Disease Control and Prevention last week due to concerns that Sinai-Grace had the highest COVID-19 death rates among hospitals in the country, the Dr. Vinay Pallekonda, chief medical officer of the DMC, told staff Wednesday.
Pallekonda has attributed the high mortality rates in Sinai-Grace to about 14 nursing homes in the neighborhood and a number of patients with hypertension, heart disease, obesity and diabetes, who are at higher risk of serious coronavirus infections.
Pallekonda declined to discuss death rates with The News on Thursday.
Another DMC official allegedly in communication with the CDC also declined to comment on Thursday. The CDC did not immediately resend an email requesting comments.
Detroit leads Michigan in per capita coronavirus cases and deaths. The city had 6,083 confirmed cases Thursday and 272 deaths from COVID-19.
And COVID-19 patients have flooded the emergency rooms of Detroit – many with serious complications and underlying health problems such as hypertension, diabetes, heart disease and obesity that expose them to increased risk of developing severe coronavirus symptoms and dying.
A DMC representative did not directly comment on the conditions at Sinai-Grace but released a statement on Thursday.
“Our top priority is the safety of our patients and our staff,” said spokesperson Brian Taylor. “Out of respect for the privacy of patients and their families, we do not provide details about the care of any particular patient. “
The crushing of the patients seems to cause a particular constraint at Sinai-Grace, a university hospital which opened in 1953 and traditionally treats indigent patients. The hospital is the only one in northwest Detroit and has the highest EMS traffic, said Taylor.
“Among the patient population served by Sinai-Grace, there are extremely high rates of underlying medical conditions such as hypertension and diabetes, which increases the risk of COVID-19,” he said. declared.
“In addition, there are a large number of nursing homes in the vicinity of the hospital. The spread of respiratory diseases and COVID-19 among this population puts even greater pressure on hospital resources because these patients are sicker and in many cases require a level of intensive care. of care. “
Elders line hallways
On a normal day, the emergency department receives patients with complaints ranging from “zero to 100”, from a trivial complication to a gunshot wound to a brain bleed, a doctor said. But COVID-19 reversed the situation.
“We hardly get any patients between the ages of 0 and 50,” said a hospital doctor, who requested anonymity. “At the moment, the patients are all between 80 and 100 years old. They are all very, very sick. “
Many of those lining the hallways are seniors from surrounding nursing homes, health care workers say. When medical staff realize that there is nothing they can do to improve their lives, they call the families for permission not to resuscitate, they said.
“The ‘non-respirators’ sitting in the hallway are many of our DNRs who die by themselves, and there are times when there are so many people that we don’t even have time to call the families to inform them of their death, “said Eichenlaub. . “Their families would call two days later and we had to say” let me find a doctor for you. ”
“It is discouraging because you can almost see someone and know that they are going to die. Then I have to say to a family member, “I know they were completely fine when they came in, but now they’re dead because the virus is so endemic. »« »
Communicating with families over the phone is “incredibly difficult,” but the doctor said any suggestion that families were forced not to resuscitate was “absolutely, unequivocally, untrue.”
The doctor said Saturday in particular of “chaos” but said that conditions have improved since.
“I marvel at the ingenuity in how the nurses were able to follow the patients,” said the doctor. “I guess this is the Sinai-Grace way. With few resources, they always find ways to make it work. “
Eichenlaub, who has been an emergency nurse for 15 years, said he expected an internal disaster order would be issued so leaders could come, help move patients and organize logistics. This has never happened – perhaps because the unit does not have a program director, he said.
“It’s almost like a military hospital, people are breathless and you continue to care for someone else who is deemed more critical,” he said.
Conditions weigh on workers
While it is important to highlight what is going on in the Detroit emergency rooms, the doctor expressed concern about the condition during the pandemic.
“The people who work there don’t have to work there,” said the doctor. “We choose to work there because we love the community we serve. These stories that come out hurt the morale of the people who have to go to work today, tomorrow, in a week. ”
A group of nurses and night emergency workers were ordered to leave Sinai-Grace late Sunday evening after a sit-in to demand more support to deal with a wave of COVID-19 patients.
Sal Hadwan, an emergency worker who was asked to leave, told The News that the service sees 110 to 120 coronavirus patients daily in the past three weeks. He said the staffing levels are insufficient.
“They need oxygen, ventilators and several drops of medicine just to keep them alive and stable,” said Hadwan, a three-year-old DMC nurse. “It is dangerous for patients to have a nurse who takes care of 25 or more patients. It is unrealistic and dangerous to try to follow. “
After calls from his director of hospital administration, Hadwan and the nurses returned to work and never wanted to leave, he said.
“All we want to do is take care of our patients. People are dying who honestly should not be in these situations if only we had enough nurses, “said Hadwan.
The nurses have been organizing sit-ins for two months without a union.
After the sit-ins, administrators assured nurses that they would no longer accept ambulance traffic and that help was on the way, said Eichenlaub.
“They told us that the people who control the EMS rejected our request, and we did not receive help for an additional eight hours, even with several patients in the corridors, no one could come,” he said. -he declares. “Children’s nurses are coming to help. No doctor is available, and they see internal doctors who are as busy as us. “
Health workers are trying to put the situation into perspective because Sinai-Grace has always dealt with difficult cases.
“Sinai-Grace has never been an easy place to work,” said Eichenlaub. “It increased during the pandemic and when the entire night shift withdrew, which the day nurses argued, we were forced to stay for 24 hours. I am sure we all went home and started sending our CVs. “
The eight-hospital system has contracts with recruiting agencies, reaching out to near-graduate nursing students and using other resources to assist with care, said Taylor of DMC. The hospital system would not provide details of deaths or nurses.
The Detroit TCF Center has been modernized to care for COVID-19 patients with mild symptoms and will begin accepting some of these patients from Detroit area hospitals on Friday.
According to the nurses, severe patients usually have flu-like symptoms and may progress to bilateral pneumonia. In some cases, respiratory failure can then develop within six hours and patients are usually intubated. Some die within 12 hours, said nurses.
Healthcare workers administer Plaquenil, the brand name for hydroxychloroquine, as well as antibiotics to each patient they can. President Donald Trump has presented hydroxychloroquine as a potential treatment and has reduced barriers to ensure more supplies in the Detroit metropolitan area.
The Detroit-based Henry Ford Health System is conducting the first large-scale clinical trial of the antimalarial drug on 3,000 volunteers to find out if it can treat COVID-19.
Despite optimism about some treatments, nurses like Aimee DeLine, a substitute DMC nurse at Sinai-Grace, said they had seen too many deaths yet.
On the night of March 31, DeLine said six patients died during the first eight hours of her 12-hour shift, three of whom she cared for.
“Two of the three, I had just entered their room, I took vital signs, they were good, nothing on their vital signs gave me the impression that they were about to crash “, She explained. “One patient even threw his shoe on the closed glass door to get our attention. “
The patient, who denied feeling pain and was just waiting for a bed, wanted to make sure the oxygen mask was properly pushed in and dropped the call light on the floor, said DeLine. She took their vital signs and continued to help others.
“Less than 30 minutes later, the monitor started to alarm,” said DeLine. “I went with another nurse and the (respiratory therapist) in the room. … The doctor arrived a few seconds later. … This patient had coded, and there was nothing we could do to bring this person back to life. ” ”
With the emergency room overcrowded with patients, she said that she and other nurses in the intensive care unit had between six and nine patients at a time, most of whom were ventilated.
“As soon as a patient was admitted and went upstairs or expired, EVS was cleaning, and within 15 minutes, a new patient would arrive, sicker than the patient before them,” said she declared.
“My heart hurts for the patients and their families who call to see them… only to call them a few hours later (or less) and tell them that their family member has died. The worst part is not being able to give them a reason for what happened, and why so quickly. ”
A traveling nurse from Sinai-Grace told The News since the start of her contract in February, that emergency rooms were at capacity with some patients on stretchers and others on chairs that were not easily visible – which is not a common practice.
“Last week,” said the nurse, “I saw a patient who had died who was on a stretcher in the hallway next to someone in a chair. “
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