Kenisa Barkai, who filed a whistleblower lawsuit against her former employer, says she threatened to alert state authorities to the problems in the long-beleaguered hospital.

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Emily Elconin / Reuters An ambulance pulls into the DMC Sinai-Grace Hospital emergency entrance amid an outbreak of the coronavirus in Detroit, April 14.

WASHINGTON — Two weeks ago, Kenisa Barkai got an unexpected call, she said. It was her former employer, the Detroit Medical Center, asking her to come work for them as a nurse and wanting to discuss pay.

The health system, hit hard by the surging coronavirus outbreak in Detroit, was desperate for more staff. They were contacting former nurses to see if they could help. Barkai had missed the call. But it seemed the woman who left a voicemail had no idea that Barkai had been fired from her nursing job at the DMC’s Sinai-Grace Hospital just a week prior after repeatedly speaking out about equipment shortages and staffing problems. “Honestly, I couldn’t believe it,” Barkai told BuzzFeed News. She said the DMC ended up calling her a second time to see if she could work — a clear example of dysfunction at the health system. Barkai said she was fired on March 27 for violating the DMC’s social media policy. A week before, she had posted a short video showing the gear she was wearing to treat a patient with COVID-19, the disease caused by the novel coronavirus. In the video, Barkai points to her mask and gown and says, “I’m ready to rock and roll. I’m going in.” Barkai said she didn’t break any rules — no confidential patient information was exposed. The social media policy, reviewed by BuzzFeed News, bans posts that interfere with work or “create potential harm to others,” including patients and staff, in addition to confidential information. The real reason she was fired, Barkai said, was for repeatedly sounding the alarm about the hospital’s problems before and during the outbreak, threatening to alert state authorities to the issues, and trying to unionize the nurses. Though they’ve said the hospital has long had issues, medical personnel at Sinai-Grace have recently described horrifying conditions inside as it struggles to handle the surge of COVID-19 patients. People are dying in emergency room hallways before overburdened nurses have time to check on them, CNN reported last week — one patient had rigor mortis by the time staff found them. The emergency department is also running out of stretchers and body bags, one nurse told MLive. And the morgue is so full that corpses have been stored in a spare room and piled in refrigerated storage units, photos show.

Barkai filed a whistleblower lawsuit against the DMC, which is owned by Dallas-based Tenet Health, on Monday alleging that the DMC retaliated against her. “You’re dealing with a systemic problem from a Texas health care, for-profit corporation that is literally killing Michigan residents and putting nurses like Kenisa at huge risk,” said her lawyer, Jim Rasor, “as well as making preposterous, egregious decisions to get rid of nurses like Kenisa during a pandemic just because they’re more concerned about their reputation than they are about patient care.”

Courtesy Kenisa Barkai Kenisa Barkai

The DMC did not respond to questions about how, specifically, Barkai violated the social media policy or why the health system contacted her about working for them after her firing. “[W]e don’t discuss matters related to personnel,” DMC spokesperson Brian Taylor said in an email. “As for staffing at the DMC, we continue to bring in additional nursing resources to help us care for patients as volumes have increased as a result of COVID-19.” Since Barkai was fired, other nurses at Sinai-Grace have joined her in publicly pleading with management for more resources. Earlier this month, emergency room nurses working the night shift held a sit-in to call attention to a severe staff shortage. Employees at hospitals across the country have also spoken out about their working conditions. A group of nurses at a hospital in Santa Monica, California, recently refused to treat COVID-19 patients unless they received N95 face masks to protect themselves; they were suspended. Detroit is one of the US cities hardest hit by the coronavirus crisis. As of Monday, the city had 7,736 confirmed cases and 641 deaths; more than 2,000 people have died in the greater Detroit area. Black people in Michigan have borne the brunt of the outbreak, dying from COVID-19 at higher rates than the rest of the population, which Gov. Gretchen Whitmer said is due in part to longtime social inequities. The disparity is echoed in major cities all across the country, where black communities are being hit especially hard by the coronavirus. But getting a sense of exactly how much the pandemic has overwhelmed Sinai-Grace has been difficult. Unlike other major health systems in the Detroit area, the DMC has repeatedly refused to reveal how many COVID-19 patients it’s treating or how many employees have gotten sick. “The COVID-19 virus has caused significantly greater than normal mortality rates in the Detroit community,” Taylor said. “This has resulted in capacity issues at funeral homes and morgues outside of Sinai Grace Hospital. Patients who pass away at our hospital are treated with respect and dignity, remaining on-site until they can be appropriately released. Like hospitals in New York and elsewhere, we have secured additional resources such as mobile refrigeration units to help temporarily manage the capacity issue caused by COVID-19.” Located in a poorer area on Detroit’s west side, Sinai-Grace has a reputation within the city’s nursing community as the hardest place to work. Even before the pandemic, staffing shortages were common at the hospital, nurses have said. “We have always said that if you can handle it at Sinai-Grace, you can go anywhere, you can handle anything,” said Barkai, who has worked for the DMC since 2011. “We definitely have seen it all.” Barkai described Sinai-Grace as the “stepchild” of the DMC health system. “There’s always been equipment that’s been outdated or old, or just not working, that you kind of just have to rig per se to try to get it to work,” she said. “The environment itself has always been paint chipping, or dirty rooms, old bathrooms, no hot running water.” The patient population also tends to have more underlying conditions and limited resources to pay for their treatment, Barkai said. “It takes one hell of a nurse to be able to manage the population and also with what you’re given as a nurse.” Taylor, the DMC spokesperson, acknowledged that Sinai-Grace has always been in a challenging position. “Sinai-Grace sees more EMS traffic than any other hospital in metro Detroit and is the only hospital in Northwest Detroit,” Taylor wrote. “In addition, there are a large number of nursing homes in the area surrounding the hospital. Among the patient population served by Sinai-Grace, there are extremely high rates of underlying medical conditions such hypertension and diabetes, which puts people at higher risk for COVID-19. Sinai-Grace Hospital remains dedicated to its mission of providing quality compassionate care to the Detroit community.” Once the coronavirus made its way to Detroit in March, the problems at Sinai-Grace only got worse, Barkai said. She said she was tasked to care for patients who did and did not have COVID-19, and was worried about infecting the patients who didn’t have it. Personal protective equipment was also running low, like at hospitals across the country. Barkai said she and other nurses at Sinai-Grace had contacted the Michigan Nurses Association about joining the union before the outbreak, which the union confirmed to BuzzFeed News. “But there has been a growing interest and sense of urgency since [the pandemic began],” union president Jamie Brown said. She didn’t know it then, but March 17 would be Barkai’s last day of work. That day, she was spread thin as she tried to care for six patients, two of whom had COVID-19, she said, and garbage was piling up because housekeeping couldn’t clean her floor. Then, a senior nurse asked her to take on a seventh patient as more came up from the emergency room. “I said, ‘Why would you expect me to do this?’”

"Nurses are being put in impossible situations."

The union has been urging Michigan lawmakers to pass a law to establish safe nurse-to-patient ratios. In California, which mandates the maximum number of patients a nurse can have under their care, nurses should never have more than six patients each — and the ratios are lower for nurses working with patients like Barkai’s. The emergency room nurses who performed the sit-in said they were caring for more than 20 patients each. “The reports that we have been hearing from nurses at Sinai Grace Hospital are horrific,” Brown said. “Nurses are being put in impossible situations. This should never have been allowed to have happened in the first place and cannot be allowed to happen in the future.”

“Sinai Grace nurses have been raising concerns about Tenet DMC’s staffing levels for years. While many union nurses have been able to win safe staffing language through their contracts, not-yet-union nurses are left without protection.” Barkai said having too many patients raises both legal and ethical concerns for her. “If you have a patient in your care, you’re responsible for that patient,” she said. “You sign your name on these charts ... and when push comes to shove, that's your patient. You've got to care for them. If anything was to happen or go to court, that’s your name, that’s your license.” Barkai took on the seventh patient, but said she told the senior nurse that the state — which can investigate hospitals for health code violations — needed to look into the staffing issues at Sinai-Grace. “The patients are the ones suffering here,” Barkai said. The next day, Barkai appeared in a local news report saying the hospital was in dire need of additional resources and that she was worried about contaminating patients who didn’t have the virus. After that, she never got any more shifts, she said, and began to suspect something was wrong. Nine days later, the local news station reported again on Sinai-Grace — this time, there was video of trash and dirty floors inside the hospital, and an interview with a different nurse.

"I have like a nurse’s guilt basically for being off the front lines."

The next day, March 27, Barkai was called into her manager’s office. She said that even though she denied providing the footage to the local news station, she felt the managers wanted to “make an example out” of her. She reiterated that the hospital’s problems deserved the state’s attention, she said. Eventually, she was handed a paper saying she was being fired for violating the DMC’s social media policy. But Barkai said the hospital knew by then that she was trying to unionize the nurses and that that — along with her repeated calls for more resources and state scrutiny — was why she was fired.

“It really broke my heart and was devastating,” she said. “I have like a nurse’s guilt basically for being off the front lines.” In a city known for its resiliency, the nurses at Sinai-Grace have expressed their commitment to taking care of the community, despite the challenges. “We can go anywhere, but we nurse right here in the city of Detroit, because there’s where we’re from, that’s where I live,” one of the nurses who participated in the sit-in said during a Facebook livestream. “It’s just ridiculous that Sinai-Grace don’t care about the patients and the community like we do.” Barkai said it’s unfortunate that she was unable to give everyone the care they deserved when the hospital was short-staffed, and that there have been cutbacks to numerous teams.

Emily Elconin / Reuters A view shows the entrance to DMC Sinai-Grace Hospital featuring a sign reading "Heroes Work Here," April 14.

Patients have died due to cost-cutting and poor medical care at the DMC, two cardiologists alleged in a lawsuit naming Sinai-Grace and two other DMC hospitals last year. The doctors said that they too had been retaliated against by the health system after repeatedly expressing concerns about patient safety. (The DMC has denied this, saying the doctors were removed from their administrative roles for violating the health system’s standard of conduct.) The cardiologists cited several disturbing alleged incidents in their lawsuit, including physicians receiving dirty surgical equipment — “some with visible tissue and blood” — and patients dying after experimental or unnecessary procedures. In their lawsuit, the cardiologists also alleged the FBI was investigating a physician who performed a procedure without consent on a patient who died.

Eight days after the cardiologists made their allegations public in 2018, a federal health agency began investigating the other two DMC hospitals, but Sinai-Grace has also been investigated by the Centers for Medicare and Medicaid Services since then. The agency did not respond to questions about whether it has received any complaints about Sinai-Grace’s handling of the coronavirus outbreak or launched an investigation. Michigan’s state licensing authority, which also oversees the hospitals, declined to say whether it was examining any of the recent claims about conditions inside Sinai-Grace. “I can confirm that we are aware of the allegations, however, we cannot comment on any current or future investigation,” wrote David Harns, a spokesperson for the Department of Licensing and Regulatory Affairs. Barkai said she and other nurses at Sinai-Grace would often voice their concerns before the coronavirus outbreak to their direct managers, who were sympathetic but unable to fix the problems. “Their hands have been tied too,” Barkai said, adding that several managers have recently left the hospital. Barkai had already hit a breaking point in late January, before the hospital saw its first COVID-19 patient, she said. “I started bawling my eyes out and crying, and just had enough.” She spoke to her manager, who then brought her to speak with the hospital’s chief nursing officer. The CNO listened and listed steps the hospital was taking to try to increase the number of nurses, but Barkai said she was unsatisfied — those were long-term solutions and she needed help right away. “I am a strong nurse, I can handle a lot,” Barkai said. “If I have issues, I always say to myself, then there’s something really wrong.” The goal of Barkai’s lawsuit is to get her job back, said Rasor, her attorney. The suit, filed in the Wayne County Circuit Court on Monday, asks for at least $25,000 and payment to cover lawyers’ fees. Rasor said they will also be filing an unfair labor practices complaint with the National Labor Relations Board. In the meantime, Barkai, who has a young son, is keeping busy with a GoFundMe campaign she recently launched called “Feed the Frontline.” She uses donations to provide meals and snacks for medical staff who are working with COVID-19 patients. “[It’s] just to keep the morale up, basically, and to just let them know that even though everything’s been going on, I’m still out here with them trying to do the best that I can to help out, and that I’m not going anywhere,” she said. “I’m not going to stop speaking up for them.”