Some Tenet nurses start their shift sobbing. They worry that recycling of masks and gowns to treat COVID-19 patients puts them and their families in danger.

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Some Palm Beach County nurses who work for health-care giant Tenet Hospitals start their shift sobbing.

They fear for their safety because they lack proper masks, gowns and eye protection as they care for patients infected with this deadly coronavirus strain.

They worry about infecting other patients. They worry about bringing it home to their families.

Nurses and doctors have looked online for these items only to be rebuffed by hospital administrators who say they must adhere to their established supply chains.

Some are threatened with being fired if they bring their own makeshift personal protective equipment — or PPE. Others have simply quit.

Health care professionals for Tenet say they are caught in a deadly game of Catch-22: Treat coronavirus patients without proper protective gear or lose their jobs.

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A Palm Beach County doctor familiar with Tenet and several nurses from different hospitals spoke to The Palm Beach Post for this story. Because of fear of retaliation, their names and the names of their hospitals are being withheld.

Tenet Hospitals responded Friday afternoon to the myriad of complaints of their employees. The company remained steadfast that it has enough PPE for its medical staff despite reports of a nationwide shortage that caused New York doctors and nurses to protest this week.

“We expect our caregivers to care for all patients, and we provide the correct PPE for them to do so safely,” said Tenet spokeswoman Shelly Weiss Friedberg.

So while President Donald Trump and the national media laud health care workers on the front line of this pandemic, these essential professionals are not treated anything like heroes in the confines of these hospitals, they said.

Tenet temporarily shut down its four Midtown Imaging Centers, leaving dozens of employees who know only that the offices are closed but nothing about where they stand.

It also recently postponed matching the 401ks of employees.

“This is a slap in the face while we’ve been loyal and been here,” said one nurse. “They are going to get federal money. Why are they skimping with our benefits? They are already cutting costs before they even have a loss.”

It is for all these reasons, some nurses are seen weeping as they start their shift. Or they break down when told to treat a patient with COVID-19.

“One girl who was supposed to come to our floor had an anxiety attack,” said one nurse treating coronavirus patients.

“I feel we got to do what we got to do, but we have to rotate so just one person doesn’t get all the exposure.”

Tenet operates five medical centers in the county — West Boca, Delray Beach, Good Samaritan, St. Mary’s and Palm Beach Gardens.

Tenet is certainly not the only hospital chain where such stories have surfaced in the past week. The New York Times wrote that the Cleveland Clinic warned doctors not to “go rogue” and wear surgical masks around the hospital.

“These are emotional times, and we need to control our emotions,” the hospital’s memo said. The company later said the memo was “not good communication.”

An emergency doctor at a Washington state hospital not affiliated with Tenet said he was fired for speaking out on Facebook about insufficient protection and testing at the hospital, The Times reported.

Still many local nurses said a culture of fear permeates Tenet’s hospitals in Palm Beach County.

“Everybody is afraid to say anything,” one nurse told The Post. “Most nurses are afraid to speak out because they are afraid to lose their jobs.”

Another said, “Why are you making nurses collateral damage? Because without us you can’t run your hospital. Do you understand that?”

Friedberg, Tenet’s spokeswoman, said, “We have supported transparency,” and pointed to written and video communications with staff. Palm Beach Health Network CEO Maggie Gill has encouraged employees to send questions through the hospital Facebook page, she said.

If nurses say they don’t want to take care of COVID patients because of their concerns, hospital administrators or managers tell them they are abandoning and neglecting the patient.

“So they threaten your job and basically your license,” the nurse said. “They say, ‘This is what you signed up for.’”

As a result, some nurses have resigned on the spot, the nurse said.

Nurses have been told not to wear makeshift face masks or even PPE outside the rooms, one said

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“Hospital administrators are threatening nurses who want to protect themselves with better masks, telling them it frightens patients,” she said.

Tenet says that it is required to use CDC-approved PPE that the company provides. Any donations or procurement of alternate PPE must be routed through the corporation’s national supply chain for vetting.

A Tenet FAQ released to medical staff outlined how it is rationing N-95 masks, which are tight-fitting and very efficient at filtration.

The masks will be used for three shifts, which for many nurses who work 13-hour shifts, constitute a week of work.

But the Joint Commission for Accreditation of Healthcare Organizations, which accredits more than 22,000 U.S. healthcare organizations and programs, said in a statement that hospitals should allow healthcare workers to use whatever is necessary to protect themselves during this pandemic.

It said privately owned masks and respirators almost certainly are better than nothing at all. “Homemade masks are an extreme measure and should be used only when standard PPE of proven protective value is unavailable,” the statement read.

Isolation gowns are shared among doctors and nurses for each patient suspected of COVID-19 or who tested positive. As many as three or four medical professionals share a gown during a shift, the hospital workers said.

“This breaks every infection rule in life,” said one nurse.

Eye protection, such as shields or goggles, are washed after every shift and passed on to be reused.

Tenet denied that one gown is being shared per COVID patient despite nurses from different hospitals reporting the policy and a photo from Delray Beach Medical provided to The Post that shows such gowns hung up outside hospital rooms.

A nurse just out of college is paid about $23 an hour: “They are so afraid because they can’t lose their jobs,” she said. “Nursing doesn’t pay a lot. No one goes into this for the money.”

Tenet could purchase more PPE but has balked because of costs — not because the PPE is unavailable, the doctor told The Post.

"There are still resources that can still be bought, but the hospitals are not willing to pay the higher price," the doctor said. "Whether it's expensive or not, you still have to protect the staff."

Not only is supply and demand driving up the costs of PPE, but transportation costs have skyrocketed as manufacturers have had to charter their own 747s, one broker told The Post on condition his name not be published.

“The squeeze is coming in all directions,” he said.

Whether it’s paying for PPE, furloughing staff or cutting benefits, the bottom line is still king during this crisis at these Tenet hospitals, said the health care professionals who spoke to The Post.

The doctor said Tenet is scheduling procedures that aren't urgent but are profitable.

He specifically mentioned cardiac catheterizations, which the hospitals could argue are urgent. The physician said Tenet is concerned about a falloff in areas of care beyond coronavirus.

“All emergent and urgent procedures and diagnostics will proceed as scheduled if delay would most likely harm the patient’s health outcome,” Friedberg said. “During the pandemic, we have put great effort into putting safe care pathways in place for those who require treatment for other chronic and emergent ailments.”

While the nationwide shortage of COVID-19 tests have been widely reported, the problem in the hospitals is when the results come back. It’s often taking more than a week.

“We are just kind of winging it and going from room to room with the same equipment,” one nurse said.

“Most of the time we don’t know who is negative or positive. Nurses are coming on their shifts crying for their health, for their family’s health and being forced to take care of these patients.”

The physician said care is limited by the delay in getting results. "We can't initiate treatment if we can't get results," the doctor said.

Adding to the confusion, Tenet has also changed policies on where to put infected patients at some hospitals, the healthcare workers say. Sometimes they are isolated on one floor and then nurses find out the next day that pregnant COVID patients have been put on the maternity ward, a nurse said.

“Regardless of which unit a patient is on, proper isolation and infection prevention precautions are followed,” the Tenet spokeswoman said.

What nurses said they want most is their voices to be heard and called on the Florida Nurses Association and others to step up.

“I just believe that the nurses feel unsupported by their employers and their professional associations,” a nurse said.

“Nurses are the ones on the front line all day every day. Why can’t nurses not be fearful to speak out about issues they have encountered?”

After stories in other parts of the nation about nurses and doctors disciplined for voicing concerns, these organizations are starting to speak out.

Willa Fuller, executive director of the Florida Nursing Association, said that one of the problems is the Centers for Disease Control and Prevention has made standards of care for COVID-19 patients a moving target. She said she wants to see evidence that nurses and doctors can use bandanas in lieu of masks.

It’s the Wild West when it comes to PPE in hospitals without proper supplies.

“The CDC has been the one that has been loosening and loosening and loosening their guidelines,” Fuller said.

“It’s not only putting the healthcare workers at risk but putting anybody they have contact with when they leave the hospital at risk because they go to other places, as well.”

The Service Employees International Union 1021, which represents some nurses, also has called for all frontline workers providing care to have proper PPE provided by employers.

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And you don’t have to be a nurse at a Tenet hospital to feel the pain.

The four imaging centers connected to Tenet’s Good Samaritan Hospital closed down shop, and workers don’t even know whether they’ve been furloughed or laid off. The centers do MRIs, CAT scans and mammograms, among its services provided.

Without access to the company’s email, the workers can’t even learn about their benefits, such as whether they are to be paid for accrued personal time off.

Two medical imaging technicians said many employees of Midtown Imaging Centers reached out to human resources but got no answers about their status. Yet, on Friday, Tenet insisted that human resources was available to these employees.

“We are wondering what is going to happen with us,” one said. “That is why we are frustrated and we can’t get any answers.”

Another imaging technician said, “It sounds like this was a perfect storm so they could just shut us down.”

jpacenti@pbpost.com

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wwashington@pbpost.com

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