Sarah Rahal and Beth LeBlanc | The Detroit News

Beaumont Health, the state's largest health care system, informed employees on Friday that anyone who refuses a transfer to work with COVID-19 patients will be considered to have resigned and ineligible for future employment.

David Guralnick

The policy, obtained by The Detroit News, provides exceptions for those with underlying conditions, and comes amid increasing angst in Metro Detroit hospital systems that are reaching capacity in the face of the nation's third largest outbreak of the coronavirus.

Adding to the stress is the news of deaths and hospitalizations of colleagues and concerns over shortages of protective equipment. A resident surgeon at Ascension Macomb Hospital died this weekend of suspected COVID-19 and a longtime Henry Ford Health System nurse died in her home last week after telling relatives she had been exposed when at work without proper protection.

"There has not been a time, in my lifetime, of so much of angst and tension in the healthcare community," said Dr. Richard Balon, program director for the psychiatry residency at Detroit Medical Center and Wayne State University, where he also is a professor of psychiatry and anesthesiology. "We are facing an additional crisis - mental health issues in healthcare workers due to this enormous pressure, tension, push for making difficult decisions, feelings of lack of support, lack of protection, long hours, not being with their families, worry about endangering their families by bringing the infection home."

There has not been a time, in my lifetime, of so much of angst and tension in the healthcare community. Dr. Richard Balon, director, psychiatry residency program at DMC/Wayne State University

Medical professionals and administrators say many in the healthcare community are rising to the challenge and even volunteering for crucial roles, including at Beaumont, where 50 retired nurses returned to work to assist.

Beaumont's policy reflects the stress of a system loaded with patients and encourages managers to make reasonable accommodations for staff with medical conditions.

At the end of the day, we have patients to take care of and we need to redeploy our staff. Aaron Gillingham, Beaumont’s senior vice president and chief human resources officer.

“At the end of the day, we have patients to take care of and we need to redeploy our staff,” said Aaron Gillingham, Beaumont’s senior vice president and chief human resources officer. By and large, employees have been “operating at their absolute best,” he said.

But there have been concerns expressed by employees nervous about working with COVID-19 patients, he said, that could compromise the hospital system’s ability to meet the demands of the crisis. The policy was put together to address that problem, he said.

The hospital system also is working to secure accommodations at hotels or other locations for individuals who cannot return home to a loved one with a compromised immune system.

The stresses at area hospitals prompted Beaumont CEO John Fox to say Sunday that Michigan "needs to collect accurate, real-time data from all hospitals across Michigan and share it in an open and transparent way, just as we have been doing at Beaumont Health.”

“We have been advocating for this both publicly and behind the scenes," Fox said. "This is an unprecedented situation. Faster action is needed to ensure we can care for the influx of COVID-19 patients over the next few weeks and months, in addition to those we serve who need emergency or trauma care, have heart attacks, give birth or need other truly emergent medical services.”

Fox said he is proud of how hospital staff have performed.

“I have been visiting all of the Beaumont campuses and have watched our team work so well together. Their response to this pandemic has been stunning and inspiring," Fox said. “They truly are health care heroes.”

Amid the heroism, however, has been tragedy.

Ascension

The death of Dr. Chris Firlit, a 37-year-old senior resident oral maxillofacial surgeon at Ascension Macomb Hospital only heightened concern among physicians and residents. A married father of three children just three months from graduation, he experienced a fever before his chief fellow drove him to Providence Hospital in Southfield, where he died of suspected COVID-19, Dr. Rafael L. Barretto, director of medical education, wrote in a message obtained by The News.

While it is not immediately clear whether Firlit's exposure came at work, Baretto's note underscored rising tensions about the increasing use of residents — physicians who are training in their specialty — in medical areas that are not their specialty during this crisis.

"As we continue to ramp up using our residents and fellows in roles outside their comfort zone (ICU and hospital floors), Chris' death may create more hesitation and uncertainty," Baretto acknowledged. "Please continue to provide support to each other in these trying times."

On Thursday, DMC administrators put out an urgent call for residents from all specialties that may be able to help.

"We are in dire need of additional physician support to assist our colleagues in MICU and the medicine service," wrote Dr. Patricia Wilkerson-Uddyback, vice president of academic and community affairs at DMC.

She noted that these residents would be asked to perform relatively straightforward tasks, including writing notes, entering orders and discharging patients.

But some doctors and nurses are feeling overwhelmed, expressing concerns about supply shortages and fears for their own safety. After a DMC nurse was fired for violating social media guidelines last month, many healthcare workers have become hesitant to talk publicly.

A Beaumont Hospital nurse, however, recently shared on Facebook that one night, a shift supervisor got emotional watching patient after patient enter the emergency room and took staff to the hospital chapel to pray for relief.

"We leave work crying, including myself last night and we all know this is only the beginning," she wrote. "I ask myself, how are we going to survive this? The virus takes over your whole body. ... And these people come into the hospital not knowing if they will come back out alive."

Facebook

The discussion in healthcare about using staff outside their comfort zone often centers on concerns over shortages of protective equipment.

Beaumont announced Sunday it has begun disinfecting and reusing N95 masks for those treating COVID-19 patients.

"With the severe national shortage of masks, this will allow us to protect our staff, conserve resources and reduce medical waste," Chief Operating Officer Carolyn Wilson said in a statement.

At Michigan Medicine, the University of Michigan's health system, Chief Medical Officer Dr. Jeffrey Desmond said the hospital has enough personal protection equipment although it is conserving it to last through the pandemic.

"Michigan Medicine made the decision to have all employees start wearing masks 10 days ago and were one of the first to adopt this policy," he said in an online statement. "We are working around the clock to obtain additional supplies. We received many offers and sources for supplies. ... We have received more than 5,000 face shields from auto companies within the last week."

Courtesy photo

A complaint about lack of protective adequate equipment preceded the death of Henry Ford Health System nurse Lisa Ewald, who believed she contracted the virus treating a patient who had chest pains when she did not have a mask. She was 54 and had asthma, her family said.

"Our hearts ache for our employee's family, friends and colleagues," Wright Lassiter, III, president and CEO of HFHS, said in a statement. "As healthcare providers on the frontlines of this pandemic, we know we are not immune to its traumatic effects."

Lassiter said they continue to use every resource to protect employees.

"Regarding employee testing, we adhere strictly to CDC guidelines. Currently, the CDC recommends testing employees only when they become symptomatic. Whether at work or at home under self-isolation, if an employee begins experiencing symptoms, they are urged to contact Employee Health and arrange for immediate testing," he said.

The stresses encountered today are not likely to be short-lived said Balon, the DMC/WSU psychiatry residency program director.