The medical aide had just started her shift at a Rapid Med Urgent Care Center north of Dallas two weeks ago when a supervisor suddenly handed her a mask and asked her to test a patient for the coronavirus.

She was terrified. She had no experience dealing with viral outbreaks. Her bosses had not instructed her or other medical assistants on how to safely collect the specimens.

Nor did they give her and the others protective gear recommended by health agencies —shields that cover the whole face or goggles to protect the eyes.

Minutes later she put on a gown and started swabbing the patient’s throat. The patient coughed in her face.

“My first thought: Oh no, I might have just been infected,’’ said the aide.

Three other medical assistants described similar experiences to The Dallas Morning News, saying Rapid Med has thrust them onto the front lines without adequate protection or training to test more than 70 patients for COVID-19 at its two centers serving Highland Village and The Colony.

They also sent their allegations to agencies that oversee doctors and worker safety.

Their worst fear: They may have been exposed to droplets from coughs, sneezes or touch, and then spread pathogens to colleagues and patients visiting the clinics for other ailments, according to interviews and complaints to the Texas Medical Board and U.S. Occupational Safety and Health Administration.

“Somebody needs to stop the testing here,’’ one of the aides told The News.

The employees requested anonymity because they fear retaliation.

Urgent care centers are set up to treat minor ailments, not major medical problems or global health threats. And because the centers are virtually unregulated, Rapid Med’s staffers struggled to find an agency to turn to for help.

Texas urgent care centers, unlike hospitals and emergency rooms, are exempt from federal health care inspections and standards required by the U.S. Department of Health and Human Services and state licensing agencies.

Even though the centers are in Denton County, its health department said it has no oversight of them. “We do not determine which providers can or cannot test,’’ a spokeswoman said.

On Wednesday, Rapid Med employees were alerted that a patient had tested positive for the virus.

Many other results have yet to come back from outside labs because the process can take weeks. The employees said they themselves have not been tested and do not have symptoms.

Aides have voiced alarm to Rapid Med owner Dr. John Gustavo Gomez and a supervisor, who were on vacation for the first week of coronavirus testing. But they have continued to ask workers to perform the procedures, staffers said.

Gomez, a 49-year-old trained in emergency medicine, declined an interview, but said in emails that employees with “axes to grind’’ are spreading inaccurate information while he is trying to meet the high demand for testing in Dallas suburbs and grapple with a nationwide shortage of safety gear.

He said he has done his best to supply workers with equipment recommended by the U.S. Centers for Disease Control and Prevention.

“As with other health care providers responding to this crisis, we are striving to stay on top of developments and respond to changing instructions and guidelines as quickly as possible,’’ Gomez said. “No employee has done a [specimen] collection without masks or gloves.''

Ten caregivers — at least six of them medical assistants — walked out of the Highland Village center Monday and Tuesday because they did not want to take part in the coronavirus testing, staffers said.

That was after Gomez and a supervisor had told them to keep testing even though the clinic had run out of gowns and eye protection over the weekend, according to aides and a complaint sent to the state medical board, which regulates doctors.

Gomez told employees last Saturday: “Let me get this straight. You guys are refusing to help them [patients]?’’ according to the complaint. Employees stressed that they must protect themselves so they don’t contract the virus then spread it to patients, the complaint stated.

Gomez told The News the complaint was inaccurate. He said he has told concerned staffers they “would be excused from their shifts until the national shortage [of protective gear] has abated.’’

A medical worker at a facility in Pearl City, Hawaii, was fully equipped with eye and body protection to test patients in their vehicles. (Marco Garcia / AP)

OSHA, which oversees workplace safety, is investigating the potential Rapid Med safety lapses, according to sources who are not authorized to speak publicly. The medical board is prohibited from discussing whether it is investigating physicians, but a board official told one of the aides in an email Wednesday that its enforcement division should be contacting her soon.

‘Shut down’ testing

Health care experts said the workers’ concerns warrant immediate intervention.

“Those employees should be self-quarantined and tested immediately,’’ said Dr. Roy Poses, head of the Foundation for Integrity and Responsibility in Medicine, a safety advocacy group based in Rhode Island. “If these allegations are true, the testing process should be shut down.’’

Before the clinics began testing on March 9, the CDC, the World Health Organization and Texas’ health department had recommended goggles, face shields, gowns and gloves for testing.

OSHA has called for the same precautions. It urged health care providers to set up training and safety protocols to contain infections. Lack of planning can lead to a “cascade of failures,’’ the report said.

In his response to questions from The News, Gomez did not address workers’ specific concerns about not receiving instruction or safety guidance before the testing began. He also did not provide a copy of any infection-prevention policy that has been used by his centers.

Gomez said supervisors have sent safety protocols to workers by email. He would not provide copies to The News. Aides said they did not receive emails addressing safety until last Saturday, after The News began questioning Gomez.

Rapid Med Urgent Care operates two facilities: One in Highland Village, the other in The Colony. (Juan Figueroa/ The Dallas Morning News) (Juan Figueroa / Staff photographer)

One reason workers say they do not want to be identified is that on Jan. 31 police came to the Highland Village facility in Double Oak to check out an allegation that Gomez had threatened to harm a physician assistant, according to a police report.

Gomez had scolded her during a heated conversation about a patient’s care, she told police. Then he sent a text to her — though the doctor intended to send it to a colleague, according to the police report. It read, “Going to kill that disrespectful slut,’’ the report stated.

The employee walked out that day and never came back. She has not filed criminal charges, police said.

Gomez apologized to the staffer, the report said.

“It was a regrettable expression of frustration,’’ his lawyer told The News.

Gomez does not believe his employees are scared to complain, the doctor said.

Less scrutiny for centers

Rapid Med has been operating in Denton County for at least five years, according to Texas business records, amid a surging demand for convenient walk-in neighborhood clinics that treat minor ailments such as cuts, rashes and sprains.

Experts question whether urgent care centers can safely or effectively deal with the coronavirus.

“They weren’t set up to handle anything serious from the beginning, much less a pandemic,’’ said Poses, head of the Rhode Island safety foundation.

And because federal and state law does not require regulation or accreditation for urgent care centers, they do not have to meet many of those safety guidelines, either.

Before Rapid Med employees were told to test for the coronavirus two weeks ago, management did not call a meeting or provide instruction on safe specimen collection. But this sign was posted inside one of the facilities.

Those standards include controlling for infections, preparing for emergencies, cleaning contaminated rooms and supervising less experienced caregivers.

Rapid Med is not accredited by the Urgent Care Association, one of the large national organizations that issues such guidelines. Gomez did not provide documentation requested by The News showing his centers are accredited by a certifying organization.

It is unclear how many urgent care centers in the Dallas area or across the nation are now testing for the coronavirus. Federal and state health officials said they do not know. Nor does UCA.

Employees for CareNow, which has more than a dozen urgent care centers in North Texas, said this past week that its facilities are not performing the procedures.

Some Dallas area urgent care centers that double as emergency rooms, and thus must be licensed by the state, are testing for the coronavirus.

Legacy ER & Urgent Care company’s six centers collect specimens from patients who pull up in their cars — an ideal isolation chamber, said Dr. Jay Woody, founder of the network.

The company requires licensed professionals such as doctors, nurses and paramedics to receive formal training and demonstrate their competency in handling infectious disease patients. They are the ones swabbing potential coronavirus patients.

Woody said his employees also must wear all CDC-recommended safety gear.

“The biggest risk right now is running out of personal protective gear,’’ he said. “I wouldn't allow any of my providers to care for people without the full gear.’’

Regulation of his facilities by government agencies and accreditation organizations has positioned his centers to safely treat suspected coronavirus patients, he said.

“Without those standards, we’d be in the blind,’’ Woody said.

‘We’re testing patients’

At the start of the outbreak, Rapid Med employees say, they referred patients to be tested at UT Southwestern Medical Center in Dallas and other major hospitals.

“Then I walk into the office and all of a sudden we’re told we’re testing patients,’’ an aide told The News. “There wasn’t even an employee meeting.”

Gomez personally oversees the Highland Village clinic — the larger of the two centers, often handling more than 100 patients a day for various ailments.

Rapid Med has routinely relied on more than 30 medical assistants instead of nurses or other licensed practitioners more educated in infection prevention to take vitals and help screen patients for most ailments, staffers said.

The expertise of the medical assistants varies, with some certified by national organizations. Generally, physician assistants or a nurse practitioner also are on site to help supervise testing. Aides said physician assistants at The Colony facility have been testing more patients for COVID-19 than at the other Rapid Med clinic.

One aide said Rapid Med had provided her some instruction more than a year ago on “point of testing’’ procedures such as swabbing for strep.

Texas regulations give physicians wide latitude to delegate such tasks to medical assistants, said Sherry Bogar, president of the Texas Society of Medical Assistants.

Yet doctors are expected to provide adequate safety instruction and protective gear for the aides before they test for threats such as the coronavirus, she said.

”If the medical assistants are not given proper safety equipment and training, it falls back on the doctor,'' she said.

The week medical assistants began conducting coronavirus tests, a supervisor sent word that they did not need to isolate patients or wear safety gear because it could scare the patients, aides said.

The medical assistant who was sprayed by the patient’s cough said a supervisor had told her Rapid Med should not be testing coronavirus patients but asked her to do so anyway.

The aide swabbed the potential COVID-19 patient for strep and influenza to rule out those conditions, a common protocol in other health care settings.

But testing for strep requires a throat swabbing, which can cause patients to cough, potentially spewing germs. Her mask, an N95 respirator, covered only her nose and mouth — a reason goggles or face shields are important, she said.

Swabbing inside the nose — a common way for collecting specimens for the coronavirus test — can trigger sneezes, sending germs downward. That’s why gowns are needed to protect providers’ lower bodies.

Aides were soon scouring the internet for guidance from the CDC and several health organizations, and questioning physician assistants and other supervisors.

They and their family members contacted several health care agencies but kept getting bounced to others.

OSHA complaint filed

A few days after testing began, aides were asked to evaluate symptoms of patients while they waited in their cars, and then walked them to patient “isolation’’ rooms if they showed signs of COVID-19.

The employees were told to wipe down the rooms before and after use, but said managers gave no guidance on how to do that.

That Saturday, an employee filed a complaint with OSHA, saying the clinics had gone without face shields and goggles for a week and workers “could have been exposed to COVID-19.’’

The complaint detailed the lack of guidance for staff and stated that a supervisor had told them earlier in the week there was no need to isolate patients.

“Our physician has put all of our health statuses at risk,’’ the complaint said.

That same day, Rapid Med management put a post on its public Facebook page saying, “Rest assured, we are performing vigorous infection-control procedures.’’

The next week, safety gear such as goggles continued to run low at the Highland Village site, yet supervisors still ordered medical assistants to evaluate and test patients for the virus, the aides said.

On March 19, an employee sent a complaint to the state medical board, citing the lack of equipment and the alleged threat Gomez made against a staffer, according to a copy obtained by The News. He “neglects to have employees working in a safe environment,’’ the staffer wrote.

Last Saturday, a suspected coronavirus patient coughed in the face of another medical assistant who did not have goggles or a gown, the employee said in an interview.

“I was in this total mindset of trying to get the swabbing done right, not protecting myself,’’ said the aide, adding that she was considering quitting but like other medical assistants said that she had no other source of income.

A walkout

That morning, several employees told Gomez their concerns were growing, and he asked them if they were refusing to help patients.

In a response to questions from The News later that day, Gomez said employees had not collected specimens without gloves or masks.

He pointed out that patients receive treatment in isolation rooms that are “thoroughly decontaminated” after each visit.

“No employee has ever made an inquiry or indicated they had a complaint to the physician in charge’’ or a physician assistant, he said.

He also said he has gone out of his way to provide employees with protective gear, even sending a driver to Houston to pick up masks.

“Masks were obtained from a local day care that offered them,’’ Gomez said. “We have acquired [safety gear] from the North Texas Trauma Regional Directory and Denton County Public Health.’’

On Monday, nine employees, including five medical assistants, walked out. On Tuesday, another medical assistant left. By Wednesday, two aides said, they had finally spoken with OSHA officials.

Gomez said he had taken the time to tell each clinical staffer that if they felt unsafe with the lack of protective equipment, they “would be excused from their shifts until the national shortage has abated.’’

“I believe all plan to return once the coronavirus pandemic has run its course or the supply chain for [safety gear] has recovered,'' he said.

The aides who spoke with The News, however, said they are looking for other jobs.

“We went into medicine to help others,’’ one aide said. “It is our moral duty to help our community. But if we are not given the proper support, training and equipment needed to handle a pandemic, we are only further risking harm to us and our patients.’’