New Jersey veterans home managers planned to penalize staff for wearing masks as COVID-19 spread, emails show
WOODLAND PARK, NJ - In addition to banning staff from wearing protective masks for the first few weeks of the outbreak, the managers of the New Jersey veterans homes, with the help of Governor Phil Murphy's office, drew up a range of penalties against nurses who removed the masks of the homes carried without permission.
More than 190 residents have died of COVID-19 in the state's veteran homes.
Emails from The Record and NorthJersey.com, part of the USA TODAY Network, show that at least one employee had to return home because management didn't let him wear a mask - despite having a doctor's letter stating he had asthma suffered.
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Managers at the Paramus and Menlo Park homes in New Jersey were so opposed to wearing masks at the start of the pandemic that they objected to outside vendors and rescue workers wearing them to the veteran's homes while they were transporting residents, like the E. -Show emails.
"If they had only done the bare minimum, they could have saved lives," Tony Agosto, CEO of Virgo Medical Services, told The Record and NorthJersey.com. Agosto had fought to get his ambulance workers to wear masks in the Menlo Park house.
"You could have stopped a lot of it," he said.
Some of the no-mask policy came from Murphy's office, whose employee relations department advised management in late March on the establishment of disciplinary proceedings against nurses and aides who attempted to use mask supplies in homes without permission.
The advice came just days before Murphy's health commissioner ordered all nursing home workers in facilities across the state to wear masks.
Michael Zhadanovsky, a Murphy spokesman, said in a statement that the homes' inventory of personal protective equipment such as masks "became overloaded in March and careful steps were taken to ensure proper use".
While health officials - especially Dr. Anthony Fauci, the nation's leading infectious disease expert - kept the public from wearing masks in the early days of the pandemic, they did so to ensure health care workers were not running out of supplies.
However, guidance from health officials on how to wear face masks in nursing homes was not always clear or emphasized in March.
An email among officials from the Department of Military and Veterans Affairs discussing advice from Governor Phil Murphy's office on disciplining nurses for "mask insubordination" - wearing the veteran's house masks without permission.
A March 3 memo to nursing home administrators for the New Jersey Health Department said two federal agencies recommended that every health care worker wear N95 masks, which offer better protection than the surgical masks that workers were asked to wear.
By mid-March, the Federal Disease Control Centers and Centers for Medicare and Medicaid Services issued guidelines for nursing homes that face masks should be worn by employees who appear sick before they self-isolate, as well as by people who cough . The guidelines also state that masks and other personal protective equipment should be provided in areas where residents are being cared for.
But at the New Jersey Veterans Homes, management actively advised against face masks for most of March, forcing some nurses and aides to defy instructions and use the homes' supplies - a desperate effort to protect their health that management termed "mask insubordination".
"I didn't give you any knowledge," said Shirley Suddoth-Lewis, a longtime Menlo Park nurse who retired this summer, of the ban. "I did not bring this virus home to my family."
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Hundreds of emails and other documents The Record and NorthJersey.com received from a series of requests for public records from May onwards show managers were concerned about limited supplies and wearing masks until the first confirmed COVID Fall of the houses did not allow.
However, due to limited COVID tests and slow processing times for the results, the first positive case in the Paramus house was not confirmed until March 28th - although many residents already had "cold symptoms".
Management's stance against masks lasted until March 30, the day New Jersey Health Commissioner Judy Persichilli ordered the "universal masking" of all nursing home workers "to stop the introduction and spread of this virus" .
By then it was too late.
Within eight days, at least ten residents were dead in the Paramus house and two died in the Menlo Park house. Dozens of other people who died were not tested but were suspected of succumbing to the virus.
The virus spread throughout the facilities. 81 residents were confirmed dead in Paramus and 63 others in Menlo Park, and each house had a male nurse. Investigators later found there were an additional 47 "likely" COVID deaths in the two homes - residents who died of similar symptoms at the height of the spike but had not been tested.
A total of almost 600 residents and employees in the two houses were infected.
The death toll - among the highest in nursing homes nationwide during the pandemic - sparked a hearing and ongoing investigation by the Attorney General and the U.S. Department of Justice. It also resulted in the overthrow in October of four senior officials from the State Department for Military and Veterans Affairs, who operate the veterans' homes, including the CEOs of the Paramus and Menlo Park homes.
Kryn Westhoven, a spokesman for the agency, said he was unable to comment on the mask policy due to dozens of claims from families of victims who intend to sue the department.
John North, a state hired attorney defending the agency and its managers, also declined to comment on the mask policy.
Since the pandemic began, workers in the houses have said their managers told them not to wear masks because it would scare residents. The emails will show:
The ambulance workers
On March 11, Elizabeth Schiff-Heedles, the manager of the Menlo Park Veterans Home, asked her colleagues at the Paramus and Vineland homes if they would allow emergency workers to wear masks when transporting residents to medical appointments, or advisers who "usually never wear masks" wear them when visiting homes.
"If they are healthy they shouldn't," said Matthew Scottlander, CEO of Paramus. "If you are sick, you shouldn't enter our facility."
Allyson Bailey, CEO of the Vineland home where three residents eventually died, replied, “Unfortunately, some information encourages people who see many potentially ill people to wear masks to protect themselves. Several medical practices have also started. ""
In the same email thread, Schiff-Heedles said an ambulance company - Virgo Medical Services - threatened to stop transporting residents of their home if their workers were banned from wearing masks.
"Is this a fight we should have or allow the Virgin to wear masks?" She asked.
An email dated March 11th among managers at the Department of Military and Veterans Affairs regarding whether ambulance workers are allowed to wear masks at veterans homes.
Bailey said many ambulance companies needed masks and advised Schiff-Heedles not to fight.
When Schiff-Heedles asked if Scottish people would agree, he replied, "I don't think they should wear masks."
In a recent interview, Virgo's Agosto said he was shocked when Menlo Park's management said they would not allow its rescue workers to wear masks and other personal protective equipment or PPE at home. He said it was clear even in the earliest days of the pandemic that healthcare workers needed to be masked.
"What kind of boss would I be if I told my workers not to wear PPE in a pandemic?" Said Agosto. "We enter a lot of facilities in one day and there is no way I would endanger my people - or the people who transport them."
Agosto told staff that he would not comply and that he would only pick up residents at the roadside. Management finally refused. When his crews arrived at Menlo Park, he said the house staff did not wear masks.
A defiant nurse
Management held several meetings with Menlo Park employees stressing that masks should not be worn as no COVID-19 has been confirmed in the building, Suddoth-Lewis said.
But she and her colleagues continued to wear masks even after she said boxes were confiscated by managers.
"We stashed a few," said Suddoth-Lewis, president of the local chapter of the American Federation of State, County and Municipal Employees (AFSCME). "We saw patients get sick. We saw what was on the news. We didn't want to take our chances."
Management wanted it to stop.
In an email on March 26, Jared Doherty, an employee relations attorney for the department, told Schiff-Heedles, the CEO of Menlo Park, that he would draft an order prohibiting Suddoth-Lewis from wearing masks or them to distribute to their employees.
"We were advised to exercise discipline when we must," Doherty wrote, but did not elaborate on who had advised him.
An email among officials from the Department of the Military and Veterans Affairs aimed at preventing nurses from using veterans home masks without permission.
NorthJersey.com asked for a copy of the order and was informed by an archive administrator that it did not exist.
The next day, Doherty wrote to Schiff-Heedles again, saying he had received "guidance from the government employee relations office" on employees wearing masks.
"We are going to initiate a progressive discipline for the insubordination of masks," he wrote.
The first offense would trigger an oral deliberation. The second offense would result in a written warning. The third would result in an official reprimand and the fourth would result in a suspension, Doherty wrote.
Zhadanovsky, a Murphy spokesman, said this month that the reference to "mask insubordination" was "solely in relation to unauthorized use" of house masks.
"Like most organizations dealing with the early stages of this pandemic," the agency's inventory of personal protective equipment "was strained in March and careful steps were taken to ensure proper use," he said.
"The agency's inventory of N95 masks was particularly scarce and distribution was controlled to ensure an even reserve of masks," said Schadanowski. "The reference to" mask insubordination "was part of an advisory discussion that exclusively related to the unauthorized takeover of state property."
However, staff said they wanted to at least use the supply of surgical masks to households. And they said even if they brought their own masks, they were told not to wear them.
Zhadanovsky said no employee was disciplined for wearing a mask and no formal policy was ever issued.
The first case
Managers appeared to be waiting for a confirmed case of COVID-19 before allowing widespread use of masks, despite residents showing symptoms.
On March 28, Sean Van Lew, director of the Veteran's Health Services Department, emailed top managers to spread "inaccurate information" reiterating that there were no confirmed COVID-19 cases - even among residents who were taken to the hospital.
That changed hours later.
Van Lew sent a follow-up email that afternoon stating that management had just been briefed on the homes' first COVID-19 case - a Paramus resident who had been rushed to hospital five days earlier after her fever persisted.
Email among managers at the Department of Military and Veterans Affairs on the first confirmed COVID-19 case. It mentions "10+ residents" with "cold symptoms" in a unit that would become the epicenter of the outbreak.
Van Lew ordered a series of new protective measures that would require all staff directly caring for the symptomatic residents to wear N95 masks. He estimated that he would need 10,000 N95 masks per house to last for the next two months.
In the same email, he threateningly mentioned that the Valor unit in which the COVID-positive resident had lived "was temporarily closed due to cold symptoms with more than 10 residents".
A doctor's letter
Even after the first case was announced at Paramus, the managers continued to discuss the mask guidelines for other employees.
At the end of March, a kitchen worker with a mask on came into Menlo Park - and was asked to take it off.
The worker later gave a message to his supervisors from his doctor that he should wear a mask to work because of his chronic asthma. He either called sick or was sent home.
"We don't allow employees to wear a mask, so he's unemployed," Dawn Graeme, a human resources manager, wrote in an email to Schiff-Heedles and other top managers on March 27.
Email dated March 27th among top executives at the Department of Military and Veterans Affairs about action against a masked kitchen worker.
Three days later, on March 30, the agency's human resources manager wrote to top managers that the kitchen worker could return to work and wear a mask. John Langston, the director, thought it was "a decent place to stay".
"He wants to come to work and you need everyone you can get," Langston said, alluding to the staff shortage the house had due to the pandemic.
Schiff-Heedles wrote to Van Lew the same day and declined the recommendation.
"When I do that, everyone comes to work with a doctor's letter," she wrote. “Or we allow all kitchen workers to wear masks. The argument is that they are on top of each other and cannot stay three feet apart. I am not sure if this is good advice. "
The discussion soon became contentious.
On the same day, State Health Commissioner Judith Persichilli ordered "universal masking" for all nursing home workers in New Jersey.
"NOW fast action is required"
At the time, it was confirmed that 52 nursing home residents across the country have died from COVID-19. The numbers would skyrocket - to more than 7,000 - in April and the following months - accounting for nearly half of the total confirmed COVID deaths in New Jersey.
"NOW, rapid action is needed to stop the introduction and spread of this virus in acute care facilities," said Persichilli's order.
Her instruction seemed to have caught managers in the veterans' homes off guard.
Susan Sweeney, director of employee relations, wrote to Van Lew: "If I read correctly, the new guidelines require that we mask everyone in the facilities at all times."
Van Lew replied, "If we have to universally mask every employee in the facility with a surgical mask, our care in each home will take about a week."
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Paul da Costa, an attorney who represents dozens of families planning to sue the homes, said he had already dropped an assistant nursing director at Menlo Park, who said the facility had ample PPE inventory but the staff were still forbidden to use them.
At the time, the Murphy administration was prioritizing masks, gowns, and other PPE for hospitals over nursing homes, fearing the state's 71 hospitals would be overcrowded with patients, according to a report commissioned by Murphy. A letter from anonymous health department officials to state lawmakers said the policy had resulted in preventable deaths in nursing homes.
By then, many veterans were at home and management had become suspicious. Workers called sick because they were either infected - or feared they might be infected.
On April 7, Van Lew wrote that more than 50 nurses in Paramus and Menlo Park had called sick because of basic conditions that prevented them from working.
These nurses "are home now getting paid while their colleagues are at home providing the best possible care for our boys and girls," he said. "My question is, what makes this different from influenza, GI, and other errors that run around the house at some point in the year?"
Van Lew said he wanted to do a "fit for duty physical exam" for any nurse who submitted a note.
"If they are so compromised that they can't be around infection or disease, why in God's name are they in healthcare?" he asked.
Email among managers at the Department of Military and Veterans Affairs about the number of nurses calling in sick after management refused to have them wear masks.
The houses sank into chaos. The quality of care for the residents suffered as a result. Communication with families who had not had access to the houses since March 14th collapsed. The National Guard and Federal Veterans Administration Nurses have been called in to fill the void.
Federal inspectors visited the Paramus House at the end of April and found that the staff was so poorly equipped and trained - and that the infection control procedures were so lax - that it was found that all residents and employees of COVID-19 were "at risk" were. The nurses' aides wore the same protective gown all day without changing as they moved between patients who were COVID-positive, COVID-negative, or pending tests.
Workers said conditions in Menlo Park were similar.
Resident Glenn Osborne told a legislative committee in August that executives had removed PPE from patient care areas in March and April. When he asked employees to wear protective equipment, they told him they weren't allowed to.
Monemise Romelus, a 61-year-old male nurse at the New Jersey Veterans Home in Menlo Park, has died of complications from the coronavirus.
Those who fell ill in April included 61-year-old assistant to Menlo Park's nurse Monemise Romelus, who was hospitalized on a ventilator for 24 days before she died in May. Her family is certain that the lack of masks and other personal protective equipment resulted in her death. You filed a lawsuit.
"My mother was told she couldn't wear a mask despite having shared her immense safety concerns," said Smirnov Exilus, Romelus' son, who is due to graduate from Johns Hopkins University Medical School next year and pursue a career as a doctor.
"Every day when she went to work she cried because she was scared of contracting COVID," said Exilus. "Unfortunately, she paid the ultimate price for the reckless behavior of the veterans home administrators."
Follow Scott Fallon on Twitter: @newsfallon
This article originally appeared on NorthJersey.com: New Jersey vets home managers banned staff from wearing masks in March
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