Later On

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“Those of Us Who Don’t Die Are Going to Quit”: A Crush of Patients, Dwindling Supplies and the Nurse Who Lost Hope

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J. David McSwane reports in ProPublica:

Nurse Kristen Cline was working a 12-hour shift in October at the Royal C. Johnson Veterans Memorial Hospital in Sioux Falls, South Dakota, when a code blue rang through the halls. A patient in an isolation room was dying of a coronavirus that had raged for eight months across the country before it made the state the brightest red dot in a nation of hot spots.

Cline knew she needed to protect herself before entering the room, where a second COVID-19 patient was trembling under the covers, sobbing. She reached for the crinkled and dirty N95 mask she had reused for days.

In her post-death report, Cline described how the patient fell victim to a hospital in chaos. The crash cart and breathing bag that should have been in the room were missing. The patient wasn’t tethered to monitors that could have alerted nurses sooner. He had cried out for help, but the duty nurse was busy with other patients, packed two to a room meant for one.

“He died scared and alone. It didn’t have to be that way. We failed him — not the staff, we did everything we could,” she said. “The system failed him.”

The system also failed her. Since the pandemic’s early weeks, Cline had complained that the Department of Veterans Affairs, which runs the nation’s largest hospital system, wasn’t doing enough to protect its front-line health care workers. She had filed complaints about inadequate personal protective equipment with the agency’s inspector general and the Occupational Safety and Health Administration, but they had done nothing. Many months into a pandemic, they were still having to ration masks and being asked to reuse them for as many as five shifts.

From Cline’s perspective and that of other health care workers I spoke with from the VA hospital in Sioux Falls, the lack of masks was a symptom of larger failures at the agency overseeing the medical care of 9 million veterans. The hospitals lacked staff and scrounged to find gowns, medical supplies, ventilators — everything needed to battle COVID-19.

While every American hospital was stretched by the pandemic, the VA’s lack of an effective system for tracking and delivering supplies made it particularly vulnerable, according to a recent examination by the federal Government Accountability Office. When the pandemic hit, the agency relied on a few big contractors to supply everything from N95 masks to needles to isolation gowns. Those few big contractors fell victim to a global shortage of masks. And the VA had no reliable tracking system to tell officials what hospitals have, what they need or what was expired. At the Sioux Falls facility, things got so desperate, the supply chain for masks relied on a guy named Steve who gave them out one at time from a nearby warehouse, employees said.

As COVID-19 overwhelmed the antiquated system, VA leadership asked employees at more than 170 hospitals to enter inventory by hand into spreadsheets every day and did “not have insight” into how resources were being deployed, the report said. In other words, the local Best Buy or Walgreen’s had more efficient ways of managing inventory to get supplies to the right place.

The resulting scramble, which ProPublica has investigated over the past eight months, was a disorganized, poorly overseen effort to buy masks and other supplies from just about anyone who said they could deliver. Hoping to compensate for a disastrous lack of preparation, the VA awarded more than 100 contracts worth over $120 million to vendors with whom it had never done business.

The COVID-19 pandemic came at a tough moment for the agency, which was more than a year into a massive reorganization by the administration of President Donald Trump that left hundreds of jobs empty and sent the VA scrambling to hire contract positions to help with, among other things, procurement of supplies.

Kevin Lyons, an associate professor and supply chain expert at Rutgers Business School, said nothing the VA did before or during the pandemic showed it had a handle on its own purchase and delivery of supplies, let alone prepare for a global shortage. His research is exploring how the Trump administration’s purge of hundreds of VA staff members created a path to disaster.

VA Secretary Robert Wilkie had boasted about across-the-board staff cutbacks in November 2019, just weeks before the first confirmed U.S. COVID-19 case, noting that he had “relieved people as high as network directors to people at the other end of our employee chain.”

Lyons, an Air Force veteran, told me top VA officials have been able to claim all’s well — even as nurses and doctors describe continued shortages and rationing — because bureaucrats who awarded contracts did little or nothing to track how they worked out. He said the rapid-fire approval of contracts gave “the appearance that we’re doing something. But there was no connection between the nurses and the doctors who actually need it.”

“All they really care about is, you know, signing a contract, and then crossing your fingers and hoping that stuff comes,” Lyons said. “And that’s just not the way that supply chain is supposed to happen.” . .

Continue reading. There’s much more.

Written by LeisureGuy

30 December 2020 at 4:40 pm

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