Some healthcare workers on the front lines of COVID-19 have taken to social and traditional media to vent about frightening working conditions, only to be punished by their employers.
Ming Lin, MD, an emergency physician at PeaceHealth St. Joseph Medical Center in Bellingham, Washington after his for better personal protective equipment turned into a .
"PeaceHealth is so far behind when it comes to protecting patients and the community, but even worse when it comes to protecting the staff," he wrote in the post. A hospital official confirmed that Lin, who'd worked at the hospital for 17 years, was fired for allegedly inciting public fear via his criticism.
While some institutions have allowed their employees to share their concerns publicly, others have cracked down. Some have issued and re-issued policies governing their employees' rights to speak out, and have disciplined providers, like Lin, who do so. The trend has infuriated healthcare workers and medical advocates.
"I find it very hard to justify firing anybody who is trying to tell stories for the right reasons," said Nisha Mehta, MD, a radiologist in Charlotte, North Carolina, who runs two large online physician communities. Most providers are trying to amplify awareness of PPE shortages in their facilities and about the virus itself, Mehta said, "so that our healthcare workforce doesn't all get sick all at once."
Earlier this week, HHS released a report that validated what many providers have been saying publicly and privately: "Hospitals across the country reported that a shortage of PPE was threatening their ability to keep staff safe while they worked to treat patients with COVID-19."
Even the American Hospital Association appeared to call out its membership on the issue: "Ensuring the public knows the challenges our healthcare heroes face and the need for protective equipment is vital," spokesperson Thomas Jordan said in an emailed statement. "That's why the AHA sounded the alarm, repeatedly urging for increased production of PPE to ensure frontline staff are protected as they care for patients."
"Local policies about speaking with the media vary across organizations, however every day we have seen many frontline staff like physicians and nurses give TV and print interviews and take to social media to discuss their urgent need for supplies," he continued. "The AHA will continue to urge that all levers be used to ensure frontline staff have the necessary PPE they need."
Yet providers can be punished due to policies like the one recently highlighted in a memo by NYU Langone Health, according to : "Anyone who talked to the media without authorization would be 'subject to disciplinary action, including termination.'"
Robert Magyar, a Langone spokesperson, told ľֱ via email that the health system has had a longstanding policy that "stipulates the same message that was highlighted in the memo that went to staff. The purpose of this policy also is to protect the confidentiality of our patients, and our staff, particularly as we respond to this unprecedented crisis."
"Because information related to coronavirus is constantly evolving, it is in the best interest of our staff and the institution that only those with the most updated information are permitted to address these issues with the media," Magyar continued. "We have a responsibility to the public at large to ensure that the information they receive from our institution is accurate."
Advocates say such policies are harming providers at one of the most vulnerable times in their careers.
"We are asking a lot of front-line healthcare workers," Glenn Cohen, of Harvard Law School's , said in an emailed statement. "They are putting themselves at risk, working in grueling conditions, and in many cases, if exposed, potentially bringing exposure back home to a family."
"I would advise hospitals not to take personnel action against those who are speaking out except in the most egregious of circumstances," he added. "I am very sensitive to the idea of the need to 'speak with one voice,' which is a [tenet] (and rightly so) of crisis communication."
Individual physicians may not know the full context that informs policies or timelines to take action, he added. "These are reasonable concerns by hospitals, but except in egregious cases it seems to me this is a time to err on the side of keeping the trust and commitment of the medical work force."
Cohen defined egregious in this context as either: stating disinformation, risking re-identifying patients, stigmatizing particular groups of patients -- especially vulnerable ones -- or "clearly and significantly [setting] back the public health efforts of the hospital."
"But unless you are facing a case like this, it seems to me unwise to sever relations with physicians and nurses that are risking so much and otherwise helping significantly," he said.
Mehta echoed that times are "really, really hard for physicians on the frontline right now. It's not like you have time to process things. ... Most are so physically and emotionally exhausted, they are not given a great chance to let everything off their chest."
Many also are self-isolating, Mehta noted, so they sometimes turn to social or traditional media to vent. "We are all groomed throughout our training to keep a lot in, but what we are seeing is too much," she said, adding that training has not prepared anyone on the front lines for what they are seeing now.
"It's very important for physicians and other healthcare workers to be able to tell their stories," she added. "The general public still doesn't have a good idea how serious things are on the front lines. We need to get those stories out. ... It's almost a public health obligation for us to let these stories get out."
Other providers also need to know what they may be walking into, Mehta said, including the hundreds of inexperienced providers that will be flooding in from medical schools and residency programs to emergency rooms over the next few weeks, and clinicians working in markets not yet overwhelmed by the virus.
Many providers recently have received general messages from their employers reminding them of existing social media policies, which often preclude them from posting while representing themselves as members of their centers.
One problem is that many younger doctors like residents were not aware of the guidelines, said Susan Naranjo, a spokesperson with the .
"There's a culture with residency where, it's unspoken, you're just blacklisted [for speaking up]," Naranjo said. "There was a chilling effect and people were afraid to talk to the media. We are past that now."
Many residents now think that if they are going to get in trouble, they may as well get their money's worth, she said: "They're so uncomfortable that they need to speak. They're agitated past that point of fear."
While some guidelines are printed and disseminated, Naranjo said many hospitals are careful not to put anything in writing that could be taken as an affront to the right to free speech -- not because it is a constitutional right, but because they have signed contracts promising not to.
"Even without a union, you are allowed to talk about working conditions, but hospitals don't want anyone talking to the media," Naranjo said.
At least one hospital monitored its residents' online conversations, especially on Twitter, while another warned residents not to speak to the media, she said. Still others asked residents to take down asking for help to purchase PPE, "because of optics," Naranjo said. "We found that infuriating. But you're okay with the optics of your residents [potentially] getting sick!?"
The pandemic threatens the safety of hundreds of providers, potentially worsening a national nurse shortage -- in addition to the PPE and ventilator shortages. Within that context, "why is [social media] the priority?" wondered Alice Johnson, JD, executive director of the . "It's pretty telling in terms of what [the officials'] main concerns are."
Most Illinois hospitals have asked nurses to engage in unsafe activities due to resource shortages, Johnson said. Nurses working at facilities protected by unions such as INA can push back. But, for others: "We can safely say there is a practice of trying to silence workers and silence nurses about concerns about safety that they have," Johnson said. "We are not hearing about it everywhere because nurses don't have the ability to speak out everywhere."
Overall, Johnson said, hospitals are "not prioritizing the safety of their nurses. They're prioritizing their image, their reputation, their ability to compete with other hospitals over the fate of their nurses and essentially addressing the problem."