Ming Lin, MD, said he knew he was taking a chance when he sent a letter on March 15 to his hospital's chief medical officer about their safety measures for COVID-19.
In fact, he posted the letter on Facebook, beginning with the statement, “I just sent this letter to our CMO. Hopefully I still have a job afterwards.” (See photo, p. 41.)
Those proved to be prescient words for Dr. Lin, an emergency physician at PeaceHealth St. Joseph Medical Center in Bellingham, WA, for 18 years. After a stint consulting at a tribal clinic in Rosebud, SD, he returned to Bellingham to discover that he was scheduled for no shifts. He said his employer, TeamHealth, told him that he would not be working at the hospital in the future. The contract management firm said in a statement on its website, however, that “Dr. Lin has not been terminated,” and that it would try to help him “find a path forward.” (March 30, 2020; https://bit.ly/2wRfvVH.)
The action ignited a firestorm, with Dr. Lin appearing on CNN and being cited in the New York Times and Time magazine. The two major professional groups for emergency physicians issued statements supporting the rights of medical professionals to advocate for the safety of their patients and themselves.
The American Academy of Emergency Medicine noted that Dr. Lin was terminated “without the right of due process for public statements about inadequate PPE in his practice setting.” AAEM's statement said it “condemns TeamHealth and PeaceHealth St. Joseph Medical Center for terminating Dr. Ming Lin.” (March 28, 2020; https://bit.ly/3aFn6Fr.)
The American College of Emergency Physicians did not mention Dr. Lin, but said in a statement that it was “shocked and outraged by the growing reports of employers retaliating against frontline health workers who are trying to ensure they and their colleagues are protected while caring for patients in this pandemic.” (March 30, 2020; https://bit.ly/349KNTz.)
‘Struck a Nerve’
Dr. Lin said the issue is less about his firing and more about the importance of allowing medical professionals to speak up when they feel their safety is compromised. Hospitals frequently forbid their physicians and nurses from speaking up about problems in delivering care, he said. “Somehow, I struck a nerve,” he said. “They fired me when this is the last thing any hospital should do is fire an emergency doctor.
“But this is something health care workers go through all the time,” he said. “If you share any concerns about your work environment or patient safety, you are reprimanded or terminated. I'm actually shocked at some of the stories I've heard about how aggressive hospitals and corporations can be. It's profit over patient safety,” he said.
Dr. Lin's letter to the CMO read in part, “I have no doubt you have as much concern about the health of our staff as I do. 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 then listed changes that would improve safety:
- If the hospital's testing company cannot run the tests, PeaceHealth should send them to the University of Washington or Skagit Valley Hospital in Mt. Vernon, WA, which can get turnaround in less than 48 hours and where their ED is not limited by quantity.
- PeaceHealth should have no restrictions for whom EPs can order testing. Dr. Lin said the ED initially had to obtain approval for COVID-19 testing from infectious disease. “Why do we need to call some expert doc at home to get his blessing and who is sometimes not available at night?” Dr. Lin wrote, noting that “even Expresscare” could order with no restrictions.
- Dr. Lin advised PeaceHealth to set up an outside triage area to see patients at risk for COVID-19. If stable and febrile, he said, they should be asked to wait in the car so staff members could collect specimens in protective gear. He also said it was “ludicrous” that the hospital decided to wait for influenza test results before ordering COVID-19 testing. “You are not just exposing the staff member twice but exposing all patients by having the patient wait in the ER for the result,” he wrote.
- Dr. Lin also took issue with PeaceHealth not doing parking lot testing. “For us to be so close to the epicenter and not do it is ridiculous. Even Rosebud, South Dakota, does it outside in the parking lot. They have no cases, and none pending,” he wrote.
- He also said temperatures should be checked and risk questionnaires given to all patients and staff who enter the ED and hospital. “We are as likely to get it from one another as from our patients,” he wrote.
Dr. Lin said his worry that the staff would be infected prompted him to speak up. “We have got to at least show we are trying to protect our staff,” he said.
‘Not a Smart Move’
Lisa Moreno-Walton, MD, the president of AAEM and a professor of clinical emergency medicine at Louisiana State University Health Sciences Center in New Orleans, said she frequently hears stories like Dr. Lin's. “We've had six people who told us they were fired because they brought PPE from home. I'm sure that not every single person who has been fired has contacted [AAEM],” she said. “The reason given is if someone brings high-quality PPE from home, then other staff is going to feel the inadequacy of the PPE they were given.”
Some EPs were told that wearing full PPE would frighten patients, she said, and that some administrators were downplaying the seriousness of the virus and its infectiousness. “Corporate medical groups are firing doctors in the middle of an epidemic,” Dr. Moreno-Walton said. “That is not a smart move.”
Physicians are not the only ones under fire. National Nurses United decried the fact that nurses were being disciplined for trying to protect patients from COVID-19. “We know that N95 respirators, at a minimum, are necessary protection against the spread of COVID-19,” the union said in an ad emailed to subscribers of the magazine Mother Jones. “But instead of trusting the science and keeping nurses safe however possible, the AHA [American Hospital Association] is hiding behind weakened CDC guidelines and is even lobbying Congress to lessen the requirements for safety standards further,” calling on the AHA to require its member hospitals to “stop threatening nurses fighting for the PPE we so desperately need.”
Robert McNamara, MD, a founding president of AAEM, said he has been talking to EPs who have found themselves out of a job for advocating for better PPE or using their own. “The position statement we put out was not done in a vacuum,” he said. “It was in direct response to what we were hearing was happening.”
PeaceHealth Northwest sent a statement to EMN on behalf of Charles Prosper, its chief executive, that said, “[M]isinformation and rumors have circulated on social media regarding our plan for addressing the safety of our medical staff, caregivers, and patients. Unfortunately this false information is counterproductive, has caused unnecessary fear and hindered the ability of our caregivers and patients to feel safe at a time when safety is paramount. We are putting forth extraordinary efforts to keep our caregivers and the community safe.”
He added that it was their policy “not to comment on any personnel issue, and that includes the issue related to Dr. Lin.”
Worth Everett, MD, the medical director of PeaceHealth St. Joseph's ED and a TeamHealth employee, said he wanted to reassure the community that the ED has the PPE and supplies to care for everyone who presents to the ED. “There are stories of no masks, no gowns, no beds, and no equipment that unfortunately exist in other parts of the nation,” his statement read. “For right now, that is not the case in our emergency department and our hospital.” (April 2, 2020; https://bit.ly/3aImWNg.)
PeaceHealth spokeswoman Hilary Andrade said the health system's leaders would not comment on the concerns Dr. Lin raised in his letter to the CMO.
Greg Blair, a senior director for Narrative Strategies, a strategic communications firm that handles TeamHealth's public relations, said Dr. Lin had been contacted by the group to discuss a position, but Dr. Lin said TeamHealth proposed positions that were not acceptable to him.
Ms. SoRellehas been a medical and science writer for more than 40 years, previously at the University of Texas MD Anderson Cancer Center, the Houston Chronicle, and Baylor College of Medicine. She has received more than 60 awards, including the Texas Human Rights Foundation Award. She has been a contributor to EMN for more than 20 years.