The Duke University Health System has played an instrumental role in the management of the COVID-19 pandemic, from delivering vaccines to treating over 1,000 patients, but not without some raising concerns about worker safety.
Between March and May, at least four COVID-19-related complaints were filed with the Occupational Safety and Health Administration (OSHA) against DUHS facilities, all of which were closed without additional inspections. Additionally, the Occupational Safety and Health division of the N.C. Department of Labor (N.C. OSH) opened an inspection into Duke Regional Hospital in December after an employee died of COVID-19, in accordance with guidelines that require it to open inspections after employee deaths.
Sarah Avery, director of the Duke Health News Office, wrote in a statement in September that Duke had not received OSHA violations or actions related to COVID-19.
“At Duke Regional Hospital, the safety of our team members and patients is our top priority,” wrote Katie Galbraith, president of Duke Regional Hospital and interim head for Community Health, in a statement to The Chronicle. She stated that the hospital experienced a 40 percent decrease in OSHA Total Recordable Injuries from 2010 to 2019, which are incidents that must be reported to the government.
Overall, the hospital has an “A” safety grade from the nonprofit Leapfrog Group as of fall 2020.
“The global pandemic in 2020 was challenging, yet Duke Regional and Duke University Health System have been unwavering in our commitment to safety through ensuring our team has necessary Personal Protective Equipment (PPE) and access to testing and contact tracing,” Galbraith wrote.
Workers can file OSHA complaints if they feel that a serious hazard exists in the workplace or that their employer is not following national safety regulations. Closed complaints, such as the ones filed against Duke facilities, are published on the OSHA website, while pending complaints are posted online with redactions. According to OSHA’s data processing guidelines, complaints are closed if they are deemed invalid, necessary inspections have started, no further action is planned, the complaint is transferred elsewhere or the employer notifies OSHA that they are aware of the issue and correcting it.
Of the four OSHA complaints filed and closed from the beginning of the pandemic until Feb. 7 against DUHS or its facilities, three pertained to personal protective equipment.
On March 12, a complaint was filed against Duke Regional Hospital alleging the hospital did not permit staff to wear PPE like masks and gloves, though the hospital had COVID-19-positive patients. This caused staff to “fear their health may be compromised.”
An OSHA complaint against Duke University Hospital was filed May 2 alleging that staff treating COVID-19 patients were “instructed to reuse personal protective equipment such as N95 respirators.”
Another OSHA complaint filed against Duke Clinic May 6 said environmental services staff were at risk of exposure to COVID-19 due to their work entailing “tasks where the face could be splashed, such as cleaning toilets” but not being given eye protection or moisture resistant masks.
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The fourth complaint, filed May 13 at Duke Health Center South Durham, alleged that the center was not enforcing six feet distances between employees and patients. Employees were crammed at the front desk, which did not have shields or barriers, and there were “lines and lines” of patients, according to the complaint.
Avery, the Duke Health News Office director, provided a statement regarding the complaints in September 2020.
“Safety is our highest priority, and DUHS has taken exemplary measures to assure a safe environment for patients, visitors and staff during the COVID pandemic. DUHS has received no COVID-related violations or actions from OSHA,” Avery wrote in a September email, although she did not offer comment regarding specific allegations.
Each year, Duke is required to publicize from Feb. 1 to Apr. 30 OSHA 300A summaries for each of its facilities. These documents, which summarize all reported workplace illnesses and injuries that occurred in the previous calendar year, showed that Duke Regional Hospital was the only Duke facility to report a work-related death in 2020.
Reba Beavers, a part-time operations coordinator and former nurse at Duke Regional, died of COVID-19 Nov. 29.
N.C. OSH opened a partial inspection into Duke Regional Hospital Dec. 8. “Partial” means that the scope of the inspection is limited to a certain area of the facility.
Inspections are triggered by fatalities, hospitalizations, or when a worker loses an eye or other body part, according to N.C. OSH. OSH may learn about an incident from media reports or other government offices. Investigations focus on the cause of the incident, whether a violation of OSHA standards occurred, how much the incident was affected by any violations and whether OSHA standards need to be updated.
In response to a records request from The Chronicle, the N.C. Department of Labor wrote that the inspection is still ongoing and information would be released from the case file after any informal conferences or possible contestments regarding the findings are settled.
Inspections can take anywhere from a few weeks to six months, according to N.C. OSH.
Galbraith’s statement did not address the death investigation.
Illness among employees
The OSHA 300A summaries showed that all three Duke hospitals reported work-related respiratory illness in 2020. Duke University Hospital reported 293, Duke Regional Hospital reported 73 and Duke Raleigh Hospital reported 49.
None reported respiratory illness in 2019, and in earlier years each reported one or two cases at most, according to OSHA injury tracking data beginning in 2016.
Galbraith confirmed these numbers in her statement to The Chronicle.
“Despite [our] vigilance, in 2020 there were 73 work-related cases of COVID at Duke Regional Hospital, 293 at Duke University Hospital and 49 at Duke Raleigh Hospital,” she wrote. “If we adjust for the COVID data, Total Recordable Injuries were in line with the last several years.”
Documents posted on Duke Health’s public COVID-19 website reveal that healthcare workers were notified of the first reported illness among staff at Duke Raleigh Hospital March 20. By April 7, 67 out of 1,700 tests among staff had come back positive, or about 3.9%. This percentage decreased to 3.67% by April 21 and 3.5% by May 4, before increasing to 4% by May 29.
“It is important that we do not become complacent with following best practices to prevent infection,” a June 15 memo reads. At that time, 4.46% of all tests were positive. By July 8, 5.9% of all team members who had been tested received a positive result. It is not clear whether these statistics are cumulative or how they varied across facilities.
An Aug. 5 update stated that there had been a “significant decline” in the number of staff members testing positive, though the exact percentage was not stated. A Feb. 8 update said that there had been more than a 75% decrease in employee infections since the vaccination process began.
The positivity rate among staff was also lower than the positivity rate for members of the general population tested by the hospital each time it was reported in a memo.
Leah Boyd and Stefanie Pousoulides contributed reporting.