The California agency that oversees workplace safety has issued a $57,120 fine to Hollywood Presbyterian Medical Center after a nurse died from COVID-19, one of the largest employer penalties handed out during the pandemic.
California’s Division of Occupational Safety and Health began investigating the Los Angeles hospital after the death of charge nurse Celia Marcos in April. The Times previously reported that Marcos raced into the room of a COVID-19 patient without proper protective gear. She died 14 days later.
The Cal/OSHA citations, dated Sept. 25, do not reference Marcos by name. But the investigators found unsafe exposures among staff on April 3, the date that Marcos was exposed, according to Times reporting. The OSHA report also refers to a staff member who died April 17, the date of Marcos' death.
The fine "affirms what we've known for a long time," said Adriane Carrier, director of education for SEIU121RN, the hospital's nurses union. "This hospital, like so many, did not do due diligence to protect its workers."
Cited for multiple violations including unsafely reusing masks and gowns, Hollywood Presbyterian is one of several healthcare facilities in California recently fined by Cal/OSHA for not keeping workers safe from COVID-19. Others include Sutter Health's California Pacific Medical Center in San Francisco and Santa Clara Valley Medical Center, though none has been fined in amounts this great.
Hollywood Presbyterian officials say they will appeal the citation. Officials maintain that any deficiencies identified by Cal/OSHA were not the cause of Marcos' death and that it is still unknown how she contracted COVID-19.
"While we are disappointed in the Cal/OSHA findings, we will continue to work very hard at prioritizing workplace and patient safety," they said in an email to The Times.
Marcos, 61, had worked at Hollywood Presbyterian for 16 years. In April, she covered the night shift overseeing a ward that took coronavirus patients when designated COVID units were full.
Because her floor wasn’t primarily for COVID patients, N95 masks weren’t regularly given to staff and instead preserved for those exclusively treating COVID patients, staff say.
So when a suspected COVID-19 patient admitted to Marcos' floor began to struggle to breathe on April 3, she raced in with just a surgical mask — and stayed in the room for at least 30 minutes while he was intubated, staff say.
Cal/OSHA's report found that during an intubation procedure on a suspected COVID-19 patient on April 3, one employee wore a surgical mask while the other wore an N95. But because of the high-risk nature of the procedure, both should have been wearing powered air-purifying respirators, battery-operated masks that filter out dangerous particles, investigators wrote. Additionally, at least one staffer also was not given eye protection during the procedure, another violation.
At the very least, all staff assigned to treat COVID-19 patients should have been provided N95s to enter rooms even when high-risk procedures were not being conducted, but they were not, the investigation found. The failure to provide the correct masks resulted in a $16,875 fine.
Hospital staff interviewed by The Times as well as text messages sent by Marcos and reviewed by The Times identified the patient she treated as a man who had COVID-19 and was exhibiting symptoms. Hospital administrators, however, say that the patient Marcos responded to did not have COVID-19, so it remains unclear how she contracted the virus.
The hospital "could not determine that her COVID-19 illness was contracted at work, especially given the ample controls the hospital has in place, including but not limited to universal masking, stringent screening of patients and staff, disinfection, ventilation," they wrote in a statement. "Meanwhile, COVID-19 was and still is widespread in the community."
The Cal/OSHA investigators also cited the hospital for not reporting Marcos' death to OSHA or the local health department and not notifying staff she worked with of their potential exposure.
The investigation also identified a litany of other COVID-19 safety problems, including: improper reuse of N95 masks; not fit-testing the masks for staff to make sure they worked properly; not having enough disinfectant supplies for staff to clean high-touch surfaces; not having a complete plan for how to protect staff from aerosolized transmission of viruses and asking staff to hang their gowns on hooks outside patient rooms to be reused, which increased the possibility of contaminating the gowns with germs.
Jamie Court, head of nonprofit Consumer Watchdog, said that given the long list of violations and their severity, the fines don't go far enough.
"It's shocking," he said. "If you don’t provide masks to your employees, you fail to report their deaths to state authorities and don’t tell other healthcare workers they’re at risk, those are potentially criminal activities, in my view, when you’re dealing with a virus as lethal as coronavirus."
This story originally appeared in Los Angeles Times.