An emergency room physician at Perry County Memorial Hospital in Perryville chose to keep treating patients on Friday, July 3, after testing positive for COVID-19.
According to hospital administration, the decision to do so came as the result of an unforeseen situation and was based on guidance from the Centers for Disease Control and Prevention, which states that a healthcare worker who has tested positive for COVID-19 but is asymptomatic may keep working in the event of a critical staffing shortage.
That's what happened on July 3, said Chris Wibbenmeyer, the hospital's vice-president of operations.
Usually, staff members who test positive are sent home to quarantine themselves until they recover, but this situation was anything but normal.
According to Wibbenmeyer, who spoke with the Republic-Monitor on Thursday, the trouble began when an off-duty doctor received a positive test result, which then set off a wider round of testing. A second physician — the one who remained on duty — tested positive in that round. Meanwhile, a third physician learned of the two positive tests, notified hospital administration that they would not report for their next two shifts and then resigned.
That left hospital administrators in a bind. The emergency room at PCMH is only staffed by one physician at a time, drawing from a pool of seven to keep one doctor on duty around the clock. Those physicians are employed by Chesterfield-based Emergency Medical Care, LLC, which contracts with the hospital to provide emergency room physicians.
Faced with a situation they hadn't anticipated, administrators contacted Emergency Medical to request a replacement physician, but in the meantime, they still had to have a physician in the emergency room, a spot that requires a certain level of specialization.
"It's really difficult to take a family practice physician, for example, and with short notice and tell them to go be an ER doctor," Wibbenmeyer said. "And we don't have ER physicians on staff and waiting for that call."
With no clear timeframe on when a replacement doctor would arrive, the second physician stepped up, donning full personal protective gear — which includes a Tyvek hazmat suit, gown, an N95 mask under a surgical mask, gloves and goggles — and remained on duty until a replacement physician could be found.
During those 10 hours, the physician treated nine patients, largely from a distance and aided by nurses to avoid as much contact as possible.
"It was the remainder of the shift and it was the soonest that Emergency Medical Care could find a replacement physician," Wibbenmeyer said.
After the replacement physician arrived, the positive doctor was quarantined.
All nine patients were informed of the doctor's positive status before being treated. Hospital staff contacted those patients again after the fact to check on their health and offer free testing.
So far, only two have accepted testing and both tests were “not detected,” but Wibbenmeyer said the offer would remain open for the others.
"We still have that order on standby for them and are prepared to do that at a moment's notice," Wibbenmeyer said.
The hospital issued a statement regarding the matter Thursday morning in response to a Wednesday night report from a St. Louis-area TV station. According to anonymous statements made to KSDK-TV, seven staff members at PCMH have tested positive for COVID-19, and one of the two doctors is expected to work again this weekend, while other is on a ventilator.
Wibbenmeyer confirmed that seven staff members have tested positive for the virus, but those positive results have been spread out over the months since the pandemic began.
"We've had seven [test positive] since this began," said Wibbenmeyer, who said the PMCH healthcare system is staffed by approximately 350 full-time employees.
"It wasn't seven that came out of our ER —we've had seven as an organization since the start of the COVID-19 pandemic. So relatively speaking, that's very few," Wibbnemeyer said.
Wibbenmeyer also said statements made in the television report regarding the doctors were both false.
"They said one doctor was on a vent," Wibbenmeyer said. "That's not true. The latest report we received told us that physician was not on a vent and never has been, and the other doctor is not working this weekend."
Wibbenmeyer said hospital staff who test positive for the novel coronavirus are required to isolate for 14 days and must be clinically cleared — which means receiving a negative result on a standard test via a nasopharyngeal swab — before being allowed to return to work.
Wibbenmeyer said the doctor who worked Friday has already stated they won't return to work until they receive two negative test results after the two weeks of isolation is over.
"That's not our normal protocol," Wibbenmeyer said, "but there are physicians who are more cautious and want that extra reassurance that they are, in fact, negative. This physician prefers that, so that's what we're doing."
Wibbenmeyer said hospital administration waited until Thursday to issue a statement because they were taking care of their patients and staff first.
"We've been preparing our public statement on this for a day or so now," Wibbenmeyer said. "We were taking care of our patients first like we're supposed to do."
All members of the ER staff have been tested for COVID-19 in the wake of last week's incident.
"We don't do regular mass testing and we don't do regular random testing," Wibbenmeyer said. "What we do is exposure-based testing. Anytime we have a known positive patient, we do contact tracings for our employees and our physicians who are in contact with that patient. There is CDC guidance on how you determine the level of risk that they are. That tells us basically if we're going to swab them, meaning they're high risk, or if they're a low risk, we don't swab them."
Moving forward, Wibbenmeyer said the hospital has some work to do in order to have a better backup system in place in case something like this should happen again.
"I've learned that I'm not going to be dependent on one source as far as backing me up in the ER, so we will address that issue," Wibbenmeyer said. "Second to that, we're going to have a backup plan for our own internal physicians — a callback list, if you will — where we have a method of creating coverage in the ER. Those are details that I have to work out, but I'm just considering options of, 'How do I create my own internal backup rather than being dependent on a single source.' "
Wibbenmeyer said the hospital's ER remains open and will continue to provide service to patients in need of medical attention.
"If you have an emergent condition, do not resist coming to the emergency room out of fear during these times of pandemic," Wibbenmeyer said. "Most often, in true emergencies, faster treatment means better outcomes."
