The following is an edited transcript of an interview The Eagle conducted with four Berkshire Health Systems executives about the first two months of providing hospital care during the coronavirus pandemic.
The participants were David Phelps, president and CEO; Darlene Rodowicz, executive vice president; Dr. James Lederer, chief medical officer/chief quality officer; and Brenda Cadorette, RN, chief nursing officer for Berkshire Medical Center.
Q: Are you at the point where you feel you can turn from a focus on COVID-19 patients to thinking about the condition of patients who are due for elective procedures?
Dr. James Lederer: Oh, absolutely. You know, I think you have to understand, we exist for emergencies. That's why we're here. We're here in case it's a little girl who falls off from her bicycle, a bus wrecks or a COVID outbreak.
This is what we do. We were the first ones in the state to admit a patient to the hospital, and then we, in rapid succession, admitted quite a few and then realized, you know, oh, my goodness, you know, COVID is here.
We made great strides in our ability to take care of what we feared would be a big surge. And that was a lot of the work that [Chief Nursing Officer] Brenda Cadorette did with some of the physicians and nursing staff.
That's what we had to do at that time. But, always in the back of our minds, and with many discussions we had with the state, we worry that we're missing people who need care, that we've scared folks so significantly over this virus that we turned the hospital from a place that was safe and nurturing and helpful to one that now you had to be scared of. And that's not us at all.
Q: How do you go about countering that?
David Phelps: When this started, the message was to get people to take this seriously. They described what you should do if you had symptoms in a way that would keep you from coming to the hospital. There was concern about if everybody showed up with symptoms in the emergency room, the implications that might have. The unintended effect is, they were so good at it that we have scared people to the point that they didn't feel safe in any of our facilities, let alone just the hospital itself.
The good news is, people hunkered down, they stayed home. They took it seriously. But, there was a risk with that, too. Hospitals are a safe place to be. It's a different world we live in today. We're really proud of the way we've been able to protect our employees. And we've protected our patients.
And now, if you're an outpatient and you come in, we're prepared to protect you, too. We all wear masks. Everybody is masked. If you go to our waiting room, they're all designed for social distancing. We just need people to understand that. Please come get the care you need.
Q: Dr. Lederer, when you arrived in January, were preparations already being taken?
Lederer: I was impressed when I first met the infection prevention team and the infectious disease physicians. They had already been well down the path in worrying about the supplies we might need, knowing that we were going to need N95 masks and we didn't have what we wanted.
A lot of the early work was with the supply chain leadership. And remember, this is at a time, in December and early January, when the federal government is still saying there's nothing to worry about, [saying] there's nothing happening here. Nothing to see.
And yet, you know, [the BMC team] knew there could be more to this.
And so they got us well down that path as an early start. While we still are short [personal protective equipment] and we still would like to have more supplies, knowing that the fall and winter are coming, I can't imagine what it would have been had they not made those early efforts.
Q: How close to overwhelmed, if at all, was Berkshire Medical Center at the peak of the rise of COVID-19 cases?
Phelps: BMC could have handled a multiple more of the patients we saw comfortably, given the preparation that they had done.
If there's another surge of some kind in the fall, we know just what to do, just where to go. And we would just kind of dust off our plans and update them where necessary, but we'd be ready to go. We learned a lot.
Q: How did the difficulty of conducting tests for the virus play into early hospital care?
Darlene Rodowicz: Initially when our first patients arrived, the only way you could test someone is if they had actually traveled. It took a few days before our physicians got approval. And even when the testing criteria expanded and loosened up a little bit, there was only the state lab that could do the testing and they got overwhelmed.
We had some results that took over nine or 10 days before we got the result. And so we had points in here where we had a group of COVID positives that have been confirmed and an equal number of people that we were waiting to see if they were positive.
In the meantime, you had to assume that they were positive.
Depending upon the testing platform, we can [now] get a result as quickly as 45 minutes. If we send it out to an outside lab, we get it in 24 to 48 hours. So, that's a significant improvement from what we were dealing with in March, which was multiple days.
Lederer: While testing is much better than it was, it's still not where it needs to be. We probably have easier access to the 24-hour, 48-hour turnaround time test, and greater volume capabilities. But, that's not where we want to be.
Phelps: We expect that it's going to get a lot better three or four months from now. But, everybody in the country is competing for these, for the ability to test more. We're competing with everybody every day. We think we have adequate testing capability to meet our current needs. But, to do the kind of broad testing that Dr. Lederer refers to, we're a while from that.
Q: How long do you expect pandemic conditions to remain?
Phelps: It's going to be a different world we are going to live in. COVID is not going away. It's going to be part of our community.
You're going to have to learn to protect your employees so they're comfortable and safe coming to work. You're going to have to protect your customers differently if you want them to show up.
Q: What is the status right now for the hospital in terms of what you can and can't do?
Lederer: While the governor's guidance came out with a list of examples of things that might be considered elective, the end of the day, every physician needs to know their patients and needs to be able to appreciate the severity of COVID and the comorbid conditions they have. And perhaps the duration of time they've postponed.
You don't want to put someone off who has a cancer diagnosis or a potential cancer diagnosis. Who can live with that hanging over their head for weeks on end? It's important to think about the whole patient, their emotional and physical needs, and what can we do as a health care organization to address those needs safely and efficiently for the patient.
Q: How has the medical team's understanding of the disease advanced over the past two months?
Lederer: I think the physicians have risen to the challenge. We have an excellent infectious disease team. We try and keep communication lines open and education flowing. Our surgeons were very aggressive to go out and seek best practices across the country so that when we planned for the reopening, they would have a process and a program that they could count on to be safe for the patients and safe for the staff.
Q: If there is a new round of infection, what will be different for patients? If I test positive for COVID-19 in October, how might my care be different?
Lederer: One of the things that will be very different is that we will know it before it happens.
I say that by virtue of all the testing we're doing, all the baseline data we have on the number of admissions that we get every day and the number of in-house patients.
The littlest lift up will be a cause for concern for us. And maybe it's just a little blip up and it's a little blip back down, but maybe it's the start of a trend.
We're going to be much more aware. We're not going to be shackled by travel requirements and international countries of exposure. It's here in the U.S. and it'll still be here in the U.S. and so we know now that the spectrum of disease can be so very mild to asymptomatic, or it can be very severe.
Things are much better known and characterized and classified. We're able to use our data. We're able to apply the appropriate care algorithms for the low-acuity patient or the high-acuity patient.
We have the resources we need in the ICU. We have excess resources if we have to really deal with a much larger surge. Now we're trying to figure out where the antibody tests will come in to help us and what it can do.
Q: David, I understand you were helping the governor's reopening committee look at things from the hospital perspective in the last week or so. Why?
Phelps: We were trying to exercise whatever influence we could on the ability for us to reopen, because we knew we were ready. We also had an interest in having the state assume a regional perspective on how they determine who else could reopen.
We knew hospitals were going to be on a separate track from general businesses for obvious reasons and we thought we'd come out OK based on what we were seeing from other states — and the conditions they were establishing for reopening. So, we knew if the governor adopted principles that were comparable, and they're all the important things you would expect, that we would be fine.
Q: Do you think the fact that Berkshire County was the site of the first hospitalization set off alarms for people? And that they should now revisit the numbers and see that Berkshire County is one of the least-affected areas now?
Lederer: When we have talked to the Department of Public Health, which we do twice a week, they've come to realize that we were able to achieve some things that few others in the state have achieved.
Because out of the blue came these first cases without a hint. But, our physicians were so dogged and determined. We kept pushing until we could get the test answers, but by then we had some exposed staff and we had to deal with it. We had to work through that to make sure they were safe.
Q: How do you think the BMC staff has come through this, emotionally?
Lederer: Our staff is no different from the community.
I think our stats right now, from a work perspective, we're down to four COVID patients in the hospital. From a high of, as Brenda pointed out, 25 known and 25 suspected.
To be down to four, it almost feels like this is just business as usual. Now we know what to do. So, I think the staff are much more comfortable, knowing what they know about the disease now. They know how it's transmitted and they know what they've done here. We were all in this together. We all work as one and we all look out for one another.
Q: How did Berkshire Medical Center respond to calls from RNs who felt they weren't given adequate access to PPE?
Brenda Cadorette: During that time, I did a significant amount of rounding, and the majority of our nursing staff thanked us for the PPE that they did have.
You know, they network. They know other nurses at other hospitals. They knew that they had more PPE than others. For instance, we gave all our staff goggles. We were one of the only hospitals that gave our staff goggles and N95 surgical masks. And gowns.
Our materials management and our purchasing department did a phenomenal job getting us that PPE. And we're conserving, so we haven't run out.
Phelps: We should all recognize that the safety of all of our staff, including our nursing staff, is paramount. We care a lot about it. Everyone was working in difficult situations and still are. It was never a case, financially, that we didn't want to spend more money on PPE.
We bought any PPE that was available in the market, and we have always had to balance today's needs with projected future needs. And I think most people, including our nurses, understand the limitations under which we're working.
Having said that, it is not wrong for a union that cares about our workers to always be advocating for them. And we understand that.