A day fighting COVID-19: U.S. hospital staff share hardest moments on shift

BALTIMORE, Md. (Reuters) – The shifts are long and the scenes are heartbreaking inside a Maryland hospital where nurses and doctors have been treating coronavirus patients for weeks, unable to let family inside to visit loved ones on their death beds.

One of the hardest moments of a recent work day for registered nurse Julia Trainor was intubating a patient, and then calling the patient’s husband so he could talk to his wife. He was not allowed in the hospital.

“I had to put him on the phone and hold the phone to her ear as he told her that he loved her so much, and then I had to wipe away her tears,” says Trainor, who works in a surgical intensive care unit. “I’m used to seeing very sick patients and I’m used to patients dying, but nothing quite like this.”

The highly infectious COVID-19 disease caused by the novel coronavirus has infected more than 580,000 people across the United States and killed nearly 24,000.

In Maryland, where residents have been ordered to stay at home since March 30 to stem the spread of the disease, around 9,000 have tested positive for the virus and more than 260 have died.

After finishing what for many was a more than 12-hour shift, some nurses and doctors at one hospital shared with Reuters the hardest moments of their days. The hospital asked that it not be named.

The medical workers agreed that one of the toughest parts of the job – more than the exhausting schedule or adjusting to work in a new unit – was witnessing the toll on patients and families.

Because of the hospital’s no-visitor policy, which was implemented to prevent further spread of the virus, the medical staff must care for the patients’ physical needs and offer as much emotional support as they can muster in the absence of the patients’ families.

“The hardest moment during the shift was just seeing COVID patients die helpless and without their family members beside them,” says Ernest Capadngan, a nurse in the hospital’s biocontainment unit.

Communicating with the families has weighed heavily on the hospital staff. Staff cannot bend the no-visit rules, even when a family calls in desperation.

“I had a patient fall out of bed today and I had to call his wife and tell her and she couldn’t come see him, even though she pleaded and begged to come see him,” says Tracey Wilson, a nurse practitioner.

“One of the hardest moments was having to see a family member of a COVID patient say goodbye over an iPad,” says Tiffany Fare, a nurse in the biocontainment unit. “You can’t see your loved one and then they’re gone.”

There are very few opportunities to rest during a shift, although colleagues look out for one another and try to cover for each other when someone needs a break.

Cheryll Mack, a registered nurse in the emergency room, says she tries to get outside for 15 minutes during the day to breathe.

“It has given me relief, just fresh air,” Mack says.

Each shift concludes with a similar decontamination drill. Nurses and doctors must remove their personal protective equipment and shower immediately before coming in contact with their family at home.

“I take a very long, very hot shower. And then I usually sit on the couch and… read a book or watch some mindless reality show in order to destress,” says Martine Bell, a nurse practitioner.

Laura Bontempo, an emergency medicine physician, says she removes her work clothing and gear in a decontamination tent she has set up outside her home, and then wraps herself in a towel and runs inside to shower.

Then she puts the scrubs in the washing machine by themselves to not contaminate any other items.

Meghan Sheehan, 27, a nurse practitioner, says she drives home each night without turning on the radio and uses the quiet time to reflect on her shift and her patients. When she gets home, she tries hard not to dwell on the day.

“I go home, I shower immediately and try to have dinner with family, and try to not talk about it,” she said. “Nighttime is definitely the hardest because you’re constantly thinking about what the next day will brin

(Writing by Gabriella Borter in New York, Editing by Rosalba O’Brien)

‘Here Comes the Sun’ gets U.S. hospitals through dark days of pandemic

By Barbara Goldberg

NEW YORK (Reuters) – The most powerful medicine being used to bolster the morale of New York area healthcare workers at the epicenter of the U.S. novel coronavirus crisis may well be music.

Daily infusions of upbeat songs from The Beatles’ classic “Here Comes the Sun” to the theme from the hang-tough movie “Rocky” are being pumped through hospital public address systems to boost the spirits of nurses, doctors and support staff.

About 545,000 people were diagnosed with COVID-19 in the United States as of Sunday, and roughly 21,600 have died of the highly contagious illness.

A 4:30 p.m. daily dose of Australian pop singer Starley’s “Call On Me” has given strength to staff at one of Mount Sinai’s hospitals in New York City, who clap as a growing number of patients are discharged from the overwhelmed facility across the street from Columbia University.

“Some people would say to accept their fate. Well if this is fate then we’ll find a way to cheat,” Starley sings. “You know you can call on me, if you can’t stop the tears from falling down.”

In New Jersey, the “Rocky” theme song filled the air at St. Joseph Regional Medical Center in Paterson when Dr. James Pruden, the hospital’s director of emergency preparedness, was discharged last week as he recovered from the virus, rolling in his wheelchair past cheering staff.

On New York’s Long Island, the joyful “Here Comes the Sun” blasts overhead on the public address system at Mount Sinai South Nassau in Oceanside every time a COVID-19 patient is discharged.

In Detroit, one of the newest U.S. hot spots for the fast-spreading disease, a Beaumont Health nurse said the 1969 Beatles hit was played not just when patients are discharged but each time they are taken off a ventilator to breath on their own.

“The smiles returning to the faces. Little darling, it seems like years since it’s been here,” rings out the song that George Harrison wrote about renewal after a long, dark winter.

(Additional reporting by Herbert Lash and Jonathan Allen in New York; Editing by Tom Brown)

‘We’re trying to keep our heads above water’: U.S. healthcare workers fight shortages – and fear

By Kristina Cooke, Gabriella Borter and Joseph Ax

LOS ANGELES/NEW YORK (Reuters) – U.S. nurses and doctors on the front lines of the battle against the new coronavirus that has infected tens of thousands of Americans and killed hundreds are shellshocked by the damage that the virus wreaks – on patients, their families and themselves.

Nurses and doctors describe their frustration at equipment shortages, fears of infecting their families, and their moments of tearful despair.

These are some of their stories:

NEW YORK CONFIRMED CASES: 53,324. DEATHS: 773

Dr. Arabia Mollette, an emergency medicine physician, has started praying during the cab ride to work in the morning. She needs those few minutes of peace – and some lighthearted banter with the cafeteria staff at Brookdale University Hospital Medical Center in Brooklyn at 6:45 a.m. – to ground her before she enters what she describes as a “medical warzone.” At the end of her shift, which often runs much longer than the scheduled 12 hours, she sometimes cannot hold back tears.

“We’re trying to keep our heads above water without drowning. We are scared. We’re trying to fight for everyone else’s life, but we also fight for our lives as well,” Mollette said.

The hospitals where she works, Brookdale and St. Barnabas Hospital in the Bronx, are short of oxygen tanks, ventilators and physical space. Seeing the patients suffer and knowing she might not have the resources to help them feels personal for Mollette, who grew up in the South Bronx and has family there and in Brooklyn.

“Every patient that comes in, they remind me of my own family,” she said.

At least one emergency nurse at a Northwell Health hospital in the New York City area is wondering how much longer she can take the strain.

After days of seeing patients deteriorate and healthcare workers and family members sob, she and her husband, who have a young son, are discussing whether she should leave the job she has done for more than a decade.

The emergency room, always a hotbed of frenetic activity, is now dominated by coronavirus cases. There are beds all over the waiting room. The nurse, who spoke on condition of anonymity, said she sees family members dropping off sick relatives and saying goodbye.

“You can’t really tell them they might be saying goodbye for the last time,” she said.

On Thursday, some nurses and doctors were brought to tears after days of physical and emotional fatigue.

“People were just breaking down,” she said. “Everyone is pretty much terrified of being infected … I feel like a lot of staff are feeling defeated.”

At first, she was not too worried about her safety since the coronavirus appeared to be deadliest among the elderly and those with underlying health conditions.

That confidence dissolved after seeing more and more younger patients in serious condition.

“At the beginning, my mentality was, ‘Even if I catch it, I’ll get a cold or a fever for a couple of days,'” she said. “Now the possibility of dying or being intubated makes it harder to go to work.”

There is no official data on the number of healthcare workers who have contracted the virus, but one New York doctor told Reuters that he knew of at least 20.

WASHINGTON STATE CONFIRMED CASES: 4,310. DEATHS: 189

A Seattle nurse has started screening patients for coronavirus at the door of her hospital, a different job from her usual work on various specialty procedures.

She doesn’t talk about her new job at home, because she doesn’t want to worry her school-aged children, she said. Her husband does not understand her work and tells her to decline tasks that could put her at risk.

“I’m like, ‘Well it’s already unsafe in my opinion,'” she said.

But she is nervous about having to separate from her family if she contracts the virus.

“I’ll live in my car if I have to. I’m not getting my family sick,” she said.

The nurse spoke on condition of anonymity because she is not allowed to speak to the media.

During her last shift, she was told to give symptomatic patients napkins to cover their faces instead of masks – and not to wear a mask herself. She ignored that and wore a surgical mask, but she worries less experienced staff heeded the guidance.

“We get right in their faces to take their temperatures because we do not have six-feet-away infrared thermometers,” she said. “The recommendations seem to change based on how many masks we have.”

Her hospital has put a box outside for the community to donate masks because they are so short of supplies.

She blames the government for not doing more to prepare and coordinate: “People should not have to die because of poor planning.”

MICHIGAN CONFIRMED CASES: 4,650. DEATHS: 111

Nurse Angela, 49, says the emergency room at her hospital near Flint, Michigan, is eerily quiet. “We’ve all been saying this is the calm before storm,” said Angela, who asked that only her first name be used.

The patients who trickle in are “very sick” with the COVID-19 respiratory illness, she said, “and they just decline really quickly.”

As they go from room to room, the nurses discuss how many things they are contaminating due to their limited protective equipment.

“You’d have to walk around with someone with Clorox wipes all night walking behind you,” she said. “The contamination is just so scary for me.”

She accepts that she and most of her colleagues may be infected. But she is worried about her daughter and her sister, who are both nurses, and she worries about infecting her 58-year-old husband.

Angela’s daughter has sent her three children, including an 18-month-old who suffers from asthma, to stay with their father to avoid possibly infecting them.

“I normally see my grandchildren twice a week and I haven’t seen them. It’s hard. I just cannot fathom what my daughter’s going through,” Angela said.

Many of her co-workers have done the same, packing off children to live with relatives because they are terrified, not so much of contracting the disease, but of passing it on.

Some of them are talking about quitting because they feel unprotected.

Angela would not judge them, she said, but she told a friend recently, “You have to remember, what if your kid gets sick or your mom gets sick, who’s going to take care of them when you take them to the hospital if all of us just leave?”

(Reporting by Gabriella Borter, Kristina Cooke and Joey Ax; Editing by Ross Colvin and Daniel Wallis)

Coronavirus rages on, putting strain on U.S. doctors, nurses

By Gabriella Borter and Nick Brown

NEW YORK (Reuters) – U.S. doctors and nurses on the front lines of the coronavirus outbreak came under increasing stress on Friday as the number of cases skyrocketed and hospital staff were forced to ration care for an overwhelming number of patients.

The United States surpassed two grim milestones on Thursday. The death toll soared past 1,000, reaching 1,261 by the end of the day, and the total number of infections topped 85,000, exceeding the national totals of China and Italy to make the United States the world leader in confirmed cases.

Worldwide, confirmed cases rose above 550,000 and deaths 25,000, the Johns Hopkins University & Medicine Coronavirus Resource Center reported on Friday.

“This is past a movie plot. Nobody could ever think of this, or be totally prepared for this. You’re going to have to wing it on the fly,” said Eric Neibart, infectious disease specialist and clinical assistant professor at Mount Sinai Hospital in New York. “The scale is unbelievable.”

After days of wrangling, the U.S. Congress may soon respond with a $2.2 trillion relief package, reinforcing an extraordinary array of economic measures that the U.S. Federal Reserve rolled out on Monday.

Leaders of the U.S. House of Representatives said they expected to pass the measure on Friday, sending the bill to President Donald Trump, who has promised to sign it.

In addition to aiding hospitals in hot spots such as New York and New Orleans, the package will bring welcome relief to businesses and unemployed workers. With much of the country on lockdown, a record 3.3 million Americans filed jobless claims last week, nearly five times the previous record set during the recession of 1982.

The counties surrounding Chicago and Detroit were also emerging as areas of concern, said Deborah Birx, coordinator of the White House Coronavirus Task Force.

One emergency room doctor in Michigan said he was using one paper face mask for an entire shift due to a shortage and that his hospital would soon run out of ventilators, the machines needed by sufferers of COVID-19, the respiratory disease caused by the virus, to help them breathe.

The doctor, Rob Davidson, urged Trump to use his executive authority to procure more test kits and ventilators.

“We have hospital systems here in the Detroit area in Michigan who are getting to the end of their supply of ventilators and have to start telling families that they can’t save their loved ones because they don’t have enough equipment,” Davidson said in a video he posted on Twitter.

New York Governor Andrew Cuomo has said any realistic scenario about the unfolding outbreak would overwhelm the healthcare system. His state, which has become the epicenter of the U.S. outbreak with more than 37,000 cases and 385 deaths, is scrambling to create more sick beds.

It is looking to convert hotel rooms, office space and other venues into healthcare centers, while setting up a convention center as a temporary hospital. Some hospitals are scrambling to convert cafeterias and atriums into hospital rooms to house intensive care patients.

Mount Sinai hospital had 215 inpatients with COVID-19 as of Thursday.

“The fear is next week we’ll have 400,” Neibart said, expecting a shortage of doctors and nurses.

In lighter moments, Neibart said he and his colleagues joke about claiming their own makeshift spots, for when they inevitably fall ill with the virus, although he said they routinely check on one another’s well being.

COVID-19 claimed the life of Kious Kelly, a Mount Sinai nurse manager whose death has led to an outpouring of remembrances from former colleagues.

“I remember him running crazy, checking on us and making sure we were OK,” Diana Torres, a nurse at Mount Sinai, told Reuters. “He would deliver our messages to administration if we weren’t happy. He wanted good things for us.”

Torres and other colleagues have also infused their tributes with angry messages about the shortage of personal protective equipment (PPE).

“It seems like we are fighting the government, (the hospital) administration and the virus,” Torres said. “We can tackle one, but not all at once.”

The New York Police Department also announced the first coronavirus death among its ranks on Thursday. Custodial Assistant Dennis Dickson was a 14-year veteran, NYPD said.

The Department of Veterans Affairs may be asked to help in New York, even as it struggles to provide enough staffing and equipment for armed forces veterans.

Maria Lobifaro, a New York intensive care unit (ICU) nurse treating veterans with COVID-19, said staff normally change masks after every patient interaction. Now, they are getting one N95 mask to use for an entire 12-hour shift.

The ratio of patients to nurses in the ICU is usually two-to-one. As of Monday it was four-to-one, she said.

“Right now we can barely handle the veterans that we have,” Lobifaro said.

(Reporting by Gabriella Borter, Nick Brown and Maria Caspani in New York and Doina Chiacu in Washington; Writing by Daniel Trotta)

UK calls in army and warns people to stay home or face lockdown

By Kate Holton and Sarah Young

LONDON (Reuters) – Britain sent in the army to deliver protective equipment to hospitals on Monday and told people to stay at home and heed warnings over social distancing or the government would bring in more extreme measures to stop the coronavirus spread.

With some doctors saying they felt like “cannon fodder”, the government said the military would help ship millions of items of personal protective equipment (PPE) including masks to healthcare workers who have complained of shortages.

So far, 281 Britons have died from coronavirus and, in the last few days, British authorities have rapidly stepped up action to try to limit the spread of the disease and prevent a repeat of the death toll seen in other countries where thousands have died.

However, there have been complaints from frontline medical staff about shortages of kit, saying they did not feel safe at work. In a letter pleading with Prime Minister Boris Johnson to increase PPE supplies, more than 6,000 frontline doctors said they were being asked to put their lives at risk with out-of-date masks, and low stocks of equipment.

Health Secretary Matt Hancock admitted there had been issues but promised action was being taken. He said the army would drive trucks throughout the day and night to get supplies to medical staff.

“It’s like a war effort, it is a war against this virus and so the army have been incredibly helpful in getting those logistics so we can get the supplies to protect people on the front line,” he told the BBC, saying the health service now had 12,000 ventilators, 7,000 more than at the start of the crisis.

Britain has brought in a series of measures to try to curb the spread of the virus.

On Monday, a much-reduced rail service was introduced and jury trials were suspended, coming days after Johnson advised Britons to work from home if possible and ordered the closure of pubs, gyms and leisure centers.

ADVICE IGNORED

But advice to stay at home and avoid social gatherings went unheeded by millions at the weekend who took advantage of sunny weather to flocked to parks and beauty spots over the weekend, ignoring instructions to stay 2 meters (6 feet) apart.

Emyr Williams, chief executive of the Snowdonia National Park Authority in Wales, said the past 24 hours had been unprecedented.

“We have experienced the busiest visitor day in living memory. The area has been overwhelmed with visitors,” he said.

The government warned that Britain would face a shutdown with curfews and travel restrictions if people continued to flout the advice.

“Well, we’re perfectly prepared to do that if we need to because the objective here is really clear which is to stop the spread of the virus. Of course we will enforce and bring in further strong measures if we need to,” Hancock told Sky News.

The government was also pondering whether to close all non-essential retail shops, the BBC’s political editor reported.

Some firms have already acted because of slowing demand, with clothing retailer Primark and department store John Lewis saying on Monday they would temporarily close all of their shops.

It comes as Britain opened the first part of a 330 billion pound ($384 billion) loan guarantee scheme for businesses , which will help small and medium-sized firms borrow up to 5 million pounds to deal with coronavirus stoppages.

(Additional reporting by Costas Pitas and David Milliken; Writing by Michael Holden; Editing by Guy Faulconbridge and Alison Williams)

Insys founder ran bribe scheme to push opioid: U.S. prosecutor

John Kapoor, the billionaire founder of Insys Therapeutics Inc, arrives at the federal courthouse for the first day of the trial accusing Insys executives of a wide-ranging scheme to bribe doctors to prescribe an addictive opioid medication, in Boston, Massachusetts, U.S., January 28, 2019. REUTERS/Brian Snyder

By Nate Raymond

BOSTON (Reuters) – Insys Therapeutics Inc’s one-time billionaire founder directed a vast scheme to bribe doctors to prescribe an addictive fentanyl spray as opioid addiction was spiraling into a public health crisis, a U.S. prosecutor said on Monday.

John Kapoor, the company’s former chairman, and four colleagues are the first painkiller manufacturer executives to face trial over conduct authorities say contributed to the U.S. opioid epidemic, which officials said killed more than 47,000 people in 2017.

Kapoor, who was also Insys’ chief executive from 2015 to 2017, turned the company into a “criminal enterprise” that paid doctors millions of dollars to push its drug, Assistant U.S. Attorney David Lazarus told jurors in Boston federal court.

“John Kapoor and his co-defendants paid doctors to abandon their medical duties,” Lazarus said.

Kapoor, 75, and former Insys executives and managers Michael Gurry, Richard Simon, Sunrise Lee and Joseph Rowan have pleaded not guilty to racketeering conspiracy.

Defense lawyers will deliver their own opening statements later on Monday.

Kapoor’s 2017 arrest came the same day U.S. President Donald Trump declared the opioid crisis a public health emergency. In 2017, a record 47,600 people died of opioid-related overdoses, according to the U.S. Centers for Disease Control and Prevention.

Two top former executives – Michael Babich, Insys’ CEO from 2011 to 2015, and Alec Burlakoff, its ex-vice president of sales – have become government witnesses after pleading guilty to carrying out the scheme at Kapoor’s direction.

Lazarus told jurors that from 2012 to 2015, Kapoor and his co-defendants conspired to pay doctors bribes in exchange for prescribing Subsys, an under-the-tongue fentanyl spray approved only for use in managing severe pain in cancer patients.

Fentanyl is an opioid 100 times stronger than morphine.

Insys paid doctors as much as $275,000 in one case to participate in speaker programs ostensibly meant to educate medical professionals about Subsys but that were actually poorly attended sham events, Lazarus said.

The scheme led doctors to write medically unnecessary prescriptions for Subsys to patients, many of whom did not have cancer, Lazarus said.

He said Kapoor also participated in a scheme to defraud insurers into paying for the expensive drug.

Insys in August said it would pay at least $150 million to resolve a Justice Department probe related to its marketing of Subsys, and that it has taken steps to ensure it operates legally going forward.

(Reporting by Nate Raymond in Boston; Editing by Alexia Garamfalvi and Bill Berkrot)

Dentists, soldiers mix cocktails to leave crisis-hit Venezuela

Carlos Alzaibar takes documents as he packs his suitcase at his home in Caracas, Venezuela March 14, 2018. REUTERS/Marco Bello

By Andreina Aponte and Liamar Ramos

CARACAS (Reuters) – Like many young Venezuelans in recent years, dentist Carlos Alzaibar felt forced to leave the country when he could scrape together only a few dollars equivalent each month doing two jobs.

So on a recent day, just before flying to Madrid, he was sadly packing a red suitcase – while stacking diplomas from a half a dozen trades he picked up in the last year from bakery and bartending to photography and burger-flipping.

Those, he hoped, would help him find work in Spain and fund the medicines his mother needs for a kidney transplant.

“If not, she’s going to die,” Alzaibar, 28, said, folding socks and shirts in his family’s middle-class Caracas apartment.

Droves of Venezuelans, including professionals like Alzaibar and even retired soldiers and prosecutors, have been taking short courses to prepare for life abroad.

Suffering a severe economic crisis that has left many people short of food and basics, nearly a million Venezuelans have departed since 2015, according to the United Nations.

The U.N. refugee agency, UNHCR, calls it one of the biggest population flows in its nearly 70-year history.

The OPEC nation sits on the world’s largest oil supplies, but has seen annual production slump to a three-decade low, along with a four-year economic recession.

COCKTAILS AND COFFEE

Valentina Maggi, 22, studied graphic design and dreams of illustrating children’s stories, but has followed in friends’ footsteps to learn how to mix cocktails at the National Bartender Academy.

“I have many friends who have left the country and have told me to do this type of course because when you get there, you have more work options,” she said in a room with a long table where she had just completed her final test: a Gin Fizz made from gin, lemon, sugar and soda water.

At the academy, 6,000 students are expected to graduate this year – up from 4,500 a couple of years ago.

With Maggi were a 60-year-old retired military officer and a 52-year-old former Supreme Court prosecutor, both hoping to land work at bars in the United States and Argentina respectively.

Asking not to disclose his name for fear of reprisal, the former soldier said his monthly pension of some $5 at the black market exchange rate, left nothing for food after paying for his two sons’ schools.

Venezuela’s economic meltdown is one of the worst slumps in modern Latin American history.

Gross domestic product is shrinking on a scale akin to that of the United States during the Great Depression and inflation is the highest in the world, nearly 9,000 percent annually, according to National Assembly data.

A monthly minimum wage is worth less than a carton of eggs.

While critics lambaste President Nicolas Maduro for failed socialist economic policies and corruption, he says a U.S.-led “economic war” including financial sanctions are to blame.

“From six or eight months ago, everyone’s getting ready to go,” said Pietro Carbone, surrounded by the aroma of freshly crushed coffee beans at his barista training center where places are fully booked for the next three months.

(Reporting by Andreina Aponte and Liamar Ramos; Additional reporting by Efrain Otero; Writing by Girish Gupta; Editing by Andrew Cawthorne and Peter Cooney; Twitter: @ReutersVzla, @jammastergirish)

Turkey orders detention of top doctors over criticism of Syrian offensive

Demonstrators scuffle with riot police during a protest against detention of the head of the Turkish Medical Association (TTB) and 10 other leaders of theÊdoctors' union, in Ankara, Turkey January 30, 2018.

ANKARA (Reuters) – A Turkish prosecutor ordered the detention of 11 senior members of the Turkish Medical Association (TTB) on Tuesday, including its chairman, after the body criticized Turkey’s military operation in northern Syria.

The prosecutor said police in Ankara had started legal proceedings on Tuesday morning and search-and-detention operations were carried out in several provinces. Media reports said nine of the medics had been detained.

Turkish authorities have cracked down on any expression of dissent over the air and ground offensive against the Syrian Kurdish YPG militia in Syria’s Afrin region. More than 300 people have been detained for social media posts criticizing the campaign since it began 10 days ago.

The association’s lawyer Ziynet Ozcelik said that the doctors faced accusations of “propaganda in support of a terrorist organization, and provoking the public”. Ozcelik said it was the first time in the association’s history that all its executive members had been ordered detained.

The association had denounced the cross-border operation into Syria’s Afrin last week, saying: “No to war, peace immediately”. That prompted President Tayyip Erdogan to accuse the union of treason.

“Believe me, they are not intellectuals at all, they are a gang of slaves. They are the servants of imperialism,” he told AK Party members in the northern province of Amasya on Sunday.

“This ‘No to war’ cry by this mob … is nothing other than the outburst of the betrayal in their souls … This is real filth, this is the honorless stance that should be said ‘no’ to,” he said.

Turkey’s Health Minister Ahmet Demircan was quoted by Hurriyet newspaper as saying the union had no right to make such a statement and added that the health ministry had filed a lawsuit to have the union’s administration removed.

“It (TTB) has made a big mistake. The necessary actions will be taken in accordance with the law,” Demircan was quoted as saying.

CALL FOR IMMEDIATE RELEASE

The crackdown on top medics drew swift criticism from an international medical organization and rights group Amnesty International, who called for protection for the members and an immediate end to the legal proceedings.

The World Medical Association (WMA) said its President Yoshitake Yokokura condemned the detentions as well as threats of violence made against the doctors.

“We call on the Turkish authorities to immediately release the physician leaders and to end the campaign of intimidation,” the WMA, which represents 111 national medical associations across the world, said in a statement.

Amnesty said members of the TTB were “subjected to threats of violence”, and called on people to submit appeals to the Ankara governor’s office to provide additional security measures for the union and its members.

Separately, the Furkan Education and Service Foundation, a group that runs Islamic schools, said several of its members had been arrested. Those detained included the group’s Chairman Alparslan Kuytul, who had made remarks deemed to be criticizing Turkey’s military offensive.

(Reporting by Gulsen Solaker and Ezgi Erkoyun, Ece Toksabay and Tuvan Gumrukcu; Editing by Ece Toksabay and Peter Graff)

Counting the costs: U.S. hospitals feeling the pain of physician burnout

Counting the costs: U.S. hospitals feeling the pain of physician burnout

By Julie Steenhuysen

ANN ARBOR, Mich. (Reuters) – Dr. Brian Halloran, a vascular surgeon at St. Joseph Mercy Ann Arbor, starts planning his garden long before spring arrives in southeast Michigan.

His tiny plot, located in the shadow of the 537-bed teaching hospital, helps Halloran cope with burnout from long hours and the stress of surgery on gravely ill patients.

“You really have to find the balance to put it a little more in perspective,” he said.

Hospitals such as St. Joseph Mercy Ann Arbor have been investing in programs ranging from yoga classes to personal coaches designed to help doctors become more resilient. But national burnout rates keep rising, with up to 54 percent of doctors affected.

Some leading healthcare executives now say the way medicine is practiced in the United States is to blame, fueled in part by growing clerical demands that have doctors spending two hours on the computer for every one hour they spend seeing patients.

What’s more, burnout is not just bad for doctors; it’s bad for patients and bad for business, according to interviews with more than 20 healthcare executives, doctors and burnout experts.

“This really isn’t just about exercise and getting enough sleep and having a life outside the hospital,” said Dr. Tait Shanafelt, a former Mayo Clinic researcher who became Stanford Medicine’s first chief physician wellness officer in September.

“It has at least as much or more to do with the environment in which these folks are practicing,” he said.

Shanafelt and other researchers have shown that burnout erodes job performance, increases medical errors and leads doctors to leave a profession they once loved.

For a graphic, click http://tmsnrt.rs/2zMlmuy

Hospitals can ill afford these added expenses in an era of tight margins, costly nursing shortages and uncertainty over the fate of the Affordable Care Act, which has put capital projects and payment reform efforts on hold.

“Burnout decreases productivity and increases errors. It’s a big deal,” said Cleveland Clinic Chief Executive Dr. Toby Cosgrove, one of 10 U.S. healthcare CEOs who earlier this year declared physician burnout a public health crisis.

WHAT TO DO?

Hospitals are just beginning to recognize the toll of burnout on their operations.

Experts estimate, for example, that it can cost more than a $1 million to recruit and train a replacement for a doctor who leaves because of burnout.

But no broad calculation of burnout costs exists, Shanafelt said. Stanford, Harvard Business School, Mayo and the American Medical Association are working on that. They have put together a comprehensive estimate of the costs of burnout at the organizational and societal level, which has been submitted to a journal for review.

In July, the National Academy of Medicine (NAM) called on researchers to identify interventions that ease burnout. Meanwhile, some hospitals and health insurers are already trying to lighten the load.

Cleveland Clinic last year increased the number of nurse practitioners and other highly trained providers by 25 percent to 1,600 to handle more routine tasks for its 3,600 physicians. It hired eight pharmacists to help with prescription refills.

Atrius Health, Massachusetts’ largest independent physicians group, is diverting unnecessary email traffic away from doctors to other staffers and simplifying medical records, aiming to cut 1.5 million mouse “clicks” per year.

Insurer UnitedHealth Group, which operates physician practices for more than 20,000 doctors through its Optum subsidiary, launched a program to help doctors quickly determine whether drugs are covered by a patient’s insurance plan during the patient visit. It is also running a pilot program for Medicare plans in eight states to shrink the number of procedures that require prior authorization.

Similarly, Aetna Inc this year began a behavioral health program that eliminates prior authorization requirements for admission to some high-performing hospitals.

DOCTOR OVERLOAD

Experts define burnout as a syndrome marked by emotional exhaustion, cynicism and decreased effectiveness. Many burned out doctors cut back their hours to cope, and a disturbing number commit suicide.

A landmark 2015 Mayo Clinic study found that more than 7 percent of nearly 7,000 doctors had considered suicide within the prior 12 months, compared with 4 percent of other workers. About 400 a year go through with it.

Driving the burnout symptoms is the burden of data entry on clumsy electronic medical records systems that doctors must use to prove the quality of their care, said Dr. Christine Sinsky, vice president of professional satisfaction at the American Medical Association.

Sinsky recently conducted an experiment in her own internal medicine practice in Dubuque, Iowa. She asked a staff member how many mouse clicks it takes to order and record a single patient’s flu shot in their electronic medical record. The answer: 32.

She has visited some practices where a doctor had to record flu shots for more than 1,000 patients because only the doctor was allowed to enter the order.

Such mandates reflect an overly strict interpretation of federal health reforms designed to encourage doctors to use electronic medical records, such as the 2009 Health Information Technology for Economic and Clinical Health Act that required doctors to demonstrate “meaningful use” of the systems.

“We have to recognize the exacting toll that the first generation of electronic health records have had on physicians,” Sinsky said. “I would identify it as one of the most important drivers of physician burnout.”

Pre-approval requirements from health insurers for many services and quality metrics built into Obamacare have added to doctors’ administrative duties.

“We’ve got this measurement mania. We’ve got to back off of that,” said Dr. Paul Harkaway, chief accountable care officer for Michigan’s St. Joseph Mercy Health System, a part of Trinity Health, a national not-for-profit Catholic healthcare system.

As a result of these requirements, primary care physicians spend more than half of their 11.4 hour workday performing data entry and other tasks, according to a September AMA/University of Wisconsin study published in the Annals of Family Medicine.

To manage, doctors often finish work at home in the evening, a part of the day known as “pajama time.”

COSTS TO THE HEALTHCARE SYSTEM

Doctors’ suffering can take a direct toll on patients. In a 2010 study, Shanafelt and colleagues found that the more burned out a surgeon was, the more likely he or she was to report a major medical error. Other studies have shown that burnout drives up rates of unnecessary testing, referrals to specialists and hospital admissions.

When doctors quit, it costs an estimated $800,000 to $1.3 million in recruitment, training and productivity costs, depending on the specialty.

Even when physicians don’t leave, they can contribute thousands of dollars in costs each year “just as a matter of inefficient functioning,” said Dr. Colin West of the Mayo Clinic.

The trend has medical malpractice experts concerned. CRICO, the malpractice carrier for Harvard University’s two dozen affiliated hospitals, recently had to settle a handful of cases because doctors were too burned out to fight, even though CRICO believed it could win.

“The clinician just wanted it to go away,” said Dr. Luke Sato, CRICO’s chief medical officer. Sato estimates that an average breast or colorectal cancer malpractice case might cost $750,000 to $1 million to settle.

The crisis has Harkaway worried for his colleagues in Michigan, and for his profession.

“Working with doctors every day, you see it,” he said. “They are just beat down.”

(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and Editing by Edward Tobin)

In Puerto Rico, lives depend on volunteer doctors and diesel generators

In Puerto Rico, lives depend on volunteer doctors and diesel generators

By Robin Respaut and Nick Brown

OROCOVIS, Puerto Rico (Reuters) – At a community center in Orocovis, an isolated agricultural town of 23,000 in the mountains of central Puerto Rico, six oxygen-dependent patients drew breath with the help of the diesel generator powering their equipment.

Then the generator sputtered as if it might die.

A dozen volunteer doctors and medical students from San Juan started assessing which patient should be transported first – in the town’s only ambulance – to a hospital an hour away, and which could survive without oxygen for a short time.

Javier Sevilla Rodriguez, a medical student, had only one way to make the agonizing decisions. He removed one woman’s oxygen tube, watching carefully to see how her blood-oxygen level responded.

“This is how we are doing triage right now,” he said.

Two weeks after hurricane Maria, many of Puerto Rico’s sick, frail and elderly are teetering on the edge, one faulty generator away from missing dialysis treatments or having critical medications go bad.

With nearly the entire island still lacking electricity, hospitals, clinics, and shelters are operating on aging generators not intended for long-term use and powered by scarce diesel fuel. Water is still not available for nearly half the population and supplies of medicines and oxygen are running low.

And residents still can’t call for help across vast swaths of the island because of widespread cellular network outages.

Many regions in the interior of the island, like this one, are only now seeing relief efforts, amid a plodding U.S. disaster response to this island of 3.4 million American citizens. The U.S. territory’s battered economy and infrastructure has magnified the humanitarian crisis wrought by the strongest hurricane to hit here in nine decades.

In Orocovis, even the sickest patients have gone largely without medical care since the storm. So the doctors worked quickly throughout the day, conferring with caregivers and writing prescriptions they would take back to San Juan to fill and then dispatch by messenger.

Now at the community center, their last stop before leaving town, time ran out.

With a loud clunk, the sounds of humming oxygen machines stopped and were replaced by a chorus of beeps and chirps warning that power had been cut.

The generator had failed.

A CALL FOR DOCTORS

The medical convoy that visited Orocovis is an entirely volunteer operation, organized by physician Carlos Mellado. After Maria hit Puerto Rico on September 20, blocking roads and crippling power and communications networks, Mellado asked other doctors at his clinic to cover for him and threw himself into hurricane relief work.

On the first day, he headed to Canovanas, east of the capital, checking on people at shelters. He promised to fill many patients’ prescriptions and send back the medications.

The next day, he went to Vieques, an island off Puerto Rico’s eastern coast, and found diabetics without insulin, heart patients under extreme stress and crucial treatments interrupted by power outages.

When Mellado returned to San Juan, he stopped by the local radio station, which in the days after the storm, had become a trusted source of information for Puerto Ricans living without communications. Invited to speak to listeners, he called for other physicians willing to join him.

Now, Mellado has a core group of 18 physicians, who rotate between the trips and their own practices, and a growing list of more doctors who want to join. Each morning, he takes out a paper map of the island covered with notes about where he’s been. The doctors pick a town and go.

The convoys have no official ties, but Mellado reports each evening on what the doctors found to Puerto Rican and federal officials in San Juan. Sometimes Puerto Rico’s housing department coordinates deliveries of the drugs back to the towns, and a pharmacy chain donates medications for patients without insurance.

The government’s death count from the storm more than doubled this week to 36. But doctors across the island believe the total would be far higher if it included people with chronic conditions who died because they lacked access to medical care.

“For these critically ill patients, if everything fails, they don’t have too much time,” said Humberto Guzman, a pediatric orthopedic surgeon and member of the medical convoy. “People are dying.”

‘WE CANNOT WAIT’

In Orocovis, after the generator failed, the doctors looked for a quick fix. Guzman ran up the street to the town’s shuttered urgent care facility.

There, he found a half-dozen oxygen tanks that locals said had been delivered the day before. Each could provide about a day’s worth of oxygen to a patient.

The tanks were quickly moved to the community center, where the doctors taught family members to use them. But before that became necessary, the generator sprang back to life.

The doctors packed up to leave, assuring patients’ families that they could switch to the tanks if the generator failed again.

“In every town right now, there are moments like this happening,” Guzman said. “That’s why you need people like us to just go. We cannot wait.”

(This version of the story corrects to fix pronoun in paragraph 4 and change “country” to “island” in paragraph 7)

(Reporting by Robin Respaut and Nick Brown; Editing by Sue Horton and Brian Thevenot)