WOODLAND PARK, N.J. – Managers at New Jersey’s veterans homes not only barred employees from wearing protective masks during the first weeks of the outbreak, they devised a series of penalties with the help of Gov. Phil Murphy’s office against nurses who wore the homes’ masks without permission.
More than 190 residents have died from COVID-19 in the state’s veterans homes.
Emails obtained by The Record and NorthJersey.com, part of the USA TODAY Network, show that at least one worker had to return home because management wouldn’t let him wear a mask – even though he had a doctor’s note saying he suffered from asthma.
Managers at New Jersey’s Paramus and Menlo Park homes were so opposed to mask-wearing at the start of the pandemic that they pushed back against letting outside vendors and ambulance crews wear them at the veterans homes as they transported residents, the emails show.
“If they had done just the bare minimum, they could have saved lives,” Tony Agosto, CEO of Virgo Medical Services, told The Record and NorthJersey.com. Agosto had fought to have his ambulance workers wear masks while in the Menlo Park home.
“They could have stopped a lot of this,” he said.
Murphy’s employee relations unit advised management in late March about setting up disciplinary procedures against nurses and aides who tried to use the homes’ supply of masks without permission.
The advice came just days before Murphy’s health commissioner ordered all nursing home staff in facilities statewide to wear masks.
Michael Zhadanovsky, a Murphy spokesman, said in a statement that the homes’ inventory of personal protective equipment, such as masks, “was strained in March and painstaking steps were taken to ensure its proper usage.”
While health officials – most notably Dr. Anthony Fauci, the nation’s top infectious disease expert – discouraged the general public from wearing masks in the early days of the pandemic, they did so to ensure that the supply would not run out for health care workers.
But guidance from health officials on wearing face masks in nursing homes was not always clear or emphasized in March.
A March 3 memo to nursing home administrators from the New Jersey Health Department said two federal agencies recommended that every health care worker wear N95 masks, which provide greater protection than the surgical masks that employees wanted to wear.
By mid-March, the federal Centers for Disease Control and Centers for Medicare and Medicaid Services issued guidance to nursing homes that said face masks should be worn by staff who appear ill before being self-isolated, as well as by people who are coughing. The guidance also said that masks and other personal protective equipment should be provided in areas where resident care is given.
But at New Jersey’s veterans homes, management actively discouraged face masks for almost all of March, forcing some nurses and aides to defy orders and use the homes’ supplies – a desperate effort to protect their health that management called “mask insubordination.”
“I didn’t give a you-know-what,” said Shirley Suddoth-Lewis, a longtime nurse at Menlo Park who retired over the summer. “I was not bringing that virus home to my family.”
Hundreds of emails and other documents obtained by The Record and NorthJersey.com from a series of open public records requests beginning in May show that managers were concerned about limited supplies and didn’t allow widespread mask-wearing until the homes’ first confirmed COVID-19 case.
But because of limited COVID-19 testing and slow turnaround times for results, the first positive case at the Paramus home was not confirmed until March 28 – even though many residents were already exhibiting “cold-like symptoms.”
Management’s stance against masks continued until March 30 – the day New Jersey Health Commissioner Judy Persichilli ordered “universal masking” of all nursing home employees “to stem the stop the introduction and spread of this virus.”
By then it was already too late.
Within eight days, at least 10 residents were dead at the Paramus home and two had died at the Menlo Park home. Dozens more who died were not tested but were suspected of having succumbed to the virus.
The virus ran rampant through the facilities, with 81 residents confirmed dead at Paramus, and 63 more at Menlo Park, along with a nurse’saide at each home. Investigators later determined there were an additional 47 “probable” COVID-19 deaths at the two homes – residents who died of similar symptoms at the height of the surge but who had not been tested.
In all, nearly 600 residents and staff were infected at the two homes.
The death toll – among the highest nationally for nursing homes during the pandemic – sparked a legislative hearing and ongoing investigations by the state attorney general and U.S. Justice Department. It also led to the ouster in October of four top officials at the state Department of Military and Veterans Affairs, which runs the veterans homes, including the CEOs of the Paramus and Menlo Park homes.
Kryn Westhoven, a spokesman for the agency, said he could not comment on the mask policy because of the dozens of claims filed by families of victims intending to sue the department.
John North, a lawyer retained by the state to defend the agency and its managers, also declined to comment on the mask policy.
Since the beginning of the pandemic, workers at the homes have said their managers told them not to wear masks because it would scare residents. Here is what the emails show:
The ambulance workers
On March 11, Menlo Park veterans home CEO Elizabeth Schiff-Heedles asked her counterparts at the Paramus and Vineland homes if they were allowing ambulance crews to wear masks when they transported residents to medical appointments, or letting consultants who “usually never wear masks” to wear them when visiting the homes.
“If they are healthy, they shouldn’t,” Paramus CEO Matthew Schottlander responded. “If they are sick, then they should not be entering our facility.”
Allyson Bailey, CEO of the Vineland home, where three residents eventually died, responded: “Unfortunately some information out there is encouraging individuals who see a lot of potentially sick individuals to wear masks to protect themselves. Several physician offices have started to do this as well.”`
On the same email thread, Schiff-Heedles said one ambulance company – Virgo Medical Services – threatened to stop transporting her home’s residents if their workers were forbidden to wear masks.
“Is this a fight we should have or allow Virgo to wear masks?” she asked.
Bailey said many ambulance companies were requiring masks and advised Schiff-Heedles not to put up a fight.
When Schiff-Heedles asked if Schottlander agreed, he responded: “I don’t think they should wear masks.”
In a recent interview, Virgo’s Agosto said he was shocked when Menlo Park management said they wouldn’t allow his ambulance crews to wear masks and other personal protective equipment, or PPE, in the home. He said even in the earliest days of the pandemic it was clear that health care workers needed to be masked.
“What kind of boss would I be if I was telling my workers not to wear PPE in a pandemic?” Agosto said. “We enter many facilities in a day and there is no way I would jeopardize my people – or the people they transport.”
Agosto told the staff he would not comply and that he would only pick up residents curbside. Management eventually reneged. When his crews arrived at Menlo Park, he said the home’s employees were not wearing masks.
A defiant nurse
Management held multiple meetings with the Menlo Park staff in which they stressed that masks should not be worn because there was no confirmed COVID-19 in the building, said Suddoth-Lewis.
But she and her colleagues kept wearing masks even after she said boxes were confiscated by managers.
“We stashed some away,” said Suddoth-Lewis, president of the local chapter of the American Federation of State, County and Municipal Employees (AFSCME). “We saw patients getting sick. We saw what was on the news. We weren’t going to take our chances.”
Management wanted it stopped.
In a March 26 email, Jared Doherty, a department employee relations lawyer, told Schiff-Heedles, the Menlo Park CEO, that he would draft an order barring Suddoth-Lewis from wearing masks or handing them out to her staff.
“We were advised to use discipline if we must,” Doherty wrote, but didn’t elaborate on who advised him.
NorthJersey.com asked for a copy of the order and was told by a records custodian that it didn’t exist.
The next day, Doherty wrote to Schiff-Heedles again, saying that he received “some guidance from the Gov’s Office of employee relations” on staff taking masks without permission and using them.
“We are going to start progressive discipline for mask insubordination,” he wrote.
The first offense would trigger oral counseling. The second offense would generate a written warning. The third would bring an official reprimand and the fourth would result in a suspension, Doherty wrote.
Zhadanovsky, a spokesman for Murphy, said this month that the reference to “mask insubordination” was “strictly in reference to the unauthorized taking” of the homes’ masks.
“Like most organizations dealing with the early stages of this pandemic,” the agency’s inventory of personal protective equipment “was strained in March and painstaking steps were taken to ensure its proper usage,” he said.
The agency’s “stock of N95 masks was in particularly short supply, and distribution was controlled in order to ensure a consistent reserve of masks,” Zhadanovsky said. “The reference to ‘mask insubordination’ was part of a deliberative discussion strictly in reference to the unauthorized taking of state property.”
But employees said they wanted to at least use the homes’ supply of surgical masks. And they said even if they brought their own masks in, they were told not to wear them.
Zhadanovsky said no employee was disciplined for wearing a mask and no formal policy was ever issued.
The first case
Managers seemed to be waiting for a confirmed case of COVID-19 before allowing widespread mask-wearing even though residents were exhibiting symptoms.
On March 28, Division of Veterans Healthcare Services Director Sean Van Lew sent an email to top managers to dispel “inaccurate information” and reiterated that there was no confirmed COVID-19 cases – even among residents sent to the hospital.
That changed hours later.
Van Lew sent a follow-up email that afternoon stating that management was just informed of the homes’ first COVID-19 case – a resident from Paramus who had been transferred to a hospital five days earlier after her fever would not subside.
Van Lew ordered a number of new protective procedures, requiring all staff caring directly with symptomatic residents to now wear N95 masks. He estimated he needed 10,000 N95 masks per home to last for the next two months.
In the same email, he mentioned ominously that the Valor unit where the coronavirus-positive resident had lived “has been on temporary lock down due to cold symptoms with approximately 10+ residents.”
A doctor’s note
Even after the first case at Paramus was announced, managers continued to debate the mask policy for other employees.
In late March, a kitchen worker came to the Menlo Park home with a mask on – and was told to take it off.
The worker later gave his bosses a note from his doctor recommending he wear a mask at work because of his chronic asthma. He either called out sick or was sent home.
“We are not allowing employees to wear a mask, so he is out of work,” Dawn Graeme, a human resources manager, wrote in a March 27 email sent to Schiff-Heedles and other top managers.
Three days later, on March 30, the agency’s director of human resources wrote to top managers that the kitchen worker should be allowed to return to work and wear a mask. John Langston, the director, considered it “a reasonable accommodation.”
“He wants to come to work and you need everybody you can get,” Langston said, alluding to the staff shortages that the home was experiencing due to the pandemic.
Schiff-Heedles wrote to Van Lew that same day opposing the recommendation.
“If I do that then everyone will come to work with a doctor’s note,” she wrote. “Or we allow all kitchen staff to wear masks. The argument is they are on top of each other and can’t stay 6 feet apart. Not sure if this is good advice.”
The discussion soon became moot.
That same day, state Health Health Commissioner Judith Persichilli ordered “universal masking” for all nursing home employees in New Jersey.
‘Rapid action is needed NOW’
At the time, 52 nursing home residents statewide were confirmed to have died from COVID-19. The numbers would explode in April and the following months – to more than 7,000 – representing almost half of New Jersey’s confirmed COVID-19 deaths overall.
“Rapid action is needed NOW to stop the introduction and spread of this virus in post-acute care facilities,” Persichilli’s order read.
Her directive seemed to have caught managers at the veterans homes off guard.
Susan Sweeney, head of employee relations, wrote to Van Lew: “If I’m reading correctly, it looks like the new guidelines require us to mask all persons in the facilities at all times.”
Van Lew responded: “If we are required to universal mask every employee in the facility with a surgical mask, then our supply in each home will last about a week.”
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Paul da Costa, a lawyer representing dozens of families who intend to sue the homes, said he has already deposed an assistant director of nursing at Menlo Park who said the facility had sufficient PPE inventory, but staff were still forbidden from using it.
At the time, the Murphy administration prioritized masks, gowns and other PPE for hospitals rather than nursing homes, fearing the state’s 71 hospitals would be overrun with patients, a report commissioned by Murphy said. A letter sent to state legislators by anonymous state Health Department workers said the policy led to preventable nursing homedeaths.
By then, many veterans home staff and management had grown distrustful of each other. Workers called out sick because they either were infected – or feared they might become infected.
On April 7, Van Lew wrote that more than 50 nurses at Paramus and Menlo Park had called out sick saying they had underlying conditions that prohibited them from working.
These nurses “are now at home getting paid while their peers are in the homes providing the best care they can to our guys and girls,” he said. “My question is, what makes this different from the influenza, GI and other bugs that run through the homes at any given point during the year?”
Van Lew said he wanted to conduct “fit for duty physicals” for every nurse that submitted a note.
“If they are so compromised that they cannot be around infection or sickness, why in God’s name are they in healthcare?” he asked.
The homes descended into chaos. The quality of care for residents suffered. Communication with families who had been barred from entering the homes since March 14 fell apart. The National Guard and federal Veterans Administration nurses were called in to fill the void.
Federal inspectors visited the Paramus home in late April and found the staff so poorly equipped and trained — and infection control procedures so lax – that all residents and staff were found to be in “immediate jeopardy” of COVID-19. Nurses’ aides wore the same set of protective garb all day, without changing as they moved among patients who were positive for the coronavirus, negative or had tests pending.
Workers said conditions were similar at Menlo Park.
Glenn Osborne, a resident there, told a legislative panel in August that he saw executive staff removing PPE from patient care areas in March and April. When he asked staff members to wear protective equipment, they told him they were not allowed to.
Among those who fell ill in April was Menlo Park nurse’s aide Monemise Romelus, 61 – who spent 24 days on a ventilator in the hospital before dying in May. Her family is sure the lack of masks and other personal protective equipment led to her death. They have filed a claim to sue.
“My mother was told that she was not allowed to wear a mask despite her communicating her immense safety concerns,” said Smirnov Exilus, Romelus’ son, who is due to graduate from the Johns Hopkins University School of Medicine next year and will pursue a career as a physician.
“Every day she went to work, she would cry because she was scared of contracting COVID,” Exilus said. “Unfortunately, she paid the ultimate price for the veterans home’s administrators’ reckless conduct.”
Follow Scott Fallon on Twitter: @newsfallon