Overcrowded in ‘normal’ times, Highland Hospital braces itself for COVID-19

Emergency room staff wearing protective gear stand at the entrance to Highland Hospital on March 26, waiting to test for the coronavirus before admitting any patients. Photo: Pete Rosos

Derrick Boutte has worked housekeeping at Highland Hospital for 20 years. He cleans rooms where patients with infectious diseases are cared for, a crucial service that helps keep staff and other patients from falling ill. Boutte said Highland hasn’t provided COVID-19-specific training for his crews, despite the fact that they’re already cleaning rooms where suspected coronavirus patients are treated.

“A lot of my coworkers are feeling on high alert and not knowing the processes and procedures,” he said.

Other Highland medical personnel say they haven’t been provided refreshers on how to wear personal protective equipment like face masks and goggles, or training on how to use new equipment, including air-purifying respirators.

Ahead of an expected surge of coronavirus patients in the coming days and weeks, some staffers at Oakland’s Highland Hospital are sounding the alarm about what they say is a serious shortage of equipment and training.


John Pearson, a nurse in Highland’s emergency department, has been using his personal Twitter account to plead directly with Gov. Gavin Newsom for shipments of personal protective equipment, like surgical masks and gowns, face shields, and coveralls. He also accused administrators with the Alameda Health System, the independent public health authority that operates the county’s five public hospitals, of “mismanaging and underfunding” Highland. 

“Patients already were not getting the care they needed, and now, on top of that, you add this stressor of a pandemic,” said Pearson, a union chapter president of SEIU 1021 who tweets under the handle @OaklandNurse.

A testing tent has been set up outside the entrance to the Highland Hospital ER. An Alameda County Sheriff squad car and emergency room staff were also in evidence on the morning of March 26. Photo: Pete Rosos

On Sunday, the Alameda Labor Council, which represents dozens of major unions, sent a letter to the Alameda County Board of Supervisors describing the Alameda Health System as “an organization that is mismanaged, unaccountable, and resistant to work with Labor Unions,” and asking the county to take over AHS’s hospitals and directly operate them.

Since well before the coronavirus outbreak, Highland, the public hospital serving Oakland and much of Alameda County, was underfunded and overcrowded, as poignantly captured in the 2012 documentary film The Waiting Room. On many days of the year, the hospital’s NEDOCS score —National Emergency Department Overcrowding Scale — is at “orange” or “red,” signifying a dangerous number of patients in proportion to staff, beds, and other resources. Nurses, doctors, and other staff say they routinely work long shifts with few or sometimes no breaks. 

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But normal times, trying as they already were for Highland, are ending.

On March 1, the Alameda County Public Health Department reported the county’s first confirmed case of COVID-19. The next day, the Alameda Health System’s 4,383 employees all received an email notifying them that precautions would be ramped up. For one thing, Highland visitors would no longer be allowed to see any patients “under investigation” for coronavirus. But some Highland staffers say the training and guidance from hospital administrators has not gone far enough.

Terry Lightfoot, a spokesperson for the Alameda Health System, said AHS is training staff on safety procedures. “Our infection prevention team and educators have created education and are on the units daily, during all shifts,” he wrote in an email to Berkeleyside. Lightfoot said Highland has also trained certified nursing assistants to act as “spotters” for their colleagues to make sure they’re properly using protective equipment.

Highland isn’t the only East Bay hospital where administrators and front-line healthcare workers are publicly disagreeing about how to keep hospital staffers safe. On Monday night, nearly 100 nurses with Kaiser Oakland Medical Center lined up outside that hospital’s entrance, staying six feet away from one another, to protest that hospital’s coronavirus policies — including a prohibition against nurses bringing in their own protective gear from home — and what they see as a dangerous shortage of protective supplies.

On March 10, the Alameda Health System, which operates Highland but not Kaiser, received a shipment of N95 masks and disposable goggles from the Strategic National Stockpile, a cache of medical supplies maintained by the U.S. Department of Health and Human Services, according to internal hospital memos. Supplies are also pouring in from volunteers. Over the weekend, Liz Miller, the sibling of one Highland emergency-room doctor, started an online fundraiser and raised over $33,000 to purchase nine PAPRs for Highland, special breathing devices used by medical personnel as they treat infected patients. 

Miller said that while it’s encouraging to see people band together to support healthcare workers, “we should not be dependent on GoFundMe for basic healthcare needs.”

Lightfoot, the Alameda Health System spokesperson, says there is not currently a shortage of protective supplies at Highland, and that the hospital is taking measures to conserve what it has. Internal emails also describe some of the steps Highland has taken to preserve its supply. They instruct staff to wear protective equipment only when entering the room of a known coronavirus patient. Any other “personal use” of protective equipment would be “considered theft,” warned one recent email sent by Highland administrators to staff. Highland workers have been instructed to re-use surgical face masks, despite earlier hospital policy that required fresh masks between patients. Medical staff say re-using masks puts patients and workers in danger, but with limited supplies nation-wide it’s unclear whether single-use is an option.

An internal March 23 memo to all hospital staff noted that “there has been a disruption for hand sanitizers, nationally, which may affect [Highland’s] wall mounted hand sanitizer stations,” and that the hospital will soon be using “washable gowns” because disposable gowns are in low supply.

Highland Hospital: Since well before the coronavirus outbreak, the public hospital that serves Oakland and much of Alameda County was underfunded and overcrowded. Photo: Pete Rosos

As for beds and life-saving medical devices, Lightfoot says Highland has 20 ventilators, but that there are another 43 at the hospital system’s San Leandro and Alameda campuses. According to the California Office of Statewide Health Planning and Development, Highland currently has 24 intensive-care-unit beds and another 27 “step down” beds where patients can receive an intermediate level of care. Rooms along the hospital’s entire sixth floor are being converted into negative-pressure rooms, preventing air and contagions from leaking out.

As of Tuesday, Highland had carried out 187 COVID-19 tests. Four patients have tested positive so far, and one of them is being cared for at the hospital. Another 18 patients with COVID-19 symptoms are being treated as if they have the virus while their tests await processing. Last week, visitation was restricted at Highland except in a handful of special circumstances, and a screening tent was erected in the parking lot outside the emergency department.

A Highland nurse who asked not to be identified because they do not have authorization to talk to the media said the hospital appears to be doing a good job of discharging patients from some of the hospital’s 112 acute-care beds, freeing up more space to respond to the pandemic. They expressed concern, however, that it can take 48 hours to process a test for COVID-19 sampled at Highland, because all testing occurs at an offsite lab. Patients with a possible infection have to wait in isolation for that time, taking up crucial bed space.

Conflicts between Alameda Health System’s medical staff and administrators have been an ongoing problem for years, and tensions are increasing as the pandemic pushes the public health system to its limits.

In October 2019, about two months before the outbreak was first identified in China, a resident doctor with Highland’s operating room spoke to AHS trustees at a board meeting about how pervasive underfunding was affecting every department in the hospital. “This is really just a cry for help,” the doctor said, describing multiple delayed surgeries due to staffing shortages, surgeons and technicians working 24-hour shifts, and senior staff quitting. “Morale is low right now. We’re trying to provide the best care for our patients that we can. The leadership is lacking.”