“I feel very disposable” | The Crisis at the El Paso Psychiatric Center

On April 14, 2020, an employee at the El Paso Psychiatric Center (EPPC) died from COVID-19.  That came on the heels of several other patients and employees at the center testing positive for the virus.  State-wide, more than 108 employees at state-supported living centers and state hospitals have tested positive. The El Paso Psychiatric Center, in particular, is being seen as one of the primary sources of the outbreak of the virus into the larger El Paso Community.  Snehal Shingavi spoke to a recently resigned social worker (here called Employee X to protect their identity) at EPPC and Aviv Rau, an organizer with the Texas State Employees Union local 6186 about the situation in the center.

What was it like to work at EPPC?

Employee X: Before all of this, I really enjoyed my job.  I was thoroughly supported by everyone. I loved working with the population, they are some amazing people.  I was learning about severe mental health issues and working with some amazing Doctors. It was a good job.

What has changed on the floor of the El Paso Psychiatric Center?

Aviv: As with all state services, there has been a general, chronic neglect over the years.  With this particular facility, they went into this crisis seriously short-staffed. Some figures that some it all up – they went into this crisis with 2 custodians and 6 Psychiatric Nursing Assistants.  The nurses were supposed to be at a 1 to 5 ratio, but there are far more than 30 people at the facility. As early as January, we had employees bringing up this as an issue that would lead to a crisis quickly.  Management said this wasn’t an issue, that they’ve got it handled. But as soon as the pandemic hit, things deteriorated quickly.

Because of the conditions at the hospital, there is a huge turnover rate, not just because people leave but also because people are terminated for no reason, at will.  This made solving the under-staffing problem even more difficult.

How did EPPC deal with the news of the Coronavirus?

Employee X: We were first hearing about the coronavirus in February; I was doing new employee training and we were hearing about the cruise ships and the news from China.  We were getting mandatory training: donning and doffing PPE, we were supposed to get PPEs and masks, but none of that ended up happening.

There were 5 Psychiatric Nursing Assistants and 1 Nurse during that training, and none of us were fitted for N95s, and we weren’t fitted because the infection control nurse was late – at the time it didn’t feel like a big deal, because El Paso had not been hit by the virus yet.  But it was the start of the pattern that began to make me feel anxious.

My supervisor and other administrators treated it like it was the flu, that it was not that bad, that we wouldn’t get sick.  When people did get sick, they weren’t given what they needed to get well. We weren’t supposed to take sick leave of personal time off.  We were told we couldn’t use sick days or personal days. We had to be on board.

When our first Coronavirus person tested positive—that’s when we all started getting nervous.  That patient is now in the ICU on a ventilator. It feels very machismo, the attitude of the administrators: I can take this on, I don’t need help, it’s not a big deal.  They aren’t asking for help or being open and transparent about what’s going on—they’re taking it on their own shoulders. And not doing the proper prevention to keep things under control.

At a meeting in April, the supervisor told me that I wasn’t a hostage, and that if I wasn’t going to cooperate, that I could leave.  When I asked for N95 masks, I was told that I didn’t need one, that a surgical mask was enough. I am just a social worker, I don’t normally have a surgical mask on.  And the surgical mask that they gave me couldn’t be exchanged for 2 weeks. I was supposed to take it home every night and bring it back. That didn’t seem right to me.  I was putting my children at risk. We didn’t have zero negative rooms where we could isolate people—so all of the contagious material was being spread throughout the air. 

We saw what the virus had done around the world, it’s killed thousands of people.  Their attitude to this day has been very relaxed. My supervisor is an LPC, licensed practicing councelor, she’s not medically trained, and she was doing COVID testing.  What was her training? She wasn’t properly disposing of her PPEs, threw gloves in the trash can, and that gave free license for other people to do the same. I spoke to her, because I didn’t understand my role in all of this nor did I understand their plan.  I was only going to practice in my scope, because I am not a medical practitioner.

As of today, there are 10 infected patients on site, and one who is in ICU at another location, and he’s not doing well.  Three positive patients were even discharged. 

We weren’t initially telling families about positive tests, but then as more people were testing positive, the director of social services had to tell them—and at the beginning it was notification by mail! Not even by mouth.  So people started calling in and asking questions, and that’s when the director took over. We all received emails telling us what we could and could not say.

Can you talk about what happened to make the EPPC such a hotbed for the virus?

Employee X: I’m reading on the news that this is the focused area; I wouldn’t doubt that this is the ground zero for the infection spread in the city.  All of the sudden, everyone is getting sick, everyone is testing positive. And all I was doing was asking for an N95 mask, and at the same time I was being reminded that I was first responder!  I just went to Sonic and the woman there had a N95 mask on. If you’re scared, imagine how scared the first responders are. Their job was to make us feel safe, but they have not supported their staff at all.  Just barely this month, I’ve been seeing a lot of emails about properly donning and doffing of PPEs, washing hands, taking care of yourself—this was just beginning to happen before I quit. This should have been happening from the beginning.  They waited because they didn’t take it seriously—and if you were anxious you were a weakling.

Aviv: The El Paso Psychiatric Center had one of the first cases in El Paso.  It really kicked off the Coronavirus problem in El Paso and really was the origin of some of the worst hotspots in El Paso (all from that zip code)—all of these new hotspots being traced to patients and employees at the psychiatric center. 

The employees at the EPPC don’t have adequate PPE, didn’t receive training in how to don and doff it, so they are reusing gloves, coming to work without masks, and so on.  There has been almost no communication about how to proceed or how to social distance from administrators. Once the cases began to kick off, employees were told not to contact the families of patients. 

It’s important to remember that the hospital provides a really valuable service to the community, especially at the border, and we cannot do without it, but the preparations for the pandemic were completely inadequate.  They were told not to communicate positive test results to families. 

So what is the hospital doing to compensate for the under-staffed facility?

Employee X: Doctors were supposed to be doing all of their work from home—starting from the end of March.  These were the psychiatric doctors, and they take care of some of the medical needs of the patients, but there was a medical doctor on site.  The director of social services was doing Covid testing, and that is just wrong, because she’s not trained for that. We are supposed to work on the mental aspect.

Aviv: The nurses had to figure out how to deal with a lot of the problems themselves.  Administrators were practicing social distancing themselves, but there were no resources provided for social workers to do the same thing – so they were put in the position of having to provide all kinds of services really on the fly.  Social workers even received communication that they would have to be in the frontline positions of providing medical care, things that are not in their job description.

As far as employees who have tested positive, all hospital employees are now classified as health care workers, so that they are exempt from the additional 2 weeks of paid sick time provided by HR 6201 (Families First Coronavirus response Act), even if they are not actually health care workers.  This is an end run around the protections that the law is supposed to provide workers and patients.

The hospital told people that tested positive that they had 14 days to come back to work.  Asymptomatic workers were told to come back to work even if they had not received test results.  They were also rotating nurses into different departments so that the possibilities for contagion and spread were already pretty great.

They were short-staffed and under-resourced to begin with, and had no plan to deal with a crisis from the start, and they certainly had no ability to deal with social distancing or even basic precautions—all of these contributed to the rapid spread of the virus throughout the facility.

What is the morale of people who work at EPPC?

Employee X: There is a lot of burnout in our department, and a lot of people are checked out.  Lots of people are in denial about what is going on. One other person resigned, too, because of a lack of child care.  I started feeling sick on the 7^th, I got a note from my doctor on the 8^th, and got an order for testing, I was put under quarantine, but management was mad about that.  The other social worker also quit for similar reasons. One social worker is terrified to leave and terrified to stay.  Workers are genuinely afraid about losing their jobs—I can only imagine that it is because they are threatened. What are you supposed to do if you have kids to feed and a mortgage and you are a single parent.  They aren’t going to accommodate you or work things out. 

I feel very disposable.  Because their plan is to use the healthy people, let them get sick, send them home, and then use more healthy people, and let them get sick, and so on.  That’s how short staffed they are. If prevention would have happened a long time ago, this explosion would not have happened.

I was told by HR that there were no other options for me.  I was told I could resign, and they would post my job, and maybe they would want to hire someone who didn’t need daycare.  There’s a whole bit in the contract about childcare. 

Aviv: There is a ton of fear.  There are a ton of people scared to go back to work.  Lots of people have resigned in the past week, including a handful of Texas State Employees Union members. Some of them are frontline workers, some social workers. Most a resigning because of how bad things have gotten or because they don’t have access to child care, and the hospital is providing no solution.  Morale is pretty low and there is a real frustration about the lack of information: including who is infected and how many, so people are genuinely freaked out about who is contagious, and all they really know is who isn’t at work today.

How does this fit into the larger picture of what is going on in Texas?

Aviv: This is how connected state employee struggles are—we see the same issues in all state agencies.  All of this has happened under the Health and Human Services Commission and they are more worried about bad PR than they are about effective communication and providing adequate resources, making the matter even worse.  They aren’t being more communicative with people inside than they are with people outside. There is a lack of leadership, people passing the buck to the person farthest down the ladder, to the unit by unit level, and it’s given a lot of discretion to different managers, some of whom have been more responsive than others. 

And what about mental health services in general in the area?

Aviv: They were doing patient diversion even as early as a few weeks ago, so they are not doing a lot of new intakes right now.  This just reinforces the need for strong mental health services, especially in the borderlands, especially in stressful moments like the ones we are in now, so that vulnerable populations have access to resources that they need.  We know that there are people who will need mental health resources, so we hope that the hospital comes out of this crisis better equipped to deal with this in the future.

Employee X: No one has control over the virus; any one can get it.  It can be severe or it can be subtle. This hospital was not prepared enough beforehand.  We cannot say that he didn’t get it at the hospital, or that he was forced to work while he was sick … because the only way you can get sick leave is to test positive, and that takes a week or two before you can get a positive test result.

They aren’t even letting me in to gather my things—someone is collecting them for me.  I don’t know if I would want to but it is terrible that they are treating me like I’m the enemy.

What are the demands to management?

From the Press Release (April 15, 2020): “The Texas State Employees Union, along with our allies are calling upon Governor Abbott to immediately test all frontline workers at State Supported living Centers, State Hospitals, and State Health Science Centers for COVID-19, as well as increase funding for additional staffing, and provide hazard duty pay for all state employees.”