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Kaweah Health Online Town Hall

Kaweah Health's Online Town Hall - Thursday, July 30

At Kaweah Health, the greatest lesson we have learned is the importance of listening carefully to our community. We are launching a live webinar, to further involve the community in our efforts to gather feedback. Your feedback will help us continually improve and make sure we are best meeting the needs of our region.

Guest Speakers:

  • Gary Herbst, Kaweah Health's Chief Executive Officer
  • Hosted by Garth Gipson, Kaweah Health Zone III Board Member

Questions and Answers

The following questions were asked via social media for our virtual town hall on July 30, 2020.

QUESTION: Are all patients admitted to Kaweah Healthtested for COVID-19?

· Answer: No, not generally. We leave it to the discretion of the physician’s assessment and if the patient is exhibiting symptoms, then we will order tests if those conditions are present. It is important to determine if a patient is positive or not.


QUESTION: If someone is tested multiple times, do each one of those tests count as a positive?

· Answer: They do not. The county filters multiple tests done on the same patient and only counts as 1 positive. But that was a concern we all have as we read the paper as Tulare County has one of the highest positive rates in the rate, Fresno only has a fraction of the positive cases. In early days of pandemic, it was common to test patient multiple times. However, there is no duplication of multiple tests.


QUESTION: Which is better - hand sanitizer or handwashing?

· Answer: Handwashing. Sanitizer a close second. However, both are great. Hand sanitizer kills the bacteria, but doesn’t remove it. Hand washing correctly not only kills the bacteria, but rinses it away. We encourage you to practice both. If you had dirt on your hands the sanitizer would kill most bacteria and viruses, like soap, but would obviously not give the same rinsing power of handwashing. Of note, 60% or higher hand sanitizer is preferred (less than 60% is not very effective).


QUESTION: When should we use gloves?

· Answer: Not in public! Not wearing gloves when shopping, for example, makes your hands feel dirty because you are touching many things – so you wash your hands or use sanitizer more frequently. When you wear gloves, you have a false sense of security and feel free to touch everything- spreading germs from item to item. Gloves actually are semi-permeable and small pores get larger and larger the longer they are used. However, if you are a healthcare worker, this is part of our standard PPE.


QUESTION: How often do we need to clean surfaces (desks, doorknobs, touchpoints)?

· Answer: Depends on the frequency and number of people using those surfaces and how high the traffic is. In homes, it is a controlled environment and if we are practicing good hygiene then maybe not too often. In public or when having guests, assume everyone has an active infection and is spreading their germs with every touch; which is why distancing, masking, and hand washing is so important.


QUESTION: It seems not all face coverings are equal. Can you review the recommended type of face covering?

· Answer: Any face covering, covering mouth and nose, helps slow the spread of infection. Any kind is better than no face coverings at all. Some masks block sneezes, some let some particles through – so without knowing which kind you have, it is always a good idea to cover your cough/sneeze (don’t rely on the mask to catch it all). There are a spectrum of masks from the n95 being the strongest to the cloth masks. We are grateful to our community who have helped make thousands of face masks for our healthcare workers. It depends on the environment you’re in, and how you wear the mask as well. Please cover your nose and mouth and avoid touching your mask often.


QUESTION: Are face shields okay if an employee doesn’t want to or can’t wear a mask?

· Answer: It will help decrease splashes to their eyes, but will not help from inhaling droplets and definitely will not help from spreading their own droplets to others. We have recently required frontline workers to wear face shields as part of the PPE as another layer of protection.


QUESTION: Can Kaweah Health help employers by certifying their employees are COVID Free? (looking for assurance before the employee returns to work)

· Answer: We use the CDC algorhythm in returning positive staff to work. Symptom free 10 days after initial onset without a fever when not taking fever reducers. As for non-positive staff, we cannot “guarantee” anyone to be COVID free. Both because there are asymptomatc cases and testing is reliant on swabbing a detectable viral load. You could have a test and it’s negative, and then later that day come into contact with the virus. Testing negative today doesn’t mean negative tomorrow.


QUESTION: If an employee is showing symptoms what does the employer do?

· Answer: Have them evaluated by their employee health department or a provider for evaluation and possible testing. (And require masking if not already doing so). If possible, please send the employee home while waiting for the COVID test. You may also direct the employee to the KD hotline.


QUESTION: If an employee is faking it or using this pandemic to stay home what does the employer do?

· Answer: Work with your HR department – if you are the HR department, follow your policy on workplace absences. At some point sick days run out.


QUESTION: Is there any type of testing that schools can do to set a baseline for contact tracing? St. Paul’s is interested in getting their staff tested before on campus learning resumes.

· Answer: Testing supplies in many counties are extremely limited, baseline testing is not recommended and in many cases, not supported. Masking, hygiene, distancing, not sharing supplies are still the best preventative measures. As mentioned, when you do the test, it is only good at that specific date/time.


QUESTION: The public has expressed frustration about how long it is taking for the results to come back. Many times they’ve been told 24-48 hours, but have not heard back. Why the discrepancy?

· Answer: It depends on the testing platform and what lab the samples have been sent to.If sent to the Kaweah Health lab, the results can come back in 24-48 hours.If you are asymptomatic, your sample will be sent to a commercial lab which can take 14 days.The County did recently install new equipment to help expedite, but they are still backlogged.


QUESTION: Does KD still have Residents working there?

· Answer: Yes, in their normal (pre-COVID) capacity. We have had hundred of employees working from home during this pandemic to minimize exposure to staff. But our residents are doctors and what a great experience to live on the frontlines of this. They remain and continue to perform their same rotations.


QUESTION: Are most COVID deaths linked to having underlying health issues?

· Answer: Patients with pre-existing conditions, especially lung related conditions, have a difficult time recovering from COVID (and many other viruses for that matter, like the flu).


QUESTION: What’s the best way to support the front line staff fighting this right now? Do you still need food from local restaurants?

· Answer: Employees will never turn down food! The community has been tremendously generous with their donations. If anyone wishes to donate anything please reach out to our foundation office at 624-2359, or email foundation@kdhcd.org. Any food needs to be individually packaged (no potluck-style).


QUESTION: Are there any volunteer opportunities at this time or in the future that you can use a large number of people, for a one-time group setting to help inside or outside the hospital or any of your other facilities?

· Answer: At the present time, we are not bringing volunteers into Kaweah Health except individuals who are clinical students or perspective students who need to complete a prescribed number of volunteer hours to complete their application or graduation. While volunteers and volunteerism is a vital part of our history as a District and even our Nation. At this time, the COVID-19 pandemic prevents us from inviting volunteers into Kaweah Health. We want to do our part to stop the spread by reducing the potential exposure of people – our patients, our staff, our volunteers or our community at large.


QUESTION: It is being reported that hospitals are overinflating their COVID numbers because they are making money off of COVID patients. Is there any truth to that rumor? Can you quickly go over the reimbursement rate for COVID patient and dispel the myth that the hospital is getting rich off of this pandemic?

· Answer: Kaweah Health receives a fixed amount per patient depending on their condition. There is a fixed payment for diagnosis that need a respiratory system. COVID is a respiratory virus. Medicare has bumped up the normal rate for respiratory syndrome patient by an additional 20%. That 20% was put in place because of the belief that COVID patients will stay longer, assume more resources, staff will need more personal protective equipment, providing different drugs, etc. The cost of care for the patient went up for us more than that 20% reimbursement rate. I can assure you that hospitals are not making profit off taking care of COVID patients.

COVID arrives in March, and by the end of the month, we started to shut down vital services. The most vital being elective surgeries, both inpatient and outpatient. As a result we started generating operating losses. We lost $2.7 million in March. We lost $14.9 million in April and $11.1 million in May. Then on May 18th, we started reopening surgeries and as a result, the loss in June was $3 million. We went from breaking even to a $31.7 million operating loss in those four months. That’s how we would have finished the year if it weren’t for the federal stimulus money. As part of the CARES act, Kaweah Health received $14.4 million which was applied to the lost revenue and reduced our loss to $17.4 million as we ended the fiscal year on June 30th, 2020. We are very excited to have just received $10.9 million from the federal government and this will help cover the loss we expect in July and August.

Additionally, over the course of the pandemic, we discharged 271 COVID patients. 84% were covered by Medicare or MediCal. They pay us a fixed regardless of how long they stay. The cost for taking care of a non-COVID patient that stays for 5 days is $15,500. This covers staff, supplies, etc. The average length of stay for a COVID patient is 11.2 days and that cost is $32,000. Medicare did increase their rate payment by 20% to $18,700, but MediCal did not implement increases to their rates. Of the 271 COVID patients that we have cared for, we experienced a $3.2 million loss.


QUESTION: We received several questions on how patients are being diagnosed and reported as being COVID positive. How does KD determine whether COVID is a primary or secondary diagnosis for patients.

· Answer: The guidelines for COVID are if the patient is being monitored, evaluated or treated for COVID and they came in for that reason, COVID is used as the Primary Diagnosis. The code that is specific to COVID 19 is U07.1 and that went into effect on April 1st of this year. This code is used when COVID is the admitting diagnosis or can just be a secondary diagnosis if that wasn’t the reason for admission. There are exceptions to this rule, like if they have sepsis due to COVID, then sepsis is listed first (CMS guideline) then COVID, or if they came in for ONLY comfort care and we don’t treat them except to make them comfortable, so there are some exceptions, but for the most part, if they came in for a COVID related problem, we are coding it to COVID. There are some instances where the patient is admitted and tests negative but later in the stay tests positive, so the admitting diagnosis would not capture the COVID patient. We are able to capture the data by diagnosis in any order – admitting, primary diagnosis, secondary etc. If they came in for say, a fall and broke their hip, the hip fracture is the primary Diagnosis and COVID would be 2nd.


QUESTION: Is there a separate space in the Emergency Department where people with COVID-19 symptoms are sent to separate them from patients who don’t have symptoms? Or do you assume everyone has COVID-19 when they come in?

· Answer:

  • When patients arrive to Tent 1 they are triaged first, vitals taken, and quick registered.
  • If they are considered clean or non-rule out COVID, they will be sent directly into MK Main Lobby to be seen in PAT/Provider after Triage.
  • If they are exhibiting symptoms of COVID or need to be ruled out and are stable, they will be seen by the Provider in Tent 1 and then to Tent 2 for swabbing and testing.
  • If the patient is rule out COVID or Non Rule out COVID and they are unstable, they will be taken back to the main ED.
  • If Tent 2 is filled with patients for Rule Out testing, we are using the Old gift shop as overflow holding of Rule out patients. The old gift shop area has been prepared for that type of use.

QUESTION: A community member has gone to the Emergency Department, on several occasions. Her experience on all occasions has been terrible on many levels. Can the ED process be reevaluated and updated to putting the patient’s needs first?

· Answer: We are so sorry that you have had bad experiences. We have a Patient Experience team that you can talk to if you feel your experiences need to be followed up on. Our ED is experiencing some of the highest patient satisfaction scores they have ever had. It is also working at capacity.


QUESTION: One of our community members is a patient at the clinic on Akers n Hillsdale Ave. She was diagnosed with T-cell Lymphoma in 1998 and has been treated with photo chemotherapy. The light box treatment has also been used to treat eczema and other skin disorders. She was informed a few months ago that the light box had been removed. What happened?

· Answer: We discontinued the service due to new specialties and physicians joining the clinic that needed the space. This was a low volume service that patients can actually do on their own at home now, with equipment that they can buy over-the-counter. Because it is not a service that requires a physician, we opted to discontinue it in favor of much needed ENT services.


QUESTION: Have any admitted patients contracted COVID while in Kaweah Health?

· Answer: Yes, we have had patients who were in the hospital for a period of time who then developed COVID-19 symptoms. Contact tracing attributed this back to health care staff and visitors who passed the virus to the patient.


QUESTION: Is KDH still performing elective or non-emergent surgeries? If so, what safety measures are being taken to ensure that it is safe for patients to enter the hospital and that they will be kept away from COVID patients?

· Answer: KD is performing surgeries that are essential for patients and their outcomes on a limited basis. We closely assess if deferring the procedure could have a negative impact on quality of life and then proceed. We are screening patients before they come in for procedures. Our patients who do not have COVID-19 are in private rooms. Our health care workers wear masks and we provide masks to patients in the hospital to help minimize transmission of the virus. We have increased cleaning, installed more hand sanitizers, limit visitors and minimize prolonged contact with people as much as possible while still maintaining a safe and high quality level of care.


QUESTION: One of our community members has a family member that is holding off on non-emergent surgery because they don’t want to be alone in the hospital. They understand the current no visitor policy, but do you have an idea when that policy will be lifted or revisited?

· Answer: No changes to the visitor policy as of yet. Every week a committee looks at whether or not modifications can be made the visitor policy. Key determinate to lifting the visitor policy is when the positivity rate in the community decreases. As soon as the positivity rate begins to decrease, there is potential to allow back visitors.


QUESTION: If a loved one passes away in the hospital is immediate family allowed to come say their final goodbyes post-mortem? If so, can the family go in together or one at a time?

· Answer: Yes, we will make sure families have that opportunity. We also make exceptions for patients who are at end-of-life and will allow a family representative to be with them.


QUESTION: A couple will be having their first child in late January of 2021. Is the father allowed to be with the mother during and after labor?

· Answer: Yes, the mother can have one visitor the entire stay. During labor, birth and delivery until they go home.


QUESTION: Will KD’s reporting graph be changed to include overall number of tests given and number of negatives and positives? This is very helpful when putting things into perspective.

· Answer: The clinical snapshot has the number of people tested and the number of positives for the last 14 days now. We have done over 20,000 tests so that is difficult to filter the duplicate positives out so we have started doing the 14 days as it is easier to sort. We did have a meeting looking at modifying the dashboard to provide more detailed specifics that the community is looking for.


QUESTION: Flu season is around the corner and COVID will still be with us. Is KD preparing for that inevitable surge? Are there other buildings that can be used for overflow?

· Answer: Yes, we are in a constant state of preparation and surge planning with multiple options. We are interested in seeing how distancing, masking, and hand washing might affect the spread of the flu. We have identified several overflow areas within the hospital in our procedural areas. We also have patient care beds at our south and west campuses. The county is setting up an alternate care site we will use if needed. Our plan is to try and perform the acute care in the hospitals where we have medical equipment, processes and staff.


QUESTION: Is KD cross-training staff? What other preparations do you need as we anticipate a rough fall/winter season?

· Answer: We are cross training licensed staff in non-clinical positions to return to the bedside and support potential surges. We have also increased traveler health care work volume and are working to over hire staff in anticipate of the fall/winter.


QUESTION: What are the age ranges for those who have died from Covid-19 at Kaweah Health?

Age

Number of Deaths

0-17

0

18-49

5

50-64

19

65+

66

Total

90



QUESTION: What is the age range of those currently being treated in the hospital?

Age

Number of patients

0-17

1

18-34

4

35-49

15

50-59

11

60-64

4

65-69

14

70-74

14

75-79

6

80+

6

Total

75

70% of those contracting virus are younger than 60. That are being hospitalist. Kaweah Health’s youngest patient on a ventilator has been 19.


QUESTION: What is death rate for persons diagnosed with Covid-19 in Tulare County?

· Answer: 37.6 Deaths per 100k which translates to a 1.9% death rate.


QUESTION: If deaths are being used as a measuring tool for COVID why is it when someone dies from another cause and tests positive for Covid-19 it’s counted as a Covid-19 death?

· Answer: Public health requires reporting of anyone who dies and has a communicable disease. We report the number of people who have died with COVID. While this may not be the primary reason for their admission, there are measures that must be put in place to prevent the spread of the virus when the patient is here in the hospital. The CDC and public health still track what has happened with individuals who have had COVID since we are still trying to learn more about the illness. This is a Department of Public Health directive; however the hospital has conversations with the County when it does not seem like a reasonable statistic.


QUESTION: When the Lifestyle Center re-reopens again, can they look into using better cleaning practices when it comes to wiping off machines, mats etc.? The spray bottle and towels are gross.

· Answer: The single use wipes are VERY EXPENSIVE and are not hospital grade disinfectants. We have moved to changing out the towels every 30 minutes to address the wet towel issue. I'm not sure what else we can do without having a significant financial impact.


QUESTION: There are several videos claiming that hydroxychloroquine, azithromycin, and zinc are extremely effective in fighting the virus in the correct dosage. Has KDH used this particular combination of medications? If yes, what was the outcome. If no, is it possible to try?

· Answer: Hydroxychloroquine was considered as a potential treatment for COVID-19 early in the pandemic before scientists and clinicians had an opportunity to fully test or develop medicines that could treat the virus. Based on studies available at the beginning of the pandemic, hydroxychloroquine was prescribed for some patients at Kaweah Health. Early studies on the use of hydroxychloroquine in patients looked to show positive results but the way the studies were conducted this may have been misleading. Many studies using hydroxychloroquine have been published in the months since the pandemic started. A majority of these studies have not been able to show a benefit with hydroxychloroquine. The studies that show no benefit that many clinicians are basing their treatment decisions on are studies that have adhered to the gold standard of clinical research and have looked at various patient types. These studies have included various different types of patients ranging from those with a possible exposure but no symptoms yet (asymptomatic patients), non-severe, non-hospitalized patients, and hospitalized patients who required oxygen support. The use of hydroxychloroquine for COVID-19 has continued to be discussed in the news and on social media but based on the best available current science, the studies are showing that it does not work as originally thought. The scientific and medical experts in the country and many of our local providers are currently not in favor of using this medication for COVID-19 treatment. Studies for azithromycin or zinc have not been as readily available. One study evaluating hydroxychloroquine for non-hospitalized patients with COVID-19 also looked at those patients also taking zinc. The study investigators found that the addition of zinc to hydroxychloroquine did not improve symptoms during the study period. While zinc is still currently in use, there are not studies that support any benefit to patients. However, it is largely a safe drug to use in patients. Another study evaluating hospitalized patients with COVID-19 found that taking hydroxychloroquine with or without the antibiotic azithromycin did not show improved symptoms after 15 days. Azithromycin may be given to patients with COVID-19 that have other medical reasons, such as certain types of pneumonia. Lastly, the FDA has issued a warning that giving hydroxychloroquine with remdesivir may reduce the activity of remdesivir, a drug that has been shown to have benefit in patients with COVID-19. All of these medications, especially hydroxychloroquine and azithromycin, do have side effects and in some patients can cause harm. It is important to keep in mind the potential benefits of any given treatment and weight these out with potential negative effects of these drugs and other factors that are specific to the patient to come to the best treatment decision. Given the studies that have recently been published around the use of hydroxychloroquine and showing no benefits, use as treatment for COVID-19 infection at Kaweah Health hospital has fallen out of favor.


QUESTION: Is Kaweah Health using Remdesivir?

· Answer: Kaweah Health is currently using remdesivir in patients that meet the criteria set up by the FDA when they granted emergency use authorization (EUA) for this medication. Patients are evaluated to ensure that they meet these criteria by the clinical team.


QUESTION: Does KD have adequate medicine and supplies to meet the needs of the number of Covid-19 patients you are receiving? What does KD’s supply of Remdesivir look like?

· Answer: For FDA-approved products with reasonable data to support their use in the management of COVID-positive patients, we are doing our best to keep the medical center supplied. There are supply challenges but currently, drug supplies are sufficient to continue our use of those medications.

Regarding Remdesivir, it is not an FDA-approved drug.Since there has been a declaration of a public health emergency and Remdesivir has shown benefits in COVID-positive patients, the FDA has issued an emergency use authorization (EUA) to allow for its use in the treatment of COVID-positive patients. Since Remdesivir is not an FDA-approved drug, the federal government controls both which patients can receive the drug as well as how the limited drug supply is allocated throughout the country. In the EUA, the FDA outlines clinical criteria that must be met for a patient to qualify to receive Remdesivir.The allotment of the drug to specific facilities is controlled by the federal government, specifically the Dept of Health and Human Services (HHS), in collaboration with State and County Departments of Public Health.Kaweah Health continues to monitor and purchase our allotted amount of Remdesivir. Our demand has consistently been greater than our allotted supplies of the medication and it is not uncommon for our supply to be depleted before the next allotted amount arrives.We continually monitor medication supplies to make sure that patients that are started on Remdesivir are able to finish the prescribed duration of therapy.


QUESTION: What about plasma?

· Answer: As of July 27th 2020, the CCBC has provided over 400 doses of CCP to hospitals in the Central Valley region, about 25% of that number going to Tulare County patients. Very recently, CCBC and other blood centers were asked by the FDA and by another federal agency, Biomedical Advanced Research and Development Authority (BARDA), to triple or quadruple CCP supply in preparation for a continuing surge in need. A major challenge we are facing is finding all the recovered COVID-19 patients and convincing them to donate their plasma. A donation center in Visalia has recently opened.

The current need for plasma donation is critical. Most of the plasma donated to CCBC is coming from outside the Central Valley. Potential donors can find more information and how to donate at https://www.donateblood.org/.


QUESTION: One of our community members tested positive for COVID in June. Her husband also tested positive but he had no symptoms. Their primary doctor suggested that they extend their quarantine to 21 days because her symptoms were so severe. What does she have to do to make sure she is no longer contagious? Is there a waiting period for a retest? Also, her primary doctor gave her a lab slip for an antibodies test. Since she knows she was positive for COVID, wouldn't it be a waste to test for antibodies?

· Answer: A retest will not necessarily tell her she is no longer contagious. Once her symptoms have improved and she is without a fever for 72 hours she is considered no longer contagious. Some tests may come back positive for presence of the virus but this does not mean she is contagious. Current guidelines do not recommend a retest, rather, watching for symptoms to resolve. An antibody test will tell her if she has antibodies present still. This is useful to determine if a person is eligible for donating antibody-rich blood for critically ill patients.


QUESTION: Some tests can show the virus even after a person is no longer contagious and no longer has symptoms. Does that mean some of our positives aren’t really positives?

· Answer: Possibly. Some tests are so sensitive they detect dead, non-contagious virus; which is why we focus on symptom-based recovery.


QUESTION: When a child gets sick with COVID, do you automatically send them to Valley Children’s Hospital? If not, what does it take to get a child there?

· Answer: The children admitted to Valley Children’s are those needing inpatient medical care. Not all children who are positive need hospitalization. The physician would evaluate them for needed inpatient care. We have a wide range of clinical expertise for sick children, and in fact have Valley Children’s physicians contracted with KDH. The pediatricians are in constant communication with our Valley Children’s partners to determine when a transfer would be appropriate.


QUESTION: If a person has COVID, what are some things that they can do to stay out of the hospital? (Breathing exercise, steam showers, etc.)

· Answer: Yes, deep breathing and steam are good as well as staying mobile in your home. Walking around, sitting up in chairs, and lying on your stomach to move air and fluids around in your lungs. It is also important to drink fluids to stay hydrated and eat healthy. Call your doctor if the symptoms are not improving/getting worse.


QUESTION: If a person has tested positive for COVID, does that mean they are immune?

· Answer: This is our hope, but we do not know enough about this virus yet. However, we haven’t heard of anyone who has contracted it twice so that is the theory. There are experiments currently happening on the vaccine.


QUESTION: If a person goes to the hospital with the virus, what should they expect?

· Answer: If they need to be admitted for more intense care they will be admitted to one of our respiratory isolation units and receive the Same world-class care as always! Everyone will be wearing masks, as well as gowns and face shields while in your room, and will expect you to wear a mask any time you are out of your room. Bring your cell phone as visitors are generally not allowed. And a discharge celebration when you are able to return home!


QUESTION: Are there lasting effects of being COVID positive? (permanent loss of smell, kidney issues, long term fatigue)

· Answer: The medical field is seeing people with longer lasting effects. This can be related to organ injuries from decreased oxygenation that has happened, especially when people delay seeking treatment. More serious infections can scar the lungs (and affect other organs) and create other issues in the future. We recommend staying in close contact with your primary care doctor throughout your illness.
We have not seen the loss of senses to be permanent as of now.


QUESTION: Are new cases because of social interaction or is there another common thread?

· Answer: There is a strong correlation between community socialization and the current surge. People who have been interviewed by public health after testing positive are typically relating their exposures back to large gatherings of people both inside and outside.


QUESTION: Why is the goal for test positivity 8%? Aren’t we hoping for herd immunity? Why are case numbers a big deal if the mortality rate is falling?

· Answer: Most of these goals are set by the state and county health departments. Herd immunity is worrisome as this will overwhelm the health systems. Given that we are currently struggling with a positivity rate of 14% as it is, more and more would be hospitalized with herd immunity. We look forward to the vaccine.


QUESTION: Do air filters really make a difference in transmission?

· Answer: Air filters that filter small particles can make a difference. Generally, most HVAC systems provide a filtering system – modifying filtration systems can help provide a faster cleaning of the air. The Filter size of 0.3 microns or smaller will filter the virus in the air. The other component is the number of times a HVAC system exchanges the air in the room.


QUESTION: It seems nurses are getting this more than doctors. Why?

· Answer: Nurses, CNAs and RTs have to spend more time at the bedside of patients while they are providing care. The physicians are present in the rooms but their role does not require them to be within 6 feet of the patients for prolonged periods of time. Proximity and duration play a key role in virus spread (hence social distancing and quarantining)


QUESTION: We hear about the rising number of cases, but very few details about where the hotspots are in Tulare County and what is being done to slow this virus in our community.

· Answer: Previously it was “easy” to identify hot spots like care homes. With such wide spread infections it is much more difficult to pinpoint; with a couple caveats – gyms, churches, and home gatherings have been cited as activities giving to high number of transmissions.


QUESTION: How is Kaweah Health’s financial implications affecting Kaweah Health employees?

· Answer: Unfortunately, we have had to take drastic measures. For the new Fiscal year, the board adopted a budget reflecting actions that do affect the employees. We will be freezing wages and not providing merit increases, but there will be no wage cuts. Additionally, we will not be able to match our 401k match which will save around $9 million. We are looking at employee health plans/benefits and shifting more of that to our employees. All of this has been done to preserve jobs as layoffs are the last thing we want to enact. On a side note, we have budgeted, for the first time, to have a zero operating margin and to break even.


QUESTION: Since SB 425 has been in place January 2020, what measures are you implementing for the protection of patients?

· Answer: As of January 1, 2020, when a patient (or their representative) submits a written allegation of sexual abuse or sexual misconduct to a health care entity, that entity must report the allegation to the appropriate state licensing agency (e.g., the Medical Board of California) within 15 days of receipt. The purpose of the bill was to not only accelerate the process in which state licensing boards receive notification about these serious allegations, but also to expand the types of entities that must report these events.

Kaweah Health’s Plan/Response:

If a written complaint is received from a patient, HR would be involved with the investigation and follow up with the employee. Risk Management assumes reporting responsibility to the appropriate Boards. Medical Staff Office will complete the appropriate form, obtain Med Staff Office Legal review, and forward to the Medical Board of California.