No-Visitor Policies Do Harm

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*Legal note: this is written under the auspices of both employee safety and in the interest of public health and debate. This commentary is almost universally applicable, regardless of geography. The policies I’m complaining about have negatively impacted thousands of lives without furthering our collective public health interests. They piss me off because people don’t understand the implications until they affect them personally. (Which might well be the national motto for the United States.)

Not all healthcare facilities and hospitals adopted a blanket approach, precisely because such policies wrongly isolate patients and reduce the quality of life of everyone involved. To those who properly implemented precautions without simultaneously severing the vital family-patient link, I thank you. Were such a facility nearby, you can be sure that you would be my first option for all healthcare services. The idea that a family cannot interact in person with their family member when they are ill is one of the most abhorrent ideas I’ve dealt with as an adult.

I have serious concerns about the no-visitor policies healthcare facilities adopted when covid made its appearance. Most of these policies weren’t based on science; they certainly went too far. When I see ‘heart-warming’ videos of long-wedded couples communicating through windows, my heart doesn’t melt. It hardens – and against those who insist that isolation in lieu of reasonable precaution is in the public health interest. We allow millions of Americans to wander in public without taking basic precautions. We are not making good decisions as people, as citizens, or as businesses.

Though it says something less than positive about me, the above angers me. It’s not an irritation that can be overlooked. I see the impact that misguided and poorly-executed policies have on real people. Your mom, sister, grandmother, son, daughter, and friend. Now, me.

Perhaps my inside view of how healthcare works discolors my opinion. Healthcare is a mammoth business. We routinely forget that healthcare is at our service. Though it is a business with a mission, it is one that should focus on the human impact of policies. They all say they agree, though when I outline my argument that demonstrates the no-visitor policies to be draconian, their faces harden and they fall back to a “trust us” stance. Failing that, they aggressively insist. After all, they hold our family members hostage inside their facilities. What can we do? Before you think that ‘hostage’ is too harsh a word, I suggest you drop a family member off at an ER without knowing they have policies that endanger your family member and isolate you from them.

Is there any other business you can think of that operates this way? By invoking the label of public safety, they can hide any motive or lack of reasoning in a policy that harms your interests. The fact that not all hospitals adopted blanket no-visitor policies logically indicates that there is strong disagreement among experts. In my case, it was nonsensical.

I did not have a voice in these policies. No family member did. As you’ll see through my emails, my presence in a hospital as a visitor constituted LESS of a risk to hospital staff than even those very hospital workers. One of the dark secrets of our covid response is that we failed to test each and every healthcare worker. Even while we were in Phase I, we didn’t test. Although the state mandated that surgical candidates would have to be tested prior to entry into the hospital, efforts to test healthcare workers at the same level of sensible precautions were stymied. The motive for such decisions probably jumps into your mind in the same manner as it does for everyone else. The public interest would have best been served by universal testing for everyone in a healthcare facility, followed by stringent testing on a scheduled basis thereafter. This can be done without fear of dismantling the healthcare industry. It would, however, make us all safer.

It is true that it would expose the fact that healthcare workers are working while infected with covid. How many might be up for debate but it would be foolish to insist that the answer is ever ‘zero.’ We can’t fix a problem by ignoring huge variables. Even though I’ve said it already, my commentary is couched inside the box of the public health interest. Only the most feeble arguments would stretch to claim that my mentioning it somehow lessens the confidence of our healthcare industry. The industry is staffed by fallible people, as is any other field such as aviation, police, or engineers. People try to do their best. When policies are shown to cause harm, they need to be modified in the same way that ‘best practices’ evolve within healthcare.

Although I intervened in the cases of others when they were fighting hospitals needlessly keeping them at a distance from their loved ones, I knew eventually the policies I loathed would affect me personally. I had several conversations with my wife. During each, I repeated that I’d rather risk a lower chance of survival in exchange for the simple human right to have her visit and watch over me and my care. It is for the same reason I’ve instructed her that I don’t give consent to ever be airlifted anywhere. I trust my local healthcare facilities. I trust them more because proximity increases the chances that people who know me will be able to visit and observe my care. I do not want to ever be in a facility that denies her access to me unless it is a prison. Weirdly enough in the case of a prison, she’d still be able to visit.

Hospitals of course weight varying interests when establishing policy. Covid, though, has caused a lot of decisions to be made with inadequate information or in fear of liability. You, as a family member, are powerless to appeal, threaten, or sue hospitals for their policies.

One of my friends in particular was forced to endure days of being away from her dying husband. She finally was allowed to see him shortly before his death. I think Northwest Arkansas was on the verge of mounting an insurrection had she not been granted access. All those days they were separated were needless and harmed the public interest. Anyone looking at the issue from a wide perspective agrees that blanket no-visitor policies only serve to hurt human beings. They are written to protect hospitals – which already enjoy immunity and liability protection. If you read my emails below, I address the futility and stupidity of these policies that prohibit loved ones from seeing their family.

During those weeks, despite the fact that the policies did not affect me personally, I wrote opinion pieces and contacted as many interested people as I could to object to these horrific no-visitor policies. The silence from those who could have made sensible changes was astonishing. The same was true regarding efforts to test everyone working in healthcare.

My mother-in-law was rushed to the ER. She was suffering from what we presumed to be diabetic shock. We all met at the ER entrance at the hospital. No one was allowed to enter the ER with her, despite her deteriorating condition and her complex medical condition. A State Trooper, complete with gun, badge, and uniform sent a clear message to my sister-in-law that family members were the problem.

My mother-in-law is 80. She sat in a chair unattended for quite a while, getting worse. No one was there to insist they be cautious with fluid intake, insulin, or the other things that were vital to her proper and safe care. My mother-in-law’s inability to have someone there as her advocate and loved one contributed to a level of care that suffered as a result. Now that the moment has passed, the hospital can claim this to be untrue. As we’ve discovered once again with our recent riots and the events that precipitated them, events that are recorded or witnessed are more difficult to excuse away. Prior to covid, one of the best means to improve a patient’s care was to have both companionship and oversight for that patient. Those will diligent family members directly improve and suffer fewer health complications than those who don’t. No-visitor policies have stripped patients of the right to have oversight by those who care for them.

I wrote the hospital through its portal. My goal was to request permission to assist in better care for my family member, as well as provide companionship. I knew that the approaching holiday weekend would increase her isolation. Here’s what I wrote:

“My mother-in-law is in your facility.

I work at another hospital. I’m COVID-negative and get screened each day.

I’d like to know why I am not allowed entry into the hospital to visit my mother-in-law.

She was admitted through the ER without a COVID test. I also know that even though hospitals are testing all elective surgery candidates, they are not testing all employees within the facility.

IF you have a method to allow me to visit, please advise me as to the protocol.

Thanks, X Teri”

Someone wrote back:

 

“Thanks for reaching out to us and I’m sorry your mother-in-law is ill. If you will send your phone number, I can have one of our nursing leaders call you. I’m copying our Interim CNO in case she is able to respond by email but I think a phone call would be easier.
These are certainly tough times for everyone and we are sorry for the pain and inconvenience these temporary policy changes on visitation are causing. As you know, they are in place to minimize risks of patients or staff health being compromised, particularly since many people are asymptomatic before they test positive for covid.”

In short, the above is a “No, you may not visit” response.

The next day, I received a reply from someone else, presumably higher in authority:

“Teri, ____________ copied me on your request to evaluate the possibility of visitation at _______________ hospital. As I am sure you recognize, this is a difficult time, the surge of Covid patients has required administration at our hospital, as well as the region, to place restrictions on visitor access. These efforts are to mitigate any possible exposure to our patient population already managing their illnesses or post surgical recovery.

We have made available to our staff access to ipads or recommended the use of phones to support face time calls and discussions with the nursing and physicians if requested by the identified contact family member to provide additional means of support. Nursing staff are available 24/7 to connect with families.

I can empathize with the challenges this places on families but safety is our priority at this time as we continue to care for our community.

Please reach out to me personally if you have any additional questions or needs.

Thank you for your understanding.”

 

Here is my reply:

 

“Thank you for replying.
 
My first name is X, as unusual as that is. This isn’t a “gotcha” email. Please don’t interpret this email as an attack. I am writing it in one fell swoop to voice my objection and concern.
 
I have a family member in your facility. I know that her initial care was less than desirable due to no one being allowed to accompany her during her initial ER visit. No matter how the issue is characterized, she did not receive the care she could have, precisely because the adopted no-visitor policy prohibited her caregiver or another person from being present. This absence needlessly caused the healthcare workers to lack information that would have affected both the timeliness and effectiveness of her treatment. I don’t expect anyone to enthusiastically agree with my assessment. It is, however, a hard truth – and one supported by the facts.
 
I understand the issues surrounding covid.
 
One of the things that has long puzzled me is that while hospitals pre-test elective surgery patients, we still haven’t tested all healthcare workers.
 
Statistically speaking, we know that we have covid-positive healthcare worker cases. We had the opportunity prior to resuming surgery schedules to test each team member at our local hospitals. For a variety of reasons, we didn’t do so.
 
This continues to trouble me greatly as I see families grapple with the ‘no visitor’ policies. I knew it would eventually come around and affect me personally.
 
Knowing that “we don’t know” whether healthcare workers continue to expose patients is an issue that I can’t get around. While I, as a worker in a healthcare facility in Northwest Arkansas, get screened daily, have been tested for covid and follow routine precautions each day, can’t assist in the healthcare of my family member. This disconnect isn’t logical and doesn’t serve my family’s interests or those of public health.
 
While I still would not agree with the visitor policies most hospitals have adopted, I find it illogical that hospitals are not doing everything possible to help our community; such efforts would include testing each and every team member at your facilities. It certainly would allow for those of us in healthcare and who have been tested to be allowed to see our family members.
 
The fact that I’ve been tested when most of your staff has not should be sufficient justification to be allowed to wear PPE and see my family member. Once you see it written that way, it is hard to continue to see fit to disagree with my claim that I should be able to visit my family member.
 
I don’t expect my reasoned response to draw a change of heart for your hospital.
 
I’ve argued against these policies from the day they were implemented.
 
Each of us is exposed and exposes others on a daily basis. It’s true that we might hopefully reduce our involvement, the statistical truth is that we have passed the point of logical precautions.
 
While it might be easier to issue a blanket no-visitor policy, it is one not based on consistent logic or one taking into account the needs of human beings when they are ill.
 
I only wrote back in the futile chance logic would prevail and I’d be allowed to visit my mother-in-law.
 
Absent that, I did not want my silence to be interpreted as agreement with a policy that goes too far and without merit to the extreme of impacting our companionship and oversight of the care our family member might receive.

 

The first person wrote me back, instead of the person higher up. A holiday weekend was approaching. It’s likely the higher-up was off for the holiday.

“X – thank you for copying me on this. I am not a clinician but what you say does make sense to me & I can assure you it will be discussed. In fact, we all know that – in ordinary times – we encourage involvement of family members & other caretakers. ______________ checks email regularly and would encourage you to reach out to her or the house supervisor any time you want to discuss a concern or have a question. Again, I’m sorry for the issues that have led to these temporary very strict policies”

I waited and heard nothing directly about my appeal or request. So, I wrote both of the people I’d heard from:

“I know the holiday probably exacerbated _________’s lack of enthusiasm to attempt a reply to me. I forwarded the email to you because you were the first point of contact for my issue. Each day that passes with rules that force distance between family members is one that cannot be reclaimed.

In your reply, you said something critical to my issue: “…these temporary very strict policies…”

From a family point of view, the policy that prohibits me from seeing my mother-in-law isn’t temporary. It could very well be permanent. I know people who experienced that very issue. They didn’t get the chance to speak face-to-face with their loved ones. They’d entered healthcare facilities without oversight and companionship. And they died in those conditions.

While I objected to these policies when they did not personally affect me, I’m flummoxed to explain to someone who hasn’t experienced them how needlessly draconian they are. Because I have a view from the inside, I know that these policies are blanket policies and do not generally advance the objective of public safety that they purport to. In my case specifically, they only do harm.

I enter a larger healthcare facility each day, get screened, and have been tested for covid. Yet, when misfortune touched my family, I was somehow classified as the general public and denied access to my family member. I’ve been tested for covid, which is far and away more than the overwhelming majority of healthcare workers in your facility can say.

Additionally, your healthcare workers live and work in one of the hottest hot spots in the United States. They eat, shop, and move about among a high concentration of people who do not wear masks and do not observe proper social distancing. Your healthcare workers, the ones caring for my mother-in-law, come to work after such exposure each and every day. Even though I work in a similar but different environment, I am lumped in with the general public, despite being tested and despite following protocols when out in public.

It is lunacy to deny me access to my mother-in-law. Factually speaking, I present LESS exposure to your staff and other patients than your own healthcare workers.

It’s easy for me to get preachy in these emails. On the other hand, hospitals are places where people experience tragedy daily.

When people are ill, especially as old as my mother-in-law, there is no such thing as temporary.

The policies you are enforcing might well be permanent in my case. I don’t know how else to say it.

When logic does not intersect with law (and voluntary rules), the effect is that people needlessly are harmed.

If hospitals don’t intelligently and scientifically lift these burdensome and needless restrictions, the same policies may one day befall you and your loved ones.

Again, I didn’t expect a reversal of policy but I honestly hoped that sense, logic, and compassion would prevail.

I’m still waiting. I’m not the first. And it is a further tragedy that I will not be the last.

X”

I haven’t received a reply, of course. Two days have elapsed. I wrote them a final email, after hearing nothing in response.

“Given that I wrote Saturday and did not receive a reply, I am assuming that my emails weren’t bumped up for further consideration? I didn’t know if there was an appeal process or if an edict had been announced that allows for no variance. I know that some patients were allowed visitors in the interim.

I can understand if you would have said, “The matter is closed.” I wouldn’t be happy, but it at least it would have been a final statement.

Since this issue came up for me personally, several people have reached out and provided me with details about other families and how they were dealt with. I have a lot to consider going forward.

Under the assumption that no one will reach out to me again, I’ll close by saying that it was wrong for _____________________ to prevent me from being with my mother-in-law in the ER and thereafter in her room. It’s a policy without logical footing and one which inhibits the public health you’re charged to protect.

Thanks, X”

As with thousands of others, the hospital has artificially and needlessly robbed me of my ability to be with my family member.

Looking at my case specifically, it is a fact that I present less of a risk to patients and staff than the staff members working in the facility do. I can prove I’m not covid positive. I can enter using PPE that eliminates the risk. Meanwhile, staff members caring for patients at the facility that denies me entry are working, shopping, and living in one of the hottest hot spots per capita in the United States. They haven’t been tested. They walk among a community that does not protect itself by wearing masks or social distance at a rational and reasonable level.

They are a bigger risk than I am.

I’m been tested. They have not.

Anyone who doesn’t question these policies hasn’t had the misfortune of watching their family member needlessly suffer.

My mother-in-law moved a few months ago from a remote location to Springdale in part to be closer to medical care when needed. We’ve visited more in the last few months than we have in years. Ironically, hospitals have worsened that wound of isolation by refusing to allow me to see her.

One hundred thousand people die from infections they receive while in healthcare facilities. This was true before covid.

The workers caring for my mother-in-law haven’t been tested, even though it is an obvious step to ensure the public health and employee safety.

Somehow, I’m the problem?

These policies must go. They must be replaced by sensible public policy and hospital rules that take into account the interests of the whole patient.

Test all healthcare workers, both now and on a scheduled timeline.

Allow designated visitors, even if a covid test is required.

Ask patients and visitors to sign a liability form, to address the primary and obvious reason that hospitals continue to abuse their discretion regarding visitors.

Require masks in public.

Or..

Continue to do the same.

.

.

.

P.S. The hospital responded to my appeal request on Friday, days after my mother-in-law was discharged. It’s hard to make this stuff up.

 

 

 

 

4 thoughts on “No-Visitor Policies Do Harm”

  1. I agree. And hospitals were like this pre-Covid. More people now get to see the dictatorial nature that the healthcare system can display in the vague guise of “safety”. I’ve seen it first hand by having the somewhat rare perspective of having babies multiple times in different decades.

    Liked by 1 person

  2. I’m certain that the administrators of all the local hospitals are going to see this. It might not change their minds, of course. If it doesn’t, it is another clear sign that reason does not win out over reaction.

    Liked by 1 person

  3. These do as we say, not as we do policies are a tragic joke! Patient care suffers from lack of loved one oversight. Meanwhile patients must endure isolation and suffer from depression brought on by lack of contact with their loved ones. Those same loved ones worry needlessly about the quality of care, or lack thereof, that the patient is receiving.

    Who knows when or if these prison lockdown style policies will even be lifted? What if this is the new normal? People need to be very worried and vocal.

    First do no harm. All healthcare workers should be regularly tested. To do less is irresponsible. It is unreasonable for any healthcare provider or facility to place greater expectations upon the public it serves, than it places upon itself or its’ employees.

    Lord knows that with these policies in place, I would rather risk dying at home than dying alone.

    Liked by 1 person

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