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Transparency in Communications Is Essential for Trust

Judy Stone, MD

Disclosures

October 04, 2021

A few days ago, my local hospital announced it was on "diversion." The "explanation" from UPMC was cryptic and unsatisfying. The hospital diverted ambulances to other communities more than 75 minutes away over mountain roads.

The Maryland Institute for Emergency Medical Services Systems website said the hospital "requested it receive 'absolutely no patients in need of urgent medical care.'" Yet, at the same time, UPMC-WMHS stated that they were accepting ambulances and "those with unique conditions suitable for treatment only at a UPMC facility."

I started in practice there in 1983 and know that while it was a very good hospital, it is a small community hospital, and I can't think of any conditions that could only be treated at UPMC. That is, however, fitting with their self-image.

Teresa McMinn, an excellent local Cumberland reporter, asked UPMC a series of reasonable, straightforward questions, including:

  • What caused the situation?

  • What happens to patients who need to go to the hospital at this time?

  • Will your urgent care facilities stay open for later than usual hours to help with patients in need?

  • Where will opioid overdose patients go?

  • Where will routine ambulance patients go?

  • What determines when such an alert is generated?

  • What is the COVID-19 status at UPMC Western Maryland? How many beds are available? How many patients do you have? Are you understaffed?

  • Will patients be transferred within the UPMC system? If not, where will they go?

UPMC officials did not directly answer the questions but issued the contradictory response above.

Why Does This Matter?

One of the ongoing problems in dealing with UPMC and the local health department (ACHD) has been the lack of transparency. UPMC has a monopoly; to get to an equivalent-sized hospital, patients must travel 75-90 minutes (in good weather) over mountainous terrain — something neither easy nor safe if you are acutely ill.

Such a lack of communication erodes trust and the ability to work together effectively. As a co-member on the Women's Action Coalition (WAC) told me via email, "Good medicine care requires trust that the medical institutions and practitioners provide us with factual, evidence-based information we need to make decisions that truly are in our best interest. A sense of trust is required. If UPMC Western Maryland is not sharing accurate information, or, currently, any information, with the public, what trust any of us have had is steadily eroded."

Allegany and Garrett Counties have the highest rate of COVID infection in Maryland. And with a death rate of 1 in 308, Allegany County's COVID response ranks worse than even Mississippi's.

The lack of communication has been an ongoing problem faced by both McMinn and WAC. In November 2020, WAC sent a letter to the hospital, ACHD, and local officials pleading with them to have us all work together: "Other than the report of how many cases have occurred, the [Allegany County Health Department] has been silent," WAC's letter stated. "We have the highest rate of cases in the state! We would expect some kind of coordinated effort by all local officials to do something about this!"

At that time, WAC member Joy Kroeger-Mappes added, "I would like to stress that the clear and repeated refusal to be transparent and let people know the status of the COVID-19 crisis creates concern and increasingly fear... Not giving people details leaves us vulnerable. We need to know the locations and groups where outbreaks took place and how many people were affected. We need to know in detail the number of COVID-19 patients in our hospital and to the extent hospital staff are affected/infected. Holding comments to the 'company line' makes us distrustful and is seriously unsettling."

Cumberland Times-News (CTN) asked UPMC officials for a response to WAC's letter.

A spokesperson said via email, "UPMC does not have a response to the letter."Similarly, UPMC has refused to answer most questions about mandatory vaccination. In June, after the Maryland Hospital Association recommended that all healthcare workers be vaccinated, they said, "UPMC awaits more data⁠ on the efficacy of the vaccines in preventing transmission of COVID-19 before requiring the COVID-19 vaccine for employees."

Contrast this type of response to that of nearby Garrett Regional Medical Center (GRMC), now an affiliate of West Virginia University (WVU). Ann Bristow, a WAC member, observed that CEO "Mark Boucot has been much more forthcoming. The contrast of WVU Medicine communication policies and UPMC are noteworthy." GRMC regularly posts the number of patients they have with COVID and their vaccination status on their Facebook page⁠.

In terms of employee vaccination, while GRMC was also late to mandating vaccines, they are much more transparent. "We've had 12 resignations over the last two weeks," Boucot said. "You're either going to have people quit because they don't want to get the vaccine, or you're going to have people out [sick with COVID-19 and] being quarantined until they're cleared to come back to work... I would rather address the issue proactively."

Once again, McMinn had asked UPMC-WMHS about staff resignations due to the state's vaccine mandate, as well as the number of beds occupied by COVID patients, and the hospital refused to answer⁠.

Unlike our health department, Garrett County also reports details of where some cases occur — for example, a new positive case is a staff member at Dennett Road Manor Nursing Home.

I've spent the summer in Maine and, in some ways, am dreading going home. The lack of leadership — from a number of the local "leaders" who have been anti-mask⁠ and anti-vax — to the local hospital and health department have contributed to the two western counties having high COVID rates. Clearly, politics plays a major role, like the red-blue divide elsewhere.

Our county finally broke a 50% vax rate but now has a 14.9% test positivity rate. Over the past several months, I've had the luxury of walking through my town in Maine without much concern. I still don't eat out or go to gatherings, even outside. But it has been relatively liberating. Now it feels like I will be going back to house arrest — both because of our high rates and because I don't feel like I can trust many of my fellow citizens to do what is right for the community.

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About Dr Judy Stone
Judy Stone, MD, is an infectious disease specialist and author of Resilience: One Family's Story of Hope and Triumph over Evil and Conducting Clinical Research: A Practical Guide.

She survived 25 years in solo practice in rural Cumberland, Maryland, and now works part-time. She especially loves writing about ethical issues and advocating for social justice. Follow her at drjudystone.com or on Twitter @drjudystone.

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