Charleston Area Medical Center (photo via Creative Commons)
Alex is a biomedical equipment technician, or BMET, tasked with inspecting everything from thermometers to ventilators. Alex (their name and gender intentionally obscured to protect their identity) works for Charleston Area Medical Center (CAMC), a hospital system with multiple locations across West Virginia. CAMC inspects equipment both in house and off site, at smaller doctor’s offices and clinics.
“Right now, we have a shortage of BMETs in the field, and health care technology management professionals in general.”
“Every piece requires an electrical safety test, and that should take a minimum of thirty minutes,” Alex says. “If you also have a performance inspection, some pieces take forty-five minutes, or an hour. Some anesthesia machines take a four-hour inspection.”
Despite such lengthy inspections, Alex was recently scheduled by CAMC to inspect more than seventy pieces of equipment in one day, according to a calendar of assignments which they provided for this article. Even at the minimum of thirty minutes per piece, and with the help of an additional technician tackling half the load, this would mean that CAMC expected Alex to complete more than seventeen hours of inspections in an eight-hour workday.
According to Alex, this is not a one-off scheduling miscalculation, but a pattern of undermining safety precautions that CAMC has perpetuated for years. Since the onset of the ongoing COVID-19 pandemic, many health care workers, including BMETs, have been pushed to the limits of exhaustion. Alex and others now fear that, without support, harm is bound to come to staff and patients alike.
CAMC employs nearly 8,000 health care workers at eight primary locations in West Virginia. Alex is part of a team of less than a dozen BMETs responsible for inspecting 30,000 pieces of equipment in house and another 30,000 pieces off site, according to their estimates.
Each piece must be inspected at least once per year, although equipment with higher risk of harm in case of malfunction may need to be inspected as often as every three months. At a minimum, equipment requires an electrical safety test to prevent electrocution of either clinical staff or patients, but it may also require a performance inspection, conducted using patient-simulation tools, to ensure its accuracy.
According to Alex, supervisors at the hospital system had long fooled staff into disregarding performance inspections altogether.
“When I was new, they would tell me things like, ‘No, this is just electrical safety,’ ” says Alex. “I trusted them and I would go out and do that, and I later realized that wasn’t true.”
Paring down the inspections to just annual electrical safety tests still leaves CAMC with at least 30,000 hours of inspections to conduct each year. With an average 2,080 hours of labor from a full-time employee annually, the hospital system would need to employ more than fourteen BMETs to keep up with even a barebones inspection regimen; according to Alex, CAMC has fewer than nine.
The resulting crunch is predictable. According to Alex, some technicians have responded to the overwhelming workload by cutting corners, sometimes going so far as to report inspections completed for equipment that they were not even able to find.
“It’s only a matter of time that someone gets hurt doing this,” they say.
Alex recalls that, one month, BMETs were driven so hard to complete the inspections of hundreds of infusion pumps that all consideration for normal clinical protocol was thrown out the window in a mad dash to mark the pumps as inspected.
“We’re not nurses, we’re not clinical staff,” Alex says. “But we were going out into these rooms, taking infusion pumps off of patients, putting them on our little cart, putting a sticker on it, taking it down to the floor below . . . and putting it back on new patients with other patients’ blood still on it. That is how determined management is for us to make these numbers, regardless of what we have to do or who gets hurt. All they care about is, ‘Are these numbers made?’ ”
While Alex insists these practices have been going on at CAMC since they were hired, prior to the onset of COVID-19, the ongoing pandemic is now making matters worse. Like hospitals elsewhere, CAMC has received large amounts of new equipment such as ventilators to treat COVID-19 patients, and this new equipment needs both initial and routine inspections. This further increases BMET workloads without necessarily increasing staff.
The Association for the Advancement of Medical Instrumentation, a nonprofit organization dedicated to the development, management, and use of health care technology, acknowledges a gap between the numbers of employed BMETs and the demands of the pandemic.
“Right now, we have a shortage of BMETs in the field, and health care technology management professionals in general,” says Danielle McGeary, the association’s vice president of health care technology management.
McGeary also notes that COVID-19 has introduced a sudden flood of new equipment to many health care providers, some of which from new manufacturers whose maintenance recommendations BMETs may not be familiar with.
“You’re always going to follow the manufacturers’ recommendations,” McGeary explains. “So when different car manufacturers started making ventilators, there could be a new type of ventilator in the fleet, and you would need to follow their recommendations for how to maintain that device.”
But that necessary training, like the necessary staff, was not forthcoming at CAMC even before COVID-19, according to Alex. They describe the negligence of not only hospital management, but outside watchdog agencies at both the federal and state levels.
“I have filed internal safety reports and reports with the U.S. Occupational Safety and Health Administration, West Virginia Department of Health and Human Resources, and the West Virginia Office of Health Facility Licensure and Certification,” Alex says. “Nothing has been done—although the Office of Health Facility Licensure and Certification did show up on site.”
“I have extensive documentation and recordings, which the Office of Health Facility Licensure and Certification would not even look at, closed their investigation and left,” they add. “I have another coworker who has also been documenting and recording, and we were recently informed that, if they catch us doing it, it is automatic termination.”
For its part, CAMC denies any allegations of wrongdoing, underscoring that the Office of Health Facility Licensure and Certification found no evidence of such. In a statement, CAMC spokesperson Dale Witte writes in part:
CAMC takes patient safety seriously, including the proper inspection of equipment. Employees are not permitted to sign off on equipment without proper inspection pursuant to CAMC policy and procedure and manufacturer recommendations.
This complaint was previously investigated both internally by CAMC and by the WV Office of Health Facility Licensure and Certification (OHFLAC) and was found to be unsubstantiated.
The West Virginia Department of Health and Human Resources and the West Virginia Office of Health Facility Licensure and Certification failed to respond to multiple requests for comment for this article.
According to documents obtained from OSHA via a Freedom of Information Act request, a complaint was filed with the federal agency responsible for workplace safety on November 27.
OSHA’s summary of the complaint states that the complainant feared inadequate repairs and inspections could cause equipment to malfunction and harm patients, and they were forwarded to the West Virginia Office of Health Facility Licensure and Certification and the complaint was marked “invalid” as “hazards do not exist.”
“I filed the complaint with OSHA,” says Alex. “I said, ‘I think someone’s going to get hurt someday. I don’t know who it’s going to be. It could be an employee or it could be a patient.’ They told me that that is outside of their jurisdiction.”
Alex similarly had no luck with the West Virginia Department of Health and Human Resources, which includes the Office of Health Facility Licensure and Certification, the state agency responsible for licensing hospitals and other healthcare providers. Emails provided by Alex for this article indicate that Michelle Dotson of the West Virginia Department of Health and Human Resources visited CAMC in mid January, but Alex says nothing came of Dotson’s interviews, meetings, and reassurances.
“I have about a year’s worth of documentation,” Alex says, referring to material they collected corroborating their allegations. “During that meeting, [Dotson] wouldn’t even look at my stuff. She said, ‘Things are going to get better now.’ And they have still not gotten better. I received a letter from the West Virginia Department of Health and Human Resources saying that they were closing their investigation and that there were no violations found. And she didn’t even look at my documentation.”
Alex contemplates resigning—while also accepting that they may soon be terminated for whistleblowing. The situation has already taken its toll on other BMETs.
“We just had another technician turn in his two-week notice yesterday,” Alex says. “Management has no plans on hiring any more technicians. They told us, when they had a little meeting yesterday, ‘You guys are going to have to pick up the slack.’ ”