Dr. Marshall Baca Jr., director of the Emergency Department at Artesia General Hospital and current task force leader and incident commander with AGH’s Incident Command Team, conducted a conference call this afternoon to issue additional information regarding the Artesia man whose death was New Mexico’s first related to COVID-19.
Of particular note was the fact that the man, who was in his 70s, had initially refused testing when he first presented as an outpatient March 18 at Memorial Family Practice and that a medical office in Roswell is being investigated as a potential source of his exposure.
Baca clarified that the man died Monday at AGH after arriving at the emergency room Sunday, March 22, with symptoms. It was initially reported by the New Mexico Department of Health (NMDOH) that the man died the same day he was admitted to the hospital.
Upon check-in at AGH Sunday, the man indicated weakness as his reason for visiting the ER and denied having experienced any fever, cough, or shortness of breath in the last 14 days. As a result, staff at registration as well as members of the nursing team who made first contact with the man were initially wearing only the simple masks AGH has required of all staff since preparations for the pandemic first began.
Baca said he was unsure whether the man’s denial of his symptoms was a result of not understanding the question he was asked.
It quickly became apparent to nursing staff, however, that the patient was indeed in respiratory distress, and at that time, Baca says protocols – including the donning of more stringent personal protective equipment (PPE) – were initiated to protect staff, and a mask was placed on the patient.
All testing indicated the man’s symptoms were consistent with COVID-19, and he was admitted to the hospital, where all necessary protocols were followed. Baca said following the man’s death, the mortuary was also notified of the nature of the situation and proceeded to follow their own protocols pertaining to PPE.
Baca also clarified that he was not present at the time the man presented to the ER, nor was he an attending physician.
As AGH and the NMDOH continue to investigate how the man may have contracted the virus, Baca provided a timeline leading up to his March 22 admittance to the ER.
On March 12, the patient is believed to have visited an outpatient clinic in Roswell, where he was seen by a mid-level nurse practitioner. However, Baca says he has received information – though not yet verified by the NMDOH – that a physician from that clinic is currently in quarantine due to travel to a high-risk area, possibly New York. That is subsequently being investigated as a possible source of infection.
On March 18, the patient was seen at Memorial Family Practice for a cough and respiratory symptoms. Baca said he was identified as a possible candidate for screening upon check-in; staff was notified and proper PPE utilized. The patient was offered testing for flu and strep as well as COVID-19 at that time, particularly due to his age and underlying conditions, and the patient refused.
Baca stressed that the patient was still instructed to engage in home quarantining, as were his family members. He is unaware whether those recommendations were followed.
As for the notification process following the man’s death, Baca called that “kind of an unfortunate series of events,” stating that he was notified of the positive test at midnight Wednesday and instructed by the NMDOH to allow that department to contact the family and initiate a press release prior to AGH releasing any information.
“Unfortunately, that plan did not really come to fruition,” said Baca, stating the family was notified by alternate means.
Baca also said that rumors AGH has not been testing for COVID-19 are untrue. Options exist for both in-house testing, with samples sent to the state, or outpatient testing, with samples sent to either the state or TriCore Reference Laboratories in Roswell.
“We’ve tested approximately, up to this minute, 35 patients in the last two weeks, and this has been the only positive patient we’ve had,” said Baca. “Every other one has been negative.”
As for the hospital staff who came in contact with the patient before his symptoms were identified, Baca said those five employees did not experience what is regarded as prolonged exposure – 15 minutes – but have still been placed on home quarantine for seven days with a requirement to check in daily regarding temperatures and symptoms.
Baca said risk of transmission is considered low for those exposed for less than 15 minutes and reiterated staff were covered by simple masks at the time. Quarantine is not indicated for those individuals who came in contact with the patient while wearing full recommended PPE.
It was also noted that all AGH staff are monitored daily, particularly those who have come in contact with sick individuals. Staff have their temperatures checked and any symptoms evaluated once daily by their respective department directors, and high-risk staff are checked twice each shift.
As of this afternoon, Baca said he was aware of no other cases in Eddy County.
When asked whether the hospital could have required the man to be tested for COVID-19, Baca noted that as long as a patient has “medical decision-making capability,” they have the right to refuse or accept.
Baca also outlined some of the protocols AGH has been following prior to the situation with the positive test case.
The hospital has eliminated access to the general public in order to avoid exposure. Adults needing to be seen are required to enter the hospital alone, while pediatric patients or those needing assistance are allowed one family member only. All elective surgeries have been cancelled, an order that has been in effect for “well over a week,” and AGH has “dialed down” its outpatient clinic visits significantly, leaving it to the discretion of the physician or provider to determine urgent cases.
“So we’ve done a lot of things and implemented screening processes both in outpatient clinics, the ER, Memorial Family Practice, to make sure that our staff is well prepared for a potential respiratory patient,” Baca said.
Baca said AGH feels that, at this time, it is well prepared to deal with this situation. Administrators meet daily, and an individual has been designated to monitor supplies and order more when possible, though the doctor pointed out that medical supplies are low throughout the country, with most being reserved for hospitals containing known cases of COVID-19.
“We haven’t experienced [a surge] yet,” said Baca. “I do feel like it’s probably coming, so that answer might evolve over time, but right now, we feel prepared.”
EDITOR’S NOTE: Dean Schear, CEO of Roswell Family Care, has contacted the Daily Press to state that as far as that particular facility goes, no Roswell Family Care staff members have travelled to high-risk areas or are in quarantine.