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As a deadly virus started sweeping through a New Jersey pediatric-care facility in late September — ultimately killing 10 children and infecting 19 others so far — health care workers repeatedly asked why the sickest of their young patients were not being transferred out to hospitals.
Two employees of the Wanaque Center for Nursing and Rehabilitation, speaking on the condition of anonymity over fears of losing their jobs, claimed that senior administrators delayed sending kids to the hospital — even as many started dying.
The reason? They said senior staff at the for-profit facility have long been consumed by the need to keep the 92 beds in the pediatric unit full, to keep Medicaid funds flowing.
At the same time, they claimed the facility was chronically understaffed to save money.
“You would be surprised how slow they were to send these kids out, even after the deaths, even after the media knew. They are still delaying,” said one employee.
In fact, as child after child developed what appeared to be a stubborn respiratory infection and spiking fevers as high as 104 degrees, symptoms were merely “masked,” not treated, the workers said. The pediatric workers said staff turned up the air conditioning on full blast in their rooms to bring down their fevers. In addition, they kept giving the children the same medications, even though they had not been effective for days.
“It’s been known for a while that they try to keep the kids there and treat the kids there as long as possible before having to send them out to a hospital … so they have the bed full,” one of the pediatric unit workers said.
The Wanaque Center and other pediatric nursing facilities receive $519.46 per patient per day, and the money stops as soon as the patient is transferred to a hospital, according to the state Medicaid office.
A spokesman for the Wanaque Center declined to comment. Eugene Ehrenfeld of New York, a co-owner for Continuum Healthcare, which operates the Wanaque Center, also declined to comment and hung up on a reporter. Continuum Healthcare operates seven other health care facilities in New Jersey and others outside the state, according to state records.
The kids at the Wanaque Center started getting sick on Sept. 26, when the Department of Health said the first child was diagnosed with a respiratory ailment. It was later determined to be adenovirus, viruses that are rarely fatal and often mimic symptoms of the flu and common cold. While people typically recover in a matter of days, in some cases infections from adenovirus can be life-threatening, particularly to those with weakened immune systems.
Four days after the first child became ill, and still more than a week before the New Jersey Department of Health knew anything about the growing outbreak, 4-year-old Doracase Dolcin came down with a fever that would rise and fall over the next few days.
Modaline Auguste of East Orange, Doracase’s mother, told NJ Advance Media in an interview last week that nurses gave her daughter cold sponge baths and applied ice to break her fever.
“I said, send her to the hospital,” Auguste said. “They said they were waiting for the doctor.”
It was an answer she would repeatedly hear for nearly a week, even after her daughter spiked a 102-degree fever on Oct. 3. On the evening of Oct. 5, Doracase was transferred to Saint Joseph’s Regional Medical Center in Paterson. She died Oct. 8.
Since then, nine others, from toddlers to teenagers, have died.
One employee said there may have been other reasons Wanaque did not want to send children to the hospital for emergency care.
“I think they were concerned about the Health Department being aware. They were concerned about the school that’s in the facility reporting them to the Department of Health,” the pediatric worker said.
Records show the Wanaque Center has been repeatedly cited for deficiencies in hand washing and infection control, both before and after the outbreak, according to state and federal inspection reports. And while the state health department said it may never know how the virus was spread, medical experts say there is a high likelihood that the only way it would have moved from one bed-bound patient to another was by someone who was caring for the kids since the virus is not airborne.
Since the outbreak, many staff members, as well as family members, have complained the facility has been chronically understaffed.
Employees who agreed to talk to NJ Advance Media said the lack of adequate help on the pediatric floor often meant kids left in soiled diapers or routinely left unbathed.
“There’s this one point that keeps coming up — how did it spread to so many patients? One thing is that … we have a history of not having sufficient staffing that we consider to be safe,” said one of those workers.
Debbie White, who heads the Health Professionals and Allied Employees, which represents 70 nurses of HPAE Local 5107 at Wanaque Center, said the nursing staff, both registered nurses and licensed professional nurses, had worked diligently to contain the spread of the disease under difficult circumstances. But, she noted that nurses “have reported a shortage of nursing staff which may lead to poor infection control practices that can put patient safety at risk.”
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She added that the staff had urged the administration to provide adequate supplies to protect patients from cross-contamination including protective gowns, gloves and masks which can reduce patients’ exposure to the virus. A recent state inspection, though, said gowns, gloves and masks were available.
Jacqueline Donker of Kinnelon, the aunt of one of the children at Wanaque who was hospitalized with adenovirus, said she had noticed the facility declined after the new owners, Continuum Healthcare, took over in 2014, with the pediatric unit becoming more run down and the nursing staff cut significantly.
“The owners that took over … let this happen,” Donker said.
In the wake of the viral outbreak, the state Department of Health has launched an investigation, and Gov. Phil Murphy has pledged to find answers. The Senate Health Committee has announced it will soon hold hearings.
The state health department, following its own guidelines for viral outbreaks, state health department spokeswoman Donna Leusner said, did not send inspectors to the facility until two weeks after Wanaque notified the state on Oct. 9 of the outbreak and that two children had died.
But Health Commissioner Shereef Elnahal said his office does not have the legal authority to investigate the medical decisions made by physicians or other Wanaque personnel to keep a child at the facility instead of sending them to the hospital.
For those who cared for the kids, the deaths and widening investigation have left many at the Wanaque Center emotionally overwhelmed, and said the environment inside is bleak. The stench of eye-burning bleach is everywhere. And the children are still suffering.
“It’s excruciating to see the children who are confined to their beds, waiting for the virus to run its course,” an employee said.
Another employee said some kids who are very alert have been “more or less quarantined,” unable to leave their rooms. And several, the worker added, remain in cribs that look like cages.
Both said they feared for their own jobs. “We are risking everything,” one said, of talking to a reporter.
One, who began to cry as she spoke, described the staff as devastated.
“You can’t possibly understand the amount of heartache the staff are going through right now and are continuing to go through as children are out of the facility, in hospitals in critical condition.”
Staff writers Kelly Heyboer, Ted Sherman and Research Editor Vinessa Erminio contributed to this report.
Editor’s note: Do you have a family member on the pediatric unit at the Wanaque Center for Nursing and Rehabilitation, or a child who has been affected by the viral outbreak there? NJ.com would like to hear from you. You may reach us at (732) 902-4559, or write to Susan Livio at [email protected], Spencer Kent at [email protected], or Ted Sherman at [email protected].
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