Nurse's plea for 'HELP' spurred urgent response at overwhelmed Riverbend, emails show

Apr. 23--An April 8th email reveals just how bad -- and desperate -- things had gotten inside the Riverbend rehabilitation and nursing home in Kansas City, Kansas.

The facility had its first two COVID-19 cases just one week before. And the infection was quickly working its way through the 135 residents, many of them elderly or in poor health, as some employees fled.

"We now have 61 confirmed cases with 7 deaths," a Riverbend nurse wrote in the email, which was sent to a former boss who works in public health. "Majority of clinical staff has quit, housekeeping department has quit. ... Wyandotte County has not been helpful in assisting us with this. The Kansas Dept. of Health has not been able to help us. We are in a complete crisis.

"The residents are very very sick, and the death toll has just begun."

The subject line of the email simply said: "HELP"

The public first learned of a coronavirus outbreak inside Riverbend Post Acute Rehabilitation on April 3, and since then almost daily reports of more deaths and more cases have come out of the KCK facility. Specific information on what's going on inside, though, has come through filtered comments from county health officials and daily updates from Riverbend that often highlight the positives but don't include the number of cases and deaths.

Emails obtained by The Star through an open records request show that it wasn't until the nurse's April 8 email that county health officials had a full understanding of how dire the situation was and the toll it was taking on the overwhelmed staff.

The dozens of emails from March 31 to mid-April are between Riverbend leadership and health officers in the Unified Government. They detail the growing needs for testing, staffing and other resources.

Riverbend has the largest COVID-19 outbreak in the state. Twenty-seven people who tested positive for the virus have died, accounting for more than half of the deaths in Wyandotte County and nearly 25 percent of the state's total. As of Wednesday evening, 119 cases of the coronavirus were connected to the facility and eight residents were hospitalized. Of those cases, 25 have been staff.

Cory Schulte, the executive director of Riverbend, responded Tuesday evening to The Star's list of questions regarding the emails and concern voiced by the nurse over what was viewed as a "complete crisis" inside the nursing facility.

He did not address specifics of how many staff members had left or current staffing levels, but acknowledged "that there have been times during the course of this COVID-19 battle where we have been challenged -- in staffing, with securing the volume of supplies needed, and with getting our arms around the issues presented by this virus."

He also defended the work done by the facility and health officials in the face of tremendous challenges posed by the coronavirus in a nursing facility.

"We have never seen anything quite like this in our history -- a virus that can be spread by asymptomatic carriers for days on end," he wrote. "We have shut down our country over it, and are wearing masks to buy groceries, and experts don't have a treatment or a vaccine. To suggest that one skilled nursing facility and one County Health Department in the State of Kansas should have had all the answers under the circumstances seems unrealistic ..."

The Riverbend nurse's email on April 8 provided first-hand details and a greater sense of urgency than had been publicly announced. It explained the issues that a thinning staff -- from both resignations and illness -- was creating.

"Our DON (Director of Nursing) and Director are filling in where needed whether that is on the floor, or doing housekeeping," she wrote. "We have had some nurse leaders come and help with supervision of the units, but it is still not enough."

The nurse wrote that they needed help, the desperation clear.

"Do you have any suggestions? Will the governor be able to do anything?" she asked her former boss, thinking that person might be in a position to help. "You are the only person I know that may have some insight. Thank you for your help."

Four minutes after getting the email, the man who received it forwarded the communication to Dr. Lee Norman, secretary of the Kansas Department of Health and Environment, and Dr. Allen Greiner, Wyandotte County's chief medical officer. That person told the two health leaders: "I know these are very trying times but I felt you should see this."

By the end of that day, Greiner had shared the email with others in the Unified Government.

"Very concerning," wrote Greiner as he shared the nurse's email. "I will be going out to Riverbend tomorrow morning for the 9am meeting.

"I realize that might not be possible for many of you. But this is a mess."

Getting mixed messages

Emails alone don't capture the extent of communication between health officials and Riverbend leadership during the early days of the outbreak. There were phone calls and meetings that also took place, county health officials said.

Details from some of those exchanges have been shared with The Star. Others have not.

What's clear, according to emails and an interview with Greiner about the released information, is that the words from the Riverbend nurse prompted officials to ask more questions and go directly to the facility to see what was going on.

In the days before that email, Greiner said health officials were "getting mixed messages" on staffing needs at Riverbend.

"I think we had heard some concerns from them, but I don't know that we had a complete sense of it," he said in an interview with The Star on Tuesday.

County health officials learned of sick residents at Riverbend on March 31, according to the emails.

That's when Schulte reached out to Terrie Garrison of the Unified Government's health department.

"We have around 12 fever, respiratory cases pop up in the last couple days here at our facility," Schulte wrote in a 10:47 a.m. email. "We haven't received any COVID 19 test results back as of yet but are obviously concerned. We were wondering if you all had access to help us with COVID testing, PPE supplies or anything else helpful for our facility?

"We have tried to reach out to other avenues at the health department with no success. Let me know if there is any help you can provide."

The next day, April 1, Riverbend leadership contacted the health department again, with news that one resident and one employee had tested positive for the virus and 20 tests were pending, according to information the health department released last week.

On April 3, county officials announced that 17 residents and two staff members at Riverbend had tested positive for the coronavirus.

"I am pleased to report that we are seeing improvements in several of these patients, and are so grateful to our talented Facility team for their focused delivery of care," Schulte wrote in an email to The Star that night.

On April 6 and 7, emails show that the UG health department and Riverbend staff -- including nurses and human resources employees -- communicated several times about staffing and employees with symptoms of the coronavirus.

Employees were calling in with symptoms ranging from fever and body aches and cough to no sense of taste or smell.

Combine the sick staff with those who resigned, and there were concerns about having enough people to work. But late on the evening of April 7, there was a message from Riverbend that seemed to indicate that those worries may have subsided. At least for awhile.

"As you are aware, many of our staff walked out of the facility when the COVID first started," Maureen Purvis, Riverbend's director of nursing, said in an email to Elizabeth Groenweghe, chief epidemiologist with the Unified Government. "As of today, we have been able to gain some control over the situation but also realize that we are not out of the fire yet."

On the evening of April 8th, after Greiner had been sent the nurse's email and he had forwarded it to his staff, Richa Jackson, clinical manager with the Unified Government health department, responded that there was "clearly some miscommunication at the facility."

"We offered to bring in other parties, but in today's meeting they declined and stated it was under control. So, I'm a little confused at this point," Jackson wrote in an email. She then added to Greiner, about his visit to the nursing home the next morning, "please be careful, we need you healthy and safe."

Jackson also said that Riverbend leadership had mentioned the housekeeping staff had quit, and that health department officials put them in contact with cleaning services.

"The clinical staff quitting is news to me, they said only a few had left. Terrie (Garrison) brought a good point, where is corporate in all of this? ... We are in communication with KDHE it sounds like we just need to take over the situation and move ahead because we can not get clear answers out of the facility."

Chad Keetch, chief investment officer for Ensign Group, the holding company under which Riverbend and several other nursing homes operate, said he could not comment on specific questions about the Riverbend situation but said an Ensign subsidiary has been helping local operators to acquire personal protective equipment and other supplies.

'Emergency help to Riverbend'

By the morning of April 9, according to the figures that had been released to the media at that time, Riverbend had at least six deaths and 56 coronavirus cases. Forty-eight of those cases were residents.

Greiner went to Riverbend for the 9 a.m. meeting.

"We don't always make site visits," he told The Star. But the email from the nurse "took it to another level for us."

He remembers hearing Schulte say that morning that he'd already had three people threaten to resign and "20 people call in sick, but we're not sure if they have COVID or not."

That brought home the need.

"I don't think we had heard something like that, where someone is giving us concrete numbers on like, 'Here's how many people that we are short.' ... Part of it is, they were trying to make due," Greiner said.

By 9:18 that morning, Greiner emailed Ron Starbuck, with emergency preparedness in the UG's health department.

"They are very very short staffed here and need emergency personnel -- nursing, aides, physical and occupational therapists, and especially a cleaning crew," Greiner wrote to Starbuck. "Their entire cleaning crew has resigned. Can you please put in a request this morning to the state?"

At 9:37 that morning, Greiner emailed Starbuck again saying there's an urgent need for thermometers.

Then, five minutes later, Greiner wrote in an another email:

"We need to get emergency help to Riverbend."

Greiner and others with the county health department worked the phones and corresponded through emails, making sure the facility had the resources it needed.

"I think they were very relieved by the end of the day Friday," he told The Star.

Schulte said he was grateful for the help of Greiner and others in the county and their guidance during "a very challenging time."

"We reached out to nurses who worked for other facilities in our immediate area and temporary staffing agencies, many of whom answered the call and showed up ready and willing to work," Schulte said in his written reply to The Star, which was also signed by Purvis, the director of nursing.

"Frankly, remembering these moments is emotional for Maureen (Purvis) and I -- this is especially true when it comes to those who volunteered with a heart full of love and a willingness to serve in a facility with a known presence of COVID-19 and a media spotlight on it.

"Our gratitude to those individuals is not capable of being captured in the written word."

Schulte hinted in his email how the virus had affected those who work at Riverbend early on.

"Staff that were found to be positive were dealing with their own health issues; over 20% of the remaining staff across departments reacted with fear and anxiety about the potential impact of the virus on them personally," he wrote.

"This was a significant blow, as you can imagine."

Residents in the facility have now "returned to their baseline" and are recovering, Schulte said. Staffing is back on track and several employees who contracted COVID-19 have recovered and are back at work.

Yet the nursing home is far from in the clear. Two more deaths and three new cases were reported Wednesday and hospitalizations didn't decrease.

It's unfortunate that the staffing issues happened, Greiner said, but Riverbend has stabilized. It's hard to see what has happened in the past three weeks, as the virus overwhelmed one facility, he said, despite all the efforts to stop or contain it.

"I just wish this would have all turned out very differently," Greiner said. "It's been a super sad circumstance, certainly for the families, these patients and even the staff that are there, who weathered all the storm and had to watch all of this first hand. I'm sure it's been horrible."

Schulte said Riverbend's leadership and staff all needed to "act and react for the benefit of our patients," adding that the evolving situation required everyone to respond "quickly and competently."

"And I maintain we did just that," he said. "Were we perfect? No. Did we do the very best we could with the circumstances that we were in? We did."

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