To some longtime staff members at Maui Memorial Medical Center, the April 6 revelation that at least 15 employees had tested positive for COVID-19 — and the maelstrom of controversy and recrimination that followed — was as predictable as it was distressing.

“The administrators cut corners, cut dollars wherever they can,” said Aaron Bear, a registered nurse in the facility’s intensive care unit. “They’re top-heavy with people who promote the image of Kaiser Permanente but don’t have any empathy for the staff, patients or community. I’ve said that the way they do things is a danger to our Maui community, and that has proven to be true.”

Maui Memorial is operated by Maui Health System, a subsidiary of Kaiser Permanente.

As of Tuesday the number of people connected to the COVID-19 cluster at Maui Memorial stood at 36 staff members and 20 patients, including a 65-year-old man with underlying chronic conditions who died Monday.

Many employees learned about the cluster when they arrived to work April 6, and over the next two days conflicting messages, quickly shifting policies and miscommunication and misunderstanding combined to raise tensions among staff and administrators, according to Maui Memorial workers who spoke to the Honolulu Star-Advertiser.

Much of the upheaval had to do with the use of masks and other personal protective equipment, access to which has been tightly controlled by management, the employees said. The confusion led to what the employees described as a chaotic situation at the entrance to the Wailuku hospital and at temperature stations where employees are screened before entering.

Union representative Joel Emerson, a registered nurse, said he spent several hours working with staff, administrators and the hospital’s human resources department to clarify the policy and resolve complaints.

“At one point there were three (policy) changes in four hours,” Emerson said. “But that’s because we were learning new things. Things were changing by the hour, and we were all trying to keep up.”

Specific questions regarding Maui Memorial’s management of the situation were sent, by request, to Maui Health’s director of strategic communication, Lisa Paulson, to be passed along to Kaiser Permanente administrators. Paulson forwarded as a response a news release about the arrival of a team of experts from Kaiser’s COVID-19 national command center to assess hospital operations, establish a local command center and assist in improving communications internally and externally.

In a cost-cutting move for the state, lawmakers passed a measure in 2015 authorizing privatization of the Maui Region of the Hawaii Health System Corp., which included Maui Memorial, Kula Hospital, Lanai Community Hospital and associated clinics. Kaiser Permanente, based in Oakland, Calif., but with a long history of providing health care in Hawaii, was selected to operate the community hospitals.

After a protracted delay involving logistical concerns and lawsuits by the Employees Retirement System and United Public Workers, the managed-care organization took over operations of the Maui County hospitals in July 2017.

To experienced nurses and other longtime workers at Maui Memorial already wary of being absorbed into Kaiser’s multistate network, the changes seemed readily apparent. Before long, employees and their union representatives were airing grievances about what they perceived to be an erosion of care at the facility.

UPW placed a full-page advertisement in the Maui News last year criticizing Kaiser for sacrificing quality of care and safety while spending millions of dollars in transition subsidies provided by the state on “aesthetics and moneymaking departments.”

“Under the state, (the hospital was) stepping up; it was pretty top-notch,” said Rose Kroner, a registered nurse who has been with the hospital for nearly 30 years. “Then Kaiser came in, and the priorities changed pretty quickly from quality patient care to cost-cutting and the bottom line. It’s been penny-wise and dollar-foolish since then.”

Kroner, 58, said the current turmoil is rooted in Kaiser leadership and its emphasis on cost control.

She said that while nurses in her department were allowed to wear masks, personnel in other departments were not provided any and were not initially allowed to bring their own protective gear from home. The masks, gloves and other protective equipment that used to be available in every hospital room in the event staff needed to deal with bodily fluids or other hazards had been removed, Kroner said.

Prior to a recent change in policy allowing all employees to wear appropriate protective equipment, Kroner said nurses who were not treating COVID-19 patients were left to attend to patients with open wounds and other potentially hazardous conditions without protection.

“If you want to fight the spread of coronavirus, they should have them,” Kroner said at the time. “It kills me that the whole administration mindset is we’re dispensable. They have the PPE in their offices, and we have to beg and plead for it.”

Kroner said attempts to raise concerns have met with threats and intimidation by management. Similar complaints were raised by Kaiser nurses in California, according to news reports.

“They came in here with their mainland attitudes,” she said. “No respect for nurses. It’s just ‘my way or the highway.’

“I’ve seen heads roll,” she continued. “The threats and intimidation and fear factor work because they’re the only show in town. They know it and we know it.”

On April 13, Bear, who has been with Maui Memorial for 11 years, initiated an online petition calling for CEO Michael Rembis and three other top administrators to resign. The petition surpassed its goal of 5,000 signatures in the first three days. This week Maui Memorial staff took out a full-page ad, again in the Maui News, criticizing hospital leadership.

State Sen. Roz Baker, who represents West and South Maui and is chairwoman of the Commerce, Consumer Protection and Health Committee, said current criticism of Maui Memorial management may be due, in part, to a “grass is always greener” mindset.

“When the state was administering, there were plenty of complaints about resources,” she said. “People sometimes get nostalgia about what used to be. Whenever Kaiser or the state needs fiscal controls or constraints, when people can’t access what they think they have a right to, you have complaints.”

State Sen. J. Kalani English of East Maui said the criticism also overlooks what he considers substantial improvements to health care on the island as a result of Kaiser’s involvement, including the recruitment of needed specialists, expansion of facilities and programs, and training of University of Hawaii-Maui College health care students.

State Sen. Gilbert Keith- Agaran, whose district covers Wailuku and Kahului, said he believed the errors in judgment that may have contributed to the COVID-19 situation were made with the right intentions.

“Hindsight is always 20/20,” he said. “I have no doubt that (hospital management) acted in good faith to follow CDC guidelines and best practices. The truth is there is a shortage of PPE, especially in rural areas.”

Agaran said the hospital has since received additional protective supplies, although more are still needed.

Emerson, the union rep who transferred to the hospital in February, said he has been encouraged by recent changes by hospital management.

“There has been more communication,” he said. “It’s not just daily updates from the top down, but more access, being able to bring issues to the top level.”