Nurses and respiratory therapists on the front lines at Kapiolani Medical Center for Women & Children are now working without a contract and say they are worried about patient care and unsafe conditions during the coronavirus pandemic.

The Hawaii Nurses’ Association, representing about 725 nurses and between 60 and 70 respiratory therapists at Kapiolani, filed three separate unfair labor practice complaints with the National Labor Relations Board on Monday ahead of the expiration of a union contract.

The union says the hospital has failed to negotiate in good faith and is putting workers at risk by requiring them to reuse N95 masks — the industry standard for protecting against COVID-19 — for five days, with UV sanitation in between, before issuing new personal protective equipment.

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“After 10 weeks of bargaining, the parties remain far apart on many important issues, including the union’s proposals to improve the hospital’s pandemic response and to protect the health and safety of employees and patients,” said Dan Ross, a registered nurse and president of the Hawaii Nurses’ Association.

Hawaii Pacific Health, parent company of Kapiolani Medical Center, said it is continuing to ensure it has enough PPE to protect employees and patients and has established a system based on guidelines by the Centers for Disease Control and Prevention, including 3D printing of face shields and UV disinfection for surgical and N95 masks.

While the hospital currently has an adequate supply of N95 masks, “in an abundance of caution” it has not changed the practice on disinfecting and reusing N95 masks “due to continued questions surrounding the availability and effectiveness of adequate replacements,” said Kristen Bonilla, a spokeswoman for Hawaii Pacific Health.

“Now that we see the COVID-19 case counts increasing across the mainland and in other countries, we are concerned that the supply of N95s will continue to be inadequate,” she said.

Still, the hospital has “made it clear to our staff that anyone who has concerns that their N95 is not fitting well due to reuse or extended use can and should ask for a new N95.”

But workers say the hospital has also downsized critical staffing during the pandemic and is requiring them to treat both COVID-19 and noncoronavirus patients during the same shift, increasing the risk of transmission.

“The biggest danger I feel as a respiratory therapist is, our management has been putting their bottom line in front of patient care,” said Ikaika Stricker, a Kapiolani respiratory therapist, adding that the hospital typically has nine therapists per 12-hour shift but has downsized to seven. “They’re constantly looking for ways to cut more and more. We’re running now at a skeleton crew.”

Paulette Vasu, a registered nurse in the family birth center, added that employees “feel unsafe” with the current COVID-19 policies, including limited communication on who has contracted the virus in the workplace.

“They just say I’m low-risk so I don’t need to worry about that,” she said. “Even if a patient tests positive, they’re not calling us and not telling us because we’re all ‘low-risk.’”

The hospital said its PPE policies have been proved effective “as demonstrated by the fact that we have not had any employees at Kapiolani Medical Center for Women & Children test positive for COVID-19 due to an exposure from a patient.”

What’s more, the company said it has made “numerous proposals offering fair and generous terms, especially considering the current environment,” but the union has not agreed to any offer. Kapiolani said it pays registered nurses on average $124,000, while mainland counterparts average $103,000.

Hawaii hospitals say they are dealing with mounting losses due to significant declines in patient volumes. Providers have had to reduce outpatient and elective procedures during outbreaks this year, and many patients have put off surgeries and other procedures. Kapiolani’s emergency room visits are down 50%, compared with the same period a year ago.

“The loss of volume and patient activity has had a significant financial impact on Kapiolani, which is estimated at (a) $21 million (loss) for the period from March through October 2020,” the company said. Hawaii Pacific Health’s loss is $81 million during the same time period, even after receiving about $50 million in federal CARES Act funds, Bonilla said.

Meanwhile, health officials reported 85 new coronavirus infections statewide, bringing the total since the start of the pandemic to 17,925 cases.

The state’s coronavirus death toll remains at 244 with no new deaths reported. The U.S. coronavirus death toll is now more than 267,000 as the nation recorded over 13.4 million cases.

The union says it wants a seat at the table to work with the hospital on best practices during the COVID-19 crisis. It has scheduled an informational picket for Wednesday.

“Our requests are fair and reasonable,” said Ross, adding that the hospital initially proposed no wage increases in addition to cutbacks on retirement and an increase in workers’ portion of medical insurance premiums. “The hospital’s financial performance is not at the same levels as before the pandemic, but now management is trying to offset this on the backs of the nurses, the very ones who have been key to the hospital running smoothly throughout the pandemic.”