Community testing for coronavirus in Hamilton County — home to the state's fourth largest city — "is improving but still needs to reach more people," according to Rae Bond, the area's COVID-19 Joint Task Force chairwoman.
The fact that Bond's announcement, which included the county's first offer of drive-through, symptom-free testing, came just this week is an outrage — and not just from the standpoint of public health. In the very real and much larger view, this is about our livelihoods.
Hamilton County is stunned with temporary layoffs as a result of social distancing and stay-at-home orders to slow the virus' spread, and testing is needed to give government and employers confidence to resume commerce. Yet this new offer of testing emphasizes that we have just begun to try to quantify the extent of the virus here.
Not until Monday did Erlanger Health System agree to begin sending outpatient COVID-19 tests to the new county lab at Baylor School, 17 days after the lab opened. As of Thursday afternoon, the region's trauma center had sent just 26 samples — and only from its UT Family Practice Clinic, according to Barbara Kennedy, Baylor's director of external affairs.
We know the negative impact of not testing enough.
"For eventual recovery, we're going to need more community testing and hopefully get to the point where people who don't have symptoms can be tested," Bond said via teleconference Wednesday. "That's a big issue that we'll be following up with."
The simple truth is testing got off to a slow start in Hamilton County. Even Tennessee Gov. Bill Lee expressed frustration with the dearth of testing here when he visited on April 3. It now appears that it also took pressure from our local state legislators to push Erlanger to use Baylor's lab.
Last week, Republican Sen. Todd Gardenhire, chairman of the coujnty's legislative delegation, became fed up with the testing logjam and Erlanger's reluctance to use Baylor's lab that opened with $1.5 million in Hamilton County money — money that will be reimbursed by the state with some of the federal COVID-19 funds.
Some state leaders already knew, though the public did not, that Erlanger — the region's largest hospital — had been a holdout, choosing instead to send its tests to commercial labs with which the hospital contracts. Those labs, in turn, were sending the tests out of town — a turnaround of about seven or eight days, Gardenhire said. The Baylor lab has about a one-day turnaround.
That's not a small difference when we're talking about either contagion or lay-offs because of that contagion. Gardenhire, after asking a lot of questions, came to fear that the real reason might be money.
The senator raised that concern — one he said he'd already voiced to Erlanger CEO Will Jackson without getting an answer — in an email on April 10 to a Brentwood company, PathGroup, which works with Erlanger for pathology physician services.
"It raises the question of why do people have to stay in the hospital that long to get the results back. Who benefits from longer stays in the hospital. If the public is looking to me for answers, I'm going to do my best to find out and correct the problem ... Someone is not telling the truth and I want to find out who. ... If pushing for the truth brings a solution, I'm for it," Gardenhire wrote.
On March 27, the Baylor lab opened. Since April 9, CHI Memorial, Hamilton County Health Department (which partnered with Baylor), Parkridge Medical Center and Rhea Medical Center have been sending test samples to Baylor, according to Baylor's Kennedy. But not Erlanger.
In early April, Gardenhire and others in the delegation had begun an inquiry.
When Gardenhire contacted Erlanger, he said CEO Will Jackson told him the hospital had to rely on the advice of the hospital's pathologists. Later, however, in a private meeting with COVID-19 Task Force members, lawmakers were told there was "jealousy in the hospital's pathology department" that led to Erlanger's decision to stick with its contracted labs rather than "a high school lab," Gardenhire said.
He and Sen. Bo Watson sought written confirmation of accreditation from federal and state health regulators for the Baylor lab. Tennessee Commissioner of Commerce and Insurance Mainda Hodgen responded on April 8 this way: "Baylor went through the exact same application process that a [L]ab [C]corp or [Q]uest would go through and they met the criteria. From what I was told, the CLIA [Clinical Lab Improvement Amendments] clearance is huge."
As a lawmaker, Gardenhire knows the long fingers of health care alliances — Rep. Yusuf Hakeem, D-Chattanooga, this week termed it "relationships" — so the delegation began asking questions about PathGroup, which employs both Erlanger's head of pathology and Parkridge's head of pathology. You'll recall that Parkridge is using the Baylor Lab.
In an April 8 email, PathGroup president and CEO Ben W. Davis wrote to Gardenhire: "I understand that you have expressed concern about COVID-19 testing at Erlanger Health System in Chattanooga and implied that PathGroup may have had some direct and nefarious role in the institution's decision not [to] use Baylor high school for hospital patient testing. I want to assure you that such decisions about laboratory testing for hospital patients are always made independently at the institutional level ... ."
So it appears that Erlanger's CEO pointed to the hospital's pathology department, headed by a PathGroup doctor. But PathGroup pointed to Erlanger's administration.
Gardenhire, after a couple of follow-up phone calls with Davis, memorialized those conversations in his April 10 return email to Davis:
"For everyone to spend so much capital (including the $1.5 million from the Hamilton County government) and not see Erlanger Hospital use this site [the county lab at Baylor] makes me leery ... ," the senator wrote. Referring to the "jealousy" angle, Gardenhire added, "You used the same terminology in your email to me on April 8th, and here are your exact words: 'Baylor high school.' ... I've been told by the President of Erlanger, Dr. Will Jackson, that the decision ... is up to the pathology department. You tell me that it's up to the Erlanger staff. I'm getting different stories here and I need to know who to believe in the future. Credibility is the issue in the future."
Before finishing the email, Gardenhire was told — a fact he noted in that same email — "I now understand that for some reason, Erlanger will now start using the Hamilton County Lab, which is at Baylor."
Gardenhire pushed the button on that email at 2:59 p.m.
Later that evening, in a 7:08 p.m. email, Erlanger's spokeswoman made it official — sort of.
"Erlanger will start using the Baylor lab for our outpatient testing on Monday," Erlanger spokeswoman Pat Charles wrote in her April 10 email, noting that tests for hospital patients would still be sent to a contracted lab because Baylor lacks capacity to handle all of the hospital's and community's test samples.
On Friday, Charles responded to Times Free Press requests for comment about the delays and financial concerns. Her statement did not address our specific questions.
"We are very appreciative that the Hamilton County Health Department and Baylor School partnered on providing lab services to our community. Erlanger is currently using the Baylor Lab, in addition to other labs, providing quick turnaround and allowing us to provide best care for our patients."
Baylor's Kennedy said the county lab at Baylor has processed 930 tests as of Thursday afternoon. The lab has the capacity to do 500 samples a day.
This is a lot of words to explain at least a part of ridiculous delays in helping residents in this region get tested quickly for COVID-19 — an illness that in a matter of weeks has resulted in 34,575 deaths and 22 million layoffs nationwide.
Hakeem, who feels that the delegation still has not "been given the whole picture," minced few words about his thoughts on our largest hospital's delay to send a portion of its tests to the county's new lab.
"The bottom line is that I feel like money was part of this process. Money was being put in front of the necessity to get tests done in a speedy way," he said.
We certainly hope not, but one way or the other, it should not have required Gov. Bill Lee's frustration nor our local legislative delegation's questioning to bring Erlanger to the local testing table.
We expect more from the hospital that touts itself as having our backs.