Documents obtained by the Courier-Herald and an official inspection report from the Washington state Department of Health and Human Services reveal how quickly COVID-19 spread through the Enumclaw Health and Rehabilitation Center while family members of clients were denied information about the number of positive cases.

It was reported at the beginning of this month that Enumclaw Rehab had a total of 12 positive cases of the novel coronavirus — 10 residents and two employees — but EmpRes Healthcare, the facility’s parent company, declined to release updated numbers in the following weeks.

It appears Enumclaw Rehab’s first cases came before the week of March 23, as three COVID-19 tests were pending that Monday, and all three were confirmed positive COVID-19 infections the following Tuesday, according to documents detailing communications between the rehab center and St. Elizabeth Hospital.

On March 26, another three patients showed symptoms of the virus, and on the following day, Enumclaw Rehab had set up two isolation wings inside the building.

A March 26 email from Jennifer Scott, the executive director of Enumclaw Rehab, confirmed that 10 clients and two employees tested positive at this time.

Over that weekend, a total of six residents needed hospitalization and were transferred out, though it was unclear how many, if any, were treated at St. Elizabeth.

By March 31, 21 patients tested positive for COVID-19 at Enumclaw Rehab.

Another 10 patients were reported having symptoms, but tested negative.

At that time, the rehab center had a total of 33 positive cases, and of those, a dozen clients were transferred to either St. Elizabeth, the St. Joseph Medical Center, or Highline Medical Center.

By April 3, the total positive case count had risen to 39. The entire facility was under quarantine, and 49 of their maximum of 57 clients remained. Of those, 26 had COVID-19, and two were in “full code,” according to documents.

The Courier-Herald has not received documents pertaining to additional communications between both health facilities after April 3.

‘FACILITY FAILED TO TAKE APPROPRIATE ACTIONS’

An April 16 report from the Washington Department of Health and Human Services claims that Enumclaw Rehab “failed to take appropriate actions related to a COVID-19 outbreak,” the report reads, taking information from interviews, record reviews, and an on-site visit on March 26. “These failed practices may have contributed to multiple residents and staff contracting COVID-19.”

Among those unsuccessful practices included failing to notify the state Department of Health when numerous employees exhibited COVID-19 symptoms; that EmpRes told staff to not put roommates of symptomatic patients “on any isolation precautions” unless they also exhibited symptoms in order to conserve personal protection equipment, two staff members told investigators; and multiple patients were put in isolation a day after they started showing symptoms of COVID-19, according to the report.

The report states 38 residents tested positive for COVID-19 on April 2, as well as five employees, information what was not included in the documents regarding communications between Enumclaw Rehab and St. Elizabeth Hospital.

The report also states that five residents had died by that point, although it’s unclear if that number includes any patients that may have been sent to another facility before dying.

According to the on-site visit, inspectors observed a housekeeping staff member walking down the facility hallway carrying their face mask, looking for guidance on how to disinfect and bag the mask. They were then aided by administration and left the building. However, it appears the staff member later re-entered the building both without their mask and without being screened for signs of COVID-19, as per CDC guidelines, according to the report.

Inspectors observed that nurses were being screened in the 500 unit of the facility, “the epicenter” of its COVID-19 outbreak, the report said.

“The only thermometer available… was an oral thermometer, so the surveyor had to remove their face mask to be screened for the presence of a temperature,” the report said. “When questioned regarding the use of an oral thermometer, Staff A stated, ‘That’s all we have.’”

Health and Human services also investigated an anonymous March 19 report that “the facility is in lockdown yet they are admitting patients from St. Elizabeth Hospital in Enumclaw where the coronavirus has affected a patient.”

The department noted two residents were admitted to Enumclaw Rehab on March 13, and a third was re-admitted to the facility from St. Elizabeth Hospital on March 17.

The full document can be viewed at the end of this article, or at https://www.scribd.com/document/458678576/WA-DSHS-report-on-Enumclaw-Health-and-Rehab-s-COVID-19-procedures

‘I THOUGHT SHE WAS SAFER THERE’

According to the communications between Enumclaw Rehab and St. Elizabeth Hospital, Enumclaw Rehab staff believed that clients and their families would choose to remain at the facility during the outbreak, telling hospital administration that it did not think clients would be transferred to local hospitals en masse.

Multiple conversations with family members of clients over the past month show that information was not reaching them about the number of positive COVID-19 cases at the facility.

“When we ask [for] the number of patients who have the virus, all they would say is ‘many,’” Martin Skagen, a relative of a Enumclaw Rehab client, said in an April 9 interview. “They wouldn’t say numbers, they’d just say ‘many.’”

Skagen said he was told his relative tested positive for COVID-19 on April 1, and died April 8.

“Once they tested her and she tested positive, they suggested we just leave her there because she’d probably get better care there than at the hospital, whatever that means,” Skagen said. “So we trusted their judgment, but maybe it was the wrong thing to do. I thought, being in Enumclaw, so remote, I thought she was safer there than more urban areas. But apparently not.”

Jim Daly, the nephew of another client, had a similar experience.

“When I called a couple times to ask how she’s doing, unless I’m the person with medical power of attorney, they won’t tell you anything,” Daly said in an April 13 interview. “I’m sure they’re concerned — officially concerned — about patient privacy, but the fact is, you don’t know what the conditions are. They’re being well hidden, and we might well have taken her out of there before she contracted the virus.”

Daly said his aunt was only at Enumclaw Rehab for a couple of months, and died April 11 from complications related to COVID-19.

Despite being so removed from more populated cities like Kirkland, where COVID-19 hit the Life Care Center hard, Enumclaw has the highest positive COVID-19 test rate in the county — nearly 579 positive tests per 100,000 people — as of April 26. As of that date, there have been 70 total positive tests.

Enumclaw also has the highest death rate at just over 172 deaths per 100,000 residents, despite having fewer deaths (21 as of April 26) than Kirkland, Renton, or Redmond.

The King County Department of Health said it was unable to provide an interview when asked about Enumclaw’s high COVID-19 positive test and death rate, “as we are focused on the crisis response,” but added that, “the rate in Enumclaw is driven by cases that are associated with long term care facilities in the area.”

Enumclaw Rehab did not provide a comment for this article by press deadline.

WA DSHS report on Enumclaw … by Ray Still on Scribd