Alaska workplace safety officers are investigating complaints from nurses at Alaska Regional Hospital that many of them have fallen ill from what they believe are hazardous air conditions at the hospital.

It's the second investigation into the issue by the Alaska Occupational Safety and Health section, after a first investigation this summer found no source for the potential contamination. A new complaint led to the current investigation, which began in September.

More than 30 nurses since April have reported experiencing symptoms including headaches, dizziness, rashes, sore throats, burning lips and eyes, breathing difficulties and other problems, said Amy Brown, a nurse with the hospital, and other nurses.

Many individuals have experienced recurring symptoms, which have largely been felt by nurses on the second floor, she said.

"We've had a nurse pass out and fall over on a patient," Brown said. "We've had nurses with chest pain and cardiac symptoms that have been to the ER."

"It seems to be affecting everyone a little bit differently, and some people aren't having any effects at all," she said.

Four other nurses interviewed for this article provided similar details. They declined to provide their names for this story for fear of retaliation at their jobs, they said.

HCA Healthcare, the Tennessee-based owner of Alaska Regional, said dozens of environmental tests conducted by experts have found no potential source for the problems, a statement provided by spokesperson Brittany Glas said.

"Keeping our caregivers safe is a top priority," the statement said. "We have taken a number of steps to research and mitigate potential air quality issues based on reports from some staff."

The nurses say they're skeptical that environmental testing by the hospital has been adequate, and they worry about long-term impacts to their health.

They just want the problem solved, they say.

The nurses say they believe the illnesses are caused by odorless vapors that might be related to the San-I-Pak system, which sanitizes medical waste on the first floor, or the ventilation system associated with the room the San-I-Pak is in.

A manager with San-I-Pak, based in California, referred a reporter's questions to the hospital's administration office, which did not return calls.

HCA Healthcare said the San-I-Pak and ventilation system in the room are "operating normally" and are "not affecting air quality," based on extensive testing.

At least 16 members of Laborers' Local 341, representing health care workers at the hospital, have reported the symptoms to the union, said Brandon Calcaterra, union president.

Only front-line health care workers have reported the symptoms, the union said in a statement.

Brown, like other nurses, said she is thinking about leaving her job earlier than expected because she keeps experiencing the symptoms, especially after back-to-back workdays.

Things were really hard around Memorial Day, when she developed mouth sores, burning skin and a bloody nose, she said. She lost her sense of smell and taste for about two weeks, she said.

"I was going to try and make it to this spring, but I'll probably leave earlier than that," she said. "I feel like every day I go in, I'm killing myself, so why ask for more health issues?"

Initial investigation

The Alaska Occupational Safety and Health section initially investigated the complaints in May.

The section closed that case in July after finding no "discernible violations" of health and safety, according to documents provided through a public records request.

Relying on results from hospital-commissioned tests, the section could not determine the potential source for the contamination, Adam Weinert, a special assistant to the Labor and Workforce Development commissioner, said in an email.

The section found that the hospital cooperated with the investigation and went to great lengths to find the problem.

But the section also found the hospital was initially slow to respond to employee complaints, records showed.

One shortcoming was roughly a weeklong gap between when employees said they reported complaints to management, and when the hospital initially said it was made aware of the complaints, records show.

Also, available air scrubbers were not in use to remove potential contaminants as of May 3, records show.

William "Dale" Williamson, the section's enforcement chief, wrote that the section believed the hospital initially did not meet legal standards to do everything possible to protect employee health.

"Through conversations with the complainants, employees, and your own management, it is evident that there was an initial delay in following up on employee complaints of a potential health hazard," he wrote.

The section decided it was not appropriate to cite the hospital for the violation, Williamson said.

But he recommended that the hospital take steps to reduce "your employees' exposure to the risk factors."

Workplace safety officer William Keen, in an inspection report in June, wrote although "the employer had originally responded to their employees' complaints hesitantly, they have since exercised every option available to them to attempt to locate the source of their employees' symptoms."

Hospital: Air found to be safe

Glas, with HCA Healthcare, declined requests for an interview with a hospital official. HCA did not directly answer several emailed questions.

All tests over several months "have come back in the normal range," the hospital in a statement.

"We first engaged outside agencies to test the air quality in May, immediately upon hearing reports from our care team members," the statement said.

The hospital has "engaged the fire department, occupational health experts and numerous outside specialists to conduct dozens of tests," the HCA statement said.

"Based on those results, the air quality was found to be safe," it said.

"In an abundance of caution, we refreshed and upgraded the area and disinfected the air handling system," it said.

The testing has been done in consultation with the state workplace safety section, the HCA statement said.

The hospital continues to monitor the air quality and appreciates the patience of its colleagues, it said.

The union statement said the hospital has taken several steps to identify the problem.

The union said health care workers continue to experience symptoms, but the number of those workers seems to have diminished with time. Nurses reached for this article said some of the employees have decreased their reporting because the problem has not been solved after many months.

Second investigation

The state's new investigation, launched in September, involves issues "nearly identical" to the first, said Weinert, with the Labor and Workforce Development commissioner's office.

The case remains open, he said.

The symptoms were initially centered in the pre-operation discharge unit, or PDU, the nurses say.

They later spread to another area, the post-care anesthesia unit, or PACU, they say. That led to the second investigation, the nurses say.

The nurses have collected more than 70 illness claim reports they say were filed with hospital managers by themselves or colleagues over several months. They provided those documents to the Daily News to review.

The complaints say that the nurses sometimes wear N95 masks in an attempt to reduce the symptoms, or even PAPRs, powered air-purifying respirators, that provide filtered air.

"I have a PAPR today but still had dizziness, nausea, flushing, raw throat and slight brain fog," an Oct. 2 report says.

"Wearing goggles and N95," says an illness report from Oct. 16, adding: "tingling lips, mouth, throat, nausea."

The union said in its statement that some of its members have shared concerns that they've been discouraged from "raising issues" or providing clear explanations to patients about why they are wearing personal protective equipment.

Nurses reached for this article say some doctors and patients have also complained of similar symptoms but are less susceptible to them.

The nurses say they believe this is because doctors and patients typically spend much less time on the second floor than nurses working 12-hour shifts.

Questions about tests

Brown and the other nurses reached for this article assert that the hospital should be doing more and has not been fully transparent about the steps it has taken to fix the issue.

An air quality assessment on Oct. 1, performed by a specialist hired by the hospital, did not find levels of concern for 76 volatile organic compounds, according to a report of tests provided by the nurses.

Air tests done earlier in the year also had not found any obvious cause for the complaints, the report says.

The Oct. 1 test was done "overnight, per hospital request, in order to obtain a representative sample of the area without interference," according to the report.

The nurses believe that potential problems with the San-I-Pak or the ventilation system in the San-I-Pak room could be causing their symptoms, if toxins are circulated into the air they're breathing.

The nurses assert that the San-I-Pak system traditionally has not been run much at night.

The waste management system uses high-pressure steam and heat to sanitize medical waste placed in chambers.

It's designed to allow hospitals to manage the waste safely and economically on-site before it can be transported for disposal.

Used needles, bloody gauzes, surgical items and other waste go into the chambers, the nurses say.

The nurses say they're worried they might be breathing hazardous air from cleaning chemicals such as ammonia or volatile organic compounds such as formaldehyde or alcohols.

A complaint about the concerns drew a response in May from federal officials with the Occupational Safety and Health Administration, according to records provided by the nurses.

The complaint alleged that one of the San-I-Pak chambers had been cracked.

The San-I-Pak system was not cracked, a hospital director wrote in a June letter to the federal agency.

There was damage to the ductwork that vents air out of the San-I-Pak room and into a loading dock, the letter says.

A dumpster had hit the ductwork, ripping a gash that was 2 feet long and a half-inch wide, the letter says.

The damage was discovered on May 15 and repaired five days later, the letter says.

The letter also lists actions the hospital had taken at that time to address the concerns, including checking pressure and air flow related to the heating and ventilation system, and finding no abnormalities.

Problem-solving 'ongoing'

Early this month, Brown sent an email to Mark Roberts, the hospital's chief executive, asking if medical waste could be sanitized off-site for a one-month trial period to see if the symptoms would go away.

Other nurses and the union made similar requests to management, the nurses say.

Hospital managers did not shut down the San-I-Pak system, the union said in a statement on Friday.

"The hospital requested that the San-I-Pak maintenance crew inspect it," the union said. "The hospital informed the union that the inspection determined that the San-I-Pak was operating properly."

However, the hospital decided to shift the San-I-Pak function to nighttime hours only, the union said.

Glas, with HCA Healthcare, declined to say when that operation began.

The union has tried to work constructively with the hospital, its statement said.

"We believe collaborative problem-solving is still ongoing," said Regional nurse and Local 341 Healthcare Representative Joleen Corlis in the statement. "Our goal is to ensure our members' health concerns are fully heard and addressed. Healthcare workers deserve a safe and transparent workplace, and we remain committed to working toward that outcome."

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