Medical director of Henrico facility where 40 have died: ‘We feel like we’re the experts in treating COVID-positive patients’

On the day Canterbury Rehabilitation and Healthcare Center in Henrico’s Far West End suffered the 40th COVID-19-related death of a resident – the second most of any single facility in the United States – the center’s medical director championed its ability to serve infected patients.

“We feel like we’re the experts in treating COVID-positive patients now,” Canterbury Medical Director Jim Wright said during a far-reaching 40-minute press briefing at Libbie Mill Library.

Only one other facility in the nation has experienced more deaths than Canterbury – the Life Care Center of Kirkland, Washington, with 43 – but Wright termed the virus’s rapid spread through the center as something that “no facility, no group could have been prepared for.

“Being an expert in an incurable disease doesn’t mean you can cure it.”

Canterbury has reported a total of more than 120 infections among its residents – 40 of whom have died – and 25 among staff members, all of whom Wright said have recovered. He described the latter as a positive, since the assumption is that people cannot contract this strain of the virus twice, meaning those staffers now can work with COVID-positive patients without fear. (In the coming week, the center will participate in a new test that may be able to identify people who have developed immunity.)

“It’s not a great niche to be in, but it’s the niche we’re in,” he said.

During his session with reporters, Wright struck a variety of tones:

• mournful, saying that that center has “been fighting a battle with COVID-19 for the past month now. And it is a battle that at times we feel we are losing.”

• annoyed, suggesting that government fines levied against nursing homes with operations infractions are “stupid” and “ridiculous” (Canterbury has not been fined, but the Life Care Center in Washington was fined $611,000 by the Centers for Medicare and Medicaid for a number of failures leading to, and continuing during, that center’s outbreak.

• critical, blaming past and ongoing staffing issues on the fact that the center is disadvantaged by the Medicaid reimbursement funding structure (“It is a chronic problem in not only our facility but any publicly funded facility to maintain appropriate staffing,” he said.)

• positive, suggesting that the worst of the outbreak is over ("The atmosphere now is one of hope," he said. "The residents see that we are nearing the end of the process.")

At the same time, Wright seemed to acknowledge that the center is likely to witness more deaths, saying that it is “under less of a crisis, taking care of patients who are dying.”

Despite the overwhelming number of deaths and virus cases at the center, Henrico Health Director Danny Avula praised Wright and the Canterbury staff’s response to the outbreak.

“The folks at Canterbury Rehab. . . have adopted new infectious control practices and have done everything in their ability to contain this virus,” Avula said. “As we’re seeing here and as we’re seeing all over the country, that job has proven to be incredibly difficult.”

Mixed messages from county officials
Avula’s tone was in contrast to that of Henrico County Manager John Vithoulkas, who April 2 issued a not-so-veiled criticism of the center through a message to the other 40 senior communities in Henrico.

“My message to [senior facilities] is, when we knock on your door, let us in,” Vithoulkas said. “When we call, pick up the phone.

“We knocked on the door initially [at Canterbury], and the reaction was not positive.”

Vithoulkas was frustrated initially by the fact that Canterbury officials did not respond to a visit from Henrico officials offering help after the facility’s first positive case of the virus became known, though he said the tone quickly changed in the following days.

But Friday, Avula said that the county’s health department had interacted smoothly with Canterbury staff from day one.

“From the get-go, Canterbury notified us of the very first case that they had of COVID-19. And we have been involved with them,” Avula said.

Wright chalked up the general government’s initial frustration to a misunderstanding.

“There was a visit from the county during our most critical phase of the crisis,” he said. “They rightly so wanted to discuss our response and how they could help. We were not able to accommodate that request because...we were dealing with a crisis and staffing shortage and simply didn’t have the bandwidth to sit down with them and talk with them. I think it was as simple as that.”

'Unfortunately, we continue to have deaths'
Canterbury, formerly known as Lexington Court, has been under new ownership since mid-January, when New Jersey-based Marquis Health Services purchased it for just more than $8 million from an organization operated by Graham Adelman (the son of its founder, Louis Adelman, who built it in 1980). Marquis hired a new administrator, Jeremiah Davis, just two months ago.

Although Canterbury experienced staffing shortages prior to the outbreak of the virus and even more afterwards – when some employees feared for their own safety and didn’t come to work – things are better now, Wright said. Marquis Health has filled positions with nurses and staffers from other states, staffing agencies have provided others and the VDH provided 20 nurses at one point to help test residents for COVID-19, he said.

“My sense is we’re up to where we should be with our staffing today,” Wright said. “Unfortunately, we continue to have deaths.”

But Canterbury staffers have learned more about the virus and how it can affect the at-risk population, he said.

“We know that not only in our population but in this particular population around the country, if someone develops life-threatening symptoms – usually that’s the viral pneumonia, where you’re having severe shortness of breath, low oxygen levels, coughing – that is not curable.

“We at first were hoping that hospitals could do something to extend the lives of those people with the viral pneumonia. So initially, we were sending a lot of those people to the hospital. We found that every one of those patients died on the ventilator within two to five days.”

From that point forward, he said, facility officials have suggested to families of residents with similar cases that “there is nothing that the hospital is going to offer to your loved one to extend their life” and that remaining at the center – comfortable around familiar faces and friends – may be a more desirable option than dying among strangers in an unfamiliar place.

Later in his remarks, though, Wright appeared to contradict himself, when describing how he has witnessed some patients recover.

“If their immune system is up to the job, you can get them to fight it off,” he said. “I’ve seen that. We’ve been able to keep people going through a viral pneumonia and come out the other side with the palliative measures that we’re doing.”

‘We are going to see this over and over again’
Canterbury officials have not been able to conclusively determine how the virus was introduced to its site, but Wright suggested that it either came from an employee or a visitor and that the former was most likely, since the facility has nearly 150 part- and full-time workers.

During a press briefing April 2, Henrico Health Director Danny Avula said that Canterbury had notified all 147 of its employees that they must work only for Canterbury if they want to continue in their roles.

But at Friday’s briefing, Wright indicated something different.

“We were working and continue to work with a number of staff that circulate between buildings,” he said, though some of those employees were told by the other senior communities at which they work that they were not welcome there after testing positive.

Asked what he would have done differently in retrospect to address the virus, Wright said he would create nursing homes with private rooms for each patient (those at Canterbury have roommates); ensure proper staffing levels; pay nurses enough so that they didn’t need to work at multiple facilities to make ends meet; and provide greater access to the outdoors.

“I would have a nursing home funded by a society that puts more emphasis on treating our elders the way they should be treated,” he said. “When we as society see that it is appropriate to warehouse our elders, to underpay their staff so that there are chronic staffing shortages – if we see that that is an adequate treatment of our elders, then we are going to have a bad time. We are going to see this over and over again.

“This will not be the last untreatable virus to decimate our elders.”