Denied care at U of I Hospitals

This past Tuesday, I drove to Coralville for an appointment at the University of Iowa Hospitals and Clinics Iowa River Landing facility. I was to see my rheumatologist, the physician who has treated me for severe idiopathic arthritis for 23 years, for a very important visit. But instead of being checked in at the front desk, I was ordered to leave the building and escorted out by Coralville police.

The reason: I refused to wear a mask or a face shield.

It was not out of obstinacy. I had presented a letter from my primary care physician stating that my health issues prevented me from tolerating a facial covering. UIHC staff refused to even look at it.

I last wrote about mask mandates in hospitals in September 2022. While I mentioned my personal connection to the issue, my overall objective was to explore possible conflicts with receiving care for anyone who cannot tolerate a mask. Issues such as anxiety, headaches, sensory disorders, skin conditions and more can make masking such a miserable experience that wearing one is simply not an option, especially in light of declining COVID case numbers and waning hospital admissions.

I am one who cannot tolerate a face mask. Idiopathic arthritis has gone after my spine, causing symptoms that resulted in a significant new diagnosis last May. Shortly before, I’d begun experiencing debilitating headaches whenever I wore a face mask — despite being able to wear them for almost two years prior. Headaches derail my entire day, leaving me nauseated and weak, unable to focus on work. They’re mitigated only by sleep and heavy painkillers that render me unable to safely drive.

For me, mask mandates as a hindrance to care have gone from being a hypothetical concept to a devastating reality. When I first pleaded with check-in staff in July 2022 to not be made to wear a mask, the clerk told me I would need an exemption letter from my primary care provider. But staff at the UIHC Family Care Clinic informed me that my primary care provider, who I’d seen for five years and quite liked, had already refused to issue such a letter — without any consultation at all, let alone a discussion of my symptoms.

That same month, I had a follow-up with a foot surgeon to check on my 12-year-old ankle replacement. Without even greeting me as he entered the room, the physician assistant looked at me and said, “You’re not gonna wear a mask?” When I shook my head, the PA abruptly turned and said, “I’m not seeing you,” and murmured something about his upcoming vacation as he walked away. I continued with the attending surgeon, but the exchange with the PA left me upset. “She is not interested in having a prolonged discussion about her ankle today as she is in some distress over the hospital mask policy …” reads the clinic note.

I saw my neurosurgeon the same day I filed my September mask mandate column. He was cold and unsympathetic about my aversion to masking and threatened to call security if I didn’t wear one. Too exhausted to argue with no hope of prevailing, I opted for the only exception the UIHC officially offers to its mask mandate: A face shield, which has never been approved or recommended by the CDC to protect against COVID on its own.

The face shield was a sheet of plastic with a foam cushion for the forehead and an elastic headband to secure it in place. The inside of it reflected my own movement in a distorted fashion much like a funhouse mirror, causing me to become disoriented and unable to walk without assistance. The pressure on my forehead from the elastic triggered a worse headache than a mask ever had. Feeling defeated, I popped an extra dose of prescription painkillers and left with a searing headache.

There were a few physicians on my care team who were willing to see me without a face covering, for which I remain grateful. But after my primary care provider denied a mask exemption letter without so much as a consultation, I realized that the problems with my care at UIHC weren’t limited to a lack of tolerance for face coverings. They stemmed from a loss of trust — in my primary care provider, in my neurosurgeon, and in the hospital administrators who were clearly tired of my angry feedback.

For the first time in three decades, the University of Iowa Hospitals and Clinics no longer seemed to be the world-class facility I loved. While moving all my specialty care elsewhere would be unwise, I moved my primary care to UnityPoint in December. After several appointments and thorough discussions, my new provider furnished me with a letter that outlined why I couldn’t tolerate a face covering. The letter was accepted by front desk clerks at the UIHC main hospital for a January appointment with a wrist surgeon who had already agreed to see me without a mask.

Because the UnityPoint letter had been accepted by hospital staff, I was shocked — and angry — when I called the rheumatology clinic the day before my Tuesday appointment to be told that it wouldn’t be accepted and I’d be required to comply with UIHC mask rules. The only accommodation available was a tele-health visit, which would have made the necessary physical examinations impossible. (Blood pressure, pulse, and oxygen levels are called “vital signs” for a reason — nine years ago, it was discovered during a vitals check at a routine neurosurgery appointment that I was experiencing a “blood pressure urgency” that required immediate treatment.) I declined the telehealth option and informed the rheumatology clinic that I would attend in person and present my UnityPoint letter.

When I arrived at the clinic, I declined a mask. Clinic staff refused to look at the exemption letter. Security informed me that my appointment was now canceled, and I could either leave or be removed by police. Hoping that they were bluffing, I insisted that I would not leave until I’d seen my rheumatologist and sat in the corner of the large waiting area. After 45 minutes, two Coralville police officers arrived to find the quiet, non-violent, disabled and unmasked patient they’d been asked to remove. Polite and friendly, they walked me to my car. I apologized for taking their time and they assured me that I wasn’t being issued any citations.

Ironically, had the clinic accepted my exemption letter and continued with my appointment, I possibly would have spent less time in the area unmasked than I did while waiting for the police.

“At this time, UI Health Care requires all staff, patients and visitors to wear a face mask while they are in our patient care facilities,” said a spokesperson from the UIHC after I reached out following the incident. “However, with recent decreases in COVID-19 and other respiratory viruses in our community, we are currently in the process of reviewing and updating our safety protocols, including mask requirements.

“In accordance with this commitment to safety, disruptive or aggressive behavior is not tolerated in UI Health Care facilities. We expect patients and visitors to be considerate and respectful to our staff and other patients. As needed, we partner with our safety and security team and local law enforcement to address these concerns.”

The statement doesn’t address the concerns of patients who cannot tolerate a face covering but need in-person care. For questions about any possible exemptions, I was referred to the UIHC Office of the Patient Experience. As of my deadline, my calls and emails have not received a response. I was, however, contacted by a behavioral assessment consultant with the University of Iowa Threat Assessment and Care program, who wanted to speak with me “as a human” to “resolve” the issue. The information provided by the consultant about mask exemption letters was contradictory — to both what the rheumatology clinic stated, and the check-in staff at the main hospital.

It remains to be seen how my own issues as a patient will play out. As a writer, I wonder if others are affected by rigid masking rules. I hope I am the only one — I wouldn’t wish the experience I’ve had on anyone in need of care.

My thoughts remain similar to those I shared back in September: If the UIHC’s mask mandate exists to protect patients, it’s worth considering whether that same mandate in fact causes them harm. And if rigid enforcement is harming others like it harmed me, maybe they should make some changes.

Comments: 319-398-8266; althea.cole@thegazette.com

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