The MaineGeneral Medical Center in Augusta, pictured in 2013. Credit: Troy R. Bennett / BDN

The Augusta hospital that came under fire for offering early coronavirus vaccines to donors last month had been cited by the state earlier in January for violating COVID-19 prevention protocols.

Inspectors from the Maine Department of Health and Human Services found a range of violations during a visit to MaineGeneral Medical Center, including some problems they had previously noted in November 2020 that went uncorrected by early January.

Nearly 10 months after Maine saw its first coronavirus case, for example, a number of MaineGeneral employees were reporting for work in the emergency department without going through screening for virus symptoms and receiving clearance to work, according to the inspectors’ report.

On Jan. 4, inspectors observed six of 22 employees use a staff entrance into the emergency department without going through screening, which the hospital said workers can do either with cellphones or at a computer station in the building. At the emergency room’s main entrance, inspectors saw one of three staffers enter without going through required symptom screening.

When inspectors asked a surgeon how he performed his symptom screening, he replied, “No one has stopped me in months, so I don’t know.” Asked whom he would send his screening to to receive clearance to work, he said, “I don’t. I don’t have a supervisor.”

MaineGeneral is one of eight hospitals the state has cited for violating COVID-19 prevention rules since last summer. Inspectors found that some of those hospitals weren’t fully screening employees and visitors either. The state has generally inspected hospitals to test compliance with COVID-19 rules when inspectors have been called to the facilities to look into any type of complaint. MaineGeneral is the first hospital the state has cited since September.

Jennifer Riggs, the hospital’s chief nursing officer, said hospital staff have been learning new information and adapting to new protocols throughout the pandemic.

“The survey findings have given us opportunities to further strengthen our processes, and we have responded accordingly,” she said.

While hospitals haven’t been identified as a major source of coronavirus infections, lax symptom screening in other settings has been blamed for some of the largest outbreaks Maine has seen during the coronavirus pandemic.

At Maplecrest Rehabilitation and Living Center in Madison, an outbreak began after an employee put in an overnight shift in August despite reporting that she had a sore throat, a cough, chills and muscle aches — common symptoms of COVID-19. That outbreak infected 40 residents and staff at the nursing home, and killed seven. The staffer was the parent of a guest at an early August wedding near Millinocket linked to 180 cases across much of the state.

At the York County Jail, a wedding guest who worked as a correctional officer put in eight-hour shifts for five days while showing coronavirus symptoms, leading to an outbreak that infected 48 inmates, 43 employees and 16 family members of employees. The jail only implemented symptom screening requirements after the outbreak began.

Riggs, MaineGeneral’s chief nursing officer, said the hospital has tightened its screening procedures since the Maine DHHS inspection.

“We have re-communicated and hold managers accountable for employee symptom screening before they enter a MaineGeneral facility,” she said.

State inspectors also found some instances of MaineGeneral employees not wearing masks in areas where they were required to, including in a shared office. In one case, a housekeeper was cleaning a patient room without a mask while the patient was there.

They also found waiting room chairs in the emergency room spaced less than 6 feet apart, as they had two months earlier. Inspectors observed a number of examples of staff not maintaining appropriate physical distance from others.

Riggs said the hospital has focused on “re-educating and recommunicating” so staff and patients understand the hospital’s COVID-19 policies. The hospital has also moved waiting room seats 6 feet apart and has signs asking staff and patients not to push them together. There are also new signs throughout the hospital spelling out COVID-19 policies, she said.

MaineGeneral drew criticism after the Bangor Daily News reported in January that it included roughly a dozen donors who were aged 70 and older in an initial 40-person vaccination test group before vaccines were widely available to older people. Nirav Shah, the director of the Maine Center for Disease Control and Prevention, said it risked a “perception of inequity.”