Even after two employees tested positive for COVID-19, Belmont Behavioral Health Hospital on the Main Line is still requiring its nonmedical employees to show up for work. Last week, while awaiting those test results, the hospital fired a teacher who insisted on working with Belmont’s juvenile patients online from home.

"I’m not a caregiver. I’m not hired in any psychiatric capacity — I’m a teacher,” said Rich Wexler, who worked at Belmont for more than two years. “I just don’t understand.”

Although most administrative employees are able to do their jobs from home, a number of behavioral health hospitals in the Philadelphia area are requiring them to report to the office.

At Friends Hospital, a Northeast Philadelphia facility run by Universal Health Services, employees in departments such as marketing, finance, and human resources were told they could use vacation days, apply for a leave of absence, or go unpaid if they wanted to stay home. Exceptions were not noted for employees over age 65 or those with medical conditions that could make them especially vulnerable to complications from COVID-19.

Officials with UHS — a Fortune 500 company based in King of Prussia — declined to be interviewed but defended the decision in an emailed statement. “Our employees in infrastructure roles are essential to supporting the work of our front-line care providers at the facility,” said Lauren Centola, a director of business development for UHS.

Gretchen Hommrich, director of investor relations for Acadia, which runs Belmont, confirmed that the health-care system was defining “essential employees” as not just those who provide direct patient care and housekeeping, but also educators.

These decisions appear to be legal under Gov. Tom Wolf’s closure orders. But they have also caused anguish for employees of Acadia and UHS, which together run more than a dozen hospitals in the tri-state area.

“It’s not like we’re looking for a two-week vacation,” said one employee of a UHS hospital, who asked not to be identified for fear of losing a job. "We all are absolutely willing and able to work. All of our jobs can be done remotely.

“We just want to be safe.”

Who is ‘essential’?

On March 19, Wolf signed an executive order closing all “non-life-sustaining” businesses.

“To protect the health and safety of all Pennsylvanians, we need to take more aggressive mitigation actions,” Wolf said. “This virus is an invisible danger that could be present everywhere.”

Of course, hospitals are a life-sustaining business. But Wolf’s order allows hospitals to decide which employees have to report to work.

Denise Keyser, a lawyer with Ballard Spahr in Cherry Hill who represents health-care systems on labor issues, said the language in the governor’s order is key to this latitude.

“They don’t say essential employees, they’re talking about industries,” she said. ”The order appears to allow each life-sustaining business to determine how it’s going to operate and which employees it’s going to require to come in.”

Such decisions are not as simple as they might seem, Keyser said. “There’s certainly another layer or two or three of people who probably are essential but the public doesn’t really see,” she said. Still, she noted most hospitals are leaning toward keeping home all but the most essential employees.

Jefferson Health has encouraged its staff — including physicians involved in telemedicine — to work remotely to make social distancing easier for those who must be in the hospitals, a spokesperson said. Penn Medicine announced plans on March 13 to have all staff “whose jobs do not require an on-site presence" work from home, said Frank Otto, senior medical communications officer. Other teams at Penn are developing staggered schedules “to maximize the social distancing necessary to protect our staff,” Otto said.

Officials at Einstein Medical Center, St. Christopher’s Hospital for Children, and Cooper University Hospital all said employees who were able to work from home were encouraged to do so. Main Line Health implemented “strong language” directing nonmedical staff to stay home, said communications director Bridget Therriault, while the human resources department worked with IT to make sure anyone who needed a laptop or special software to do their jobs had access.

A spokesperson for Wolf said the governor did not intend for hospitals to make everyone an essential employee. “This does not mean that everyone who works in a hospital, and particularly those that may have administrative roles, needs to be at work," Lyndsay Kensinger said in an email.

Andrew Duffy, who represents catastrophically injured workers for the Philadelphia law firm Saltz, Mongeluzzi & Bendesky, said it’s possible that employees who get the virus on the job might seek legal redress.

“I fully expect there to be COVID-related workers compensation and third party liability litigation," Duffy said.

‘One mask for a week’

Acadia Healthcare, the nation’s largest, for-profit owner of psychiatric hospitals, with annual revenues of $3.1 billion, and UHS — one of the richest U.S. health-care systems with annual revenues of $11.4 billion — are typically competitors. Acadia has three psychiatric hospitals in the Philadelphia area, and one in Pittsburgh, while UHS has 13 behavioral-health hospitals across Pennsylvania, Delaware, and New Jersey.

UHS employees told The Inquirer that Fairmount Behavioral Health System in Philadelphia and Brooke Glen Behavioral Hospital, just north of the city in Fort Washington, were initially offering work-from-home options for its nonmedical staff. But after a complaint from Friends Hospital, which was not given this option, all employees at Philadelphia-area UHS hospitals were required to physically report to work.

Centola confirmed that nonmedical workers were not offered remote work but insisted that medical-leave policies allow those with underlying conditions to stay home.

At Belmont, nonmedical staff who said they felt unsafe reporting to work were told they have an option: Resign.

“We classify teachers ... as mental-health workers and hospital personal [sic] and therefore we consider you an essential employee,” wrote Laura Longstreet, the chief executive officer of Belmont, in a March 23 email to Wexler, the teacher. “Should you choose not to come in we will accept your resignation effective immediately.”

Wexler, who has no mental health-care qualifications, says he was perplexed. The governor had ordered teachers to stay home from schools across the state. In an email to Longstreet, he offered to teach remotely: “I am happy to set up a Google classroom and provide work to students in the same vein as study hall.”

After he refused to resign, Wexler says he was fired. Two days later, Jenna Pacini, Belmont’s operations director, sent out an email to all Belmont employees. “This morning we have received notice of 2 confirmed employee cases and 1 suspected [patient] case of COVID19 at Belmont Behavioral Hospital,” it began.

Pacini went on to say that all “exposed employees” would be contacted in the coming days by the Philadelphia Department of Public Health about being tested for the coronavirus or needing to quarantine.

“Until then,” she wrote, “all staff that are not symptomatic should continue to report to work.”

A cook at Belmont, who asked not to be identified for fear of losing a job, said that employees are worried for their own health as well as that of the patients.

“They gave us one mask to wear for a week,” said the chef. “They told us they were reusable. But they are paper masks. I know that they are not.”