In the span of just two weeks, the San Jose Kaiser Christmas Day outbreak sickened at least 77 employees and 15 patients with the coronavirus.

One woman, an emergency department receptionist, died.

Santa Clara County slapped the hospital with $43,000 in fines—$1,000 for every Covid-sick patient Kaiser failed to promptly report to public health officials. The U.S. Centers for Disease Control and Prevention launched an investigation into the superspreader event. As did the California Department of Public Health.

Health officials say the outbreak was one of several throughout the county linked to a new coronavirus variant, whose transmissibility and vaccine-resistance remain unknown.

It’s one of the worst outbreaks in Santa Clara County, which is reporting an average of 1,262 new Covid-19 cases and 19 deaths per day.

Though the official cause of Kaiser’s flare-up is still under review, the hospital has repeatedly cited an unnamed employee as a potential source of the outbreak. In statements to reporters over the past few weeks, Kaiser officials explained that the person’s air-inflated Christmas tree costume may have spewed Covid particles throughout the emergency ward.

“The exact source of the outbreak is under investigation,” Irene Chavez, Kaiser’s senior vice president and area manager, said in a statement to San Jose Inside earlier this month. “A staff member did appear in the emergency department on Dec. 25 wearing an air-powered costume. This staff member did not have symptoms at the time, but subsequently tested positive.”

But state records suggests the problem is far bigger than a single careless staffer.

According to state regulators, San Jose Kaiser is one of California’s worst violators of pandemic safety mandates.

Well before Santa Clara County hit Kaiser with financial penalties for late reporting earlier this month, Cal-OSHA fined the South Bay hospital $85,375 for seven offenses, four flagged as serious. The penalties stemmed from violations reported last spring, in the early days of the pandemic.

Kaiser disputes all the charges.

But it’s worth noting that Cal-OSHA levied some of the same late-reporting allegations recently raised by Santa Clara County.

Records filed last fall for incidents reported between March and June also accuse the San Jose hospital of, among a slew of other things, failing to alert Cal-OSHA about Covid-19 cases in a timely manner, using unauthorized cleaning chemicals and for inadequate policies to limit aerosol-transmissible disease exposure.

State regulators also say Kaiser failed to sufficiently train its San Jose employees on how to prevent the spread of Covid-19, failed to investigate exposures to the disease and failed to equip staff with the powered-air-purifying respirators needed to perform life-saving procedures on coronavirus patients.

The problems appear to be widespread in the Bay Area-based healthcare company, which operates medical centers throughout the state.

Cal-OSHA has cited a little more than 100 businesses for Covid-19 violations since the pandemic began. Kaiser hospitals make up 10 of those cases overall—with two of the company’s facilities ranking in the Top 10.

The San Jose hospital at the center of the Christmas Day outbreak places seventh.

Kaiser Oakland is eighth after Cal-OSHA issued $78,300 in fines for five violations.

No other Bay Area hospital—or business, for that matter—comes close.

Besides Kaiser, no employer in the nine-county region broke into the Top 10 of Cal-OSHA’s index of violators.

The San Leandro Kaiser faces $87,500 in fines for—again, among other things—“failing to establish, implement and maintain an effective respiratory protection program in multiple instances” and “failing to ensure that employees used respirators” suitable for “high-hazard procedures … and suspected cases of Covid-19.”

Like its Kaiser peers in other jurisdictions, the San Leandro hospital was also accused of failing to notify staffers who had “significant exposures to Covid-19” and failing to give them “post-exposure medical services.”

Cal-OSHA also charged the hospital with “failing to immediately report” an employee’s hospitalization for Covid-19, which regulators call “a repeat violation.”

Kaiser’s Redwood City Medical Center faces $39,685 in fines for similar allegations. Cal-OSHA charged the hospital for a lack of respirators and multiple failures to investigate, document, report and notify staff about significant Covid-19 exposures.

Cal-OSHA fined Kaiser’s Behavioral Health Center in Santa Clara $11,200 for five violations. “Employer was cited for not fit-testing employees for respirator use and for not notifying employees of potential exposure incidents,” according to a Cal-OSHA summary of the violations. The agency also alleges “improper record-keeping” and ineffective controls to prevent the spread of Covid-19.

In Santa Rosa, Kaiser was ordered to pay $55,350. In a log of the violations, Cal-OSHA wrote that the hospital was cited for “not implementing screening protocols for employees or patients entering the facility for Covid-19 symptoms.” The fine also relates to the hospital neglecting to investigate coronavirus cases, notify staff and offer required medical services to people exposed to the virus.

Kaiser in San Francisco faces $16,400 in fines; Kaiser Antioch, $56,000; Kaiser Lancaster, $5,000; Kaiser San Diego, $1,535; Kaiser Ontario, $18,075.

While Cal-OSHA casts the hospital corporation as a routine violator of safety standards, Kaiser officials deny every single allegation.

“Each of these citations is under appeal by Kaiser Permanente and as such they should not be considered final determinations,” reads a statement emailed by a hospital spokesman. “They stem from allegations early in the pandemic, as healthcare systems including ours grappled with national shortages and evolving public health guidance.”

The hospital also points a finger at labor unions.

“Early in the pandemic, some advocacy groups undertook efforts to file OSHA complaints as part of their campaign to advocate for change in the then-current regulatory guidance—and filing complaints against Kaiser Permanente provided high visibility for these efforts,” the email goes on to state. “We understand that, but it doesn’t take away from the great work that has been done to care for our patients, keep our staff safe and comply with federal, state and local public health guidance under unprecedented circumstances.”

This article has been updated to include additional comments from Kaiser about the Christmas Day outbreak and how the official cause remains under investigation.