Texas Hospital Violated Basic Precaution in WHO Ebola Patient Treatment Guidelines

The incompetence of Texas Health Presbyterian Hospital Dallas is staggering. In following today’s rapidly developing story of a second nurse at the hospital now testing positive for Ebola, this passage in the New York Times stands out, where the content of a statement released by National Nurses United is being discussed (emphasis added):

The statement asserted that when Mr. Duncan arrived by ambulance with Ebola symptoms at the hospital’s emergency room on Sept. 28, he “was left for several hours, not in isolation, in an area where other patients were present.” At some point, it said, a nurse supervisor demanded that Mr. Duncan be moved to an isolation unit “but faced resistance from other hospital authorities.”

The nurses who first interacted with Mr. Duncan wore ordinary gowns, three pairs of gloves with no taping around the wrists, and surgical masks with the option of a shield, the statement said.

“The gowns they were given still exposed their necks, the part closest to their face and mouth,” the nurses said. “They also left exposed the majority of their heads and their scrubs from the knees down. Initially they were not even given surgical bootees nor were they advised the number of pairs of gloves to wear.”

The statement said hospital officials allowed nurses who interacted with Mr. Duncan at a time when he was vomiting and had diarrhea to continue their normal duties, “taking care of other patients even though they had not had the proper personal protective equipment while providing care for Mr. Duncan that was later recommended by the C.D.C.”

From the context of both the New York Times article and the nurses’ statement, it seems most likely that this movement of nurses from treating Duncan to treating other patients took place during the period after Duncan was admitted to the hospital and before the positive test result for Ebola was known. However, from the nurses’ statement showing that at least some of the personnel on duty realized Duncan almost certainly had Ebola, proper isolation technique should have been initiated immediately.

And that movement of nurses from a patient who should have been in isolation back into the general patient population is a huge, and obvious, error. Consider this publication (pdf) put out in August by the World Health Organization, summarizing precautions to be taken in care of Ebola patients. The very first page of actual content, even before the section labeled “Introduction”, is a page with the heading “Key messages for infection prevention and control to be applied in health-care settings”. The page lists nine bullet points about dealing with ” hemorrhagic fever (HF) cases” (hemorrhagic fever diseases include Ebola). Here is the third entry on that list:

Exclusively assign clinical and non-clinical personnel to HF patient care areas.

There really is no point in saying a patient is isolated if staff are freely moving back and forth between the isolation area and the general patient population. I’m wondering how long it will be until there is a whole new management team at Texas Health Resources, the parent firm for the hospital.

Many years ago, Jim got a BA in Radiation Biophysics from the University of Kansas. He then got a PhD in Molecular Biology from UCLA and did postdoctoral research in yeast genetics at UC Berkeley and mouse retroviruses at Stanford. He joined biosys in Palo Alto, producing insect parasitic nematodes for pest control. In the early 1990’s, he moved to Gainesville, FL and founded a company that eventually became Entomos. He left the firm as it reorganized into Pasteuria Biosciences and chose not to found a new firm due a clash of values with venture capital investors, who generally lack all values. Upon leaving, he chose to be a stay at home dad, gentleman farmer, cook and horse wrangler. He discovered the online world through commenting at Glenn Greenwald’s blog in the Salon days and was involved in the briefly successful Chris Dodd move to block the bill to renew FISA. He then went on to blog at Firedoglake and served a brief stint as evening editor there. When the Emptywheel blog moved out of Firedoglake back to standalone status, Jim tagged along and blogged on anthrax, viruses, John Galt, Pakistan and Afghanistan. He is now a mostly lapsed blogger looking for a work-around to the depressing realization that pointing out the details of government malfeasance and elite immunity has approximately zero effect.

26 replies
  1. Teddy says:

    I think you’ve missed the obvious Rick-Perry solution, Jim: more deregulation of health care facilities. The Invisible Hand would never move from HF patients to other patients’ care — and if it did, it’s invisible!

  2. Ed Walker says:

    The money in hospitals is spent paying damned fool administrators. This is the really disgusting part of the story: “At some point, it said, a nurse supervisor demanded that Mr. Duncan be moved to an isolation unit “but faced resistance from other hospital authorities.””

    This is why you pay the damned business majors all the money? To get results like these?

  3. Ben Franklin says:

    Thanks to Congress funding for NIH was cut drastically, plus they won’t confirm a Surgeon General.

    These words of assurance…from NBC

    “”I wish we had put a team like this on the ground the day the first patient was diagnosed. That might have prevented this infection,” Frieden added. “But we are prepared to do this in the future with any case anywhere in the U.S.”

    ‘We are prepared’ unlike we were for first US patient, even after Ebola had been raging in W.Africa. Don’t they look at statistical models? Were they so entrenched in the groupthink of ‘zero chance’ that they sloughed it off?

    You be the Judge.

    • lefty665 says:

      Don’t forget President Change=Same (or worse) proposes and Congress disposes. In 2013 O proposed cuts to CDC’s budget and Congress appropriated more money than O proposed. There have been plenty of morons on both sides of the aisle, like Warner running for re-election in Virginia on cutting the deficit.
      .
      Looks like CDC initially thought the dingbats in Dallas had brains. Boy were they wrong! But they knew they were dealing with Texas, and Perry should have been a big red flag.
      .
      Looks like lots of people in denial, from failing to isolate Duncan and those attending him, to the nurse flying, to the NBC doc going out to pick up takeout. Everybody in unison now “Oh no, it can’t be me, even though I’ve been exposed I can’t be infectious.”
      .
      Want to start a pool on how many cases will ultimately come out of Duncan? I’ll take 7.

  4. Ben Franklin says:

    ” Boy were they wrong! But they knew they were dealing with Texas”

    Tell me about it. Texas is the worst place to get sick. My Dad had an episode while visiting, and he had no attending physician. Under Texas regs, Drs wait like vultures at emergency in a dignified line. As people come in, they get patients. The husband/wife team kept him disoriented by controlling his meds. I had to fly in and found sympathetic Drs and nurses who allowed us to discharge while his team was off-duty. I know there are good people in that system, but the system is fubar.

    • lefty665 says:

      Glad you were able to extract him. I’d like an enterprising reporter to identify who it was that resisted the nursing supervisor’s (one of the good ones) push to isolate Duncan. That mofo, and several more, might profit from assignment to the Presby mission in Liberia.

      • seedeevee says:

        My thoughts exactly. Sometimes “naming names” is the right thing to do.

        They will eventually come out in the lawsuit . . . .

  5. earlofhuntingdon says:

    Resistance from hospital administers over putting a patient with ebola-like symptoms in isolation? Couldn’t be out of concern for who would pay, could it? If so, the cost in money and jobs is now significantly higher, the risk to the health of an unknown number of other people significantly greater. Who says Ford Motor Company’s Pinto gas tank-fix formula and Enron- and bankster class morality has not metastasized into mainstream corporate culture?

  6. TarheelDem says:

    The listed CEO’s background, from the Texas Health Resources web site:

    Berdan earned a bachelor of science degree in biology from Texas Christian University in Fort Worth and a master’s degree in business administration with a specialization in hospital administration from the University of Chicago Graduate School of Business.

    And then went through a series of administrative jobs in hospitals from Chicago to Arkansas to Texas.

    • Mary Margaret McCurnin says:

      “Berdan earned a bachelor of science degree in biology from Texas Christian University in Fort Worth and a master’s degree in business administration with a specialization in hospital administration from the University of Chicago Graduate School of Business.”

      Going to undergrad school with Jebus and grad school with the devil.

      • Ina Pickle says:

        Don’t be absurd. “TCU” is a real university, it also happens to be a seminary for the Disciples of Christ. Which is a fairly mainstream protestant denomination. It’s not Jebus, for that you go to Baylor. They actually have required comparative religion courses: in short, they make everyone who goes there find out what the Upanishads are.

        They also have a very well-respected nursing school.

    • P J Evans says:

      Without hearing the calls, or having transcriptions of them, it’s impossible to judge.
      However, it’s supposed to be safe if you don’t have a fever yet.

  7. pdaly says:

    The nurses not only treated Duncan while wearing non-impermeable gowns but they also moved back and forth between his bed and other patients’ beds? Incredible! Crazy!

    And this doesn’t bode well either. From the conference call with the nurses today: “Lab specimens from Mr. Duncan were sent through the hospital tube system without being specially sealed and hand delivered. The result is that the entire tube system by which all lab specimens are sent was potentially contaminated.”
    .
    .
    Those vacuum tubes suck hollow plastic “footballs” through the hospital walls and deliver them to a lab. The tubes blow air around as the plastic football arrives at its destination. Did anything break or leak?

  8. qweryous says:

    keeping up with Texas Health Resources

    Testimony of Dr. Daniel Varga Chief Clinical Officer and Senior Executive Vice President Texas Health Resources to Subcommittee on Oversight and Investigation re: Ebola.

    http://www.nbcdfw.com/news/health/Hospital-We-Made-Mistakes-Deeply-Sorry-279369492.html

    Additional on Dr Varga

    Texas Health Resources selects Daniel Varga, M.D., as chief clinical officer http://www.prnewswire.com/news-releases/texas-health-resources-selects-daniel-varga-md-as-chief-clinical-officer-183819431.html

    Physician joining health system as chief clinical officer in co-leader model designed to advance clinical quality and operational excellence

    ARLINGTON, Texas, Dec. 17, 2012 /PRNewswire-USNewswire/ — Texas Health Resources has selected Daniel Varga, M.D., as chief clinical officer (CCO) and senior executive vice president of the health system, effective Jan. 14. Dr. Varga will be responsible for achieving full and seamless integration of the entire Texas Health clinical enterprise, including quality, patient safety, and patient experience initiatives. He will also oversee physician relationships, clinical integration, care design, and clinical research and education.

    Dr. Varga will work hand-in-hand with Barclay Berdan, the system’s chief operations officer (COO) and senior executive vice president, and they will have joint responsibility for execution of the next phase of Texas Health’s 10-year strategic plan launched in 2007. Both positions report to Doug Hawthorne, FACHE, chief executive officer of Texas Health Resources.

    The CCO position is critical to the strategy of transforming Texas Health Resources from a hospital-centric organization to a patient-centered, fully integrated health system, creating a team of clinical and operations experts working side-by-side at the system and geographic zone levels to successfully integrate clinical care and enterprise operations.

    Confirmed: Drs. Dan Varga, Kim Alumbaugh out at KentuckyOne
    http://insiderlouisville.com/business/confirmed-drs-dan-varga-kim-alumbaugh-out-at-kentuckyone/

    • qweryous says:

      Not to make light of the bungling, but the happy horseshit was really deep just a few months ago. The COO in the previous comment was promoted to CEO in July of this year. Instead of training and equipment apparently everyone has spent years focused on climbing to the Summit of Transformation Mountain instead of worrying about issues like Ebola preparedness.

      Suffice it to say, apparently Texas Health Resources has now peeled off Transformation Mountain in a long forecast storm. It is yet to be determined if whatever protection they had in place held or pulled out.
      .
      .
      Texas Health Resources’ incoming CEO Barclay Berdan tells me his top goals will be to have a smooth leadership transition and to continue the system’s climb up Transformation Mountain.
      .
      .

      That second part refers to Arlington-based THR’s move toward becoming a nationally recognized benchmark health care system and to a redesigning of the system already underway to be well positioned as health care reform plays out over the next decade. THR is in the final three years of its 10-year strategic plan.
      .
      .

      “The task is making sure people stay focused on the strategy that we’ve adopted,” Berdan told me in an interview. “We’re in the final two-and-a-half years of executing a strategic plan — our climb to the summit of Transformation Mountain as we call it internally — and we need to stay focused.”
      .
      .
      New CEO Barclay Berdan plans to continue Texas Health Resources transformation
      .
      .http://www.bizjournals.com/dallas/blog/2014/07/new-ceo-barclay-berdan-plans-to-continue-texas.html

  9. rich says:

    Christ, none of you have any clue how hospitals work and “who” controls beds?
    Nurses control beds.
    Sure blame the administrators but recognize many of those administrators are nurses who failed their profession and “sought” the lucre of “leadership and administration”.
    Plus talk about the art of covering your ass by blaming someone else for your mistakes. Nurses mastered that too.

  10. RUKidding says:

    As with so many other “businesses,” the Med/Hospital business is all about profit and making more money for those at the top of the heap. Almost no one in Hosp Admin gives a flying feck about such trivial issues as curing people or helping them to get well. Why would they be bothered with such trifling piffles when there’s big huge buck$ to be made?

    Go to the Hosp (or your own Doc these days) and witness the plethora of charges for ?? who knows; some are mainly for just breathing the contaminated/contagious air within the confines of the Hosp building. Yeah: Best Health Care RIP OFF in the world!!!11!!

    Good luck to us all, as it’s clear that the greedy morons at the top are just that: greedy incompetent morons. Goes double for the idiot allegedly “running” the CDC. And of course, the moronic greedheads in Wash DC can’t be bothered to figure out how to appoint a US Surgeon General. much more fun to engage in pointless worthless Kabuki Show finger pointing pissing matches.

    Behold: our tax dollar$ at “work.”

  11. Spring Texan says:

    In response to a NY Times article, someone named Jack posted the following:
    “As a medical staff member at Presbyterian Hospital, I’ve witnessed a slow deterioration of quality over the past several years including departures of many of the specialists who once made it a regional referral center. The CEO of the hospital departed in August, with no permanent replacement named as of yet. On top of that, the CEO and COO of the parent organization, Texas Health Resources, have only been in their jobs for around 60 days. A system adrift. Little wonder that no one in the chain of command in the administration knew that most of the specialized protective gear (long impervious gowns, ‘space suit’ head gear, and waterproof knee high boots) the nursing staff should have been wearing were one floor below the ER in the operating room, hiding almost in plain sight. To make matters worse, the chairman of the THR board of trustees is a socialite/philanthropist who splits time between Ft. Worth and New York. Odds of the board ever calling for an independent investigation of what went wrong/who is responsible are slim to none”

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