Turns out Texas was a really bad place for our first imported Ebola case.

[kestrel91316]

http://www.cnn.com/2014/10/14/health/texas-ebola-nurses-union-claims/index.html?hpt=hp_t1

Nurses at Texas hospital: 'There were no protocols' about Ebola

On the day that Thomas Eric Duncan was admitted to the hospital with possible Ebola symptoms, he was "left for several hours, not in isolation, in an area where other patients were present," union co-president Deborah Burger said.

snip

A nursing supervisor faced resistance from hospital authorities when the supervisor demanded that Duncan be moved to an isolation unit, the nurses said, according to the union.

snip

After expressing concerns that their necks were exposed even as they wore protective gear, the nurses were told to wrap their necks with medical tape, the union says.
"They were told to use medical tape and had to use four to five pieces of medical tape wound around their neck. The nurses have expressed a lot of concern about how difficult it is to remove the tape from their neck," Burger said.

snip

"There was no one to pick up hazardous waste as it piled to the ceiling," Burger said. "They did not have access to proper supplies."

~~~~~~~~~~

So tell me again how this is all CDC's and Frieden's fault.

[Downwinder]

1. Parkland, Methodist, and Baylor have Level I Trauma Centers.

Last edited Wed Oct 15, 2014, 12:56 AM - Edit history (1)

Presbyterian's is not rated.

[Thor_MN]

21. Trauma has little to do with infectious disease.

It's unknowable if they would have done better.

[etherealtruth]

68. What in the world does trauma have to do with this ...????? n/t

[The Magistrate]

2. That Was My First Thought Hearing The Initial Report, Ma'am

I expect they would do better in Mexico City than Dallas.

[kestrel91316]

11. So do I, sir.

[KittyWampus]

3. The trashing of the CDC is coming from Republicans. For sure once CNN started on that bandwagon...

The Republicans and their austerity, budget cutting and lack of concern for public health WILL eventually contribute to a some sort of epidemic. Hopefully not ebola. Hopefully not anything if we can get people to understand how important it is to fund government and public health facilities.

[kestrel91316]

5. We've had some frothing-at-the-mouth CDC trashers right here on DU.

I won't name names, but they were thick as thieves here yesterday and today.

[LisaL]

6. Didn't CDC claim that hospitals in US are ready for Ebola?

I certainly seem to recall something like that.

[dbackjon]

67. All hospitals should be ready

The CDC can send out guidelines to do training etc.

But if a tight wad administrators don't fall those protocols then how can you blaime the CDC?

[liberalhistorian]

69. And there are, unfortunately, far more

tightwad administrators throughout the nation than there are sensible ones. It appears people on other threads this morning are far too naïve about that little fact, thinking that hospitals are now going to open the wallet because the scrutiny is too high. I say bullshit. Hospital administrators will still only think of money first, and those run by counties with tight budgets will have the worst problems. Most administrators are penny wise and pound foolish, even with the lights of the nation trained on them. That is not the CDC's fault, the CDC cannot have people in every single hospital and clinic in the country ensuring that all of their protocols are followed every second.

[Tweedy]

83. the CDC relied on the hospital's ability to treat patients appropriately

There are 5,723 hospitals in the U.S. The CDC has 15,000 employees deployed throughout the U.S. and the world. The CDC wrongly expected hospitals to follow their basic duties, like ensuring a treating physician obtains the full admitting history of the patient being treated. This needs to occur every time whether Ebola is a possibility, or never existed. Medical tape on the neck is not appropriate protective gear, and that hospital should have known it. There are good hospitals in Texas; this particular one was awful in this situation ANDit was not the nurses' fault, or the CDC's. Expecting a hospital to follow basic protocols is not expecting too much. This hospital should be thoroughly investigated. Perhaps Lt. Gov. Abbott should rethink his attacks on medical malpractice lawsuits.

[CTyankee]

89. everybody is thrashing around with this thing. It's so damn scary, there's a temptation to

start pointing fingers first and think later...this is a toughie...

[LisaL]

4. Well, I dunno.

Even CDC admits they should have send a big team down there right away instead of just assuming this hospital could handle an Ebola case.
But I guess they are totally blameless here.

"DALLAS — The director of the federal Centers for Disease Control and Prevention said on Tuesday that the agency planned a more robust response to any future Ebola cases in American hospitals, saying for the first time that quicker and more concerted action on its part might have kept a Dallas nurse from becoming infected by the virus."

http://www.nytimes.com/2014/10/15/us/cdc-says-it-should-have-responded-more-quickly-to-dallas-ebola-case.html?_r=0

[Tweedy]

84. Yes, the hospital failed

The hospital failed its patient and its workers. The CDC will properly ensure that failure ends. We have never had a CDC large enough to run every hospital in this country. When we do, it would be appropriate to blame the CDC for something like this. Until that happens, blame the administrators at that hospital who were in charge of ensuring health care workers had the information and tools they needed. Otherwise, nothing will change and this will happen again. Next time, it might be a patient dying during an operation because the surgeon did not know the patient ate too soon before surgery, or had an allergy. The failure to get the admitting history to the treating physician is the original sin here.

[moondust]

7. "The nurses at the hospital are not members of a union, officials said."

I wonder if any nurses in Texas are unionized. Probably illegal or made de facto illegal by political tricks.

[LeftInTX]

72. I don't think they are

[vlakitti]

8. Texas? Somehow

this whole story is emblematic of Texas, for me. Totally fucked up on every level, and that beyond recognition.

No nurses's union? Who could possibly have guessed?

[kestrel91316]

10. I knew from the start that this was going to end badly.

And as soon as I heard about the sick nurse I knew that the hospital had failed to train staff and probably threw all the CDC alerts and guidelines and communications in the freaking trash.

I must be psychic.

[LisaL]

19. I knew it way before I heard about a sick nurse.

As soon as decision was made to leave Mr. Duncan in a regular hospital instead of transferring him to one of the four special ones.

[SoCalDem]

58. He was a foreign, black man with no insurance

They probably just stuck him wherever...and when they found out how contagious he was, they probably prayed about it..

[Dorian Gray]

59. Yep

You really told everybody so. ::Sarcasm::

[Tweedy]

85. Some things work in Texas

It is not all bad in Texas. The state did have strong protections for home buyers which minimized the cost of the housing bust there. On the other hand, kids in Texas pledge allegiance to the republic of Texas and its flag every day in school.

[MontyPow]

9. TexAsses, all hat no brains

[defacto7]

12. People expect instant experts?

on Ebola?

It's a learning experience for everyone from CDC to local nursing staff let alone hospital execs. and law officers, and it will continue to be so for a long time.

There are no experts on Ebola... not yet.

[kestrel91316]

13. Well, there certainly won't be any if you COMPLETELY IGNORE ALL

GUIDELINES AND COMMUNICATIONS FROM CDC, the best minds in the world when it comes to Ebola.

And nobody is going to learn a damned thing if they get ZERO TRAINING.

What, does every fucking person in the medical profession have broken fucking google fingers??? The information everyone needs to stay safe is right there on the CDC's website in plain fucking English. Time to get off some lazy, entitled asses and get proactive about your Ebola education, folks, instead of expecting Mommy and Daddy to spoon feed it all to you.

Hell, I probably know more about Ebola than most American medical "professionals" because I pay attention and read stuff without being required by law or on pain of losing my overpaid job. And that's not just disgraceful. It could lead to the deaths of unimaginable numbers of people.

No fucking wonder Frieden says more are likely to get it. Jesus H. Christ on a truck trailer.

[vlakitti]

35. Thanks. I appreciate it when people get the tone

right. And you sure did.

[annabanana]

74. What YOU said!! ^^^^^. . .n/t

[Ilsa]

96. Reading is a good start but training must

go beyond reading the website. Practicing putting on clean gear, then safely removing soiled protective gear, is a big deal. Resources and training are critical.

[jtuck004]

14. People expect hospitals to have solid protocols against deadly diseases that might walk in the

front door at anytime. They don't expect shortcuts that save money for the owners and expose patients and workers to deadly diseases they should not have been exposed to, as the carelessness above shows.

In medical work we have protocols we have to follow, and it looks like the hospital - which would be the owners and the people making the profit-making decisions - may have fallen down on that. Too bad no one will go to jail, but perhaps there will be a large lawsuit to get their asses off their pillows.

[kestrel91316]

18. I know I sure expect infectious disease protocols and compliance with them.

But then I have a freaking microbiology degree.

All the hospital has are corporate bean counters. Who need to be forced to clean that damned hospital on their fucking knees with no PPE if it takes them an entire year.

[xocet]

32. The Great State of Texas will have no truck with your ostentatious book learnin'. n/t

[hedgehog]

76. Ah, yes, cleaning. Most disinfectants require a residence time of several minutes

once they are sprayed on a surface if they are to actually kill microorganisms. Watch hospital cleaners some time - spray and wipe, spray and wipe. They are under the gun to get so much done within a certain time. I guess hospital managers have never read the instructions on the disinfectants they use.

[defacto7]

39. Agreed...

"People expect hospitals to have solid protocols against deadly diseases that might walk in the front door at anytime"

And that is my point. We expect solid protocols... professionals... for everything from a broken toe to Ebola. The broken toe usually can be taken care of, Ebola is not within the reach of a perfect protocol that will protect everyone or anyone. We just don't know... yet.

I'm not protecting the owners and stock holders, I loath those who would choose the buck over humans, but expecting even the best professional hospital staff to know everything there is about this disease and how to deal with it even with the best knowledge available is not realistic.

As professionals educate themselves on the subject, the general public had better do the same. And the information will change.

[kestrel91316]

42. If a penniless nursing student in Liberia can safely treat her whole family

at home with only trash bags and a handful of masks and gloves and plastic sheeting and a gallon of bleach for protection, then a hospital in Dallas MUST be expected to be able to do the same with a single patient.

Running Ebola-filled bodily fluid lab samples through a tube system instead of hand-carrying to avoid contaminating said tube system? WTF is THAT about?????

Covering up unprotected skin with freaking adhesive tape instead of providing proper PPE????? Are you kidding me??

Holding an Ebola suspect in a public area with other patients for HOURS while arguing that isolation was NOT necessary??? Give me a freaking break.

The death penalty is too good for these people (and I mean the negligent admins and decision makers).

[LisaL]

45. CDC guidelines don't call for all skin to be covered.

Look at these graphics. The head isn't covered. Naked neck is not a problem. So why do you have a problem with it?

http://www.nytimes.com/2014/10/13/us/cdc-will-offer-more-ebola-training-to-health-care-workers.html?_r=0

[defacto7]

46. Maybe the penniless nursing student in Liberia

after showing us how to treat Ebola successfully can teach hospitals how to deal with staphylococcus.

[kestrel91316]

48. She probably can. I doubt the hospitals in Texass, at least,

have bothered to do even cursory infection control training.

She's proof that it isn't rocket science.

"God damned feds ain't gonna tell US how to do things! No sirree!! We're gonna keep doin' 'em the way we always have."

[Dorian Gray]

60. "She's proof that it isn't rocket science"

How is that so? Can you explain what you mean by that? Thanks.

[LisaL]

63. One persond didn't get infected using garbage bags.

So apparently the logic hear is that nobody should get infected if they use garbage bags.
Which is mind boggling.
This woman could have had immunity to Ebola.

[lapislzi]

66. Don't be ridiculous

The nursing student avoided infection because she probably diligently, painstakingly, followed the exact same procedures every single damn time she nursed her infected family members. Maybe she has natural immunity. That's anyone's guess, and is in no way assured or assumed.

It is not rocket science. You might wish it was. It is tedious, boring, time-consuming, uncomfortable, impatient work. And it must be conducted flawlessly every single time. The urge to skip steps as being overkill (ha!) or unnecessary must be overwhelming. And I would guess that one can only learn to perform these procedures perfectly, robotically, by practicing over and over and over.

Fact is, if a nursing student could stave off infection by using garbage bags, surely a hospital in the developed world with much better equipment and supplies could do it--only more so. That's the point.

[FSogol]

64. Here ya go

[LisaL]

54. Per CDC, proper PPE is a gown.

Neck/head being covered is not required.
It's a gown, mask, face shield or goggles, and gloves.
Sounds like by taping the neck, employees were trying to go above CDC guidelines.

[Tweedy]

86. Tx gop at war with medical malpractice cases

Not if Lt. Gov. Abbot has anything to say about it.

[kestrel91316]

16. And in case you hadn't noticed, Ebola has been around for

nearly 40 years. I learned about it in freaking COLLEGE as an UNDERGRADUATE and I'm almost 58 now. And this epidemic has been in the news for MANY months.

If people don't like learning how to deal with infectious diseases they need to leave the medical professions. Right fucking now. Before their utter lack of professionalism kills somebody.

[defacto7]

28. And it seems after all that intelligence and education

you still know very little about Ebola. If you were that read-up on the subject you would know at least that much.

Sure we need health professionals who educate themselves and are prepared, but neither you nor CDC nor scientists in microbiology have Ebola figured out.

I suppose your real rant is about the "bean counter" execs. and on that point I agree but lambasting the workers because they are not up to your standards is ludicrous. You, me, the CDC... no one knows what we are up against and the only truly total protection... well... there isn't any.

Following protocol is all we have and yes, people had better do it and stay informed. And the information will change.

[kestrel91316]

38. While I think the nurses and other staff could have exercised far more common sense,

based on what we know so far about how Duncan was handled, I feel that the vast bulk of the blame lies with the grossly negligent hospital administration for ignoring CDC guidelines and failing to train staff.

You'd think Ebola had come completely out of left field instead of after having been warned about repeatedly and at great length by CDC.

Those nurses should have been screaming bloody murder to OSHA and CDC from Day One. I certainly hope at least some were. If none did, that reflects poorly on them, though perhaps being in Texass they don't know that OSHA exists, or even CDC.

[defacto7]

41. Agreed.

I hope this is a lesson that is taken seriously across the board. There will be more lessons I'm afraid.

[valerief]

53. Yeah, I guess 40 years knowing about it isn't long enough. nt

[defacto7]

56. Honestly...

probably not. And we really don't know about it yet. I should probably say "them". We don't know about them yet... there's more than one variety and we don't even know how may varieties there are. It is very unstable and easily mutates much like the flu. The information will change.

[mwrguy]

15. Who knew that a ten-gallon hat wasn't acceptable protective gear?

[annabanana]

75. (ha!). . . . . .n/t

[Downwinder]

17. Might be time to think which local hospital ER you would or

wouldn't go to in a similar situation.

[kestrel91316]

20. Well I live in a blue state and we have an excellent, highly functional public health

department and I am on a first name basis with several of the medical and veterinary staff there. I still might prefer treating myself at my cat hospital, rofl, over the private hospital down the street.

But in Texass?? Good god. Remind me to never set foot in that state. It's a death trap for sure now.

[LisaL]

22. Well, we do travel to other states every now in then.

So if you think you are safe, I guess you better think again.

[Downwinder]

23. There are 18 Level I trauma centers in the state, don't judge

them all by a for profit one without even a Level IV rating.

[kestrel91316]

29. I'm going to assume, for my own protection, that all hospitals in Texass

are run by RWers who refuse to do a damned thing CDC recommends, out of sheer spite ad hatred of the feds.

I hope they choke to death on all the money they made by cutting corners on staff training and putting CDC guidelines into practice.

Filthy corporate fuckers.

[LisaL]

33. Pretty naive to think that this problem exists solely in TX.

Don't you think?

[Tweedy]

87. Pick a good hospital

Every state, and every region has its bad hospitals. Good idea to do the research before you are ill, or need surgery.

[orleans]

24. why was this patient sent to that hospital? n/t

[LisaL]

30. He wasn't send there. He showed up there.

Twice.
First time they let him go. He came back after several days.

[orleans]

37. oh god--i've heard a lot of horror stories about hospitals (e.r.s) sending people

home the first & second time they show up.

[Tweedy]

88. No insurance, no Medicaid expansion

He had no insurance. Texas has refused to accept Medicaid expansion.

[kestrel91316]

31. Probably a corporate policy of some sort designed to maximize SOMEONE'S profits.

I mean that's why everybody there does anything. It's a money-grubbing regulationfree and commonsenseless free-for-all, apparently.

[Skittles]

25. Texas never misses an opportunity to embarrass itself

[Kablooie]

26. The hospital said they had just recently trained the staff in Ebola protocols.

and once again management lies and blames their underlings for their own deficiencies.

[LisaL]

27. They did have a seminar.

[jtuck004]

40. Did the seminar include the fact that they were furnishing insufficient protection, I wonder?

That neck being open is a really serious flaw in a protection scheme. But then, they probably pocketed a few bucks at the top by making workers wear cheap shit.

[LisaL]

52. Neck being open appears to be just fine with CDC.

CDC requires a gown. It doesn't require head cover. See for yourself.
http://www.nytimes.com/2014/10/13/us/cdc-will-offer-more-ebola-training-to-health-care-workers.html?_r=0

[jtuck004]

55. 1st sentence says cover from neck to knees, and

"Within the dozens of pages of Ebola information, the instructions for health care workers include a summary of the personal protective equipment that must be worn:

Gloves
Fluid-resistant or impermeable gown
Goggles or a face shield
Face mask over the nose and mouth"

But most of those gowns aren't impermeable - the germ specialist doc treating my wife a few years ago wore those silly paper ones, but she wasn't contagious.

These folks aren't used to dealing with it, but as a medic I had to be ready to deal with anything, anywhere, anytime. And as soon as we came across someone infectious, like the guy with tuberculosis that was sleeping in the back room of the cafe on the potatoes, things changed dramatically.

It doesn't sound like the Texas hospital got serious soon enough.

[LisaL]

62. Look at the images.

The gown does not cover the neck. The neck is naked. Apparently CDC thinks it's fine and dandy.

[jtuck004]

79. Seen this?

http://www.cnn.com/video/data/2.0/video/us/2014/10/14/erin-intv-jennifer-joseph-friend-nurse-pham-ebola.cnn.html

According to this she was in a full hazmat suit - that would have been a hood, etc.

That can't be comforting.

[LisaL]

80. Not always.

Nurses claim that for the first several days they didn't have hazmat suits. Just regular gowns with neck open, that they used tape on.

[jtuck004]

81. This woman said the specific nurse that was assigned to treat him once they

knew he had ebola wore it. From what I understand she didn't see him until he was admitted for the virus, so she knew what she was walking into.

The rest, as you said, may not have.

Wonder if that will increase the popularity of the cotton gown...

[LisaL]

36. Now you have gone off the deep end.

Mr. Duncan died from Ebola. You know, the disease that has 70 % death rate?
Nobody murdered him.

[Dreamer Tatum]

65. what a stupid post.

You said it's murder but then you said it's gross criminal negligence. Do you ever read what you write?

[Texasgal]

71. She's literally become unhinged

over these threads.

Damn! What an ugly,ugly post.

[valerief]

43. "Move along, folks. Nothing to see here. We've got this. We know what to do.

We've done this before. We've handled ebola for 40 years."

Does anyone believe these assholes anymore?

"Ebola? Oh, I thought you said ebonics. Ebola, ebonics, we got this. Move along now, folks."

[HeiressofBickworth]

44. I wonder how prepared ANY hospital is for infectious diseases.

This time last year I was hospitalized for surgery on septic kidney stones. I was fine entering the hospital but five days later (I was still in the hospital) I became sicker than I ever knew I could. I tested positive for H1N1 flu. The CDC says there is a 2 - 4 day incubation period for H1N1 so I must conclude that I got it in the hospital. It was so bad my chest filled with fluid and I had congestive heart failure. I was moved to what was claimed to be an isolation room in the wing with the congestive heart failure patients, but with nurses, doctors, housekeeping, lab technicians, breathing techs, food delivery, etc. coming and going, I have my doubts about the effectiveness. They donned gloves and a mask (paper, over nose and mouth) with the odd one or another putting on a gown, some actually putting it on and some just draping it across the front. When they left the room, the used items were placed in a cloth laundry bag sitting in the hall outside the doors of other patients. Yes, this wasn't ebola, but H1N1 is highly infectious and with a compromised immune system, the effects are multiplied. One would think that with other congestive heart failure patients, efforts would be scrupulous to avoid contamination.

I have read that there is an expected infection rate at any hospital. They do their best to control it, but with ebola, "best" just isn't good enough. So, based on my experience (granted, it's just MY experience), I would be reluctant to go to ANY hospital that also had an ebola patient.

So what are the choices? 1) isolate and treat at the nearest hospital to avoid exposing others, or 2) isolate and move to a regional hospital with better isolation facilities, risking exposure to more people in the process. I don't think there is a perfect answer.

[kestrel91316]

49. Well, you start by not throwing the CDC guidelines in the circular file.

And you follow up by actually developing in-house protocols and having employee training of the meaningful and useful sort.

[xocet]

47. To Whom It May Concern: Here is the CDC's webpage on Ebola....

http://www.cdc.gov/vhf/ebola/

[kestrel91316]

50. Their google fingers are broken - that much is obvious.

I'm afraid even their "left click" fingers might be broken. And their eyeballs.

[hedgehog]

77. That's an excellent link. More people should see it.

[underpants]

82. Thank you for the link

[Warpy]

51. I said from the beginning Texas was one of the worst places for this to happen

Some of their hospitals are first rate. Most are not.

There have been enough scares here in NM since I've been here that hospitals are a bit more awake, like hantavirus when we were getting slammed with cases and nobody knew quite what it was except patients were drowning in their own blood in their lungs.

Texas has had too many years of starving everything that living breathing people need in favor of reducing taxes on oilmen. It's why that idiot Perry made the knuckleheaded move of not expanding Medicaid under ACA, turning down lots of Federal dollars to keep the Koch boys happy.

Lack of access to care will keep sick people at home in the community. If Ebola goes outside the hospitals, that's how it will happen and it's most likely to happen in a dumb state like Texas that votes for idiots who make knuckleheaded moves.

[Cha]

57. "Private hospital in a red state".. :( of course it will be blamed on our gov.

http://www.democraticunderground.com/10025667279

mahalo, kestrel

[boston bean]

61. Can you tell me again how "nurses don't know hygiene"

and "just didn't wash their hands"?

That is what you said the issue was.

When in fact what I said turns out to be the truth. ie, "flawed process or equipment or insufficient or direction and training. Blaming healthcare workers who are putting themselves at risk is repugnant."

[Arugula Latte]

70. Regulations? We don't need no stinkin' regulations. What can go wrong?

Well, besides fertilizer plants blowing up, Ebola spreading, and so forth ...

[Avalux]

73. It's Perry's fault. The master of de-regulation.

I live in San Antonio and work in the medical community. Lots of chatter going on about this....

[riverwalker]

78. It ws a non-union hospital

the nurses in the Texas hospital were non-union, had no where to turn.
They turned to National Nurses United the union for help in dealing with this. I think that's pretty remarkable. They are representing concerns of the non-union hospital, that don't pay them dues, because no one else will listen!

National Nurses United is a labor union yet they are at the forefront of this. American Nurses association is a academic/professional organization.

I am due to retire, but I remind the young new nurses not to take the union for granted. "The NNU is one bad ass union". They have our backs.

[CTyankee]

91. Nurses have my complete and utter support and admiration.

These women (and men) should be listened to more. They are supremely diligent and skilled...I can't say enough about them...

[KamaAina]

94. Lest we forget, worker safety was one of the backbones of the labor movement

especially the United Mine Workers.

[Baitball Blogger]

90. Republicans are blaming all of this on the CDC.

[CTyankee]

92. yep, gummint can't do anything...

then when these sorry asses get sick they whine about their own care. I have no use for their obnoxious bullshit.

They make me SICK...

[Baitball Blogger]

93. It's unbelievable.

They are whining, "The CDC didn't do their job." "They had a budget increase of $300 mil more than Obama asked for, where did it go?"

I just want to know if the two nurses had contact with Duncan in those two days before we heard about Duncan. Because it would definitely put the responsibility on the hospital's protocol.