What the . . .? Health Care Workers Who Cared for Ebola Patient Barred from Public Transportation — But Allowed to Work at Hospital
From Sept. 28-30, staff treating Duncan wore basic personal protective gear consisting of gowns down to the knees, face shields or a mask and latex gloves. Texas Health Presbyterian Hospital Dallas said in a release that once Duncan’s Ebola test came back positive, staff members were issued hazmat suits. But they admitted some were too big and nurses had to pinch and tape the suits for them to fit.
Some of the health care workers being monitored are being furloughed, but others have continued to work, depending on the level of their exposure. None are allowed to use public transit.
So they aren’t allowed to ride the bus for short periods of time, but they can work at the hospital.
It sure is reassuring to have the federal government on the case, isn’t it?
UPDATE: Commenter nk notes something I should have noticed: the “no public transportation” rule is not the federal government’s, necessarily. It was a rule emanating from the Democrats who run Dallas. (Yes, they are Democrats.) Which just goes to show you that there are nincompoops at every level of government.
Words fail.
Patterico (9c670f) — 10/16/2014 @ 9:45 pmAt this point, government officials and the hospital are just making things up in response to tat day’s public concern. If the media or the public expressed concerns because people exposed to ebola were wearing purple shoes, they would probably ban purple shoes.
DRJ (a83b8b) — 10/16/2014 @ 9:54 pmThe only thing they won’t do is ban travelers from high-risk areas in West Africa.
DRJ (a83b8b) — 10/16/2014 @ 9:56 pmIt’s not the federal government. http://dfw.cbslocal.com/2014/10/16/commissioners-decide-against-emergency-disaster-declaration/
nk (dbc370) — 10/16/2014 @ 9:56 pmFrom the link: Instead of declaring an emergency disaster members of the Dallas County Commissioners Court decided Thursday to take no action and rely on individuals potentially exposed to the Ebola virus to adhere to self-monitoring/isolation guidelines and avoid public transportation and “public places.”
nk (dbc370) — 10/16/2014 @ 9:57 pmI think we’ve been giving the CDC too much of a bum rap. Their role appears to advise, recommend, and train, with enforcement authority left to the state/local governments.
nk (dbc370) — 10/16/2014 @ 10:00 pmUPDATE: Commenter nk notes something I should have noticed: the “no public transportation” rule is not the federal government’s, necessarily. It was a rule emanating from the Democrats who run Dallas. (Yes, they are Democrats.) Which just goes to show you that there are nincompoops at every level of government.
Patterico (9c670f) — 10/16/2014 @ 10:04 pmThat’s why I initially said government officials and the hospital, nk, and then I widened the scope of my criticism to the national officials. They all are responding to the public, but they are doing it in ways that don’t reassure us.
DRJ (a83b8b) — 10/16/2014 @ 10:05 pmI don’t.
Patterico (9c670f) — 10/16/2014 @ 10:07 pmThe same Dallas County officials were also considering putting the hospital workers into shelters. I don’t know what they decided to do about that, if anything, but I can’t imagine that’s a workable solution.
DRJ (a83b8b) — 10/16/2014 @ 10:08 pmThere’s a limitation on federal preemption of local law as well in the federal statute. http://www.law.cornell.edu/uscode/text/42/264
(e) Preemption
nk (dbc370) — 10/16/2014 @ 10:19 pmNothing in this section or section 266 of this title, or the regulations promulgated under such sections, may be construed as superseding any provision under State law (including regulations and including provisions established by political subdivisions of States), except to the extent that such a provision conflicts with an exercise of Federal authority under this section or section 266 of this title.
nk:
Even the New York Times says the guidelines were too lax, saying: “Federal health officials effectively acknowledged the problems with their procedures for protecting health care workers by abruptly changing them.” And this Emory Hospital infection control doctor went even further:
The CDC has earned every bit of this criticism.
DRJ (a83b8b) — 10/16/2014 @ 10:20 pmI read that as saying as long as the local law does not conflict with the federal law, the locals have the discretion as to how to carry it out.
nk (dbc370) — 10/16/2014 @ 10:21 pmOf course they do, nk, but what hospital would be foolish enough to ignore the CDC guidelines? It’s the standard of care for exotic infectious diseases that no one has seen before? To ignore their guidelines would also invite federal oversight and sanctions, not to mention lawsuits that the hospital ignored the only applicable standard of care.
DRJ (a83b8b) — 10/16/2014 @ 10:24 pmI have no brief for the CDC. I’m just hunting where the ducks are. Judge Jenkins did not make a good first impression, but I have no particular brief against Dallas County either.
nk (dbc370) — 10/16/2014 @ 10:26 pmAs for the Dallas County officials, I concede they get to make the rules. They can prohibit people from riding the bus, they can put them in shelters, they can quarantine everyone in sight. The question is whether it’s helping to fix the problem, and I fail to see how letting people work but prohibiting them from riding public transportation will work if anyone is still infectious.
DRJ (a83b8b) — 10/16/2014 @ 10:27 pmif only fatal was stupid to the carrier solely, rather than so often taking out those around them, w/o a personal consequence to the bearer.
and please, how the hello do you become an RN and NOT understand just how dangerous Obola is?
no way in hello would i have gone in that room, dressed as they were, and i’m not even a fing RN.
hell, i’d have demanded PPE just to handle stuff coming back from the floors to my department, to include a decon process for carts and such, and would have quit on the spot if it wasn’t provided immediately.
but then again, i was a 54 series back in the bad old days, so my attitude on such things is government issue.
redc1c4 (dab236) — 10/16/2014 @ 10:30 pmJenkins didn’t make a good first impression on me, either. He seems to let his emotions get the better of him. But he’s getting good press in Dallas.
DRJ (a83b8b) — 10/16/2014 @ 10:30 pmDOH
“if only stupid was fatal to the carrier solely…”
that’s what i get for poasting s*ber. %-)
redc1c4 (dab236) — 10/16/2014 @ 10:31 pmred,
Some of these nurses did object but many are young. I wasn’t a young nurse but I was a yong attorney, and I know I didn’t make the same cautious decisions as a young professional that I would now.
DRJ (a83b8b) — 10/16/2014 @ 10:32 pmthere is little ro no risk for *exceeding* the CDC guidelines, especially if they seem inadequate or overly complacent.
you rarely get gonged in healthcare for doing MORE than required, especially if billing isn’t involved.
IOW, if the standard is paper gown, pair of gloves and a paper mask, you’re not getting in trouble for saying, “full suit, respirator and total body decon after exposure”, unless the patient is Medi/Medi and you try to pass the additional costs on.
of course, since most acute care reimbursement these days is flat rate, and damn little of that, it’s a moot point.
redc1c4 (dab236) — 10/16/2014 @ 10:38 pmBefore Duncan came to town, why would the hospital have known the CDC guidelines were inadequate or overly complacent? It and its healthcare providers had no experience with ebola. Why would they doubt the guidelines the CDC was giving them?
DRJ (a83b8b) — 10/16/2014 @ 10:41 pmI looked them up but the internet is not the actual Federal Register. There was an October 6, 2014 handout, and before that the PPE regulations I found were from 2007. I guess that’s what the nurses were trained in.
nk (dbc370) — 10/16/2014 @ 10:45 pmwhen i was a young HCW, i called out everything i saw that i either new was wrong or had concerns about.
long before i walked into my first day of w*rk in an HCF, i knew what Obola was, as well as nerve agents, blister agents, nuclear contamination, and had a strong w*rking knowledge of what the risks were with each of them and how to deal with them, at least at my level of care. i wasn’t, and still aren’t, an SME on them, mostly because i’m out of the field for the most part, partly because, with some of those things, the best data is classified at a level i’ve never had clearance for, and because i could spend all day, every day studying it and never get to the things IRL i need to tend to.
you have to have either lived in a cave or be hopelessly uninformed these days, especially if you have an RN license, or be willfully uninformed, to NOT at least have heard of the disease, even before this event. i know my ears perk up every time i hear about a strange or unusual disease in the news, or elsewhere, and i’m not even a direct provider of patient care.
redc1c4 (dab236) — 10/16/2014 @ 10:46 pmDo you think the MERS guidelines are inadequate or overly complacent, red? Prior to this week, do you think hospitals had evaluated the MERS guidelines and found them inadequate? I suspect hospitals are going to reevaluate everything now but, before the Duncan ebola case, I doubt hospitals (other than the 4 biocontainment facilities and infectious disease specialists with specialized experience) had reason to question the guidelines.
DRJ (a83b8b) — 10/16/2014 @ 10:47 pmThis one, I guess. http://www.cdc.gov/hicpac/2007IP/2007ip_part2.html#e
nk (dbc370) — 10/16/2014 @ 10:47 pmInfectious diseases interest you so I bet you took special precautions based on your research. Did your colleagues and the hospital administrators where you worked feel that way, too? That would be great if they did, and it would certainly be in their best interest to be prepared. I’m just not convinced that providers in general would question the CDC guidelines.
DRJ (a83b8b) — 10/16/2014 @ 10:52 pmIt’s one thing to hear about the disease. It’s another to have experience with it and make decisions based on your experience. It’s hands-on experience that makes things like this real and gets people focused on knowing exactly what to do.
DRJ (a83b8b) — 10/16/2014 @ 10:54 pmI’m sorry about the wrong MERS link. Try this.
DRJ (a83b8b) — 10/16/2014 @ 10:56 pmI don’t think that providers are allowed to question CDC guidelines, DRJ. From what I found and posted in the other thread, the CDC makes the guidelines for OSHA which does have enforcement authority. And hefty fines not to mention private causes of action from injured employees.
nk (dbc370) — 10/16/2014 @ 10:58 pmYou’re going all legal on me now, nk … and you’re probably right.
DRJ (a83b8b) — 10/16/2014 @ 11:03 pmhow easy is it to spread something around a hospital, via nursing staff?
damn easy. (details left vague to protect both the guilty and everyone else, story is TRUE.)
patient comes to hospital in Lost Angels from a very rich ME nation, with strange laws & traditions. PT is there for a kidney transplant (how they got on the list, let alone got a kidney here, when they live on the other side of the planet is a different question) PTs family was paying bill in cash, which obviously explains all sorts of things. 😉
PT is young, 20ish female, from a *very* influential family in the kingdom, and was accompanied by a variety of female family members, who all stayed in the same room (so much for the issues of immune suppression, disease transfer, etc…$$$)
PT goes through surgery, and is recuperating, getting standard initial anti-rejection therapy, etc, when her nurse calls down and asks if we have Kwell on hand. since said facility did NOT have an ED or an L&D, no, we don’t. (w/o those departments your HCF *isn’t* going to get random people off the streets, only patients admitted by doctors with privileges. that helps keep the riff-raff, and their bugs, out of the building.)
RN hangs up, then, a few minutes later, the Dept Director’s phone rings… he comes out and asks if we have any Kwell… same answer: nope, we’ve never needed it.
well, how much is it and how much can we get, ASAP?
turns out the tourists all had hair lice, and the lice had made their way all over the rest of the floor, to patients & staff alike. we bought out the local warehouse and had to get a drop shipment in to have enough to treat everyone… glad i wasn’t the one who had to call discharged patients and tell them to check their hair.
i had a GI haircut at the time, so i was good to go. 😎
redc1c4 (b340a6) — 10/16/2014 @ 11:06 pmone of my maxims for life is “perfect paranoia is perfect awareness”. a case in point would be the recent experience of those poor brave bastards from DWB. with over half their 16 person tean symptomatic, something went wrong, and their processes failed them. the CDC just redid their protocol, which is a tacit admission they know they have a problem as well. at this point in time, i’d say a good lawyer could winningly argue that *just* following the published protocols was needlessly endangering his client.
arguably, DWB know as much, or more than anyone else about how to actually give patient care to acute Ebola patients, even more than the CDC. i haven’t looked at either set, but i know which one i would have had more faith in, inherently, a few weeks ago, and, if necessary, i’d take the most stringent and protective steps from each, and any others i could find, official or otherwise and build a hybrid protocol that exceeded all the standards. call it the belts & suspenders approach.
from all the regulatory surveys i’ve been through in health care, governmental or otherwise, i’ve never seen anyone catch hell for exceeding a standard or building in additional safety steps, as long as all the basic requirements were met as you went. the only thing they will get you for then is if you create a cumbersome policy no one follows because it makes no sense.
if you did get questioned or cited, the argument that the steps had been deemed clinically necessary for patient care & safety, to avoid nosocomial infections of the disease in question, would be a lead pipe cinch defense.
after all, i’m sure you could find an lawyer to argue that you don’t have to be all that careful with a ruthlessly deadly disease, but even here in #Failifornia, most judges & juries would know better.
redc1c4 (dab236) — 10/16/2014 @ 11:25 pmnk: the field of healthcare is/was about asking questions: that’s how we advance care & cure things.
the thing about guidelines/standards/protocols/etc is, you can meet them or exceed the stated standards (assuming there is no downside to the extra whatever you do) and everyone’s happy. you only get hit when you don’t meet the minimum, which is what the “standard” really is: it’s the healthcare world’s equivalent of a “C” grade when you were a kid.
IOW, there’s always room for improvement on what they give you, and a BLS-4 threat really ought to get people thinking, rather than just following orders.
redc1c4 (dab236) — 10/16/2014 @ 11:32 pmThis whole Federal vs. Local contretemps brings to mind one of the more tragic over-reaches by the Feds: Grabbing JFK’s body before the county coroner had an opportunity to examine it, which was the clear duty and obligation of the coroner. The Secret Service, at the behest of Kennedy’s staff, who had zero authority, literally grabbed the body as the medical staff at Parkland insisted it was illegal to do so.
Had this autopsy happened, soooooooo much of the conspiracy garbage would have been obviated. This is not to mention the salutary consequences of adhering to the Rule of Law.
The irony is off the charts that this argument is now happening for events in the very same county.
Ed from SFV (3400a5) — 10/16/2014 @ 11:38 pmI have kind of dealt with that. This time, 22 years ago, I was briefing a conflict between an employer’s interpretation of OSHA and Title VII sex discrimination. Women wanted to work in a dangerous environment because it paid more but the employer restricted it to men. SCOTUS held, in another case already pending before it, in favor of Title VII. The old fogies had no regard for frail womanhood.
nk (dbc370) — 10/16/2014 @ 11:44 pmThe thing to watch for will be the information gaps. Soon
(we may already be there) expected news, such as how Duncan’s
family is doing, will be absent. We already have that as
there’s been no news re how they’re doing and any testing
being done for quite a few days.
They’re already obfuscating the disease as emt’s are being
told not to say ebola over the air in some places. They are
also going to start inventing names to shift perceptions from
the scare word Ebola to say EVD Ebola viral disease.
Liberals/bureaucrats do this as a first line defense when caught
jakee308 (d409c2) — 10/17/2014 @ 12:17 amscrewing the pooch by the public;
1. Deny
2. Lie
3. Shift blame
4. change story
5. silence
6. change the words
Well, the public transport thing is partly explainable, as follows…
Inside the hospital, protective clothing works both ways. In the bus, you aren’t wearing the mask, the gown, the gloves, etc, so you can more easily spread any sickness you might have.
It doesn’t quite explain why one could still work in the hospital, but it isn’t completely deranged.
Kevin M (b357ee) — 10/17/2014 @ 12:25 amPerhaps they want them coming in, not to work, but to be observed, and to be in a known location rather than flying off to Cleveland.
Kevin M (b357ee) — 10/17/2014 @ 12:26 amAlong with what Kevin M said, I think there is a rational concern about the difference between low risk known contacts (perhaps in a work setting) and low risk unknown contacts (public transportation).
That said, when working in a hospital one comes into contact with many people, and maybe the difference isn’t that great.
People are used to living their lives, they have things to do, they are not living at a subsistence level where they are happy with staying in their hut if someone brings food to them like in a rural village in Africa.
MD in Philly (f9371b) — 10/17/2014 @ 5:42 amThat said, the best thing to do is “bite the bullet” and make exposed people stay home.
If I was an ICU nurse that worked with the others, I would strongly consider living in some separate quarters from my family for 21 days.
I am not sure a unit clerk in the ICU that never went into Duncan’s room needs the same precautions, though I guess the risk is not zero.
Al Gore’s internets say that the chances of survival are higher if the disease is diagnosed early. How is that? What do they do with them in the hospital when they only have a 101 fever? Feed them well and keep them rested to save their strength for when the heavy symptoms come?
nk (dbc370) — 10/17/2014 @ 5:52 am> Al Gore’s internets say that the chances of survival are higher if the disease is diagnosed early. How is that?
My understanding is that the benefit of earlier diagnosis is (a) hydration and (b) mineral replenishment – vomiting and diarrhea consume huge quantitites of liquid, and dehydration makes everything worse.
aphrael (af3e66) — 10/17/2014 @ 5:57 am> from all the regulatory surveys i’ve been through in health care, governmental or otherwise, i’ve never seen anyone catch hell for exceeding a standard or building in additional safety steps, as long as all the basic requirements were met as you went. the only thing they will get you for then is if you create a cumbersome policy no one follows because it makes no sense.
That said, if exceeding the standard is more expensive than simply meeting the standard, you will have strong pressure to simply meet the standard.
aphrael (af3e66) — 10/17/2014 @ 5:59 amso the Norridge, I mean Dallas City council, is pretty much useless,
narciso (ee1f88) — 10/17/2014 @ 6:17 amKevin M:
That’s reasonable but, if so, they should say that. It doesn’t inspire confidence in the community or in the people who use the hospital to believe that the people taking care of them might have ebola.
DRJ (a83b8b) — 10/17/2014 @ 6:24 amnarciso,
The Mayors and/or City Councils of Houston, San Antonio, Dallas, Austin, and El Paso are all Democrats or affiliated with Democrats. The only thing keeping Texas red is that more people live in rural areas and the suburbs.
DRJ (a83b8b) — 10/17/2014 @ 6:30 amthat’s why I used the Python reference, DRJ
Apparently everything operares by those rules
http://www.defenseone.com/threats/2014/10/dallas-hospital-had-ebola-screening-machine-military-using-africa/96713/?oref=d-channelriver
narciso (ee1f88) — 10/17/2014 @ 6:32 amI have a picture of those two poor girls in isolation; seeing only people dressed like Tusken Raiders; with three or four lines stuck in them; likely in diapers; subsisting on Tylenol and hospital food; lying in a hospital bed for a week waiting to start throwing up and lose control of their bowels.
nk (dbc370) — 10/17/2014 @ 6:47 amnk, at this point I tend to agree with you, that at the current time the main reason for early diagnosis is isolation and quarantine to minimize spread,
though I also agree with aphrael to a point, it is certainly better to begin treatment before someone gets too dehydrated
until there is a known treatment that works best when given early, there is no reason for the patient to diagnose as early as possible
the one exception being if you have A+ blood type and you can get some antibodies from Dr. Brantley!!!
Maybe one of the currently available experimental drugs will soon have a track record of being reasonably safe and apparently effective.
It appears that the team in Boston was going above and beyond the CDC recommendations and using decontamination procedures.
The cost issue here is that investing up front to eliminate spread is much cheaper than the chaos of having just one HCW become infected. When that happens not only are your operating procedures a mess, but you will loose revenue from people staying away from your hospital.
I think cumbersome procedures are only cumbersome when you don’t see the point and think it unnecessary. I don’t people think that with Ebola.
MD in Philly (f9371b) — 10/17/2014 @ 6:49 amThat said, the appropriate procedures may need training, practice, and supervision.
What do we always say about links from narciso?
MD in Philly (f9371b) — 10/17/2014 @ 6:54 amthat helps a previous discussion point about the types of available testing for Ebola.
Oh, narciso, thank you for the link but that is so discouraging.
nk – Ms. Pham looks good to me. I know she’s very sick but she’s such a doll, even when ill. And her dog is enjoying eating and classical music. I confess having the dog listen to classical music is typical Dallas, but a bit pretentious for West Texans like me.
DRJ (a83b8b) — 10/17/2014 @ 7:03 amDoes your dog prefer Hank Williams, DRJ?
nk (dbc370) — 10/17/2014 @ 7:11 amPennsylvania state representative warded off armed robbery with return fire.
As usual, the teenagers (there were four) were not described. But their names are Jamani Ellison, Jyair Leonard, Derek Anderson and Zha Quan McGhee.
papertiger (c2d6da) — 10/17/2014 @ 7:41 amFrom that little bit of information we can infer that none of their parents could spell.
The good thing about the details of this case is it shows the hospital personnel were not properly dressed to avoid infection. The original assumption was that those in contact with Duncan were wearing elaborate space-type hazmat suits, meaning if they still contracted the virus, it must be a much trickier microbe than assumed.
The CDC (etc), if it had any sense, and in order to calm the public, would do a remote press conference with Duncan’s family, based on reports they’re not infected with Ebola or are not showing symptoms of it, even though they spent a large amount of direct-face time with him in a heavily contaminated apartment.
But the clown car (with Obama at the wheel) rolls on.
Mark (c160ec) — 10/17/2014 @ 8:01 amNor does it explain why Obama says it’s OK to ride the bus.
I am not saying it’s crazy to keep those exposed off buses. I am saying it’s crazy to let them work in a hospital if they aren’t safe to ride a bus.
Patterico (98c6ca) — 10/17/2014 @ 8:25 amMeanwhile, everyone involved in the initial treatment of Duncan appears to have taken leave of their senses.
Apparently someone who ‘handled clinical samples’ decided to get on a cruise ship. (Even if the person has a reasonable belief that there is no risk, it’s still a mindnumbingly stupid thing to do).
aphrael (af3e66) — 10/17/2014 @ 9:42 amYesterday, narciso linked a story to Patrick Sawyer, the American lawyer from Minnesota who took Ebola from Liberia to Nigeria. He knew he had been exposed to Ebola. Instead of taking the first flight home, he used his government connections to be allowed to go to Nigeria. There,he infected 19 people. Five of them, now dead, deliberately. They were hospital workers who told him he had Ebola and was going to be detained under quarantine. He unzipped his pants and urinated on them.
nk (dbc370) — 10/17/2014 @ 9:48 amEven if the person has a reasonable belief that there is no risk, it’s still a mindnumbingly stupid thing to do
Maybe it’s an experiment.
Kevin M (b357ee) — 10/17/2014 @ 9:50 amWhat I really wonder about is the PR sechel that allows them to say that their duty nurses might have Ebola. As opposed to: “Potentially exposed personnel are tested and monitored each day at the hospital, but have no interaction with patients.”
Kevin M (b357ee) — 10/17/2014 @ 9:55 amBut maybe they actually are working with patients. It is hard sometimes to translate from Stupid.
Kevin M (b357ee) — 10/17/2014 @ 9:57 amThere’s a rumor a 3rd person was screened last night for ebola at Baylor Medical in Dallas, before being transferred to Texas Presbyterian. If I were in Dallas, I would have gone to Baylor, too.
DRJ (a83b8b) — 10/17/2014 @ 11:00 amConfirmation of the rumor from CBS11 in Dallas, but there may not be anything to it:
DRJ (a83b8b) — 10/17/2014 @ 11:06 am47. From the link:
But good news. The FDA is working fast “extremely rapidly” to
make a determination on an Emergency Use Authorization. A week or two maybe, and meanwhile put the onus on the manufacturer to fill out some forms.
It figures.
The FDA now has to approve medical devices (and noninvasive tests) too.
In most cases of delay, it’s more than well established that it works – it never would get to that point if it wasn’t. Even saying that there’s some uncertainty about it, and you don’t know the false positive and false negative rates, or whether it will break, it is still much much better than not using it.
If something that was wildly wrong were tried, you’d know very quickly.
Rapid tests for ebola are needed – and scientific rigor be damned.
We cannot afford this kind of thing if any kind of new disease hits.
Sammy Finkelman (c2bb62) — 10/18/2014 @ 7:44 pm