Ebola failure: Local health care executives decry government response to disease

Texas Health Resources headquarters in Arlington

Carolyn Poirot Special to the Fort Worth Business Press

A panel of leading North Texas health care executives pointed the finger squarely at federal officials for their response to the Ebola virus while applauding the work of caregivers at Texas Health Presbyterian Dallas. “This is a failure on the national level, a big failure,” said Baylor Scott & White CEO Joel Allison. “Ebola was known for years. If they would have addressed it when it needed to be addressed it could have been stopped, in my opinion, in West Africa.

“The CDC [U.S. Centers for Disease Control and Prevention] was not handling this well. They dropped the ball, and it fell back on Presbyterian Dallas,” Allison said. He and other top administrators from the largest four health care systems in North Texas spoke at a breakfast discussion sponsored by D CEO magazine and D Healthcare Daily.

Barclay Berdan, the CEO of THR, who has apologized for any “mistakes made in handling this very difficult challenge,” said THR has been sharing information and discussing the problems involved with treating emergency patients who have the highly contagious, deadly virus in a community hospital with the CDC, state, county and local officials and other hospitals throughout the country to “help keep everyone safer.” The other panelists applauded Berdan and his team for the way they managed the first outbreak of Ebola in the United States.

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Texas Health Presbyterian Dallas has shared the lessons learned here with hospitals throughout the nation. There are still many ongoing review projects and informational webinars revolving around the Ebola case, and there will be for a long time, Berdan said. “It is a real challenge for a community hospital to try and figure out how to manage a disease like this with the safety of employees, the safety of the institution and the safety of patients” all of grave concern, Berdan said. “The outcome is that your hospitals are safer than ever before. Medicine and science – not politics – have made them safer. Ebola is not going to be the last disease like this. “You have to learn how to change systems to best manage all those concerns,” he said. “We know we have to change the triage function [for example] to better control the flow of patients.”

Changes also have been made in protocols that assure doctors and nurses use the best-established practices to get protective gear on and off.

And, while electronic records are invaluable, they cause people to interact with each other less effectively, Berdan said. Texas Health Presbyterian officials have said that miscommunication among health care officials played a part in the initial failure to suspect Ebola. The Associated Press reported that when Thomas Eric Duncan first appeared in the emergency room of Texas Health Presbyterian Hospital late on Sept. 25, his fever spiked to 103 degrees. According to medical records the news service said were provided by his family, he also complained to hospital staff of abdominal pain so severe he ranked it an eight on a scale of one-to-10. Dizziness, headache and decreased urination were also noted on his chart. When a CT scan ruled out appendicitis and stroke, Duncan was prescribed antibiotics and Tylenol and released, according to the report.

In a note in Duncan’s chart dated the next day, a doctor wrote that the patient was “negative for fever and chills,” despite an earlier note that highlighted Duncan’s fever with an exclamation point. “The condition of the patient at this time is stable,” the doctor added. Various health care providers must make sure they are all talking to each other, and checking off details of care, Berdan said. Caregivers who help admit a patient should be speaking to their colleagues instead of relying totally on what is put in the electronic health care record and checking off details all the way through discharge, he noted. The current focus on technology and electronic health records can depersonalize health care, Berdan said in his first public comments since the Ebola virus arrived in North Texas with a patient from Liberia in September. Electronic records, telemedicine and video conferences were also discussed by CEOs on the panel, set up to talk about the business of health care.

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“We almost have to put the soul back into medicine,” said Dr. Bruce Meyer, executive vice president of health system affairs at UT Southwestern. “All of our health care providers have to get comfortable with new technology, and patients need to get comfortable with care provided through that technology.” Federal health officials on Oct. 20 tightened infection-control guidelines for health care workers caring for Ebola patients, explicitly recommending that no skin be exposed.

The beefed-up guidelines also called for health care workers to undergo rigorous training, and to be supervised by trained monitors when putting on and taking off personal protective equipment. The government issued step-by-step instructions for workers to follow in doing that. The revised protocols from the CDC were issued amid a debate over whether protection is adequate for nurses and doctors caring for Ebola patients. The controversy flared when two nurses from Texas Health Presbyterian became ill after caring for Duncan. Panelists also addressed other issues with health care in Texas and the nation. Meyer and others emphasized the need for more physicians and residency programs to keep more medical school graduates in Texas and the need for better utilization of more physician assistants and nurse practitioners to care for an ever-increasing patient population.

“We need to get health care repositioned in outpatient settings,” said Stephen Mansfield, president and CEO of the Methodist Health System. “Our greatest emphasis should be on expanding more and more patient care outside of hospitals. We need many more access points to provide better care.” – This story includes reporting from the Washington Post.