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Thursday, October 27, 2016

By Todd J. Gillman, Matthew Watkins and Michael E. Young, The Dallas Morning News (MCT)

WASHINGTON — Members of a U.S. House subcommittee sharply criticized national and Dallas medical officials Thursday for errors in the Ebola crisis that they say have eroded public trust in the hospital system.

Fumbles by the Centers for Disease Control and Prevention and by Texas Health Resources Presbyterian Hospital Dallas have demolished CDC assurances that any hospital in America could effectively deal with an Ebola case, said Rep. Tim Murphy (R-PA), the subcommittee chairman.

“CDC and our public health system are in the middle of a fire. Job One is to put it out completely,” Murphy said.

The subcommittee’s top Democrat, Rep. Diana DeGette of Colorado, echoed the concerns.

“It would be an understatement to say that the response to the first U.S.-based patient with Ebola has been mismanaged, causing risk to scores of additional people,” she said.

The questions on Capitol Hill about Presbyterian — and about U.S. hospitals in general — arose as Nina Pham, a Presbyterian nurse infected with the Ebola virus, was moved from Presbyterian to a National Institutes of Health clinic in Bethesda, Md. Pham, 26, was among those who cared for Thomas Eric Duncan of Liberia, who died of Ebola in the Dallas hospital on Oct. 8.

Amber Vinson, 29, a second Presbyterian nurse diagnosed with the disease, was moved earlier to Emory University Hospital in Atlanta, which has special isolation units and has treated three Americans who contracted Ebola in Africa while on aid missions.

The fact that two nurses at Presbyterian contracted the disease while treating an Ebola victim proves that “the frightening truth is that we cannot guarantee the safety of our health care workers on the front lines,” said Rep. Michael Burgess (R-TX), a physician.

Dr. Tom Frieden, director of the CDC, and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, a part of the NIH, testified before the committee in Washington. Dr. Daniel Varga, chief clinical officer at Presbyterian, spoke from Texas. Frieden faced some of the toughest questions.

He was pressed him to explain whether Vinson should have been allowed to travel by commercial airliner to visit family in Ohio after she was identified as having been one of Duncan’s caregivers.

That would have been fine, Frieden said, had she worn proper protective gear while treating Duncan. If she hadn’t, she shouldn’t have traveled, he said.

Frieden acknowledged that Vinson called the CDC before her return flight to Dallas, said she had a minor fever, and asked whether she could travel.

“My understanding is she reported no symptoms to us,” he told the committee.

But a day earlier, Frieden said that since Vinson had a fever, she shouldn’t have flown.

A series of bad decisions, beginning with Presbyterian’s failure to admit Duncan when he showed up at the emergency room with a high fever and severe pain, has left hundreds of people with potential exposure to the deadly virus.

More than 70 are Presbyterian health care workers who had contact with Duncan, sometimes without proper protective clothing, according to nurses at the hospital. (Varga disputed the nurses’ claim about inadequate protective gear.)

Many more were either on the Frontier Airlines flight that Vinson took from Cleveland to Dallas or were on subsequent flights before the aircraft was taken out of service.

Concerns about passengers’ exposure have spread nationwide, including in North Texas.

On Thursday, Rockwall County announced that four residents who were on Monday’s flight were being monitored by the state health department and the CDC. Another county resident, a Presbyterian health care worker, is also being monitored.

Despite her slight fever, health officials said, the chance that Vinson spread Ebola to other passengers was very small.

Still, school districts in Ohio and Texas contacted parents after learning that some of their students had been passengers on the plane or were the children of passengers. Some schools were closed so they could be disinfected.

And officials in both states were eager to speak with Vinson’s mother, who left Ohio on Tuesday and traveled to Dallas.

Donna Skoda, assistant health commissioner for Summit County Public Health in Ohio, said the mother contacted Dallas public health officials before going to an undisclosed hotel.

“We have no idea where she is at,” Skoda said. “She has elected, even though her daughter was transported to Atlanta, to self-quarantine in the hotel.”

An uncle of Vinson’s, Lawrence Vinson, released a statement thanking people for their good wishes and requesting privacy for the family. He said his niece was stable.

He praised her as “a respected professional” who was passionate about nursing and said, “She’s trusting in her doctors and nurses, as she is now the patient.”

The decision to move Pham on Thursday to the NIH clinic in Bethesda was made in consultation with the nurse and her family, officials said.

In a statement released by Presbyterian, Pham said: “I’m so thankful for the outpouring of love and support from friends and family, my co-workers and complete strangers. I feel very blessed and have gained strength from their support.”

Later Thursday, the hospital released a video of Pham talking and joking with her physician before she departed for the NIH clinic.

In the video, Dr. Gary Weinstein thanked Pham for being part of the team that volunteered to care for Duncan.

As he told her the hospital staff was proud of her, Pham started to cry. “I love you guys,” she said. “We love you, Nina,” Weinstein responded.

Weinstein, chief of pulmonary and critical care medicine at Presbyterian, said it was “a difficult decision to transfer Nina, a member of our own family and someone who is greatly loved and respected.”

He said her condition continued to improve. “She’ll be in wonderful hands at NIH,” he said.

In Dallas County, officials worried that health care workers who had contact with Duncan needed to limit their own contact with others.

After initially considering passage of a declaration that would have given County Judge Clay Jenkins authority to control their movements, the Commissioners Court instead decided to obtain from those potentially exposed signed “voluntary agreements” to avoid public transit and other public places. Those who don’t sign would be subject to court orders restricting their movement.

The commissioners heard from Dallas Mayor Mike Rawlings, who said they should not declare an emergency.

“We should ask them to voluntarily restrict their travel,” Rawlings said. The workers will monitor themselves and submit to visits from health department employees twice a day, he said.

“They can walk their dog,” Rawlings said. “But they can’t go to church. They can’t go to schools. They can’t go to shopping centers.

“If we focus on doing that, we believe that is the appropriate measure. If, on the other hand, we dial this up to another level, we might accomplish that as well but we might also have other people suffer in the process.”

Signing agreements with health care workers means the county will have control of all local residents potentially exposed to Ebola. The county health department had been responsible for tracking 48 people who came into contact with Duncan before he was hospitalized. But they weren’t in charge of the health care workers. That was handled by Presbyterian and the CDC.

The health care workers hadn’t been notified of the agreements before Thursday’s meeting. Rawlings was asked how he thought they’d respond.

“I don’t care,” he said. “Sorry, I’m not trying to be flippant. But this is the right measure. We have to focus on these individuals.”

Jenkins said he had no worries about compliance.

“These are not criminals,” he said. “These are not risks to the community. They are not disease carriers. They are disease contacts.”

Photo: Olivier Douliery/Abaca Press/MCT

  • Independent1

    One of the statements in this story that bothers me the most is this one: “A series of bad decisions, beginning with Presbyterian’s failure to admit Duncan when he showed up at the emergency room with a high fever and severe pain, has left hundreds of people with potential exposure to the deadly virus.”

    How in all good conscience, could a hospital emergency room fail to admit someone who came looking for medical care who had a “high fever and severe pain”? Forgetting about Ebola, high fever and severe pain are clear symptoms of some form of infection within a persons body; sending a patient seeking treatment home knowing that they have some form of infection is to me unconscionable and a clear example of why Texas has been rated as having the worst health care delivery system in America.

    And I’m left wondering if the hospital has even confirmed that the two nurses who have contracted Ebola were not on duty at either the emergency room, or in one of the departments that Duncan may have been checked out in when he came in with a high fever; as they may have contracted Ebola from him then, or even later from Duncan’s mishandled body fluids that were left in the hospital during that visit, and not when they were being more cautious in treating him later.

    • howa4x

      Easy he was uninsured and there is probably a policy or at least and understanding by ER triage nurses not to admit a non payer

      • Independent1

        You mean, against the law which Reagan signed back in the 80s which requires that ERs treat everyone who comes in for health care despite the fact that they can’t pay for the care they need?? A red state not honoring legislation that a Republican put into law??

        • howa4x

          Technically they did treat him and sent him home. They didn’t place him inpatient so they met the bare minimum of the law

  • howa4x

    This is a tempest in a tea pot. Both nurses exposed to Ebola will probably survive as did those flown back from Africa. This is not a threat to America. Even in Africa where the Virus originated only 50% die, and that is with no medial assistance. This is another chance for the close the border mentality that has carried over from the immigration debate, and whip up public hysteria on the eve of the mid term. Absent is the debate about funding the public health infrastructure to deal with emerging pathogens, like Ebola in the future. As the world is becoming more interconnected Ebola is just the 1st major virus to get attention. There are others out there and this event shows clearly how a bioterrism attack could succeed.
    Hospitals will not respond to respond to uninsured patients and especially in states like Texas where over 1/4 have no coverage. There is probably an unwritten policy not to admit them. States that took the Medicaid expansion have a better chance of recognizing an outbreak, since the expensive lab tests will be covered. This is more about medical economics then bungling a threat.
    I used to do Bioterrorism threat planning and outbreak control. The index case or the 1st infected always dies and the next to get ill are the care givers, and close family members, so there will be more cases contracting Ebola. Will it rise to an epidemic, no. That is because we have sanitary disposal of waste and clean drinking water, and Ebola is not spread airborne like flu. We have enough PH workers to monitor the exposed people and a health care system now on high alert. This is why it spreads in Africa and not here. So clam down everyone. We have 35,000 flu deaths per year so if that doesn’t scare you why does 1 Ebola death?

  • George Kato

    It’s important to remember that Obamacare is designed to deny health care to older, mostly conservative people.