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Ebola: When the Lightbulb Doesn't Want to Change [Oct. 15th, 2014|05:04 pm]
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[Current Mood |angry]

Texas Health Presbyterian Hospital--the hospital that misdiagnosed Mr. Duncan in the Emergency Room and sent him home, and then--once he came back with Ebola diagnosed by a family member--not only did not save his life, but managed to allow two nurses to become infected with Ebola while treating him--is a member of a group of hospitals run by Texas Health Resources.

"I don't think we have a systematic institutional problem," Dr. Daniel Varga, chief clinical officer of Texas Health Resources, told reporters, facing questions about the hospital's actions.

Medical staff "may have done some things differently with the benefit of what we know today," he said, adding, "no one wants to get this right more than our hospital."

Dr. Varga is wrong.  He is wrong factually (just the ER visit alone shows that THPH has an institutional problem in its Emergency Department--which other previous complaints and ratings also showed, previous to Mr. Duncan's visit.)   He is wrong in implying that medical staff acted properly with the knowledge they had at the time: they did not.  He is wrong administratively and politically, in not facing the reality and accepting responsibility.    Yes, there is an institutional problem.  His name is Dr. Varga.   He is the reason--or one of them--that Texas Health Resources has an institutional problem, and every other hospital in that group probably has the SAME institutional problems as THPH.

Dr. Varga just screwed the pooch.

So when the lightbulb doesn't want to change, and the lightbulb should be giving the light needed to see and fix a problem...you reach up and yank that sucker out of there and put in a new one.  A different one.  Both the CEO (to whom Dr. Varga presumably reports, and whom, presumably, he's shielding here) need to be replaced, and the replacements need to be informed upfront that they will be held accountable for lapses in quality care.

And in the meantime, the relevant hospital accreditation board should take a long hard look at not just THPH, but every other hospital within the Texas Health Resources group.  At the least, these hospitals should be audited for quality in every kind of case they accept, and put on probation to ensure they meet all standards in all areas.  I wouldn't close them all...but patients deserve better--all their patients deserve better.


From: 6_penny
2014-10-16 02:45 am (UTC)
I am bemused (to put it very mildly) about the total incomprehension of basic principles of quarantine when applied to individuals who have been in contact with epidemic diseases.
The middle ages figured it out - villages with plague were isolated.
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[User Picture]From: e_moon60
2014-10-16 05:19 am (UTC)
It's not incomprehension of the principles of quarantine--it's the belief that they don't apply because [excuse.]

Now in some cases the excuse has some rationality to it. In the countries where the outbreak started, most people had no way to store food at home, or money to buy more than one day's food, if that. Nor did they have running water at home. So they had to go out to the market every day--and fetch water every day--and they had to find work for enough money to buy some food every day. One key element of getting people to stay home is bringing food and water to them.

Here, there's not that excuse *as long as they are not penalized for staying home from work*. Many people are.

However, the decision to go visit family in Ohio for a week was...irresponsible, IMO.
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From: 6_penny
2014-10-16 05:02 pm (UTC)
The hospital authorities should have made requirements clear to their employees at least -and of course not penalized them for complying.

I am boggled by the idea of a trained nurse thinking that it was ok to fly while she was in the incubation period (or not thinking at ll probably).
Especially as she had personally witnessed someone dying of the disease. Even if endangering all the strangers on the plane was not real to her, one would think that she would be concerned for her family she took the trip to see.
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[User Picture]From: e_moon60
2014-10-16 08:34 pm (UTC)
Those hospital authorities are not the most competent hospital authorities in known space, to put it mildly.

She took the trip to finish planning her wedding, apparently. Love Conquers All, except when you have Ebola. She has claimed she called and was told she could fly, but I suspect she was thinking "On the reservation I already have" and they were thinking "a chartered private plane."

But no, she shouldn't have left home.

Then again, as many people have pointed out, nurses now do not get the same training about contagion they used to get pre-antibiotics.
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From: 6_penny
2014-10-17 04:54 am (UTC)
Reminiscent of the guy who was newly diagnosed with drug resistant TB and took off for a trip to Europe. It turned out that it was not the worst type of resistant TB-just close. All the people on the plane, his wife -all in danger because of his obliviousness and selfishness,
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From: 6_penny
2014-10-17 04:35 pm (UTC)
Back in the day of measles/mumps/ckickenpox epidemics we all experienced some variation of quarantine principles. I guess it is a consequence of the ability to immunize against them.
But then I have met nurses who proudly informed me that they did not believe in getting flu shots.
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[User Picture]From: e_moon60
2014-10-17 06:00 pm (UTC)
Widespread immunization and antibiotics have seriously degraded education, experience, and knowledge of medical staff, esp. nurses--yes, they have more to learn, but important "old" stuff has been left out.

Growing up on the Mexican border in the '40s and '50s, with a mother who had actually had polio, malaria, brucellosis etc, as a nursing student gave me a background most people born after 1960 do not have. There was an outbreak of diptheria about 10 miles away when I was a kid--on the US side; there was still smallpox in Mexico and we saw people with smallpox scars. All of us kids had measles, rubella, mumps, and chicken pox (schools did not expect perfect attendance), and some had polio. The school required immunization for smallpox, whooping cough, tetanus, and diptheria--and later the newer immunizations, if you hadn't had the disease--I got the polio shots, but by then had had measles (both kinds), mumps, and chickenpox. I'd had whatever encephalitis nearly killed me (wasn't specifically diagnosed beyond "encephalitis.") I had friends who were in braces from polio (and one who died of it), who were deaf from measles, knew men who'd had mumps late and were infertile as a result. And of course there were the "rubella babies" born of mothers who were exposed to rubella by children bringing it home from school while they were pregnant.

Anyway...when you've been sick with the "childhood illnesses" you know they weren't trivial (and the panic of parents over a 101 or 102F fever now--let alone a little fever after an imunization--is the result of privileged ignorance. Measles routinely sent the temp to 103 or 104 for days, as did mumps; both were painful, especially mumps, miserable with the fever, and debilitating. The encephalitis I had spiked mine--I was told later--to 106+. I was packed in ice for three days trying to get it down to a safer level (104F was considered safe.) Kids suffered permanent brain damage from illnesses that pushed the temperature up that high. I was lucky to have only transient deafness and mild one-sided weakness when I came out of the coma.

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From: 6_penny
2014-10-18 12:42 am (UTC)
I encountered German measles when I was in grad school. I was a really sick puppy with it, And had eye complications that lasted for over a year. -horribly light sensitive, couldn't look through a microscope without weeping, and couldn't be within 20 feet of someone with a lit cigarette. The last in those days made me exceedingly antisocial.
They are nasty bugs. Anyone who doesn't inoculate is nuts.
My late aunt got pertussis from one of her great grand kids. Again nasty, ane even worse for an 85 year old.
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[User Picture]From: e_moon60
2014-10-18 04:40 pm (UTC)
Although I'd had pertussis vaccine as a kid...it doesn't hold immunity forever. I got pertussis itself as an adult, and it was nasty for an early-thirties healthy and athletic woman.
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From: (Anonymous)
2014-10-19 02:08 am (UTC)
Well, there is the possibility that she was unaware of her own breach of precautions, and therefore thought that there was no way she could be considered infected or likely to be so. I'm one of the modern nurses you are so busy maligning: it is true that we aren't that conscious of contagious disease, mostly because it is very rare. The bugs that spread in a hospital spread by contact, not droplet, and are usually only dangerous to other patients, not ourselves. While we take great care to avoid cross contamination between patients, we ourselves are somewhat less cautious: most of the time we aren't susceptible.

I'm not at all sure these people are on paid leave. If they're using their own PTO, I can see the link between the instinctive denial of a life-threatening illness and the thought of well, if I *have* to use all my vacation I'm going to enjoy it, dammit.
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[User Picture]From: e_moon60
2014-10-19 03:59 am (UTC)
1. Anonymous comments all went to moderation. I would appreciate your identifying yourself. You say you're a nurse: please give us a name (at least partial) and location, something about your background. Disclosure builds trust.

2. I am not "maligning modern nurses." I said modern nurses do not receive adequate training in some areas (and better training in others.) I did not say that was the nurses' fault. I do think any doctor or nurse has an obligation to keep up with current medical issues, including those in the news--if nothing else, to assist patients in understanding them and to correct misinformation. Since Ebola had been in the news since at least July (and in medical reports since early in the year) I find it difficult to excuse anyone working in any ER for not being alert to the possibility.

3. Nosocomial infection (hospital based) still spread by a variety of means, not contact alone. Having had to clean up ER trauma rooms and ambulances myself, and worked in EMS with both sick and injured persons, and in a rural clinic, I'm very aware of the multiple modes of transmission in medical care environments: airborne droplets, blood, vomit, fecal contamination, etc. as well as skin-to-skin or skin-to-glove (and then glove to skin) contact.

4. I did not say that all the people _were_ on paid leave: I said paid leave _should_ be ensured for them. If I had the authority, that would be done, as well as assistance provided in other ways. But leaving that aside, medical personnel have an obligation to do no harm. That includes a responsibility not to spread disease. That "if I *have* to use all my vacation I'm going to enjoy it, dammit" attitude is irresponsible, childish. Nobody--not you, not me, not anyone--has the right to be irresponsible with killer diseases. To make other people pay for their snit-fit. It does not *matter* whether the person is actually infected or not--just by taking public transportation, they may unfairly cost other people time and money. And while someone with no medical training might not understand the gravity of the situation, both nurses and doctors certainly should.

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[User Picture]From: saare_snowqueen
2014-10-16 08:32 am (UTC)
You're not the only LJ / writer friend I claim who lives in Texas. My heart goes out to you all and to the people of Texas which has become a flash spot in the battle to contain Ebola. You all have a right to a medical service that you can count on. Sadly it seems that in too many places this is not the case. I hope this becomes the wake-up call that is heeded before too many more people have to die.
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