Wednesday, October 15, 2014

ITOLDYOUSOITOLDYOUSOITOLDYOUSO - UPDATED


Surprising no one with a brain, and thus everyone at CDC and most any media outlet, it turns out that No one in any capacity at Texas Health Presbyterian Hospital was prepared or equipped, physically or mentally, to properly and adequately deal with and treat Ebola patient Thomas Duncan, not even on the SECOND time he entered that facility for care.

JUST LIKE EVERY OTHER HOSPITAL IN THE US FROM MAINE TO MOLOKAI, OR KEY WEST TO KENAI.

(CNN) -- The Texas hospital where a nurse contracted Ebola while caring for a patient had guidelines that were "constantly changing" and didn't have protocols on how to deal with the deadly virus," a nurses' union claims.
"The protocols that should have been in place in Dallas were not in place, and that those protocols are not in place anywhere in the United States as far as we can tell," National Nurses United Executive Director RoseAnn DeMoro said Tuesday night. "We're deeply alarmed."
Texas Health Presbyterian Hospital Dallas treated Thomas Eric Duncan before his death from Ebola last week. Nurse Nina Pham, who cared for him, is being treated for the virus.
CNN Chief Medical Correspondent Dr. Sanjay Gupta said the claims, if true, are "startling." He said some of them could be "important when it comes to possible other infections."
Officials from National Nurses United declined to specify how many nurses they had spoken with, nor identify them to to protect them from possible retaliation. The nurses at the hospital are not members of a union, officials said.

Here's a look at some of the allegations the nurses made, according to the union:
Claim: Duncan wasn't immediately isolated
On the day that 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.
Up to seven other patients were present in that area, the nurses said, according to the union.
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.
Claim: The nurses' protective gear left their necks exposed
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.
Claim: At one point, hazardous waste piled up
"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."
Claim: Nurses got no "hands-on" training
"There was no mandate for nurses to attend training," Burger said, though they did receive an e-mail about a hospital seminar on Ebola.
"This was treated like hundreds of other seminars that were routinely offered to staff," she said.
Claim: The nurses "feel unsupported"
So why did the group of nurses -- the union wouldn't say how many -- contact the nursing union, which they don't belong to?
According to DeMoro, the nurses were upset after authorities appeared to blame nurse Pham, who has contracted Ebola, for not following protocols.
"This nurse was being blamed for not following protocols that did not exist. ... The nurses in that hospital were very angry, and they decided to contact us," DeMoro said.
And they're worried conditions at the hospital "may lead to infection of other nurses and patients," Burger said.
A hospital spokesman did not respond to the specific allegations, but said patient and employee safety is the hospital's top priority.
"We take compliance very seriously. We have numerous measures in place to provide a safe working environment, including mandatory annual training and a 24-7 hotline and other mechanisms that allow for anonymous reporting," hospital spokesman Wendell Watson said.
The Dallas mayor declined to comment on the accusations against the hospital.
"I don't comment on anonymous allegations," Mike Rawlings said.
But the Centers for Disease Control and Prevention released a statement following the union's claims.
"For health care workers in Dallas and elsewhere, the Ebola situation is extremely difficult," CDC spokeman Tom Skinner wrote.
"The CDC is committed to their safety, and we'll continue to do everything possible to make sure they have what they need so they can prepare to safely manage Ebola patients."

There was no protocol in place.
There IS NO PROTOCOL IN PLACE.
They made shit up as they went along, every day.
They exposed staff, other patients, and anyone nearby to a deadly disease because of incompetence, no planning, no training, and flagrant disregard for everything but their bottom line.
Equipment, basic supplies, and routine infrastructure was utterly lacking, and totally inappropriate to manage so much as ONE Ebola patient safely or successfully.
They ignored staff concerns, and resisted common sense suggestions on the spot.
They're falling back on "annual CYA training" to paper over their reckless disregard for common sense and everyone's safety.
They threw front-line staff under the bus at the first opportunity, both figuratively, and by letting them be exposed to a deadly pathogen.
The other authorities within whose purview the hospital functions have their heads up their asses, and continue to spout happygas platitudes, while refusing to step in, lop off heads, and fix the problems RIGHT FUCKING NOW.
They're STILL NOT READY TO DEAL WITH EBOLA, IN ANY WAY, ANYWHERE.

I take no joy in Dallas getting exactly the people they deserve, from hospital administrators to the mayor, because the situation is no different in any and every city in America right now. Including yours.

And the lack of preparedness, the cavalier disregard of common sense, the blatant stupidity, the blind allegiance to and faith in their own non-existent competence and intelligence, have exposed Americans to Ebola, infected Americans to Ebola, and will, in all likelihood, kill Americans with Ebola, just as if they put a bullet in their heads with their own hands.

Pitchfork, torches, and a noose, motherfuckers. Right now, across the board.
And no, I don't mean metaphorically.

If I lived in Dallas, I'd be building a goddamned scaffold across the street from THP, and I'd have WANTED:MURDER posters with pictures of the mayor, the heads of the county heath and state health departments, and the hospital officers, going up on every wall and pole in that city, right now.

The CDC (and the lifelong asstards at the Joint Commission) , nominally responsible for ensuring that hospitals have their infectious disease crap together, deserve their own scaffold in D.C.

And it's still not too late. Because for some mistakes, "Sorry" just doesn't cut it.
Now does anyone not understand that if their lips are moving, they're lying to you?
And have been since this outbreak started?



UPDATE: THP Nurse Today Show exclusive interview
No prior Ebola discussions
No prior training
Infectious Disease specialists called: 
"We don't know [what you should do.] We'll have to call you back."
Nurses caring for Duncan + other patients at same time
Duncan placed in non-isolated ER area near other exposed patients
Inadequate protective gear
No disinfection for doctors moving from Duncan to other patients, and told by Infectious Disease staff that was okay
Isolation patient handling protocols changing daily
Nurses were lied to by supervisory staff
Infectious Ebola materials left exposed in common areas of hospital where everyone was walking by - staff, patients, and visitors
Nurse in interview concerned about hospital reprisals for speaking out publicly

13 comments:

redc1c4 said...

i'm sure the JC (we LOLd at the name change here @ our house) will release some new standards for next year...arrogant much?

and raise the price of the new edition as well. we used to call their type "oxygen thieves" in the Army.

Ex-Dissident said...

Finally an official who spoke truth. I am very impressed with the behavior of the nurses union. As you said, I am facing the same situation at my hospital. We had a meeting that many couldn't attend and were told to wear face-shield which has a surgical mask attached to it, a paper gown, and regular vinyl gloves that often tear as you put them on. We are to put these on and remove them inside the room with the patient and stand there unprotected before exiting the room.

The administration doesn't even blink before throwing the hospital staff under the bus and they don't seem to understand the danger we're facing. I don't know if this is retardation or some sort of pathological viciousness, or a combination.

For whatever it's worth, your blog has been a comfort in that I don't feel completely alone.

Anonymous said...

Meanwhile, up the Devil's ass in Africa, see this thread (and read everything by salad222777).

http://www.reddit.com/r/ebola/comments/2iunwg/why_is_ebola_not_in_or_not_reported_in_bordering/

Aesop said...

I would not be surprised that that is the case, but sooner or later, the cat gets out of the bag, inevitably.

I also suspect in weeks to months one or more of the primary three governments collapses, and both healthy and infected people bombshell outward as refugees at the speed of feet, canoes, or whatever they can arrange.

And then we do this all over again in Senegal, Guinea Bissau, Mali, and Cote d'Ivoire.

Sooner or later, it gets to someplace like Cairo, Delhi, Jakarta, Manila, etc., and that's really the ball game as far as keeping a lid on it.

Here I think we'll see civil collapse before epidemic, because there the governments are pretty worthless even without the disease, so no one misses them as much.

If trucks, trains, and planes stop running in this country, the whole world has a problem. Look back at what losing just air travel did to us after 9/11, when people could still jump in the car and drive anywhere.

This is the tip of the iceberg, with far too much left to come.

Anonymous said...

OMG Another health worker in Texas tests Ebola positive. This is appalling! What is the point of having BSL 4 facilities for just such an emergency if instead patients are treated in an average hospital without the skills or the gear?

Ex-Dissident said...

It is not too late for people who can reason. With the group now in charge, the only way this epidemic ends is through an act of God.

Anonymous said...

I worked in a govt building that had Asbestos abated from within while there were people still working in other parts of the building. The contractor that did the work came in beforehand and put up temp walls and tons of plastic sheeting and SEALED it all. The air from the work area was ducted to a trailer outside with a filtration plant.

This was a temporary setup just for asbestos... I'm sure they could do something similar to a hospital to retrofit it to handle Ebola...

DaShui said...

We got the best medical system in the world, come on...

DaShui said...

What happens if it gets down in Juarez?

Aesop said...

That won't be a problem.
Jeh Johnson has assured us that the border is totally secure.

Bob said...

This was just forwarded to me from my wife. I'm not sure who wrote it but it does tell a bit about what we are in for.

How did the emergency department staff of a Texas hospital see, and discharge, a patient infected with Ebola?

First of all, America’s emergency departments are straining to keep up with the volume of patients that come through their doors. In 2010, the number of visits in the US was 129.8 million, according to the CDC. This numbers rises every year, despite the belief that the Affordable Care Act would direct people to primary care doctors and away from the ER.

The emergency departments of America bear the brunt of trauma, poisonings and drug abuse, of chronic diseases and social drama. They hold suicidal and psychotic patients for days to weeks when there is no other option available. An Ebola victim, with general, initial symptoms of fever, chills, vomiting, diarrhea, abdominal pain and headache, is a small needle in a big hay-pile of feverish, vomiting, suffering humanity.

Furthermore, many people with insurance (including Medicaid and Medicare) can’t find doctors, and large numbers who had insurance before subsequently lost it in the reshuffling of health benefits that has been going on since the ACA was passed. The emergency department is often all they have.

Second, it’s getting much, much harder to focus on that pesky but ubiquitous feature of the modern hospital, the patient. There is data to enter (which keeps nurses and physicians more focused on screens than adolescent boys playing on their Xbox). The electronic medical records systems are unfortunately complex and rarely intuitive. They require so much information that often, relevant points like ‘fever and came from West Africa,’ can be lost in the midst of endless time stamps, and required fields like ‘feels safe at home,’ ‘denies suicidal thoughts’ and ‘bed rails up, call light at bedside.’

Also, there are rules to follow to avoid censure. There are metrics to measure: time to stroke treatment, time to the cardiac cath lab for heart attacks, time from lobby to room, time from triage to doctor, time to discharge and many more; all of them contributing to the Holy Grail of modern health care, the high patient satisfaction score. (Which is being increasingly tied to job security and reimbursement, despite the bad science involved in the process.) Who has time to focus on a single, sick patient when so much depends on screens, rules and data entry?

Third, the rules for admission are ever more complex, based on what Medicare, Medicaid and private insurers are willing to cover. Patients we admitted without question ten years ago are now sent home and told to ‘come back if you get worse.’ In fact, it’s so hard to admit people that I now send home patients I would never have discharged, simply to avoid the misery of explaining the problem to already over-taxed hospitalists who are themselves constrained hand and foot by impossible rules. In this milieu, an otherwise healthy man with a fever is barely a blip.

I know this because earlier this year I was working in a teaching hospital and called the infectious disease specialist on call. My patient had just returned from a mission trip to the Caribbean and had a high white blood cell count, a fever, chills and rash. I was curious if I should have any particular exotic concerns. The specialist’s annoyed answer was this: ‘Sounds like he has a virus. He needs to see his family doctor this week.’

Now that we have Ebola in the US we are reminded that we in medicine, on the front lines, might miss something important. The medical pundits are wagging fingers and lecturing everyone about how best to manage this crisis. (Lecturing, that is, from the relative calm and safety of television studios, rather than the in the mind-numbing chaos of the ER.)

I agree. We need a plan. But the system, as it stands, functions every day on the very razor’s edge of disaster. We need to address that fact if we’re going to have any hope of dealing with Ebola, or other disasters, in the future.

Anonymous said...

Hi Aesop,

I tried posting a link a couple of days ago on another post reply, but the anti-spam thing swallowed it. The link was to an an article, I think from Science Daily, that stated that Ebola carriers are infectious BEFORE they are symptomatic; which has great implications for those that may not desire to be digested alive by this microbe. Since you're far higher on the nursing and medical food chain than I am, would you please comment on this aspect of Ebola?

Best Regards,

Stefan v

Anonymous said...

I conducted a poll at the hospital I work at. None of the RN's I polled plan to go to work if our hospital is inundated with ebola patients. Hell, we can't even control the spread of c-diff and MRSA.