Above photo: This 2011 photo provided by Wilmot Chayee shows Thomas Eric Duncan at a wedding in Ghana.
Update: On October 17, President Obama selected a long-time Democratic Party operative, Ron Klain, to be his point person on Ebola — the Ebola Czar. Klain has no public health experience or education. He is an attorney, who from 1989 to 1992 served as Chief Counsel to the Senate Judiciary Committee where he joined Biden in urging treating drug abuse as a crime rather than a health problem. He also served as Chief of Staff for vice presidents Al Gore and Joe Biden.
Note: The current cases of Ebola in the United States highlight the risk of a serious epidemic that many of us have worried about for a long time. Of all of the industrialized nations, the US is at high risk of an epidemic that could cost hundreds of thousands of lives and billions of dollars due to our fragmented and backwards healthcare system. Our healthcare system is not designed to improve or protect the health of our population, it is designed to create profit for a few.
The three articles below highlight the tragic story of Thomas Eric Duncan who presented to a hospital with obvious risk of Ebola and was mistreated, likely due to being uninsured (he was visiting his son in the US for the first time), the financial priorities of the ‘non-profit’ hospital where he sought treatment and the reality of hospitals run by MBAs rather than health professionals.
[A fourth article from National Nurses United has been added that reports our lack of preparedness for controlling an Ebola epidemic.]
First, some background: In the United States, health care is treated as a commodity – people get the amount of health care they can afford – rather than as a public good – something that all of us need and improves our society. The design of our healthcare system thwarts attempts to address public health threats.
What would a health system based on public health look like? There would be universal access to care without financial or other barriers. There would be facilitation of open and accurate communication between health professionals, institutions and the public. There would be a structure in place to assess the health needs of our population, prioritize them and then apply our resources to address them. For example, in the European Union, universal access to health care is a priority especially for migrants because their health systems recognize the risks of infectious diseases spreading to the whole population. However, in the United States, immigrants are discriminated against the most – the Affordable Care Act excludes them from buying health insurance through the exchanges and excludes them from public health insurances.
If the United States had a health system based on health instead of profit, considering the amount of money that we spend on health care and the excellent research and health institutions that we have, we would have some of the best health outcomes in the world. But we don’t. We consistently rank poorly because our healthcare system is the opposite.
Our healthcare system based on profit leaves tens of millions of people without insurance and even those who do have health insurance often delay or avoid seeking care because of the cost of care not covered by insurance. Our fragmented privatized system impairs communication. And our profit-oriented system competes for technology and patients that bring in the most money, rather than providing care to those who need it the most.
In 2008, Sara Robinson, a trained futurist, compared the Canadian and US healthcare systems:
Our every-man-for-himself attitude toward health care is a security threat on a par with unsecured ports. In Canada, people go see the doctor if they’re sick for more than a day or two. It was this easy access to early treatment, along with the much tighter public health matrix that enables doctors to share information quickly, that allowed the country’s health care system to detect the 2003 SARS epidemics in Toronto and Vancouver while they were still very localized, act within hours to stop them before the disease spread any further, and track down and treat exposed people before they got too sick to be helped. In both cases, the system worked flawlessly. The epidemic was stopped within days and quashed entirely in under a month, potentially saving of millions of lives.
In the U.S., that same epidemic might easily have gone unnoticed for critical days and weeks. If the first people to get sick were among those 75 million without adequate insurance, they probably would have toughed it out a few extra days before finally dragging their half-dead carcasses into an ER somewhere. Not only would they be much farther along in the course of the disease — and thus at greater risk of death themselves — every one of them could have infected dozens or even hundreds of other people in the meantime, accelerating the spread of the epidemic.
Worse: America’s underfunded public health system might have taken several days to piece together the whole picture of an epidemic; and perhaps another week or two might have passed before the E. Coli conservatives in charge (having thrown out the science-based management plans thoughtfully developed by the bureaucracy) cooked up some kind of half-assed ideology-driven decision about how to proceed. (It would, of course, involve spectacular amounts of lying to the public.) By that point, tens of millions could have been infected, leading to a death toll that would make 9/11 and Katrina look like minor statistical blips.
Instead, ABC News reports:
The woman coordinating the Obama administration’s response to the nation’s first Ebola scare in history has no background in public health or managing an outbreak. Lisa Monaco, the president’s homeland security and counterterrorism adviser, is a lawyer with a background in federal law enforcement, criminal prosecution and crisis response. ABC’s DEVIN DWYER reports she was formerly assistant attorney general for national security and spent years working inside the FBI. For several years she served as counsel and chief of staff to then-director Robert Mueller. The White House says she is a “highly competent individual” with experience coordinating federal agency responses to national security threats, which include Ebola.
This is why I advocate for Medicare for All.
-Margaret Flowers, M.D.
Exclusive: Ebola didn’t have to kill Thomas Eric Duncan, nephew says
By Josephus Weeks in Dallas News
On Friday, Sept. 25, 2014, my uncle Thomas Eric Duncan went to Texas Health Presbyterian Hospital Dallas. He had a high fever and stomach pains. He told the nurse he had recently been in Liberia. But he was a man of color with no health insurance and no means to pay for treatment, so within hours he was released with some antibiotics and Tylenol.
Two days later, he returned to the hospital in an ambulance. Two days after that, he was finally diagnosed with Ebola. Eight days later, he died alone in a hospital room.
Now, Dallas suffers. Our country is concerned. Greatly. About the lack of answers and transparency coming from a hospital whose ignorance, incompetence and indecency has yet to be explained. I write this on behalf of my family because we want to set the record straight about what happened and ensure that Thomas Eric did not die in vain. So, here’s the truth about my uncle and his battle with Ebola.
Thomas Eric Duncan was cautious. Among the most offensive errors in the media during my uncle’s illness are the accusations that he knew he was exposed to Ebola — that is just not true. Eric lived in a careful manner, as he understood the dangers of living in Liberia amid this outbreak. He limited guests in his home, he did not share drinking cups or eating utensils.
And while the stories of my uncle helping a pregnant woman with Ebola are courageous, Thomas Eric personally told me that never happened. Like hundreds of thousands of West Africans, carefully avoiding Ebola was part of my uncle’s daily life.
And I can tell you with 100 percent certainty: Thomas Eric would have never knowingly exposed anyone to this illness.
Thomas Eric Duncan was a victim of a broken system. The biggest unanswered question about my uncle’s death is why the hospital would send home a patient with a 103-degree fever and stomach pains who had recently been in Liberia — and he told them he had just returned from Liberia explicitly due to the Ebola threat.
Some speculate that this was a failure of the internal communications systems. Others have speculated that antibiotics and Tylenol are the standard protocol for a patient without insurance.
The hospital is not talking. Until then, we are all left to wonder. What we do know is that their error affects all of society. Their bad judgment or misjudgment sent my uncle back into the community for days with a highly contagious case of Ebola. And now, officials suspect that a breach of protocol by the hospital is responsible for a new Ebola case, and that all health care workers who care for my uncle could potentially be exposed.
Their error set the wheels in motion for my uncle’s death and additional Ebola cases, and their ignorance, incompetence or indecency has created a national security threat for our country.
Thomas Eric Duncan could have been saved. Finally, what is most difficult for us — Thomas Eric’s mother, children and those closest to him — to accept is the fact that our loved one could have been saved. From his botched release from the emergency room to his delayed testing and delayed treatment and the denial of experimental drugs that have been available to every other case of Ebola treated in the U.S., the hospital invited death every step of the way.
When my uncle was first admitted, the hospital told us that an Ebola test would take three to seven days. Miraculously, the deputy who was feared to have Ebola just last week was tested and had results within 24 hours.
The fact is, nine days passed between my uncle’s first ER visit and the day the hospital asked our consent to give him an experimental drug — but despite the hospital’s request they were never able to access these drugs for my uncle. (Editor’s note: Hospital officials have said they started giving Duncan the drug Brincidofovir on October 4.) He died alone. His only medication was a saline drip.
For our family, the most humiliating part of this ordeal was the treatment we received from the hospital. For the 10 days he was in the hospital, they not only refused to help us communicate with Thomas Eric, but they also acted as an impediment. The day Thomas Eric died, we learned about it from the news media, not his doctors.
Our nation will never mourn the loss of my uncle, who was in this country for the first time to visit his son, as my family has. But our nation and our family can agree that what happened at Texas Health Presbyterian Hospital Dallas must never happen to another family.
In time, we may learn why my uncle’s initial visit to the hospital was met with such incompetence and insensitivity. Until that day comes, our family will fight for transparency, accountability and answers, for my uncle and for the safety of the country we love.
Josephus Weeks, a U.S. Army and Iraq War veteran who lives in North Carolina, wrote this piece exclusively for The Dallas Morning News. Reach him at josephusweeks@yahoo.com.
Hospital turns to PR to fight Ebola
By Steven Brill for Reuters
This New York Times story on Thursday outlines the damage done to the reputation of Texas Health Presbyterian Hospital in Dallas as a result of its mistakes in dealing with Ebola patient Thomas Eric Duncan. The hospital, the Times reports, has now “hired Burson-Marsteller, the global public-relations firm, to help tell its side.”
It would be great to see a story detailing the advice Burson is giving the hospital — especially because hospitals, which rarely contend with a skeptical let alone hostile press, are terrible at dealing with the media. It would be even better to see stories that go beyond recording what is already a hospital apology tour clearly suggested by Burson.
Typically, hospitals are every community’s favorite charity — though they make exorbitant profits and often bill patients abusively. Thus, the Times reported:
Until three weeks ago, few questioned Presbyterian’s status. With nearly 900 beds and 1,000 doctors, it is the eighth-largest hospital in Texas and has excelled in delivering both cardiac care and babies…. It is the hospital of choice for some of the region’s richest and most prominent residents. The board chairwoman at the hospital’s parent company, Texas Health Resources, is Anne T. Bass, the wife of the billionaire investor Robert M. Bass.
But then the Times reported on some suits brought by patients alleging bad care in the hospital’s emergency room and that “the hospital’s most recent tax filings, from 2012, show that it had $613 million in revenue and $1.1 billion in net assets. The hospital’s president at the time was paid $1.1 million.”
The Times, however, missed some more important numbers that provide a fuller picture of what may be among the most successful businesses in northern Texas, such as:
- The hospital had an operating profit (revenue over expenses, with noncash depreciation added back) of $89 million. That’s a profit margin of 14.5 percent — amazing for a people-intense service business, let alone a supposed nonprofit.
- I’m sure Anne Bass and others in the Dallas community are charitable, but of that $613 million revenue, just $7.8 million, or 1.3 percent, came from contributions.
- Meantime, the hospital was still able to realize those profit margins while paying seven executives more than $600,000 each and three more than $1,000,000.
- That is still not the full picture. The Dallas hospital is a subsidiary of a 25-hospital system called Texas Health Resources (the client that retained Burson). This parent company had revenue of $3.7 billion in 2012, with operating income (excluding depreciation because it is not a cash expense) of $473 million. I counted 20 executives on the parent company’s tax form earning more than $600,000, with the highest earner topping out at $2,685,000.
Why am I laying out all these compensation numbers? Because any good reporter should want to put Burson and its new client to the test by asking how much of the large bonus portion in each compensation package is based on the executives’ attention to quality control.
So far, Burson seems to have encouraged hospital officials to end their early silence and engage with the press, and even to own up to their early mistakes. Burson obviously believes this will take some of the heat off.
It shouldn’t.
As with most hospitals, Texas Health Resources form 990 filing has a lot of high-sounding gobbledygook about how judiciously the compensation of its executives is determined. It cites its board’s retention of “independent” compensation consultants to determine, among other things, the metrics that should be used for its bonus plans.
I’ve found, however, that despite the way nonprofit hospitals and their boards like to refer to their mission in terms of providing quality care, even to those who cannot afford it, the metrics these boards typically set mostly — if not completely in some cases — have to do with two cold, hard business numbers: revenue and operating profit.
How, in fact, are the bonuses at Texas Health determined?
How much does the quality of the care — for which federal regulators now have multiple, comparative measures — count?
One of the most important of those measures has to do with the rate of infections contracted in the hospital. Is any executive’s compensation in any way based on that? Is there a separate board quality-control committee that monitors this aspect of the hospital’s performance?
Those questions should be followed by asking for specifics related to how often the hospital did drills for dealing with infectious diseases, who was in charge of those drills and how were they documented.
With the original mistake in mind — that Duncan, who obviously had no insurance, was sent home from the emergency room when he should have been admitted — any good reporter should ask if any policies or incentives were in place at the hospital to discourage potential nonpayers from being admitted.
If Burson and its client are in any way cagey about providing all documents and making available all officials and doctors related to this process and these policies, the reporter should find doctors or nurses who will provide the information, even if they will not allow their names to be used.
A hospital that, like most, has enjoyed a relatively easy ride in the media has now been thrust into the international spotlight in a horribly negative way. It’s time for the media not to record its apology and move on, but to look at this institution, and others like it, as the aggressive — and vitally important –businesses that they are.
Will Ebola Vanquish the MBAs Who Run Our Hospitals?
By Yves Smith in Naked Capitalism
Yves here. This discussion from the BBC gives a damning picture of the performance of the supposedly “best of all possible worlds” US health care system has been in dealing with Ebola:
The Dallas Presbyterian Hospital treated one Liberian, Thomas Duncan, who died. From caring for him, two nurses have now contracted the disease.
Nearly 80 health workers are under observation. It is claimed by the biggest nursing union that those charged with his care did not have the right protective clothing, flesh was exposed, there were no clear guidelines of what to wear, how to wear it, and how to disrobe.
The US Centers for Disease Control and Prevention (CDC) concedes that it is possible flesh was left exposed when treating Duncan. And that is why among those nearly 80 still under observation, no one can rule out the possibility that there will be further cases.
This is a crude, and damning, statistic but so far Medecins sans Frontieres (Doctors without Borders) has treated thousands of people in West Africa with Ebola, and has seen 16 medical workers contract the disease. This hospital in Dallas has treated just one patient, and has two sick healthcare staff.
Note how the BBC contacted an organization with actual experience in treating Ebola. How many US news organizations have interviewed Medecins sans Frontiers? Lambert and I haven’t seen a single mentions of them in the large number of Ebola-related stories we’ve read between us. Given how deeply embedded exceptionalism is in the American psyche, odds are high that the CDC hasn’t talked to them either.
This sorry performance looks even worse when you read a New York Times story on how the hospital handled the outbreak. Even with thin details and image-burnishing efforts by PR giant Burson Marsteller, staff clearly had no idea what to do and their improvisations often increased risks. Ironically, Presby, as it is called locally, is also described as the Neiman Marcus of hospitals, with a stellar local image and a Margaret Perot wing. But while it does well with treatments for the affluent, like heart surgeries, emergency care is another matter:
In Medicare’s most recent ratings, the hospital scored well on surgery, obstetrics, and cardiac and stroke care. But it did less well, below state and national averages, on assessments of its emergency department. For instance, it took an average of 52 minutes for an emergency patient to be seen by a doctor or nurse, twice the state and national averages.
One of the things we’ve mentioned occasionally about the short-sightnedness of the “crush ordinary workers and squeeze government so that it becomes incompetent and no one will want to pay for it” is public health risks. Wealthy people can’t avoid contact with people at the bottom of the economic food chain: servants, yard men, hospital orderlies, service staff in restaurants. They might be able to insulate themselves from bad economic and political results of their looting schemes, but they can’t escape the ravages of infectious diseases. Remember, FDR was a polio victim. And this has been brought home earlier than we might expect by a medical facility that caters to the well-heeled becoming the American ground zero for a disease from poverty-stricken West Africa.
The article below goes into considerable, damning detail about the considerable mismanagement of Duncan’s case and how it demonstrates how short-sighted it is to have MBAs run hospitals. These details have become public despite a gag order having apparently been put in place on the staff of the hospital that treated the first patient, hospital, Texas Health Presbyterian. Imagine what we don’t yet know.
By Roy Poses, MD, Clinical Associate Professor of Medicine at Brown University, and the President of FIRM – the Foundation for Integrity and Responsibility in Medicine. Cross posted from the Health Care Renewal website
Introduction
News and opinions about Ebola virus are swirling around the US, fueled by a tragic epidemic in West Africa, and fears that more infections could appear here. On October 6, 2014, I posted my concerns that despite a tremendous amount of confidence expressed by government officials and health care leaders, our dysfunctional health care system might have trouble containing Ebola virus. Less than two weeks later, my concerns do not seem so extreme. The first patient to be diagnosed with Ebola virus in the US has died. Two nurses who cared for him now have the virus.
There seem to be millions of words on paper and on the internet about Ebola appearing every day. So I certainly do not want to try to deal with the problem in all its aspects. I do want to revisit a particular set of issues from my October 6 post: the hazards posed by generic management deluded by business school dogma running health care institutions in the time of Ebola. In particular, my focus is the management of the US hospital at which one patient died, and two nurses were infected, based on what has come out since October 6.
The Incoherence of Hospital Leaders
On October 6, we noted that the hospital, Texas Health Presbyterian, part of the Texas Health Resources hospital system, had issued conflicting and confusing statements about why the first Ebola patient, Mr Thomas Eric Duncan, was sent home from the hospital when he first presented. The first specific statement by hospital managers was that there had been a problem with the hospital’s electronic health record (EHR), as had been suspected by my fellow Health Care Renewal blogger, InformaticsMD. Then the hospital retracted that statement, but provided no explanation with which to replace it.
Since then, there have been more inconsistencies in statements made by hospital managers.
Fever or No Fever?
First hospital managers said Mr Duncan arrived without a fever, but then review of his medical records indicated his temperature was as high as 103 degrees F while he was in the hospital, a fever high enough that it might reasonably have prompted admission given his other symptoms, even if Ebola was not a concern. (See this Dallas Morning News story.)
Readiness for Ebola Patients?
Hospital managers assured the public they were ready for Ebola virus patients, e.g., in the Dallas Morning News story of September 30, 2014,
When Ebola arrived, they were ready.
The staff at Texas Health Presbyterian Hospital of Dallas did a run-through just last week of procedures to follow if the deadly virus landed in Dallas.
‘We were prepared,’ Dr. Edward Goodman, an epidemiologist at Texas Health Presbyterian, said Tuesday in a news conference. ‘We have had a plan in place for some time now in the event of a patient presenting with possible Ebola. We are well-prepared to deal with this crisis.’
Presbyterian said it is following recommendations from the U.S. Centers for Disease Control and Prevention and the Texas Department of Health in responding to the patient, described as being ‘critically ill’ at the hospital in northeast Dallas.
All precautions are being taken to protect doctors, nurses and others in the hospital, officials said.
Sadly, this statement soon seemed, as one politician once said, inoperative. an October 14 Washington Post article described how hospital health professionals had to essentially make up their procedures as they went along.
The hospital that treated Ebola victim Thomas Eric Duncan had to learn on the fly how to control the deadly virus, adding new layers of protective gear for workers in what became a losing battle to keep the contagion from spreading, a top official with the Centers for Disease Control and Prevention said Tuesday.
‘They kept adding more protective equipment as the patient [Duncan] deteriorated. They had masks first, then face shields, then the positive-pressure respirator. They added a second pair of gloves,’ said Pierre Rollin, a CDC epidemiologist.
Also,
He said the hospital originally had no full-body biohazard suits equipped with respirators but now has about a dozen. Protocols evolved at the hospital while Duncan was being treated, he said: ‘Collecting samples, with needles, then you have to have two people, one to watch. I think when the patient arrived they didn’t have someone to watch.’
Worse, in the last 24 hours, there have been reports by anonymous people said to be nurses at Texas Health Presbyterian that the hospital was clearly not ready, per the Los Angeles Times,
The nurses’ statement alleged that when Duncan was brought to Texas Health Presbyterian by ambulance with Ebola-like symptoms, he was ‘left for several hours, not in isolation, in an area’ where up to seven other patients were. ‘Subsequently, a nurse supervisor arrived and demanded that he be moved to an isolation unit, yet faced stiff resistance from other hospital authorities,’ they alleged.
Duncan’s lab samples were sent through the usual hospital tube system ‘without being specifically sealed and hand-delivered. The result is that the entire tube system … was potentially contaminated,’ they said.
The statement described a hospital with no clear rules on how to handle Ebola patients, despite months of alerts from the U.S. Centers for Disease Control and Prevention in Atlanta about the possibility of Ebola coming to the United States.
‘There was no advanced preparedness on what to do with the patient. There was no protocol. There was no system. The nurses were asked to call the infectious disease department’ if they had questions, but that department didn’t have answers either, the statement said. So nurses were essentially left to figure things out on their own as they dealt with ‘copious amounts’ of highly contagious bodily fluids from the dying Duncan while they wore gloves with no wrist tape, flimsy gowns that did not cover their necks, and no surgical booties, the statement alleged.
‘Hospital officials allowed nurses who interacted with Mr. Duncan to then continue normal patient-care duties,’ potentially exposing others, it said.
In response, the official hospital statement (authored by one Wendell Watson, “a Presbyterian spokesman,” according to the AP) contained vague assurances, but no specific responses to the allegations,
‘Patient and employee safety is our greatest priority, and we take compliance very seriously,’ the hospital said in a statement. ‘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. Our nursing staff is committed to providing quality, compassionate care, as we have always known, and as the world has seen firsthand in recent days. We will continue to review and respond to any concerns raised by our nurses and all employees.’
So while hospital officials (and local and national politicians and government leaders) kept up reassuring statements that our sophisticated, high-technology hospitals were totally ready to deal with a disease like Ebola, the reality appeared far different.
Other Inconsistencies:
According to a USA Today story, other inconsistencies included hospital statements about the date Mr Duncan’s diagnosis was confirmed, and whether or not the hospital was diverting ambulances.
Were Health Professionals Silenced?
Of course, given the suddenness of the arrival of Ebola in the US, the acuity of the first patient, and the general atmosphere of panic, initial confusion in public statements however critical the information they were meant to contain may be, is understandable.
However, there are now allegations that hospital management was not merely confused, but trying to keep critical information secret, and the allegations do not seem incredible.
In a Washington Post story on October 12, about how many US hospitals seem not well prepared for Ebola infected patients, appeared this from Bonnie Castillo, director of Registered Nurse Response Network, part of the union, National Nurses United,
Castillo said the union has been trying to contact nurses at Texas Health Presbyterian Hospital, where Thomas Eric Duncan, the Liberian man diagnosed with Ebola, died Wednesday.
‘That hospital has issued a directive to all hospital staff not to speak to press,’ Castillo said. ‘That is a grave concern because we need to hear from those front-line workers. We need to hear what happened there. … They have them on real lockdown. There is great fear. This hospital is not represented by a union. Our sense is they are afraid to speak out.’
The Los Angeles Times story included,
The Dallas nurses asked the union to read their statement so they could air complaints anonymously and without fear of losing their jobs, National Nurses United Executive Director RoseAnn DeMoro said from Oakland.
The October 14 Washington Post story noted\
the labor organization National Nurses United read a statement that it said came from nurses at the hospital who ‘strongly feel unsupported, unprepared, lied to and deserted to handle their own situation.’
The AP story of October 15 stated,
The Presbyterian nurses are not represented by Nurses United or any other union. DeMoro and Burger said the nurses claimed they had been warned by the hospital not to speak to reporters or they would be fired.
The AP has attempted since last week to contact dozens of individuals involved in Duncan’s care. Those who responded to reporters’ inquiries have so far been unwilling to speak.
Covering up information vitally needed by health care professionals, other institutions, the government, etc to better manage a potentially fatal disease that is already epidemic in other countries appears completely unethical. Doing so to preserve the reputation of managers seems reprehensible. But the implication of the recent stories is that is what happened.
Why Hospital Managers May Not Deserve Our Trust
The US has had no recent experience with any disease like Ebola. So that mistakes, sometimes very serious ones, were made in the management of the first Ebola patients is not a big surprise.
What may be a big surprise to many Americans is how untrustworthy health care leaders, and in particular the managers of Health Texas Presbyterian hospital and its parent system, Health Texas Resources now appear. After all, USA Today published on October 14, “Texas Health Presbyterian was a respected, renowned hospital.” While even people at respected, renowned institutions make mistakes when confronted with sudden, unfamiliar problems, should not the institution’s leaders at least be trusted to in their public pronouncements?
Instead, it appears that the leaders appeared tremendously overconfident, and worse, may have silenced employees from raising concerns that could have reflected badly on leadership. This occurred in a context in which transparency was imperative so that other people who might have to deal with Ebola patients might be better prepared.
On the other hand, based on what we have been posting on Health Care Renewal for nearly 10 years, the conduct of the Texas Health Resources leaders should have come as no surprise. On Health Care Renewal we have been connecting the dots among severe problems with cost, quality and access on one hand, and huge problems with concentration and abuse of power, enabled by leadership of health care organizations that is ill-informed, incompetent, unsympathetic or hostile to health care professionals’ values, self-interested, conflicted, dishonest, or even corrupt and governance that fails to foster transparency, accountability, ethics and honesty.
We have seen many examples of hospital executives who seemed vastly impressed by their own brilliance, egged on by board members who were themselves executives of other organizations, and by marketing and public relations functionaries dependent on these executives for their own career advancement. In particular, we have posted examples of hospital CEOs and other top executives making millions of dollars a year based on their supposed “brilliance,” or “visionary” capacity, at least according to the board members who supposed to be exercising stewardship over their institutions, and the public relations people they hired. Such brilliance has often been asserted, but rarely been explained or justified (The latest example was here, and much more discussion is here.)
Most such ostensibly “brilliant” hospital executives had no direct experience in clinical care, public health, or biomedical science.
Making hospital leaders feel entitled to make more and more money regardless of their or their institutions’ performance seems to be a recipe for “CEO Disease,” leading to disconnected, unaccountable, self-interested leaders. Hospital leaders suffering from the CEO disease may be particularly willing to countenance suppression of any facts or ideas that might raise doubts about their brilliance.
So the leadership of Texas Health Resources may in fact be very typical of that of large non-profit hospital systems. THR is such a system. A Dallas Morning News article about Mr Doug Hawthorne, the Texas Health Resources CEO who just retired in September, 2014, stated
In 1997, Doug Hawthorne helped reshape the health care industry in North Texas by leading the creation of Texas Health Resources, an alliance of Presbyterian Healthcare Resources, Harris Methodist Health System and Arlington Memorial Hospital.
By 2014,
With more than 22,000 employees in fully owned and joint venture operations, Texas Health is one of the largest care providers in North Texas. For its 2012 fiscal year, it had $3.7 billion in total operating revenue and $5.3 billion in total assets.
For leading this system, Mr Hawthorne made a lot of money, although apparently no recent data is available on his compensation,
He was among the most highly compensated not-for-profit CEOs in the region. For 2012, the most recent information available, his base salary was about $1 million and his bonus was about $1.1 million.
It should be no surprise that to justify this compensation, Mr Hawthorne was proclaimed a visionary. According to the Dallas/ Fort Worth Healthcare Daily, Mr Hawthorne was inducted in 2014 into the Texas Business Hall of Fame. At that time,
‘A healthcare visionary, Mr. Hawthorne is at the helm of one of the largest faith-based, nonprofit health care delivery systems in the United States, Texas Health Resources,’ the Hall said in a release announcing the induction.
Yet Mr Hawthorne had no direct patient care experience, public health experience, or biomedical or clinical science experience. Mr Hawthorne is on the board of directors of the LHP Hospital Group Inc, a for-profit that provides capital and services to non-profit hospitals. The official bio, posted by LHP stated his educational background only included
B.S. and M.S. degrees in healthcare administration from Trinity University in San Antonio.
Furthermore, as we mentioned earlier, the current CEO of Texas Health Resources, Mr Barclay E Berden, who has only been on the job since September 1, 2014, also was hailed by system board of trustees for his “unique leadership strengths.” His current compensation is unknown, but I would guess is likely over $1 million/year. He highest degree is a MBA, and like his predecessor, had much experience in hospital management, but apparently none in clinical care, public health, or biomedical science.
Summary
Texas Health Resources’ recent CEOs have been paid millions, and hailed for their brilliance, despite a lack of any direct experience in health care, public health, or biomedical science. Leaders convinced of their own brilliance may live in bubbles that prevent penetration of any ideas or facts that may challenge that brilliance, making them thus susceptible to hubris.
So should we have been surprised that the leadership of the first US hospital system to directly confront Ebola de novo seemed more concerned with polishing their supposed brilliance than with transparently providing the information that other people who have to confront Ebola in the future so greatly need?
No, but one tiny silver lining to the time of Ebola is that it may make it glaringly obvious that we need true health care reform that focuses on reforming the leadership of big health care organizations. In particular, we need leadership that is well-informed about health care and public health; that upholds the values of health care professionals, specifically by putting patients’ and the public’s health ahead of their own remuneration; is willing to be held accountable; and is honest and unconflicted.
Allowing the current dysfunction to continue, while it will be very profitable to the insiders who run the system, will continue to enable tragic outcomes for patients and the public.
Statement by RN’s at Texas Health Presbyterian Hospital as provided to National Nurses United
National Nurses United, 10/15/14
This is an inside story from some registered nurses at Texas Health Presbyterian Hospital in Dallas who have familiarity with what occurred at the hospital following the positive Ebola infection of first the late Thomas Eric Duncan and then a registered nurse who cared for him Nina Pham.
The RNs contacted National Nurses United out of frustration with a lack of training and preparation. They are choosing to remain anonymous out of fear of retaliation.
The RNs who have spoken to us from Texas Health Presbyterian are listening in on this call and this is their report based on their experiences and what other nurses are sharing with them. When we have finished with our statement, we will have time for several questions. The nurses will have the opportunity to respond to your questions via email that they will send to us, that we will read to you.
We are not identifying the nurses for their protection, but they work at Texas Health Presbyterian and have knowledge of what occurred at the hospital.
They feel a duty to speak out about the concerns that they say are shared by many in the hospital who are concerned about the protocols that were followed and what they view were confusion and frequently changing policies and protocols that are of concern to them, and to our organization as well.
When Thomas Eric Duncan first came into the hospital, he arrived with an elevated temperature, but was sent home.
On his return visit to the hospital, he was brought in by ambulance under the suspicion from him and family members that he may have Ebola.
Mr. Duncan was left for several hours, not in isolation, in an area where other patients were present.
No one knew what the protocols were or were able to verify what kind of personal protective equipment should be worn and there was no training.
Subsequently a nurse supervisor arrived and demanded that he be moved to an isolation unit– yet faced resistance from other hospital authorities.
Lab specimens from Mr. Duncan were sent through the hospital tube system without being specially sealed and hand delivered. The result is that the entire tube system by which all lab specimens are sent was potentially contaminated.
There was no advance preparedness on what to do with the patient, there was no protocol, there was no system. The nurses were asked to call the Infectious Disease Department. The Infectious Disease Department did not have clear policies to provide either.
Initial nurses who interacted with Mr. Duncan nurses wore a non-impermeable gown front and back, three pairs of gloves, with no taping around wrists, surgical masks, with the option of N-95s, and face shields. Some supervisors said that even the N-95 masks were not necessary.
The suits they were given still exposed their necks, the part closest to their face and mouth. They had suits with booties and hoods, three pairs of gloves, no tape.
For their necks, nurses had to use medical tape, that is not impermeable and has permeable seams, to wrap around their necks in order to protect themselves, and had to put on the tape and take it off on their own.
Nurses had to interact with Mr. Duncan with whatever protective equipment was available, at a time when he had copious amounts of diarrhea and vomiting which produces a lot of contagious fluids.
Hospital officials allowed nurses who had interacted with Mr. Duncan to then continue normal patient care duties, taking care of other patients, even though they had not had the proper personal protective equipment while caring for Mr. Duncan.
Patients who may have been exposed were one day kept in strict isolation units. On the next day were ordered to be transferred out of strict isolation into areas where there were other patients, even those with low-grade fevers who could potentially be contagious.
Were protocols breached? The nurses say there were no protocols.
Some hospital personnel were coming in and out of those isolation areas in the Emergency Department without having worn the proper protective equipment.
CDC officials who are in the hospital and Infectious Disease personnel have not kept hallways clean; they were going back and forth between the Isolation Pod and back into the hallways that were not properly cleaned, even after CDC, infectious control personnel, and doctors who exited into those hallways after being in the isolation pods.
ADVANCE PREPARATION
Advance preparation that had been done by the hospital primarily consisted of emailing us about one optional lecture/seminar on Ebola. There was no mandate for nurses to attend trainings, or what nurses had to do in the event of the arrival of a patient with Ebola-like symptoms.
This is a very large hospital. To be effective, any classes would have to offered repeatedly, covering all times when nurses work; instead this was treated like the hundreds of other seminars that are routinely offered to staff.
There was no advance hands-on training on the use of personal protective equipment for Ebola. No training on what symptoms to look for. No training on what questions to ask.
Even when some trainings did occur, after Mr. Duncan had tested positive for Ebola, they were limited, and they did not include having every nurse in the training practicing the proper way to don and doff, put on and take off, the appropriate personal protective equipment to assure that they would not be infected or spread an infection to anyone else.
Guidelines have now been changed, but it is not clear what version Nina Pham had available.
The hospital later said that their guidelines had changed and that the nurses needed to adhere to them. What has caused confusion is that the guidelines were constantly changing. It was later asked which guidelines should we follow? The message to the nurses was it’s up to you.
It is not up to the nurses to be setting the policy, nurses say, in the face of such a virulent disease. They needed to be trained optimally and correctly in how to deal with Ebola and the proper PPE doffing, as well as how to dispose of the waste.
In summary, the nurses state there have been no policies in cleaning or bleaching the premises without housekeeping services. There was no one to pick up hazardous waste as it piled to the ceiling. They did not have access to proper supplies and observed the Infectious Disease Department and CDC themselves violate basic principles of infection control, including cross contaminating between patients. In the end, the nurses strongly feel unsupported, unprepared, lied to, and deserted to handle the situation on their own.
We want our facility to be recognized as a leader in responding to this crisis. We also want to recognize the other nurses as heroes who put their lives on the line for their patients every day when they walk in the door.