Ebola crisis reveals massive disparities in U.S. hospital preparedness

A few days before the Ebola-infected Thomas Eric Duncan arrived in Dallas-Fort Worth Airport to reunite with his fiancee, the Centers for Disease Control and Prevention released a sternly worded alert to the nation’s hospitals.

“Now is the time to prepare,” the memo said in bolded letters at the beginning of a detailed six-page checklist of steps that hospitals should take to ready themselves for a patient like Duncan. “Every hospital should ensure that it can detect a patient with Ebola.”

As is clear now, Texas Health Presbyterian Hospital in Dallas was not ready to detect Ebola — they sent Duncan home with antibiotics after he showed up with a fever and and abdominal pain, and acknowledged he had recently been in Liberia. He came into contact with dozens of people after that — including schoolchildren — before his disease worsened and he returned to the hospital in an ambulance.

On Wednesday, he died.

CDC Director Thomas Frieden called the hospital’s lapse a “teachable moment,” and the agency sent out another round of alerts to hospitals last week, again urging them to prepare themselves for the incurable and highly fatal disease.

But in the decentralized U.S. health care system, hospitals don’t necessarily have to take the CDC’s advice — and federal funding streams to help them do so have been slashed in recent years. The result is a health care system where some hospitals are running intense, life-like drills featuring hypothetical Ebola patients and others are just now beginning to send around memos on the topic.

“We hope that hospitals will disseminate this information to their staff members,” CDC spokeswoman Melissa Brower told Yahoo News in an email. But just in case they don’t, the agency also sends their messages to other groups, such as professional organizations for emergency room employees.

While there’s no national polling on how many hospitals are following the CDC’s advice to prepare, an informal online survey by a nurses’ union of 1,800 registered nurses in 700 hospitals around the country found that 76 percent were unaware of any hospital policy around Ebola patients as of this Thursday.  A spokesman for the National Nurses United union, Charles Idelson, said that some nurses are just being told to look at the CDC website as the extent of their training — others had never heard of Ebola until reading about it in the news.

The CDC is in “initial conversations” with the Centers for Medicare & Medicaid Services (CMS) to include Ebola preparedness in their annual certification process for hospitals, according to Brower. A host of regulations require that hospitals be prepared for infectious disease, generally, and doctors say the preparations needed for Ebola are not so different from those needed for any other outbreak.

Hospitals have to make tough choices about whether it’s worth taking valuable nurses and doctors out of circulation for time-consuming drills to prepare for a disease that’s killed only one person in the U.S. so far.

“You could certainly argue that with one case in the United States you probably aren’t going to put a lot of resources in it,” said Dr. David Klocke, chief medical officer for Regional Health hospitals in South Dakota. Klocke’s hospitals sent out the first memos on Ebola about two weeks ago, he said, and are just now considering conducting a drill to prepare for a potential patient. “We really are in general very well prepared to deal with dangerous microorganisms anyway,” he said. The hospitals prepare for outbreaks of flu and other diseases, as well as mass casualty incidents like plane crashes.

Rural hospitals like Klocke’s are a world away from Jackson Health System in Miami, Florida, which has 10,000 employees and is close to Miami’s international airport. Dr. Abdul Memon, the institution’s chief medical officer for disaster and emergency preparedness, said hospital leadership began meeting about Ebola in mid-August — and has done several virtual and live drills since. In one drill, conducted on Sept. 29, staff had to figure out how to deal with an Ebola-infected pregnant woman who was about to give birth. After an emergency cesarean-section, the hypothetical woman died, and the morgue practiced disposing of the body according to CDC standards.

The hospital’s plan was so detailed that security officers were told to check the parking lot for the patient’s car, to make sure no one else drove it in case it was contaminated. Since then, the hospital treated two actual patients who thought they had Ebola but were found to be negative for the disease.

Just as hospitals can ignore the CDC’s pleas for preparation, they can also go farther than the agency recommends. Jackson Health System is purchasing hazardous material suits for their staff to wear in the event of an Ebola patient. The CDC says that face masks and gowns are enough protection, but Memon said his staff wants to be fully covered with hoods. Frieden said on Wednesday that he didn’t think the more protective gear — referred to as space suits by some doctors — was a good idea, because it can increase the chance of infection when staffers take it off. “The more cumbersome personal protective equipment is the greater the chance there will be a problem,” Frieden said.

At the University of Texas Medical Branch in Galveston, Dr. Glen Mayhall says he is currently recruiting volunteers to be trained next week in a special Ebola treatment unit. One of the most important parts of the training will be putting on and taking off the protective gowns, since staff can contaminate themselves with the virus if they remove their clothes improperly. “This takes a lot of education and drilling. They have to do it over and over,” Mayhall said.

All of this preparation also costs money. Asked if he gets enough money from the government to support this training, Memon answered, “We wish.”

The federal funding stream for hospital emergency preparedness that began after the Sept 11 attacks is half of what it was 10 years ago. Last year, the federal government gave $229 million to states for hospital emergency preparedness, compared to $498 million in 2004. “We will be scrambling,” Memon said.

But Memon added that no amount of drills and CDC material compared with the experience of having two real patients come into the hospital who thought they had the disease. “That’s where all the learning takes place,” he said.

Mayhall, meanwhile, said he learned from watching the case in Dallas. “Anybody who has a fever is going to get screened."