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How truly prepared for emergencies are we?

October 3, 2014

Governments are supposedly the best-equipped to deal with national and international emergencies, but the Obama administration is constantly surprised by every crisis. Thank goodness we have the press to tell them what’s going on.

The most recent example is the Ebola patient now under care in Dallas, Texas.

Leaving aside whether the gentleman lied on his application to leave Liberia, or simply didn’t know that the lady he helped had (and subsequently died of) Ebola, once he was in this country almost everything that could go wrong did go wrong.

First, the very fact that he was from Liberia, information presumably available on his travel documents, and regardless of what countries his flight itinerary included, should have raised red flags upon entry. It didn’t.

That’s because there is no protocol in place at any level to flag travelers who have interconnected through or from infected countries. While his flight plan once he reached Brussels includes specific flight data, there is no public reporting on how he got there from Liberia.

Second, the much-vaunted EHR (electronic health record) system that is supposed to provide continuity of care through integrated reporting for all patients, and is a Federally-mandated upgrade in recordkeeping, didn’t even function within the walls of the hospital. The human component didn’t work either. The admission and/or triage protocol should include a visible tag, a badge or wristband of some sort,  flagging any suspicious admission for all to see.

Third, while the health authorities have quarantined the immediate and closest contacts in their apartment, they have no workable system in place to safely remove and decontaminate the biologically contaminated waste from the apartment and grounds where the patient was staying.

Although the CDC has protocols for the process, there was no contractor available with the necessary permits to do the work. That amounts to quarantining people in a Petri dish. The CDC has response teams that could have done it, but apparently that was not an option.

Fourth, left out of the constant reminders about how hard it is to contract the disease is any mention of how a supposedly gowned and gloved ob-gyn managed to contract the disease from a patient reported to have been asymptomatic during delivery of her child, or how an NBC cameraman contracted the disease. It could have been simple carelessness, but the question niggles at the fringes of the epidemiological history.

This is bureaucracy at its worst. With apologies to Dr. Frieden of the CDC, any ensuing public unease isn’t grounded in a media-fueled “phony scandal”. It is the direct result of yet another failure between the theoretical best case scenario and real life.

Granted, there will be lessons learned from this. It is likely that the first modifications will be adopted by health care providers, who are not as constrained by worrying about elections as the government. Perhaps airlines will put public safety ahead of immediate revenue, like British Airways,  and institute some safeguards.

If this was the only instance of systems breakdown in the government, people would probably dismiss it, but it isn’t. Nearly every major government agency, from  the Secret Service debacle, to ICE, to  the IRS, to the Justice Department, to the VA and the intelligence community has been outed as corrupt, dysfunctional, disregarded by the White House, or all three. In short, folks just don’t trust the government to do anything right.

Politicians want to assign public unease and dissatisfaction to certain target populations to divide and conquer the electorate. In actual fact, people sensed and can now see that Washington isn’t in control of anything.

Huge bureaucracies don’t necessarily make things better.

In the same report cited above much is made of the fact that the hospital where the patient was admitted has previously had a “higher than normal” readmission rate, i.e. that people seen there had to be readmitted within 30 days for the same complaint, but it also states that the hospital is about at the middle range for all Texas hospitals in the past year.

If that is your criteria for competency, then there are some 325 facilities that are worse than Texas Presbyterian, based on the reported number of hospitals in Texas.

Lost in that statistic is the fact that hospitals are graded by the Federal government on two diametrically opposite standards. On one hand, they are subject to review and censure for keeping patients too long or ordering too many tests, i.e. spending too much money on them,  while they are also being censured for not curing patients on their first visit. If you are the providing facility, you may feel you are stuck between a rock and a hard place, but the patient is the one getting crushed.

Did that dynamic impact the hospital’s initial care of Mr. Duncan?  We’ll probably never hear any bureaucrat say so, but you have to wonder.

Once they get their act together, the CDC has a pretty good record of handling health emergencies within our borders. The question is, can we wait?

No one expects the government to get everything right every time.  But even a 50th percentile ranking would be better than what we have now.

From → op-ed

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