Republicans blame President Obama for letting Ebola cross the border, because Presidents are supposed to be able to stop such things with their magical brain waves, apparently. Others are calling for the head of the CDC to resign, or perhaps to commit ritual suicide. But the picture that is emerging just about everywhere but on Fox News is that Ebola spread to two nurses (so far) largely because of really bad hospital management.
Which takes us to our next installment of “When Capitalism Kills.” I’m not sure when the last one was, but I’m sure I’ve written on this general theme before.
The husband of an ER nurse at a Florida hospital formerly owned by Gov. Rick “ball fan envy” Scott writes at TPM that his wife’s place of employment is run like most large companies/corporations in America. That is, the people at the top have no background or interest in how the products or services their companies provide actually happen. They are strictly money guys who have backgrounds in finance or something related but couldn’t manage production of their own products if you put a gun to their heads and threatened to shoot them if they don’t get that toothpaste into the tube.
Further, they have no respect for the expertise of the people who really are somehow making the products or services happen and would no more think to consult them about how to run the company better than they’d try to fly off the roof of corporate headquarters. Instead, if they decide something is amiss they hire outside consultants who will spend a few days having lunches with upper management and who will provide recommendations that, if implemented, would make everything worse. Just about anyone who has ever worked in the trenches of production or engineering departments of large companies/corporations will tell you this.
If you are such a person, read this and tell me how familiar it sounds —
… it is obvious to those who work there that the combination of lax training and toxic labor relations ‘leaders’ like him have brought to the company are emblematic of a big problem for US hospitals if a major outbreak of ebola or other infectious disease occurs. My wife’s ER has an ‘ebola cart’ with some lightweight protective gear and written instructions for putting on a PPE, but the instructions are a loose bundle of papers and the pictures don’t match the gear in the cart and has inaccuracies that put them at serious risk. It’s an object of gallows humor for the staff. That’s the totality of their training or preparedness so far. As we all now know, PPEs are not easy to put on and take off correctly. Even though nurses all have experience with standard droplet control (they see TB and HIV all the time), ebola is a special case. They have gone months and months without a nurse education director because no one wants to deal with their management and take the position. Her coworkers are clear that they will refuse to treat an ebola patient because they have woefully inadequate training in the correct procedures and lack proper gear.
And yet the head of infectious disease at this hospital went on the local news to proclaim the hospital was ready to receive ebola patients safely. They obviously didn’t bother to speak to a single nurse on the front lines. I’m not particularly panic-y about ebola, even though obviously the family members of ER personnel have a lot at stake in ebola preparedness. But I think that this situation will be the weak link in any major national response. So many of our hospitals are run by lunatics like Rick Scott who seek only the highest profit margin. They do not invest in training, they build charting mechanisms that are good for billing but not treating patients, they constantly fight with their unionized employees, they lie to the public, etc, etc. We like to imagine that competent, highly-skilled medical institutions like Emory will save us, but we have way more Dallas Presbyterians in this country than we have Emorys. You can see exactly this managerial incompetence—and toxic labor relations—woven through the statement released by the nurses at Dallas Presbyterian today. Also see the head of National Nurses United on All In With Chris Hayes for a similar perspective.
To put it bluntly: we’ve entrusted our national medical system to the managerial competence and goodwill of the Rick Scotts of the world, and that is much scarier than a podium fan.
One of the nurses at the Texas hospital said that in the second week of the Ebola crisis at her hospital she was provided insufficient protective gear that left her neck exposed. Meanwhile the hospital was releasing statements to the press saying they were taking every precaution and going beyond CDC recommendations.
In other words, standard corporate bullshit.
Meanwhile, many politicians of both parties are babbling about hiring an “Ebola czar,” who no doubt would end up being the public sector equivalent of private sector consultants — some Very Important Person who will perform public “we’re doing something about this” theater. And nothing any VIP does will ever trickle down to the level of the people directly confronting Ebola in hospitals, working with inadequate direction and protection because management doesn’t know the difference between a virus and vichyssoise.
Because here in America, that’s how we roll.
Before they clamor for an Ebola Tsar, maybe the Senate should approve Obama’s pick for Surgeon General!
America:
Profits, before people!
You hit a point with corporations and training…or lack thereof…a short story bout protective gear and training…I took a week long course for Hasmat response…I paid five hundred dollars, thinking this course would look good on my resume…there were similar thinking folks there and we teamed up and decided we were going to nail it…well, we ran into all sorts of simulated dangers, and in every one of them we had to dress out in full hazmat gear…it was “fun” for the first few hours, until the reality hit that all of us, ALL of us did not survive any of the simulations…at the end of the week we managed to live through a low danger chemical spill…Moral of this story is…unless you are prepared to die, do not go into hazmat, without Massive Training, and top of the line equipment…and I never, ever, mentioned this training in any resume since…
Bob — what you say makes me think that containment of a potentially catastrophic disease shouldn’t be just left up to hospitals so much as to teams of highly trained specialists who can swoop in and take over when such a disease is diagnosed. And apparently the CDC isn’t able to do that, although sometimes they do on TV dramas. And these teams would need to be kept ready and fully trained and equipped even during times when no particular threat is on the horizon, and entirely managed by people who know what they are doing. Which is to say, it won’t happen, because as a nation we’re no longer capable of doing anything that sensible, or at least adequately funding it.
I worked for non-profits since the late 70s. After Reagan was elected, there was a scramble to adapt a more businesslike model. Sadly, this article describes it very well. Often it seemed that when the programs I was involved with worked the best, it was in spite of all upper management types rather than because of them. They seemed interested only in the appearance of “having all their ducks in a row,†rather than actually building a practical and well functioning program. Disinterested management and toxic labor relations were definitely part of the mix. And by the way, the worst directors I worked for were Reaganite Republicans who were just serving time until another rung of their career ladder appeared and they all took two hour lunches, by the way.
The other story involving HCA is the scandalous and cutthroat way they pursued the acquisition of additional hospitals. Fellow commenters from the Tampa Bay Area may recall their assaults on University Community and St. Joseph’s hospitals. It was some really nasty stuff.
The CDC has not done a very good job with Ebola. As recently as two days ago, its PPE protocols for Ebola were just a generic infection-isolation procedure for communicable pathogens in general, and were far less elaborate than the procedures used in West Africa by the people who handle the dead bodies of Ebola victims (which involve liberal spraying of the gowns and gloves before removing). Their protocols for exposed health workers said nothing about travel during the 21 day monitoring period. They are trying to catch up but they have much to explain in their original response.
Ebola is far from being the most important public health problem we face in the United States, but it is far and away the sexiest. This year, boring old flu and boring old HIV and boring old Hepatitis C will kill thousands of Americans, not to mention boring old lung cancer and boring old opiate overdose.
Meanwhile, Syracuse University deserves condemnation for disinviting a Pulitzer Prize winning photojournalist , Michel du Cille, from an upcoming journalism seminar. He has covered the Ebola crisis in West Africa, has been back in this country for more than 21 days, has been monitored for fever and symptoms for that whole time, and spent yesterday on Capitol Hill taking pictures of the goddamn CDC director during his testimony! But the university disinvited him because some students had “concerns,†and the dean had “concerns,†and that is what future journalists are going to learn by example at that pathetic excuse for an institution of higher learning.
I think this ebola scare will motivate people to sign up for Obamacare health insurance since they wouldn’t want to get sent home from the hospital because they didn’t have health insurance like the fellow in Dallas who died.
I think I first saw the dynamic we’re bound to get with the Ebola czar back in 1991 or so. EPA was having a conference on the superfund sites in our community, and the regional director was ebullient about the new funding for public relations. Not remediation, not more help for the litigation against the companies that both released the pollutants and also wanted to profit by operating a combined municipal waste/toxic waste incinerator. No the fantastic news was they could produce more spin.
It caused me to increase my activism on the issue. The incinerator was stopped.
That said CDC and public health needs some public relations help given the massive amount of fear mongering by both the media and politicians. It would be nice if there was a concurrent effort to equip and train front line workers. I’m not holding my breath for this to happen though.
Your second and third paragraphs perfectly describe my wife’s employer, a (wait for it) state (un)funded university.
What a sad joke this country has become.
Some of you may have seen this before. A classic.
Part of the problem is the AMA racket. The doctors have a lot more impact and input into policy at a hospital than the nurses, and yet pretty clearly Texas Presbyterian wasn’t prepared, which is virtually the same thing as saying the doctors don’t have a clue. Introducing competition, a la Milton Friedman’s Capitalism and Freedom (as concerns occupational licensure) might improve the quality of some of the decision-making.
Robert Johnson — I am skeptical any approach that includes the words “capitalism” and “freedom” is the way to go.
Robert Johnson — I actually doubt doctors have that much to say about overall hospital policy regarding training and purchasing of hazmat equipment. Those are administration issues. If your suggestion is to drop occupational licensure requirements, given the incompetence of management in no time there’d be no point to hospitals at all. Might as well stay home and treat outselves.
I think this ebola scare will motivate people to sign up for Obamacare
You just gave Fux Noise their next pseudo-scandal — Ebola is a deliberately-engineered epidemic to save Obamacare! And it came from Africa, where BENGHAZI!!! is located!! Throw in an IRS angle and they’ll run with it for months.
I can’t be sure of what Robert Johnson was intending with his occupational licensure comment, but my guess would be that he’s alluding to the gap between being a license holder and being competent in the profession in which the license is held. my observation is that licensing has more to do with power and control that it does with knowledge in the field and professionalism.
I heard that Obama is considering going the Czar route.. My recommendation would be General Barry McCaffrey. He’s proven himself to be a universal type Czar. A good plug-in for any type of situation where a Czar could be needed. He did wonders as a drug Czar…I’m sure he could bring this Ebola crisis under control with just a couple of TV appearances.
Swami — in the case of medicine, in most states to be licensed you have a degree from an accredited medical school and you pass standard state board exams. If you want to be treated by someone who doesn’t have the degree and flunked the state board exam, be my guest. The license is not an absolute guarantee of competence, but I’d say it increases the odds.
Communication cannot cross a power gap; therefore the higher up, the less they know, even though they ought to know all. Therefore power corrupts the intellect as well as the heart. This plagues corporate business, as you rightly point out, but also religion and politics.
These comments are why I come here. There is humor, bitter critique, a variety of viewpoints, experience brought to bear, and ideas worth my time. Thank you all. I will mention the student nurse in Africa who used garbage bags and gloves to help 3 of her 4 stricken family members survive using medical supplies passed to her from a distance. Equipment is only as good as the ability to use it, and use depends on availability, accessibility and understanding of proper procedures. I was told that one of the TV docs demonstrated donning the outfit, dipped his hands in chocolate, washed them and doffed the outfit. When done, he showed the audience that even with care he had gotten chocolate syrup on two places on his body. That tells me that we have a long road ahead. I will say that anyone on an exposure list needs to stay home for 21 days, IMHO. I would do that as a courtesy and from care for my fellow citizens, even if asymptomatic the whole time.
I haven’t heard the Ebola virus as being the wrath of God argument yet.. What gives? Isn’t it evident that this virus has been visited upon us as a just recompense for allowing gay marriages?
Is Huckabee going to be left alone as the voice crying out in the wilderness until you liberals turn from your wickedness?
My guess is that the CDC does not want to go to war with the private hospital system in America. A temporary ‘czar’ can step on toes with impunity. My hope is that the new guy will get a clear set of instructions what equipment and training hospitals – especially in Texas – need to have have in place NOW. Start doing inspections, naming names and putting the public pressure on. Then advise an immediate bump in the budget for CDC and ask whey the hell Congress won’t get off their butts and approve a Surgeon General. The tripe from Rand Paul is that the private sector is best equipped to handle this – let’s demand that the private sector step up to do their part – ask why the public sector isn’t funded and staffed and turn this issue around. The GOP wants to play political football with this issue??? I suggest we take the ball and run it right up the middle with straight talk.
I have many comments regarding the Ebola panic. To keep things in perspective, remember the “red scare” from the cold war days. Then there was the panic over aids, y2k, al Qaeda sleeper cells, the anthrax scare, Saddam’s weapons of mass destruction, SARS, bird flu, swine flue, shoe bombs, and the end of the Mayan calendar. ( I forgot the Nostradamus quatrains and Alex Jones)
I have read that the reason we have no big Ebola vaccine program is there is no fortune to be made, since Ebola has been confined ( so far ) to poor rural areas of sub Saharan Africa, where malaria kills far more people. It appears the containment issue and the scope of the epidemic has changed. If the aids epidemic was a model for contagens and treatment research, and the money is no longer an issue, a cheap and effective treatment will soon follow ( along with a vaccine).
While people have been freaking out over Ebola, there has been a second mass shooting in Florida where a man has shot his family to death. If all those children and teachers in sandy hook had died from Ebola, the country would have been freaking out.
And there must be some connection between Ebola and Obama. They share many of the same letters, have African “links”, and they hate America. The rapture is due any moment….
I nominate Vladimir Putin for Ebola czar. He’s tough, he’s Russian, and he’ll get the job done 🙂 .
Like erinyes, I have many thoughts about the situation. I like the demonstration with the chocolate cause it demonstrates there is no foolproof system. When i was working as a nurse, there were questions as to why we were told to wash our hands after removing gloves. How could they be contaminated? Then we were shown a video that demonstrated no matter how good the gloves were, there were always microscopic holes that could allow passage of bacteria, etc. I also wonder how nurses could be expected to give patient care in a hazmat outfit.
As for a vaccine, I do believe there will not be a serious effort by big pharma until there is money to be made. And I do not understand not wanting to impose a travel ban. What is the purpose of a quarantine anyway?
Lastly, I see Putin as more logical than our own government. He is not the evil “other”. He is looking out for the interests of his own country which conflicts with the USA interests. Did the cold war ever end?
erinyes.. you forgot acid rain and the snail darter.
Right you are, swami. Zombie Apocalypse too.
Grannyeagle; in the CPR / first aid course I take every two years, we practice removing rubber gloves. Its pretty difficult to do properly, and I can imagine how that would be under the stress of a real emergency situation.
As for the cold war, I don’t think it ever ended, it just took a nap.
I agree with you about Putin. I view him more as an Ayn Rand follower than a Communist. I think this is why the right is so afraid of him, he out “rands” them. I read that Moscow was the most expensive city in the world, and Russia has many very wealthy people. That was several years ago, don’t know if its still so.
According to CNN, Moscow has dropped to number 9; cities in the African nations of Angola and (of all places) Chad are now numbers one and two respectively.
I’d guess that Robert Johnson’s idea was “if we had a competing licensing agency so that the AMA had to be the best licensing authority, or lose market share…”.
I think that’s ridiculous an inefficient. It assumes that the most competent licensing standards would “win”, and there’s no reason to suspect that’s the case. If we assume perfect knowledge and rationality, we’d still have to have failures before we could see what went wrong.
Maha, one of your statements is very good – training for very low probability events (like an Ebola patient) is usually brutally inefficient and the best option is a form of insurance – making sure there are people who are trained to handle these things, spread out so that they can form an emergency response team. I even ponder if these folks should be quasi-military, to allow job protections a la the Reserves/National Guard (you can’t fire a reservist for being called up to active duty). This way, the cost of the training would be spread out among all entities and you could have a rapid, competent response.
Of course, medical responses of this nature are sufficient rare that even this might seem like too big an expense over too small a risk. When was the last equivalent to an Ebola infection?
When was the last equivalent to an Ebola infection?
Well, I can’t be certain, but I think that according to the hysteria generated by the wingnuts it would have to be one of the Plagues of Egypt.
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