More on the Dallas Ebola patient zero and the hospital
There is little question in my mind that Duncan, Dallas’ Ebola patient zero, knew he most likely had Ebola when he got sick, and particularly as he got sicker. His first trip to the hospital, and their negligent (perhaps even criminally negligent) failure to admit him then, is one of the most perplexing, frustrating, and infuriating parts of the whole story.
It seems, though, that once he got very sick, he may have made a belated (and perhaps unsuccessful) effort to avoid infecting others directly [emphasis mine]:
Two days after he was sent home from a Dallas hospital, the man who is the first person to be diagnosed with Ebola in the United States was seen vomiting on the ground outside an apartment complex as he was bundled into an ambulance…
“His whole family was screaming. He got outside and he was throwing up all over the place,” resident Mesud Osmanovic, 21, said on Wednesday, describing the chaotic scene before the man was admitted to Texas Health Presbyterian Hospital on Sunday where he is in serious condition.
It seems likely, from the details I bolded, that the man and his family knew the score and they were terrified—otherwise, no one would be screaming just because a man was vomiting. Nor would someone ordinarily go outside to vomit; the person would stay inside and use the bathroom. It seems pretty clear to me that Duncan’s move outside was an effort to not have so much contact between the people in his family and his body fluids. But of course, his move potentially exposed the neighbors, although not unless someone acted so strangely as to go up to investigate what he had produced.
And the ambulance crew is a whole different story. Did anyone—the man himself, or anyone in the family—try to convey the actual situation to them? My guess is that they didn’t, perhaps in part out of fear that the crew would refuse to transport him if they knew. The situation is right out of a horror movie.
One thing that keeps stunning me is the incredible negligence—in my mind amounting perhaps to criminal negligence—of the hospital. If Duncan had been admitted on the first go-round it would have still been a big story and a distressing one, but nothing like as awful a situation as what actually has transpired. More than anything else in the entire tale, the hospital’s failure undermines anyone’s lingering faith in the ability of our health care system to get this thing right and to protect us adequately.
And yet there’s been little focus on how the snafu happened. The statements by hospital official Mark Lester are totally inadequate as an explanation. I have been unable to find a full transcript of Lester’s statement that includes reporters’ questions to him (they seem to have been inaudible in this transcript of his press conference), but here’s the relevant section. Note how relatively unconcerned Lester appears to be, and how he defends the hospital’s decision by saying that Duncan’s symptoms weren’t “typical at that time yet for Ebola.” Ah, so they have to wait until symptoms are full-blown to admit someone? And even if the staff failed to realize that the patient had come recently from Liberia, wasn’t it obvious that he was an African national? Was no one interested in that fact at all? Or was it too un-PC to have noticed and paid attention?
INAUDIBLE QUESTION)
LESTER: A checklist was in place for Ebola in this hospital for several weeks. And Dr. Ed Goodman (ph), to my right, had led the implementation of that. That checklist was utilized by the nurse who did ask that question. That nurse was part of a care team. And it was a complex care team taking care of him in the emergency department.
Regretfully, that information was not fully communicated throughout the full team. And as a result, the full import of that information wasn’t factored into the clinical decision-making. The overall clinical presentation was not typical at that time yet for Ebola. So as the team assessed him, they felt clinically it was a low-grade common viral disease. That was the presentation.
(INAUDIBLE QUESTION)
LESTER: He volunteered that he had traveled from Africa in response to the nurse operating the checklist and asking that question.
(INAUDIBLE QUESTION)
LESTER: I can’t answer that question because that’s one piece of information that would be factored into the entire clinical picture. The clinicians did not factor it in. So it was not part of their decision-making.
(INAUDIBLE QUESTION)
LESTER: I — that’s a question that’s really not in my domain.
(INAUDIBLE QUESTION)
LESTER: We are carefully assessing that now. And that is being investigated. So we are investigating it. I can’t give you specific information. We will look very carefully at that.
QUESTION: Sir, would I – would I call that a misstep, would you not?
LESTER: I would call that not factoring all the information among the team that was present so that all the information wasn’t present as they made their clinical decision.
QUESTION: Was there any (ph) expressed any information that this person (INAUDIBLE).
LESTER: That information was not obtained when the patient was in the emergency room.
QUESTION: But do you know that now?
QUESTION: (INAUDIBLE QUESTION) you name is, sir?
LESTER: Oh, I’m Dr. Mark Lester…
Lester won’t even call it a “misstep.” This culture of failure to take responsibility is so widespread as to be a sort of epidemic in and of itself. Or maybe a pandemic.
Lester never answered the questions I have for him:
What is the usual protocol of the hospital for “factoring in” such information? What is the “full decision making” process? How is it that you think this information failed to get conveyed? Who was in charge of the discharge decision, and did that person even speak to the nurse who had questioned the patient and received the information? Has this protocol been changed to correct this problem? Has anyone been fired or disciplined? Have you reviewed other protocols to see where they might be lacking? Who sets these procedures?
[ADDENDUM: Liberia is planning to prosecute Duncan for lying during an airport screening when he was asked if he’d had contact with an Ebola patient. If Duncan dies, however (which for many reasons I hope does not happen), I assume the suit would be moot.
The article mentions, however, that when Duncan helped the ill woman into a cab, he allegedly thought she had a pregnancy-related illness. This is possible, because she was nauseated or vomiting and was in fact seven months pregnant. Although pregnancy-related nausea tends to occur much earlier in pregnancy, it would certainly not be hard to believe that Duncan may not have realized she had Ebola. Of course, if he later got the news that she had died, that would be more difficult to argue.]
[ADDENDUM II: Duncan’s nephew says he had to call the CDC to get his uncle admitted to the hospital.]
[ADDENDUM III: Much more, worth reading, here.
Stunning, shocking stuff.]
I had a conversation with my brother-in-law yesterday about this. He is a retired lawyer who works out multiple time a week in a facility adjacent and connected to Presbyterian Hospital in Dallas. The Ebola hospital.
What I have been told is that the patient did inform the nurse that he had just returned from Liberia and the intake nurse wrote that down on his from durning his processing in as an ER patient. Evidently the doctor who saw and treated Duncan did not read the information and dropped the ball big time.
My guess now is that due to legal exposure no one in the hosptial will admit much of anything about anything, probably not even confirm the time of day. I also understand that the entire government structure, from Texas Governor Perry on down through the county, city and school system in Dallas are taking everything very seriously and watching and waiting to see what happens next.
Mark Levin had an observation on this case. He suggested that people in west Africa who fear they are ill with ebola could intentionally fly to the US and present themselves at a hospital.
That’s a good argument for shutting down the airlines serving west Africa and refusing transfers from other flights.
Peasants should not question their Doctor Class rulers
Anderson Cooper broke a story today (Rush had this) on CNN: the guy’s girlfriend is marooned in her apartment with all the contaminated clothes and bedclothes; not until CNN showed up was anyone sent to the apartment to clean out the hazardous materials.
She was told to stay in the apartment for 21 days, along with a kid who was present; but apparently no monitoring or assistance were supplied. She didn’t have anything to eat for today. Is taking her own temperature.
We’re in the hands of incompetent backside-coverers.
sadly… there may have been a janitor that had to clean it up… if there were chunks, then pidgeons, rats and mice may have picked it up.
ie. he may have created permanent vectors that way
given that i work in research computing for such a hospital, i was never confident…
Or was it too un-PC to have noticed and paid attention?
well.. maybe its the fact that given the way the medical area is administrated… ie. leftist central, pc correct, raises only go to management, lots of lower class employees they unload higher skill tasks onto, etc..
one has to realize that medical personell are constantly inundated with special crap to handle that is often rediculous or part of other laws and things they have to follow.
for instance… the questionaire for ebola was probably circulated to docs, and nurses on staff. but in an emergency room, they often send you over to administration to sit and fill out information that goes into the computer and a non medical person does triage.
i have seen this myself. you go, your not dying, and to speed things along, they sit you down, and they have an admnistrator behind a window try to fill out the records for the visit. given the clues of asking if he had a social security nuumber, this is waht happened.
now, here is the point of failure… the person who is asking the questions and so on, do NOT get the ebola questionaire. ALSO, they get tons of hypochondriacal self diagnosis… so what happens is that they reword the information, and what the doctor pays attention to is the document NOT the patient… so in essence, the form filler hears all this data, liberia (wheres that?), symptoms of flu (ssounds like flu)… says ebola (ridiculous, thats in africa), and creates a filled out form that the more full information becomes a quick billeted list of salient points
now the doc gets that paper, read the board, liberia is left out, the patient doesnt say anything cause they told them already, and so on and so on.
its a critical thing, and one i have watched happen more thanonce in my life, and in the way things are run, if you try to fix or say something… the response is NOT welcome. ie. you get fired as not being a team player, causing trouble, and perhaps even affecting their good standing with the inspectors.
the admins of the hospital aer very politically concious of image and appearnces, not substance. and depth. even if they were docs, they seem to lose this as a requirement, often being handsome or pretty and images playing a role.
to answer your last paragraph without reproducing it, here it goes.
go to google and look up “hospital intake”, what you will find is a administrative job called hospital intake coordinator.
A hospital intake coordinator performs in-person risk assessment, contact referral sources, and coordinates references. Hospital intake coordinators are an integral part of a hospital staff and may be responsible for the successes and failures of a health care provider
Hospital intake coordinators are required to have a bachelor’s degree in allied health, health care policy, or in a related field. While in school, it is important for a student to gain experience in crisis intervention, administration, assessment, and intake. Classes will include psychiatric diagnoses, chemical dependency, behavior management, and human development, among other more general course topics.
so while the medical doctor might have the info, the patient cant get to the doc without first sitting with a hospital intake person. they make sure the persons ss number is known, if they havce insurance, and where they live… they may even use a machine to record the persons eye patterns to make sure that they are not trying to game the system. (patients will game the system for all manner of things ranging from drugs to a desire to be operated on repeatedly)
they also have another name: admitting interviewers
Admitting interviewers are also known as admitting clerks or patient representatives. They are usually the first employees that patients meet when entering a hospital. Admitting interviewers gather information that is required for patients’ admission to the hospital and sign patients in to the hospital. They explain the hospital’s rates, policies, and procedures to patients and to those who bring patients to the hospital. Admitting interviewers arrange for new patients to be taken to their rooms. They enter this information into the hospital’s computer system, keeping careful records for each patient.
the point is that peoples fantasies about how things work rarely match up with how things work!!!!
Applicants should have a high school diploma. Courses in math, business, and word processing are important. Experience in other clerical jobs is useful. Job applicants who have worked as volunteers in a hospital or who can speak a language in addition to English may also be preferred. Admitting interviewers generally learn about hospital forms and procedures on the job.
and so.. now we know that THIS is why it was not handled well.. how could the doctor handle it well when this form of admin creates a wall between the doc and the patient to speed things along given that healthcare was screwed by certain policy laws of the left ages ago
Art…
You are ENTIRELY correct.
Ebola is quite happy and able to its thing in other mammals.
And, who can forget that MOST viruses are vectored around in birds — the descendents of the dinosaurs.
For, obviously, these pathogens have been around for eons of time.
We may be witnessing a (ebola) re-mutation back to what had been common fifteen million years ago — who’d know one way or the other?
Viruses are pretty tough on their own.
Plant viruses are well known to survive out and about, ready to infect next year’s crop.
http://en.wikipedia.org/wiki/List_of_potato_diseases#Viral_and_viroid_diseases
Get a load of just how many microbes and viruses are feeding on potatoes.^^^^
&&&&&&&
Folks, Venice ENTIRELY avoided the Black Death.
That city-state simply pulled up the welcome mat.
THAT’S the solution, the ONLY solution.
Surely the Europeans are going take a hint, too.
While I am not excusing the hospital’s negligence, is there any indication that Duncan himself volunteered that he had been in contact with an ebola-infected person recently? He had to suspect he had caught it by the time he felt sick enough to visit an ER.
It looks to me like the hospital only found out that he was recently in from Liberia because they asked him a direct question. Duncan chose not to provide anything more than what was asked. He is at fault for withholding this information, contributing to the delay in his hospitalization & isolation.
Old Texan:
There is no question in my mind that fear of lawsuits is driving Lester’s obfuscation of what happened.
How comfortable are we with the assertion that Duncan was asymptomatic before boarding the flight in Liberia? We all know that our own bureaucracy has reached the level of a banana republic in efficiency and integrity. Should we expect better from someone in Liberia? And there would appear to be several parties with a motive to be less than honest about this.
I traveled from Vietnam to Kentucky during a course of about 42 hours with second and third degree burns on the left side of my chest and my left arm. I was heavily bandaged under my uniform and I would bet that no one else on the aircraft knew that I was injured.
Art…
You are fulsomely incorrect.
The trouble maker is NOT the intake person. Out my way that person doesn’t make any decisions, and doesn’t even enter anything into the digital record!
All that they do is hand out a clipboard, eyeball you, and ask you to wait in a chair — or (panic, rare) accelerate you into triage.
It’s the NEXT person that’s the trouble maker. She or he (seen both) is the FIRST person to build your digital record for that admission — and everything is digitized by now.
To do so, they don’t use Word Perfect or MSFT Word. Instead they go down custom (medical) software per their protocols. (They must revise this code every other week.)
Having witnessed it, most of the operator’s responses are PRE LISTED – as in a pop-up selection list.
In my case, (a trivial staph infection) this resulted in the data-dude tickling the wrong selection.
(My record is STILL contaminated by his error. Once digitized, NOTHING is ever corrected/ revised — certainly not by the attending physician.)
My sinus infection turned into an ear infection.
THIS is the kind of error that converts ebola virus into “he’s got an upset stomach” — cause ebola as an option is NOT on the tick list.
(Expect this to be revised by next month.)
The attending physician scans the digital record — but will not deign to key in any information. That’s for lesser fingers. However, since he’s all alone at that instant, nothing is going into the digital record.
(Voice to digital is needed ASAP.)
%%%%
The very nature of ANY pandemic disease means that victims refuse to admit they’ve got it as long as possible.
If you have followed the reportage, this has long been the norm in west Africa.
&&&&
This pervasive deceit is EXACTLY why ONLY quarantine is effective.
Absolutely no victim levels with health authorities in a timely manner.
In this case, the patient could have repeatedly mentioned his status. Naturally, he didn’t.
The CDC should get a clue from this fiasco — now a tragedy.
I humbly change my claims…
Art is correct.
Artfldgr, blert:
I’m not sure. I see this passage from Lester as describing a situation in which a nurse asked the question. Although it may have also been asked previously by the intake coordinator (not a nurse), it seems to have been asked by a nurse who was part of the “care team.” From Lester:
It sounds like it was fully communicated—in terms of the information being written on the chart. Apparently it was not fully received (i.e. read, noticed) by the doctor or doctors in charge of the release.
That’s my take on it, anyway, from reading the transcript of the Lester press conference.
Ebola Zaire. The most highly virulent subtype of Ebola. first appeared in 1972
Ebola Sudan. An extremely pathogenic subtype. First appeared in 1976
Ebola Reston. This subtype originated in Asia and was brought to the U.S. (and to Italy) by infected macaques imported from the Phillippines.
Ebola-Tai. A new strain which appeared in 1994 and was isolated as a unique subtype in 1995
The natural reservoir for Ebola is unknown.
there may be several.. we know that once again, like AIDs, many of these “new” virii are in monkeys/primates even if their regular vectors are not known, and in africa, primate bush meat is a favorite.
10% of all Asian and African monkeys have antibodies to filoviruses. though given that it kills primates as much as it does humans, its beileved that they are not the vectors
contact between viremic persons results in infection rates of approximately 10%
while the creature is not an airborne infector, there ARE incidents where it was transmitted by air!!! ie. coughing in the imediate area can create small short lived particles others breath.
most dangerous point: Virus particles can exist in dried materials. meaning that, one can come across some left over material weeks later, rewet it, and get the virus. (i suspect that the apartment building that he was in and such will be torn down and destroyed. if not, it should be)
there are 7 genes in ebola that make proteins, the same as marburg. there are lots of creepy analogies with marburg.
The virus itself is sensitive to lipid solvents, detergents, commercial hypochlorite disinfectants, and phenolic disinfectants. The virus can also be destroyed by ultraviolet and gamma radiation.
while they talk that bats may be the resevoir, they also believe an arthropod transfers it or can hold it as well. this is interesting as there are not very many arthorpods that live on humans, and in the US most of them are not very common compared to other parts of the world.
this is the link to the CDC info packet if your curious
http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/Fact_Sheets/Ebola_Fact_Booklet.pdf
the scary thing is that adult mice are resistant (it kills baby mice). Rats are more problematic…
Reports: China body-searched 10,000 pigeons
http://www.nbc12.com/story/26672237/reports-china-body-searched-10000-pigeons
The 10,000 doves released in a ceremony Wednesday for China’s National Day underwent unusual scrutiny, each having its feathers and anus checked for dangerous materials
i am trying to find:
Experimental inoculation of plants and animals with Ebola virus.
Word of the Day: Ebolation – The act of allowing a deadly, as in death, virus to enter the USA, get mis-diagnosed in the hospital in Dallas and find out that 100 people have been exposed in less than one week and then wonder what will happen next.
Mr. Duncan’s nephew, Josephus Weeks, told NBC that it was only after he called the CDC that medical folks took notice:
If all that is true, maybe the ambulance and its crew were geared up for ebola?
And this seems to indicate that Duncan deliberately came to the U.S. for treatment:
Ann:
Wow. That’s some story.
I have felt it is highly likely Duncan came here purposely, not because he knew he already had Ebola, but with the hope that if he did get it (and he knew he ran a high risk) he would manage to survive.
Obamanation turns into Obolo-nation.
Once it was the American nation, now no more.
It sounds like it was fully communicated–in terms of the information being written on the chart. Apparently it was not fully received (i.e. read, noticed) by the doctor or doctors in charge of the release.
sometimes the intake person IS a nurse, sometimes not. sometimes they refer to them as nurses when they are not. terminology is not exacting.
in other cases, the layout of the information on the forms can be blamed. ie. X information is on the first page, other information is on the third page. the key information is not necessarily together. these things DO influence outcomes as doctors and others become acclimated to the forms and try to save time by only looking at the parts that matter to them. (also, many of these others have tenure, and job security to the point where other people in the chain and around them will not say anyting to them out of what they want because they can cause a lot of trouble for minor things, and people walk on eggshells!)
i was not necessarily blaming an intake person, or anything other than describing the process in a large urban hospital, which often is different than the process in more rural areas given that urban areas have large volumes of regulars, and peope who try to game the system, and all manner of oddities most people would be incredibly surprised to find out.
some hospitals require the intake person to be a LVN at minimum, others not. i am unaware of the law around this, and suspect that it varies from state to state.
however, i AM aware that many hospitals are trying to save money by pushing off work of doctors to registered nurses, and registered to lesser nurses, and lesser nurses to clerks. (one state is looking into whether non medical persons can perform abortions!)
ultimately the game of making society worse for the political benefit of certain parties is the key here. there is a long chain of political groups associated with this and each one ticks off as liberal and comes with a desire to ignore the messy parts of reality unless they can use them…
the blocking of h1n1 flights, but not ebola is a political choice… the passing the buck in brussels is another as they could have stopped it as well. and on and on.
though its interesting that some writers are now bringiing up the effect i mentioned in the other thread that bringing people to the medicine and not medicine to the people, created a desire in the infected and otehrs to get to the US hospital for the treatment whether or not there is any left.
So, if Presbyterian Hospital a government hospital?
How do the medical personnel there become liable to the “society” at large for everything they do?
It sounds as though we are demanding the medical profession be incorporated into some Federal militia.
I don’t quite grasp the concept.
A doctor missed that the lying son-of-a-bitch had been in Liberia. Ok.
Therefore?
is Presbyterian a …
I don’t know if I’d assume he was vomiting outside on purpose to protect his family. Couldn’t the information simply mean that he was vomiting while the ambulance team transferred him from his apartment to the ambulance because he couldn’t help it, by that time being desperately ill?
As for whether his screaming family told the ambulance drivers on whom he was vomiting what they clearly knew about his history and suspected about his illness: of course they didn’t. The news reports about the incident with Duncan and the dying woman back in Liberia indicate that they had to put the dying woman into a taxi because no ambulance would come for her, knowing better. Of course they would have feared that the same thing would happen here if they told the truth to the US ambulance drivers, and they’d get no help. (I have read that the ambulance continued to be used for a couple of days after transporting him. Haven’t heard when the drivers were taken off the road.)
Mr Duncan is apparently not very big on sharing the whole truth: the checklist that the nurse completed on his first hospital visit was apparently an Ebola checklist, developed for the precise purpose of avoiding precisely what happened. He apparently honestly responded that he’d been in West Africa, but kept to himself that he’d carried around a dying Ebola victim just a few days ago. I can’t imagine that THIS would not have been “communicated” to the rest of the team, had he shared it. This selective approach to truthtelling doesn’t exactly reassure me as to how certain we can be that he was not symptomatic a few days before in that airplane.
This thing is unfolding exactly like the plot of a not-very-well-done B horror movie, and it’s every bit as hard to believe — except that it’s real.
he cant get the same kind of treatment the four others got as there is no more serum, and what they had was not approved for humans anyway…
as i poiunt out, there was a huge social fault in brining the people to the meds and not the meds to the people
Not unrelated is Obama’s planning to use flight attendants and the Border Patrol to contain the Ebola virus. Is this incompetence or malign neglect? Is this a fortuitous crisis that cannot be allowed to go to waste? Is it paranoid to think Obama will use a pandemic to postpone the election? What motivation should one ascribe to a politician who has friends who brag about getting with murder?
This thing is unfolding exactly like the plot of a not-very-well-done B horror movie, and it’s every bit as hard to believe – except that it’s real.
a few threads back i said
Note the actual events are resembling a hollyweird horror flick:
http://neoneocon.com/2014/10/01/dallas-patient-zero/#comment-833658
a case of life imitating art?
Mrs Whatsit:
Agree about the horror movie.
But the non-symptomatic-on-the-plane idea is because supposedly they took his temp before he got on the plane, as is standard now in departures from these countries. Elevated temperature is one of the earliest symptoms of Ebola.
Of course, we don’t really know whether they DID take his temperature. But if they did, and his was not elevated, that indicates he probably didn’t have symptoms then.
I agree we don’t know why he was outside to vomit. But the way it was described, I thought it’s at least possible he went outside on purpose.
I agree he probably did not reveal his previous exposure to the virus, probably because of fear. But that shouldn’t have been necessary in order to get the hospital’s attention. Any symptoms, plus his saying he’d been in Liberia recently, should have been more than enough to cause an admission and a quarantine for observation.
Yeah, it sounds to me as if the hospital had a lousy ebola protocol in place. It should not have been enough to simply write down the fact that Duncan had been in Liberia. The protocol should have called for that information to get an immediate red flag, something no one could miss. As well as being immediately fast-tracked.
Ann:
Let me add that somewhere I read that Dallas has a very large Liberian population, something like 10,000 or so people. Therefore hospitals there should have been extra-vigilant, and yet this hospital dropped the ball, big time.
Artfldgr’s info is appreciated.
As far as I’m concerned, OF COURSE Duncan flew to Dallas for better health care, should that become necessary. He did not seek medical help until he was ill and contagious, however. So his Dallas girl friend, mother of one of his children, and her other 4 kids are now incubating Ebola.
It took the “authorities” until today, four days after he was diagnosed, to send a decontamination squad to the apt where he’d been violently ill. Four days. That alone is enough to impeach the CDC and the Dallas and Texas State health “authorities”.
We should all recognize that no one of any real ability goes into public health anymore, and that getting an M.P.H. (Master’s in Public Health) is an immersion in Leftism of the worst sort.
The good news, if good news there be, is that the massive governmental ineptitude now exhibited will be correctly extrapolated by many to other areas of government control, and that loathing of central government and bureaucrats will increase.
Neo,
About those hospitals in the Dallas area needing to be “extra-vigilant” because of the large Liberian population there — perhaps that very fact worked the other way. That is, maybe the hospital emergency room often saw visiting relatives of local residents, and so this man appearing, with an accent and just in from Liberia, may not have been all that unusual, and so no red flag.
Neo:
The hospital’s personnel may not be blameless, but let us put the onus where it properly belongs, on Mr. Duncan. The story as I understand it is he was puked on, etc., in Liberia by a pregnant female who died of Ebola the same day, and the next day, Sept. 19, he boarded the 1st leg of his trip to Dallas. On Sept 26 (a short incubation period, so perhaps this virus is becoming more virulent) he first went to hospital. He accepted the ER “Fanny Pat” of flu syndrome and left. There is no info I’ve seen that says he was profoundly symptomatic at that time.
Telling someone you do not have a SSN because you are Liberian is not equivalent to saying that you’re Liberian and just arrived from there. There are unfortunately more than 10,000 Liberians in the Metroplex, so are not rare birds, as you have already pointed out above.
If Ebola spreads as our annual flu season simultaneously erupts, there will be Hell to pay, just sorting the two out.
Don Carlos:
I blame both Duncan and the hospital, but I blame the hospital far more, and I’ll tell you why.
Duncan is not in a position of power, authority, trust, professional responsibility. He was a patient who was very ill. He had a moral and human responsibility to tell all he knew, but his burden of responsibility is less than that of professionals charged with doing this as their business, and supposedly armed with expertise and information. They are the gatekeepers, they are the watchmen. They are the ones who should ask the right questions and evaluate the answers.
They were given enough information that they should have known what to do. They failed to do it.
The medical system is not prepared to efficiently and safely address ebola or the other diseases coming across our borders. A disease like ebola and its victims are not deterred by check lists. Like all other federal bureaucracies, the CDC top administrators are political animals first and foremost. They follow the pc agenda of their boss. BTW, the decision to allow incoming flights from west Africa comes from the oval office.
The idea that passengers can be adequately screened for ebola in a place like Liberia is preposterous, as is the assumption any would be passenger would be truthful about recent contact with anyone infected with ebola.
Neo: yep, I pretty much agree with everything you said. However, it’s a long flight from Liberia to Brussels to Dulles to Texas: couldn’t a fever START after a person boards a plane, even if we agree (reluctantly) to trust that people in Liberia accurately measured that person’s temp many hours earlier? (and what about tylenol, ibuprofen, other fever meds — who knows whether they might artificially depress an elevated temp early in the course of the disease?) My guess is that he was not symptomatic on the plane, if only because he was not yet severely ill several days later, when he went to the first hospital. But still: it’s wishful thinking to say that we’re CERTAIN that he wasn’t symptomatic by the time he got to Texas, only because we’re pretty sure he wasn’t symptomatic yet when he left.
I fully agree that — while Duncan certainly should have told the full truth the first time around — he gave the hospital enough info that they should have acted. ER nurses of my acquaintance tell me that they have to fill out stacks of paperwork (electronic or otherwise) at the inception of each patient’s treatment to gather info that may not always seem exactly high priority (You may have been asked, for instance, “Do you have any cultural or religious preferences that might affect your care?”) I can’t help wondering whether the highly-pertinent red flag information that he’d been in Africa got lost in the snowdrift of mandated trivia.
Mchenrybob,
From my pov you are not paranoid.
Ann….
Absolutely correct.
The ‘regulars’ in Sacramento are shoo’d right through the system.
For us that means Latinos — and a few Black stragglers who have yet to flee to Atlanta.
(Sacramento almost lost its entire Black population during the CRA Policy era. The Poles and Russians moved into the ghetto and turfed them all out.)
(Yes, yes, the Poles and Russians are all illegals, too. The word is out everywhere.)
http://www.aol.com/article/2014/10/02/us-ebola-patients-family-under-quarantine-as-he-faces-criminal-charges-liberia/20971446/
“Duncan lying on his health form has prompted Liberian officials to announce they will file criminal charges against him for carrying the deadly virus through Europe and two U.S. cities, the Associated Press reported.”
I suppose if you have a dark sense of humor you might reflect that ebola has been brought to our country just in time for the onset of the cold and flu symptom season.
He lied.
“… his burden of responsibility is less than that of professionals charged with doing this as their business …”
No.
“They are the gatekeepers, they are the watchmen. ”
Since when? You make the practice of medicine sound like the equivalent of a state religion.
Again and again, this ebola crisis shows the folly of permitting mass illegal immigration.
The ONE thing that all legal immigrants have to deal with is their health status.
Way back in the law books, Congress banned immigration of souls who would be a burden on the nation. It was this rationale that permitted the FDR administration to stiff arm fleeing Jewish refugees. The Nazis had made them broke. Broke ‘anybodies’ are not popular anywhere.
Ebola is fulsomely capable of exploding through our cities. We could be in a national crisis before the month is out.
Imagine Halloween with ebola.
It must be cancelled — right now.
We ought not to assume that ebola-zero is the only critter to fly into America.
He can only be the leading tip of flight.
His pit stop in DC may prove interesting. I don’t think anyone has a clue as to who he might have infected during that layover.
Yet DC is one of the MOST connected American cities.
Think about it.
It’s connected internationally like no other city on this Earth.
It’s node zero.
Don Carlos said
“If Ebola spreads as our annual flu season simultaneously erupts, there will be Hell to pay, just sorting the two out.”
Oops. Someone said it before me.
DNW:
A hospital in a big city—and actually, all physicians—have long operated in tandem with a public health system that deals with epidemics.
Are you such a libertarian that you think there should be no public health system with directives on such things? Physicians and hospitals act as gatekeepers re public health and epidemics. That’s been going on for many decades, and is at least in part responsible for the quelling of many infectious diseases and their containment.
They deal with venereal diseases, TB, all sorts of things like that, all the time. There are protocols in place and rules to follow.
I shouldn’t think this would have to be explained.
Contact tracing, quarantines, etc., are time-honored ways to prevent epidemics getting out of control. Patients need to cooperate, although they don’t always do so. The health care people need to ask the right questions, and at least pay attention to the answers. This is basic, and is their professional responsibility.
DNW…
Our man zero should have spoken up — erupted, in fact — as he was being discharged.
For THIS was the exact sequence that killed off that gal back in Liberia.
He made himself, pretty much, a dead man.
We HAVE to broadcast to the world at large: America actually doesn’t have any ebola medicine. Our entire supply was consumed by merely four individuals.
And at the time, it was expected that even that stuff was going to kill the patients. They were human ‘lab rats.’
The cupboard really is bare.
Sounds as if the CDC was at one time on the ball, but politics and economics intervened — Obama administration scraps quarantine regulations:
As a matter of national policy, to deter thousands from making the same terrible trek, only palliative care should be rendered.
It’s a cinch that we’ll run short of medicine for native Americans — and in a major way.
Curing aliens while killing Americans is a sure fire vote killer.
I think that you are missing an important point. Or just assuming that the status quo is not only that private physicians in private hospitals operate within certain public guidelines, but that they have essentially been co-opted as organs of the state. At least in much the same way that a militia can be called up of all such X in the event of Y.
This may in fact be the default assumption nowadays, or even the actual case, in places like Detroit where the municipal system basically collapsed.
But once someone in an ostensibly private practice becomes a gate keeper and shock absorber for the state, we might as well toss the traditional concept of law as we have known it, aside.
DNW:
I fail to understand your point. Physicians have operated under such guidelines for many decades—perhaps about a hundred years, maybe more? That does not mean they’ve been “co-opted as organs of the state” any more than obtaining a license to practice medicine means it. There is no escaping the fact that epidemics are a public nuisance and that government has long had a role in trying to control them, for obvious reasons, and has set up a public health system and rules for physicians to follow.
I have no idea what the penalties are for violations, and don’t have time to look right now. I assume lawsuits and/or stripping of licenses, if the failures are egregious. None of this is the least bit new. The same is true of professionals such as lawyers and therapists, and even the real estate and insurance businesses (although the issues there are not epidemics).
Just a health tip for those interested.
Start consuming lots of Green Tea, it is high in anti oxidants & a huge boon to your immune system.
I have a 8 yr old grandaughter and have alerted her mom to this with that entero virus striking kids.
Buy DECAFFEINATED tea, (Bigelow puts one out that has lemon flavor). With the decaff tea you can actually place 3 or 4 tea bags in 1 cup & it is drinkable. Cant do this with the regular variety as the caffeine will make it too bitter to drink. I flavor mine with sugar free lemonade powder but you could use regular lemon juice & sugar or honey.
History of green tea in China & Japan shows that it was used almost as an *antibiotic * for 1000s of years. All it really seems to do is just super charge your own immune system to fight things off.
Plus extra intake of fluids is standard medical advice, you know what you hear from medical people “Drink lots of fluids, force fluids etc …”
Drown the buggers !
See the Addendum for more on Duncan’s responsibility/culpability. Liberia is planning to sue him for lying to airport personnel about his Ebola exposure.
Democrats will forcibly remove Elian Gonzalez from his home, at SWAT gun point, but won’t quarantine people from Africa.
Get the fairness yet?
Much more, worth reading, here.
Stunning, shocking stuff.
If it is true that the nephew called the CDC for help — and if he told them that Duncan had been exposed to Ebola — and if the consequence even THEN was an ambulance crew who permitted him to vomit outside — well then, could we please stop kidding ourselves that our health care system is even remotely ready to cope with this situation?
Earlier today I saw a helicopter photo purporting to show a crew wearing no hazmat protection and hosing down the parking lot of Duncan’s apartment with a PRESSURE WASHER and no visible containment, while a woman in Indian garb stood in spatter range with bare toes peeking out from under her sari. Let’s hope it’s a fake.
Ymarsakar–This morning, I was thinking of the Elian Gonzalez debacle juxtaposed to this current folly of the Democrats.
Mrs Whatsit:
He was vomiting outside the apartment before they arrived, apparently. Not sure how they could have stopped that, if they weren’t even there.
Neo: I disagree vehemently with your claim of negligence: “His first trip to the hospital, and their negligent (perhaps even criminally negligent) failure to admit him then”.
Admit him? Why exactly, on his first trip? Because he is Liberian? He is only mildly ill, with a flu syndrome. He has no means to pay, even if admission were medically indicated, which it then was not.
He is the first Ebola case in the US, and they should ignore the rule that “Common things happen commonly” and the other rule that “When you hear hoofbeats, think of horses, not zebras”?
But you assert “perhaps even criminal” negligence. You sound like a typical hyperbolic trial lawyer. You have no reasonable basis for your emotional arm-waving. We here are not those whom trial lawyers wish to have serve on their malpractice juries, the people who know nothing and wish to stay that way.
Neo,
Again, I am having difficulty understanding your point as well.
We can place aside what those not yet revealed penalties might tell us about the actual state of affairs at present .
But you seem to indicate that not only do physicians have to abide by certain statutory obligations, but that they have one and all become public health agents, patrolmen, “gate keepers” in your terminology, responsible for more vis-a-vis the state, than operating competently within their license and abiding by statutes.
There seems to me to be no limit to what one might be tempted to call criminal negligence under that scheme of interpretation.
We are not talking here of a physician failing to report treating a gunshot wound (to refer to an old image) but rather your wish for a moral (and possibly legal?) indictment for his failing to be proactive enough.
I’m not aware that some national state of emergency had been declared, and that all medical practitioners had been press-ganged into national service at the time of this incident.
Now, I happen to think that a fair number of physicians, especially young ones whose egos are fed not only by their professionalism and social standing, but by their sense of their own altruistic piety, would happen to agree with you.
But I don’t.
The question regarding licensing is whether persons are municipally licensed for competency in order to perform a service for hire? Or, as quasi public servants of some kind.
It seems to me that your theory of implied responsibility is edging well toward the latter.
Don Carlos:
Admit or place him in in-house isolation, as has been done with many others.
He felt ill enough to go to the hospital. That’s the first thing.
They knew (or should have known) he’d recently been in Liberia. That’s the second thing.
I am operating in accord with incidents I have read about prior to the Dallas case, where a number of people (I forget how many) in several different US venues were either put in the hospital for observation, or told to stay in the home and visited often for observation, because of very very similar situations. None of them prior to Duncan actually had Ebola (I think several ended up having malaria, if I’m not mistaken). But the hospitals acted in accord with what I’m suggesting.
The criminal negligence, by the way, might be the failure to have noticed the notation in his chart that he had just come from Liberia. To have completely ignored it is an unconscionable failure.
Sharon W,
They’ll also forcibly starve comatose girls in Florida, because her husband with his mistress and children wanted it, against the wishes of the bio family and the life support paid by said bio family.
That’s legal. That’s RIGHTEOUS. You dying of Ebola, they don’t give a F. They never have. To them, to the Leftist alliance of Born Rulers and Doctor Class overseers, you all, all of you are here, are worth no more than pigs and cows on the farm.
We have certified fools running the ‘system’ — straight into the ground.
Obviously, “containment” is strictly a psy-ops concept.
It’s the TRUTH that’s being contained.
Doh!
Rather than being prepared, the CDC doesn’t even have the first clue as to truly effective protocols.
1) The victims are absolutely NOT to be brought to any general health facility of any kind.
2) They are to be immediately quarantined in clean conditions and entirely away from known contamination.
3) Any known (contaminated) habitation needs to be burned down. There is no sequence of cleaning that can possibly get at dormant viruses. They simply get everywhere.
4) Sacrificial transport is to be used. Full on ambulances are a total waste. Further, EMTs are not needed, either.
5) The transport needs to have a biological barrier between the patient and the driver. The patient area has to be suitable for a TOTAL washdown. Any internal seating/ garments etc are to be burned right at the scene with mobile incinerators.
Nothing is to be hauled around town to some fixed facility.
6) We must provide palliative care for every possible victim — and unique isolation for each — to the extent practical. Otherwise, all that happens is that they cross contaminate each other — and fresh victims refuse to come in under the protocol.
This latter aspect is what’s running wild in west Africa. They are cross-contaminating each other – and refusing to provide enough palliative care and above all, isolation.
The obvious result is that EVERYONE is getting contaminated.
We can’t permit ebola patients into the regular health care system.
It’s not set up in any way to address the need for PROMPT isolation and to stop cross-contamination.
West Africa has shown us exactly what does not work.
7) The patients need to be fed, etc across viral barriers. I should expect that cranes dropping materials over a high barrier will be required.
8) The FEMA emergency facilities have to be immediately opened up and configured for this triage.
9) An enforced vacation of one-month is hardly a life sentence. Forcing probables and possibles into a tight ball = a death sentence for all.
10) That’s what’s so wrong in Africa. They’re cross-contaminating everyone — no matter what — once they enter any health facility.
All of their stuff should be burned down IMMEDIATELY.
They need to take probables out into the desert for any to have a chance.
Most African habitation is going to HAVE to be burned down to the ground entirely. It’s all a complete loss. I wouldn’t leave a stick standing.
West Africa is now and forever afterward going to be treated like the Gobi desert: one signs ones life away — and life insurance — before entry.
To restate the obvious: we have no curing agent.
So placing victims in a hospital ruins the hospital while doing exactly NOTHING for the patient.
If this protocol is not started immediately America will lose ALL of its hospitals. They will become dead zones.
This is EXACTLY what’s transpired back in Africa. No-one goes to any health facility, except to die.
Would you?
Duh!
We here are not those whom trial lawyers wish to have serve on their malpractice juries, the people who know nothing and wish to stay that way.
Your Doctor Class and award + credentials aren’t going to save you, DC. Especially not from your Leftist authorities, remember that.
Ok, I have a dinner appt. and cannot wait around, but let me introduce some obviously (when examined at all closely) specious because over-broad, and falsely predicated claims which we have all seen; and which bear in form I think, a resemblance to a certain predicate assumption being made here:
“You have to have a license in order to drive a car anywhere.”
or
“You can’t buy a car without a license”
“You have to have insurance to own a car.”
or
“You have to have insurance for a house”
“Hairdressers, need a license, why should not gun owners?”
Then there are the “it’s tax supported” arguments; which are made by people apparently oblivious to any distinction between income and use (gasoline for example) taxes, and or municipally collected fee for service arrangements and ordinary operating milages.
The first error of course is that one is licensed to operate a motor vehicle on a public highway. The others are similar in principle.
Anyway, the the kind of distinction I am aiming at.
There are several problems and corruptions inside the medical system. Many of the good doctors have already retired and probably gone overseas to await the Collapse.
They have no skin in the system, any more, and are no longer under any Authority. But like the corrupt police system the Left picked up, there will always be former and current LEOs who pipe up and defend their “bros” doing the work of protecting society. They think they have a moral cause, like the doctors do.
And they are just as they wrong, because once the Left obtains your “profession”, it is gone forever so long as the Left exists. It will never revitalize. It will never become efficient and productive again. Its purpose and manpower will be corrupted. All complaining about it does is to cover up that fact.
The Left’s lawyer unions are placed and situated to win, no matter what people do or say. Child sex practices increase in CPS and education, who wins? Lawyers. Leftists infiltrate gay mafia and stapo circles into Catholic Church, who benefits? Lawyers do. 50-70% of the multi billion damages go directly to lawyers. Directly.
The doctors that remain in America’s “healthcare system” will either toe the line of the REgime or they will be eliminated. Whatever privileges and honor they have left, they will be allowed to pretend to keep, while digital medical services and the ACA do the real decision making.
Neo, if that’s true, then no wonder you thought he might be protecting the others in the apartment. However, the reports I’ve seen suggested otherwise, stating that neighbors saw him vomiting WHILE he was being moved into the ambulance. Meanwhile, his partner/girlfriend/wife is apparently claiming he never vomited outside at all. It’s all the fog of war, anyway: most of the facts we think we know about this today will likely turn out to be wrong by tomorrow or next week.
DNW:
I don’t see your analogy as correct.
I am not predicating any of my arguments about the public health responsibilities of physicians on the fact that the state licenses them, nor am I making an analogy to the licensing of other people. I merely mentioned licensing as one of many ways in which the government regulates and imposes requirements on people in certain professions.
Here are the paragraphs in which I mentioned licensing:
The public health roles of physicians are of a different order and type than licensing requirements, but they are both examples of government involvement in these professions. And the loss of license can become a penalty for failure to abide by the rules that have been set up, whether they be licensing rules or other rules (like failure to follow the reporting rules about public health—or about child abuse, for that matter).
On another thread here on the subject of Ebola in Dallas I said that I was not happy with the idea of just telling people who were potentially exposed to patient zero to “stay in their houses,” as opposed to an actual and very strict medical quarantine.
And I was saying that I was worried that if some of the people involved were not too bright or irresponsible they might take such orders lightly or simply ignore such orders, and go outside their houses to visit friends, eat, or even shop (I hadn’t even considered ordering food delivered, and their interactions with the deivery person).
Well, I came upon the middle of a press conference by Dallas officials on FOX a couple of hours ago, which had them announcing all sorts of measures dealing with the apartment complex that patient zero was living in with his relatives. But it was only after seeing some later news that I realized that all of this was because patient zero’s relatives—the people who had the closest contact with him and the greatest chance for contracting Ebola–had apparently not stayed in their house as ordered.
So now the cops surround the building, the building’s outside is to be pressure washed–did the guy throw up on the building itself or spit on it?–food is being delivered to the family, and contractors are going to go in and clean up their apartment.
Yeah, everything is in the best of hands, and totally under control.
P.S. –Numerous reports now say that patient zero was vomiting profusely outside of his apartment building as he was heading for the ambulance.
On FOX today, when a doctor was asked what would happen if you stepped into this vomit–certainly something that fits the description of a highly infectious “bodily fluid,”–he said that you could potentially get Ebola because the virus would stay alive on surfaces for several hours, and similarly, if you happened to track some of this vomit home on your shoe, he thought there might be some possible chance of someone in that house picking up Ebola as well.
However, later I heard a Dallas health official say, when asked, that they were not worried about the patient’s having vomited outside his apartment, and any possible contagion from that source.
Folks, laboratory conditions — for the destruction of unwanted viruses — provide absolutely no protocols for detoxifying the world we live in.
The dang ebola viruses are tiny enough to float on oral mist. It will condense EVERYWHERE. EVERY nook and cranny.
All of this was discovered in the 14th Century. The ONLY solution to contamination was to burn the entire asset to the ground.
Forget all of the other junk. They can’t possibly have any ability to destroy a virus that they can’t touch.
Further, as Art mentioned, ebola is going to shortly jump from ebola-zero to our pets, our livestock and every feral mammal in the biota.
That’s what breakout really means.
And based on the Stooges in Charge, I’d say breakout has already occurred.
The experts got their true-false test entirely wrong — when random chance would’ve been at least half right.
Bringing the first victims to America was a fatal error. The morale hazard is going to afflict us all.
With that gal coughing all over him, you BET our man knew he’d come down with ebola. He couldn’t possibly imagine anything else.
Would you?
Do you get the feeling that things are far from “all under control”, that these supposed “experts” are making it up as they go along, and will say anything to stop the public from panicking, whether it is true or not?
Ymarsakar–In most arenas I have disabused myself of the notion that the government is here to help. In MANY ARENAS they act no different than the mafia. You make a mistake, that is on you…they make a mistake, that is on you. I offer this as a citizen of Los Angeles CA where only those that try to be law-abiding and are the ones that pay into the system, have their cars towed, receive tickets (many bogus!), etc etc. We are the cash cows paying the infrastructure’s payroll and pensions. As a small business operator, there have been numerous times I have received penalties for “late payments”, only to have to show them the postal receipts (all things bureaucratic should be documented) and then after numerous phone calls, set the record straight. What the heck? They tried! And now we are seeing just how broken this system truly is, with rampant disregard of the basic laws of immigration and the unwillingness to confront matters head-on by closing our borders to countries fighting this epidemic. These are the fundamental areas wherein our government is meant to have jurisdiction, and yet they are awol. Even worse, funding things like studies on why fat girls don’t date. “The National Institutes of Health (NIH) awarded a $466,642 grant last week for the study, which will examine whether social skills have an impact on why obese girls have fewer dating experiences than their less obese counterparts.” The nice liberals (our family and friends) conflate what they wish were true (our government will make it right), with reality and we all lose.
Yet one more sign of the seemingly complete unpreparedness re ebola, or any other highly infectious disease for that matter:
They’ve got to rely on contractors to do that kind of work?
And “a little bit of hesitancy” takes the cake for understatement in this situation.
Wolla Dalbo:
I didn’t read that she was coughing, but that she had stomach problems and was convulsing. See this.
Those are symptoms that can occur as a result of pregnancy. As I wrote earlier, if Duncan knew she (and other relatives of hers) had died, then you would have to conclude he should have known it was Ebola. But not from any coughing, which does not seem to have occurred.
It’s hard to get the facts straight, though, to say the least.
No problem with the vomit, heh?
Look at this still, which supposedly shows a couple of maintenance guys pressure washing the vomit in question away, while a women stands near to the runoff in flip flops (https://twitter.com/wfaachannel8/status/517739906211528704).
“Aerosolization” anyone?
Reminds me of this case:
http://en.wikipedia.org/wiki/2007_tuberculosis_scare
DNW, Don Carlos:
I said “perhaps” criminal negligence. It’s not clear that the negligence rose to that level, but it certainly might have. The term is defined thusly:
It partly has to do with whether the person could have, or should have, foreseen the possible results of the omission. There’s a lot more to it, as well. It’s rather complex–and again, I don’t know whether it would apply here. But the omission was egregious and negligent, perhaps criminally so, given the training and knowledge on the part of the health care people and the direness of the possible consequences (of which they were or should have been aware).
There is the knowledge to contain and eradicate ebola in advanced societies. There are also well known, establised procedures to address this crisis. There are plenty of people at the CDC and elsewhere who have the skill sets and training to put in place a system to tackle this issue. What is lacking is leadership, starting with dear leader and his sophmoric underlings. I am positive there are professionals within the beltway who have wayed in and given bho the advise he needs. He just does not want to listen because he is a better epidemiologist than the epidemiologists offering expert opinions.
The messiah wants death, panic, and chaos. Ebola and the other diseases crossing the border are perfect tools to accomplish his agenda. I can not fathom any other explanation for what is happening.
parker…
Plainly, Barry figures that ebola can escape containment — and yet, he, the wonderboy, will skate on by — along with all of his apparats.
Yet, because he IS a politician, he figures to be extremely vulnerable.
America actually has no cure — Mayo says so.
All that May recommends is palliative care:
http://www.mayoclinic.org/diseases-conditions/ebola-virus/basics/treatment/con-20031241
You’re pretty much on your own — and it’s safer all-the-way-around that way.
What no-one should want is to be forced to stay in a tight community of fellow suspects. For at least one figures to actually have ebola. Quickly, everyone will have it.
That’s been the dynamic in Africa.
As far as ebola goes, there’s nothing so special about our race or nationality: we’re all food.
Neo: I wish you would consider the other side. You seem to me inclined to excuse or misrepresent Duncan’s thinking and conduct in Liberia—pregnancy etc (where Ebola is an everywhere occurrence), and not understand the medical side here in the USA, which I attempted to explain.There is no statute or medical staff bylaw that required the hospital and ER staff to do anything on his first ER visit. Period.
You impute duties to physicians as individuals which are Statist in flavor….their public health duties, duties contingent on licensure, etc., which are regrettably incorrect. Their public health (reporting) duties are specified by law. No law specifies what they must do medically to treat a Duncan, thank God. There are some criminal laws that punish certain acts, things docs may not do, as you well know.
Maybe if the spokesman did not have to worry about the hospital being sued out of existence, he would be more willing to admit wrong. The incentives are all wrong for people to accept blame. Want the culture to change? Get rid of the pervasive victim-oppressor mindset.
Don Carlos:
I already specified what I think would have been the possible criminal negligence, and it was not the treatment decision (although obviously, that was incorrect).
In the post, I was general, and just said the following:
I didn’t specify the possible criminal negligence as I saw it, and the fact that I added the conditional “if Duncan had been admitted…” could make it sound like I meant the failure to admit was the possible criminal negligence. That’s not what I was thinking, and I realized I hadn’t made it totally clear and tried to clarify it in my later comment at 6:13 PM (which was specifically addressed to you):
And then, in my comment at 7:10 PM, I attempted a very brief explanation of criminal negligence.
I will clarify still further, and say that I don’t think they would have been criminally negligent, or even negligent, if they had asked him about recent travel and he had lied to them and said he’d not been out of the country, and they released him, even if everything else was the same. Nor would they have been criminally negligent or even negligent if he’d come in with a broken leg and said he’d just come from Liberia, and they set his leg and let him go, then he got Ebola symptoms, and everything else was the same. Etc. etc. It was the fact that they knew—it was right on his chart—that he’d come from Liberia, and he had symptoms that were consistent with the early stages of Ebola, AND then they completely ignored the fact of his country of origin, which would make them negligent and possibly liable for damages that flowed from that decision based on their negligent ignoring of what was in the chart.
Here’s an article on medical criminal negligence. As I have said several times, I am not saying the people in this case were in fact criminally negligent. I am saying it is a possibility.
I don’t know enough about the details of the case to say. My gut feeling is that they were negligent, but not criminally so. Unfortunately, the possible consequences of their oversight could be many more deaths. I hope that does not come to pass.
Don Carlos: “There is no statute or medical staff bylaw that required the hospital and ER staff to do anything on his first ER visit. Period.” Perhaps not. But by its own report, the hospital adopted an Ebola checklist in an effort to fight the disease, used it, collected the critical information: and then failed to follow through. Criminal negligence? Perhaps not. But negligence, yes, surely: it’s an ancient idea that one who assumes a task, also assumes a duty to do so responsibly.
If you and DNW think the physicians and nurses and public health experts should not be the ones who stand on the front lines guarding the rest of us from contagion, then who the hell should be? Leave the freighted word ‘statist” out of it — as far as I know, the Dallas Presbyterian hospital is in no way a government entity — but if a hospital isn’t there to help protect the public health, then why is it there at all?
Every other nation is lifting the drawbridges…
But not Barry.
Mrs Whatsit:
I don’t know whether you saw my comment right above yours, but it’s relevant to the question.
As for the answer to your question about what hospitals are there for, it’s to treat sick people. Public health is something a bit different. There are private entities that study and promote public health, and public ones. For many many decades, the government (particularly the CDC) has had a role in public health, and there are laws and/or recommendations saying what responsibilities physicians and hospitals have regarding public health. For example, for many years there were reporting laws for some venereal diseases and for TB. This sort of thing.
DNW, Don Carlos, Mrs Whatsit:
Here’s an article on some the legal issues involved in the 2-day delay in admitting the Ebola patient in Texas. It sort of skims the surface, but it offers some information:
I would say the possible negligence here came in the “screening” process.
Hospitals exist to suck up cash from the people and the gov, to launder it for the medical unions. That’s about it these days. The independent clinics and corporations that might have provided better ethical care somehow disappeared with ACA, even with the exemptions.
They won’t be solvent for long, even if they did survive.
Hospitals are being inundated with emergency care as normal care for those without insurance. That was the case before ACA, but ACA broke the back of the camel, literally.
Hussein O Regime knows this, that is why they are pressuring insurance agencies and collapsing the care system with more costs, more regulations, more lawyer BS, and more patients.
Meanwhile, the Regime’s buddies are coincidentally raking in a lot of cash from these inefficiencies. Cash that isn’t being spent on patients, patient care, doctors, or government programs. It’s being spent on the personal luxuries of the REgime’s cronyies.
blert,
If there was the will, there exists the means. Unfortunately, the will at the rotten head of the fish wants death, panic, and chaos to further a nefarious agenda. Banning all seeking to enter from west Africa in addition to all Islamic nations, national guard at the borders to enforce border control with shoot on sight orders, and standard procedures of sterile conditions of isolation/quarantine are all remedies that are well known and not so difficult to comprehend.
This is all orchestrated from the desk of VJ with Soros whispering in her ear. Meanwhile, michelle is monitoring lunch room menus.
Lawyers are lawyers, and physicians are physicians. They do not think alike, nor will they ever. Mrs Whatsit and Neo ignore some of the medical points I raised and slipped over into the lawyerly way. I can’t help that. Giving up trying.
Go admit yourselves to a hospital when next you get a flu syndrome that makes you feel only moderately bad and that might be some weird disease that has never occurred on this side of the ocean. Or maybe it’s Chikungunya! Go circulate more rules to be read on top of all the other crap that has to be circulated and read. Always insist the retrospectoscope is yours alone, and its view is perfect in determining negligence. So sue ’em; they are there to serve. Lawyers never get their hands dirty either.
Don Carlos:
I’m not a lawyer (not that there’s anything wrong with that). I have a law degree, which I got so many years ago I’d be embarrassed to say. I have never practiced law, and I don’t think I have a lawyer’s sensibility or a lawyer’s experience.
You write:
Are you really suggesting that the doctors and staff in Dallas were unaware of Ebola and the possibilities with patients from Liberia? I, a layperson with no special medical training, and probably most of the people who read this blog, are well aware (and were well aware before Mr. Duncan ever came to this country) of the dangers, and the need to ask a patient if he/she has recently come from a Western African country.
That’s basic knowledge in the common domain, not some sort of hindsight-driven ex-post-facto criticism of this hospital. What’s more, we know that the hospital was well aware of the possible danger, because they knew the man had early symptoms of Ebola and they knew he’d been in Liberia. There was nothing esoteric about the situation or the risks.
In your hypothetical fact situation “go admit yourself to a hospital when next you get a flu syndrome that makes you feel only moderately bad and that might be some weird disease that has never occurred on this side of the ocean” you leave out a rather huge elephant in the room, don’t you? That would be “but which had become endemic in your home country, and which has garnered headlines all around the world and which health authorities in this country are on the alert for.”
What’s more, we have no idea how bad Mr. Duncan felt on his first attempt at admission. After all, he went to a hospital. He might have felt very bad, or perhaps not. I have read no description of the seriousness or moderateness of his symptoms. But that’s not really the issue here. The issue is his recent arrival from Liberia combined with his symptoms, which were early symptoms of Ebola. Anyone with those two fact situations—recent arrival from Liberia, and symptoms (even if only moderate) of Ebola, should have been either hospitalized or sent home and closely monitored. That’s the way several other people around the country with that fact situation had been treated.
I believe that ebola has broken containment.
All of the talking heads are wildly understating the speed of transmission.
America escaped previous ebola outbreaks in Africa because jumbo jet travel did not permit Africans to infect Americans.
It will be beyond strange if no-one in Brussels was infected.
It will be even stranger still if no-one in DC was infected.
Ebola virus is distributed throughout the body pretty much from the outset. The only thing that is ‘timed’ is the viral concentrations.
Consequently, a carrier is infectious right from the outset, certainly from the first hours. It’s only at that stage that the concentrations are so low that it APPEARS that the victim is not transmitting ebola.
Because ebola is so virulent, even ‘trivial’ contamination merely means that you have a few additional days before you realize that something is REALLY wrong.
Being an exponential, ebola impacts are back-loaded.
But long before then, enough ebola is kicking around in ones system to make one fearsomely infectious.
The idea that fellow jet travelers are in the clear is a flat lie. It’s actually more like a CDC prayer.
T.E.D. was leaving ebola virus every step of his way.
That’s simply the way it is. I’d expect most of it to be by way of sneezing, coughing, nose blowing, — but even a deep breath (with exhale) is sure to kick out a cloud of ebola particulates. Ebola, per se, is so small that it can easily spread as an aerosol, wafting off into HVAC spaces and across the aisle.
All of the Whites coming down with ebola in Africa are not glad-handing the locals. They are taking ALL of the practical precautions.
They simply don’t work.
There’s a real reason ebola was studied for biowarfare: it figured to be unstoppable.
Now we know that’s actually true.
It’s actually imperative that T.E.D. die with palliative care.
Otherwise, we’ll create a moral hazard that will lead to an absolute flood of flight victims.
It’s not as if we actually have anything to give anyone.
Africans think that American medicine brings magical
results.
They’re going to find out our limitations. And in doing so, they’re going to kill most Americans now living. Ebola has that track record.
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The native Hawaiians lost well over 20% of their population to German measles and a slew of other common diseases. (This low figure is extremely suspect, as no-one was tabulating fatalities any distance from Honolulu harbor. Local legends tell of entire clans being wiped out in the outer islands. This is the primary reason why the smallest Hawaiian island STILL does not allow non-natives to even visit! (Ni’ihau) Other legends tell of mass abandonments of fish farms, taro fields, etc. — all exactly like the 14th Century Black Death in Europe. All of this coincided, more or less with the Californian gold rush. Hawaiians were either sailing to California and back or shipping foodstuffs at a terrific mark-up. (Three crops per year!))
Since waves of Whites didn’t promptly descend upon the islands, they were able to (largely) repopulate. In truth, they never fully recovered. (socially, psychologically — the pandemics still come up in conversation generations latter.)
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Once a pandemic is set loose, it travels faster than any medical treatments ever devised.
That’s why these diseases are even termed pandemic level pathogens.
Ebola is so devastating that even the survivors are biologically crippled. It’s common for them to have short lives, damaged organs, and misery all the way to the end. Right now the CDC is giving us happy talk that as much as 30% MIGHT survive ebola — to suffer along, that is.
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It’s high time that articles of impeachment be drafted. By the time ebola really gets rolling, the votes will be there.
Even a President Biden (2014) will raise the draw bridges.
As of this morning, I saw a news report that the hospital’s electronic medical record system failed — the information that Duncan had been in Liberia was entered into his record, but then was not displayed, so the rest of his treatment team never saw it. (Of course, the report may or may not turn out to be accurate.)
Don Carlos, you’re right, I was approaching the question from a legal point of view — but that’s precisely because you said that no “statute or bylaw” required the hospital to act — you may not think like a lawyer, but it was your idea to talk about law. My point was that statutes and bylaws aren’t the beginning and end of all legal obligations. As for medical obligations, of course people with low-grade virus symptoms aren’t usually admitted — but if the fact that Duncan had been in Liberia wasn’t relevant to his medical care, and his relatively mild symptoms were all that mattered as you seem to be suggesting, why had the hospital adopted an Ebola checklist that included a question about whether he’d been in West Africa?
I make plenty of mistakes every day that (thank goodness) usually don’t affect other people’s health. I have doctors and nurses in my family, and I’m much more sympathetic than you seem to think to the massive difficulties faced by people who are trying to care skillfully and responsibly for other people’s health. I don’t care whether anybody is punished or penalized or fired or sued or whatever for the release of Duncan after his first hospital visit: I just hope people are looking hard at whatever went wrong with the goal of preventing similar failures from occurring elsewhere.
You’re probably already familiar with the work of Atul Gawande on how to improve medical care by, among other things, minimizing human error, including (ironically) “The Checklist Manifesto.” Fascinating, thought-provoking stuff, specific to medical care but just as relevant to other fields of human endeavor. I wonder what Gawande thinks of the failure of this particular checklist.
Don Carlos, one more comment — I fully agree with you about “all the other crap that has to be circulated and read,” and recognize that my profession bears a good part of the responsibility for the impact of some of those requirements on yours. Somewhere in another thread on this blog on this same subject, I wondered in a comment whether Duncan’s travel history got lost amidst all the rest of the mandated information, often trivial and questionably relevant, that ERs are required to ask every patient about.
Regarding Mr. Duncan. We might want to cut him a break. His native land has one of the lowest IQ levels of any on the planet:
http://www.photius.com/rankings/national_iq_scores_country_ranks.html
The IQ in Africa moves to Europe and America. Just as you saw.
MRSA, Ebola, Entero virus, flu, etc.
It’s like America’s bio warfare lab is mixing and matching various diseases in one person to try to see if a person, in a hospital, can mutate or express viral traits in a hybrid manner.
The Nazis and Imperial Japanese did bio warfare tests on humans, to see how to generate resistances and treatments. We’re not supposed to utilize human experimentation on this scale, but I suppose the Hussein O Regime doesn’t really care about that limit.
There is an obvious common-sense prevention and anticipation deficit with this administration as evidenced by ISIS and now Ebola problems crossing preventable thresholds despite that they were open-source news for a long time.
All of the fuss hinges on what exactly was the “Liberia question” posed to Duncan. “Where are you from?” vs. “Have you been in Liberia in the past month?” I do not know.
I have read he was asked for his SSN, which is normally asked at the front end, as basic ID, to which he allegedly replied, “I don’t have one. I’m from Liberia.” So the Liberia question may not have been asked, having been pre-emptively answered. There are 10,000 Liberians in North Texas, and they probably use ERs all the time.
And if he was not profoundly ill on ER visit #1, why did he not say “I’m from Liberia and I might have Ebola” as they gave him the antibiotic and sent him home?
This coming week will tell a most profound story about our future, as more illness occurs.
Eric, like the VA issue where they were killing veterans instead of paying pensions and benefits out. They also sent them to Africa, 3k american soldiers. If they get back and are infected, will the VA be treating them?
My roughly analogous statements were presented for the purpose of provoking more accurate thought on the actual predicate for licensing in the first place.
Are, on the one hand, licenses to ensure that certain levels of competency are met by those offering personal or highly technical service for hire (medical doctors or civil engineers), or for engaging in a consequence freighted public privilege (driving a motor vehicle as opposed to walking on a roadway)?
Or, on the other hand, is licensing for the purpose of bringing socially valued activities, and their practitioners under close government control and direction?
It’s obvious that many on the left have forgotten or reject the original purpose of licensing, and imagine it as the latter position by default.
In your case, you have now explicitly denied that the duty you mention is related to the license, and have apparently only mentioned licensing in the first place as part of an ensemble of fait accompli government encroachments, statutory and otherwise.
“If you and DNW think the physicians and nurses and public health experts should not be the ones who stand on the front lines guarding the rest of us from contagion, then who the hell should be? … I know, the Dallas Presbyterian hospital is in no way a government entity – but if a hospital isn’t there to help protect the public health, then why is it there at all?”
Neo has more or less answered that question, I see.
As for public hospitals …
Some cities which once had them – Detroit for example had two major and one smaller ones – no longer do: due to the moral and managerial incompetency of the population in control of and drawing upon, them.
Which is probably a good part of why the private is being appropriated under whatever pretext is handy, by the incompetent public.
I suppose we could even make laws that anyone with certain kinds of knowledge could be commanded by the state to perform certain kinds of acts, or face penalties.
I’m not sure why I would be interested in preserving the health and life of persons like that, though.
” You drive on public roads, therefore you owe me a lift”
I worked in a busy inner city emergency room for five years, on the night shift (where the head nurse wanted a male), and I just don’t feel like I know enough here to comment — as for one thing, the person the hospital sends out to talk to the press usually knows very little about what really went down. Their job is delay, distract and divert. They would never come and talk to those who actually were present when whatever allegedly happened, happened.
Protocols may have changed a good deal since the time when I worked, though from fairly recent experience as a patient it seems like the basics are the same.
The patient often tells the clerk one story, a second version to the nurse, then something completely different when the doctor comes in. And communication between those on the staff is variable, depending on their own rapport, how busy it is just then, and whether the patient’s case seems interesting or out of the ordinary vs routine. How well did this patient speak English? ER physicians are often under the gun to control the patient interview and glean the essential problem as quickly as they can. I remember hearing from a doctor who worked at Kaiser for a while that they were pressured to spend no more than seven minutes with each patient before making a working diagnosis and moving on.
So-called “flu-like symptoms” represent a large percentage of those who visit the ER unnecessarily and lead to it being swamped, At the boat people we would hear “baby sick”, end of story, again and again.
And some doctors are jerks. So I don’t know. Too many variables to have any clear idea what this patient’s ER visit was really like.
Speaking of public health …
Anyone interested in a little comic relief – in the sardonic sense I earlier mentioned – might enjoy reading this article from a leftist site.
Even their “power to the people” paint job cannot cover over the cracks they reveal in their own argument while presenting a few simple facts.
It also seems that they cannot quite believe the ignorance and the incompetence of their own left-Democrat ideological constituency currently [as of 2012] inhabiting positions of civic authority.
Read it and weep, or laugh, as your personal constitution disposes.
miklos000rosza:
And those details still don’t seem to be forthcoming. For obvious reasons, I think: protecting against the lawsuit they fear.
In this case, Lester said it was a “complex care team” doing the intake. Now, that might just be a BS Orwellian term that doesn’t actually mean much of anything complex, or caring, or demonstrating teamwork. But it implies some sort of coordination. And supposedly the Liberian origin of the guy was written in the chart. Should have been red-flagged, highlighted, etc., but apparently was not.
That’s all we can say about the details of the intake at the moment. Don’t sit on a hot stove awaiting further word on it from the hospital, either.
Don Carlos:
You write “so the Liberia question may not have been asked” (for medical reasons, that is), and suggest that his Liberian connectoin might have emerged merely in response to a request for a SS number.
And yet, in the excerpt I provided from Lester’s press conference, he seems to explicitly be saying that it was explicitly asked: “He volunteered that he had traveled from Africa in response to the nurse operating the checklist and asking that question.”
“The checklist” I believe would be a series of questions that follow guidelines relating to infectious diseases, and “asking that question” indicates she asked the question about travel to/from Africa, not a question about a Social Security number (a question that had probably already been asked, probably by the clerk early in the intake).
In addition, you ask, “why did he not say ‘I’m from Liberia and I might have Ebola’ as they gave him the antibiotic and sent him home?” We certainly all wish he had; it would have been an excellent idea, and I’ve wondered it myself, but I have several answers: he may have thought he’d already communicated that fact when he told the nurse he was from Liberia, and then demonstrated/described his symptoms. Did he need to provide a possible diagnosis, too? Also, although it’s hard to tell from the stories that have been given out, I’d say there’s a good possibility that he did not know the woman in Liberia he’d helped drive to the hospital died of Ebola rather than some pregnancy-gone-wrong, or even that she’d died in the first place. I’ve read several articles on that, and it’s not been made clear.
I don’t think it was up to the patient to provide a possible diagnosis for his own illness, especially as terrifying a one as that, which I would imagine sparked a lot of denial and wishful thinking in the patient. The medical people had more than enough information to put two and two together, and should have done so—at least, in terms of suspicion and cautionary measures. They completely and utterly failed.
“When Mr. Duncan, 42, was first taken to the emergency room at Texas Health Presbyterian Hospital on Sept. 25, he was examined and sent home with antibiotics by doctors who apparently did not suspect Ebola. A nurse had learned from Mr. Duncan that he had traveled from Liberia, one of three African countries where the virus is rampant, but that detail apparently was not communicated to the rest of his medical team, hospital officials said.
http://www.nytimes.com/2014/10/03/us/dallas-ebola-case-thomas-duncan-contacts.html“
If you want to know what it’s like to work in a busy emergency room, read the award-winning 1987 novel WITHIN NORMAL LIMITS, by Todd Grimson, published by Vintage Contemporaries. Good review in the New Yorker, trashed on PC grounds by a hardcore feminist at the New York Times. Steven Spielberg turned it down as a possible film project because he judged it “too dark.”