One of the real problems with Ebola and U.S. hospitals is

[MineralMan]

that most for-profit and many non-profit hospitals do not have medically-trained people in the top management jobs. Instead, those jobs are filled by MBA folks and bean-counters. They are the people who make the decisions about how the hospital is run in most cases. Since medical staff cannot override directives from the non-medical management team, situations like what has happened in Dallas are always a threat.

When budgetary matters override medical decisions, the result can be deadly. Preparing for something like Ebola is very costly, requiring expensive items to properly protect staff members who will actually have to care for patients. In addition, policies designed to keep uninsured patients from being admitted can lead to people being sent home who should have been admitted.

So, many hospitals have minimal or no preparations for worst-case situations. Management resists costly preparations, so they don't happen. That's very probably the situation at the hospital in Texas. Decisions made by non-medical management override the wishes of the medical staff. Management simply does not understand medical needs, and only concerns itself with budgetary matters. It's a prescription for serious problems.

[boston bean]

1. So, it was common sense to question what others were saying, right?

ie, that our health system is the best in the world and we can handle an outbreak and know what to do....

We all know that is complete and utter bullshit at this point and time.

[MineralMan]

3. Actually, we do know what to do.

Not every hospital or area, however, is properly equipped to do what we know how to do. What we know is that two health care workers have contracted Ebola at this particular hospital. On the other hand, no health workers contracted it at other hospitals where Ebola patients were treated.

We do know how to handle this. Whether we will actually do what we know, however, is a matter of individual health care facilities. I suspect that what has happened in Texas is going to be a real wake-up call for other facilities. I also know for a fact that the major hospitals in the Minneapolis St. Paul area are well prepared. They've even been running drills to test their preparedness, and have the materials needed on hand and ready. They have specific teams in place to respond to any Ebola patient who might turn up. The Twin Cities have about 20,000 residents who are immigrants from the affected areas in Africa. There is travel between here and there, as well.

Earlier this year, a Lassa Fever case was handled in the Twin Cities. The patient survived and no health care workers were infected. So, yes, we know what to do with hemorrhagic viral diseases. If we do what is needed, they can be handled safely. See the link below:
http://www.startribune.com/lifestyle/health/253926981.html

Different places are doing different things. However, the current problem in Texas is evidence that better preparedness is required. Will the lesson be learned and followed in other places. In some, yes. In others, I suspect not.

So, what preparations are being made where you live? Do you know? Let us know what you discover.

[Erich Bloodaxe BSN]

10. I'd like to see which type of personal protective gear was used in each.

Having just read this morning that nurses in Dallas were 'taping their necks', I'm pretty sure they were using gowns that cut off at the neckline, and that also makes me wonder whether they were just wearing goggles/glasses or full face shields, and whether hair was covered, and the disposable shoe cover booties worn.

[MineralMan]

13. Yes. I have no information, really, on that.

[boston bean]

20. Yet, you want me to investigate hospitals in my area and determine factually

what it is they are doing?

Come on.

[MineralMan]

21. I know exactly what the hospitals in my area are doing to

prepare for Ebola. About hospitals in Texas, I don't have information. Perhaps you misunderstood me. If you're concerned about Ebola, then you really should know how the hospitals in your own area are preparing. That was my question to you. I took the time to learn what my own area's hospitals are doing, because we have a large West African immigrant population here, and there is a small amount of daily travel from affected countries. So, I'm interested in how our local healthcare facilities are preparing. As it turns out, they're doing an excellent job with it, so I'm not all that concerned about possible Ebola cases here.

Now, I don't know how many West African immigrants are in your area, nor how often people from affected areas travel to your area. You'd be far better equipped to know that. The risk of Ebola cases in the US is directly related to the number of people from affected areas who travel to an area. I suspect that the Boston area has at least some West African immigrants, who have families still in affected countries. If that's the case, there is probably travel going on between the two, as there is here in the Twin Cities.

So, again, how are your local health care facilities preparing and how will any Ebola cases be handled there? I certainly don't know, but if I lived there, I'd make it my business to know, as I have here.

[boston bean]

23. Oh you do. CDC thought they knew what TX was doing too.

You don't know.

[DisgustipatedinCA]

35. He's the Voice of Authority

dont mind that 180 degree turn he's executing at the moment. He's still the voice of authority when he completely changes his stance from the one he was taking last week.

[boston bean]

38. I notice a lot of those "voices" seeing things a bit differently.

I was called a racist for suggesting that we not allow people from hot spots into the US.

Mark my words... another 2 or 3 imported cases and that will happen. And everyone who was against it will be for it.

[MineralMan]

40. Mark my words: It's not going to happen.

Not unless things get really nasty.

[boston bean]

41. we'll bookmark this.... and time will tell.

[Zorra]

50. [phone] nt

[TexasMommaWithAHat]

18. Patients in Nebraska were in a Bio Level FOUR Unit

And personnel dressed accordingly and had very serious and repeated training in dealing with this level of hazard.

The nurses' union says its nurses are NOT TRAINED and NOT PREPARED for ebola all over the country!

[riverwalker]

30. Nada

I keep asking about it.

But we must be "ready and prepared" because the health department says we are, right?.

[MineralMan]

32. Knowledge is not the same as implementation.

That's the issue.

[TexasMommaWithAHat]

37. +1

actually, +1,000!

[DemocratSinceBirth]

4. We have the best health care money can buy. That would be more accurate.

That's why when potentates from foreign lands, especially from developing nations, need treatment and complex procedutres they come here.

[MineralMan]

6. We don't do so well with public health emergencies, though.

Our health care system is a business, and money tends to come first in many cases. That's the most serious flaw in the system, in my opinion.

[marions ghost]

2. You are probably right

I hope some in-depth investigating is done on this...

People need to realize the vulnerabilities of medical care that is too tightly bound to the bottom line. Surgical intervention may be needed.

[MineralMan]

5. Yes. I hope the wake-up call from Texas is heard.

[hedgehog]

7. The next problem is that when it's not headed by an MBA, it's headed by an MD.

The key to running a good hospital is to have an excellent nursing staff. There are more and more nurses with Masters and PhDs. We need to put people with actual working experience in charge.

[MineralMan]

8. Nurses, of course, are the primary health care providers,

or should be, anyhow. Many hospitals have cut nursing staffs to the bone to try to save money, and nurses with long experience and advanced degrees are often replaced by far less costly new nurses. The result is that much actual patient care now is done by poorly trained people who cost less to employ. Nurses tend today to be in supervisory and data management roles than in actual hands-on patient care much of the time.

Health care at the hospital level has changed, and not for the better, in my opinion.

[hedgehog]

14. People think they go to the hospital to see the doctors,

but surgical success rates depend upon a solid nursing team. You go to a hospital for nursing care. I agree about the problem of saving money by breaking down nursing tasks and hiring lower paid workers to do them. There is a difference between someone popping in , taking your temp and leaving versus a nurse coming in, taking your temp, checking your blood pressure, talking with you and evaluating your overall state.

[MineralMan]

16. RN staffs are thinning in most facilities.

They have less and less time for hands-on care, sadly. I'm seeing more and more time in hospitals, now that my parents and my wife's mother are in their 80s and now 90s, in my parents' case. It's not a good experience, really.

[MannyGoldstein]

9. Clearly true on patients being turned away

But that's a decision that Americans have made as a whole, to have incredibly-stupid health care financing.

Being a member of the medico-industrial complex, FWIW, I don't think docs are any better than MBAs. Both are primarily driven by personal profit which leads to bad stuff happening. But I don't think that's the problem in the case of Ebola spread in Texas.

The problem in Texas is that the American medical model discourages collaboration and process, in favor of lone-wolf medicine. Medical staff are bad at following protocols, and medical administrators are bad at creating and enforcing protocols.

I recommend Atul Gawande's "The Checklist Manifesto" for a good assessment.

[MineralMan]

12. We don't disagree on this.

Putting profit before health care is the problem. It is an almost uniquely American problem.

Being the first hospital to have an Ebola patient walk into the ER is part of the problem, too, of course. There was bound to be one that would be the first to be faced with an actual Ebola patient. What happened there could have happened at any random hospital in the country. We're not really good at preparing for extremely unlikely situations. It's expensive and complicated to do so.

And Ebola is very unlikely to be an issue in most places, so the problem will continue to be a real one in many areas. Still, our major cities really, really need to put a strategy in place yesterday. I think that message is becoming clear. Smaller cities probably don't face the same risk, and will probably decide not to make the preparations, though.

No matter what happens, numbers and odds will still be part of the consideration. We have a private health care industry. Individual facilities make whatever decisions they choose to make. We have no way to force compliance with anything, really.

[cbayer]

11. Where do you get this information?

Hospital Executive Committees are generally made up of the following:

CEO or COO - generally not clinically trained, but can be

CFO - financial, not clinical

CMO - medical officer, generally clinically trained

CNO - nursing, generally clinically trained

CIO - information systems, generally not clinically trained.

Head of Legal Department - not clinically trained

Medical staff do actually have a great deal of power in a hospital and can challenge directives from the management team. The board makes the final decisions and generally hears form both the medical executive committee and the management team.

Do you have direct experience with hospital management?

[MineralMan]

15. Hospitals are run as businesses in most cases.

Budgetary matters rule the day when it comes to expenditures for unlikely events. And make no mistake, Ebola is an extremely unlikely event in any given hospital, and will remain so.

Equipment, PPEs and training are expensive. Many health care facilities will decide to skip it. I guarantee that. Most will never see an Ebola patient, and they know that. Why invest in preparations for an extremely unlikely event.

Major city facilities may well decide to prepare, or at least some will. Beyond that, I suspect that preparations for Ebola will be minimal in most facilities.

It's still a very unlikely case that an Ebola patient will present in any given ER. There's a financial decision to be made, and the odds will rule in very, very many facilities.

[cbayer]

17. Hospitals are a sometimes precarious balance between business and medicine.

The Joint Commission and Medicare both have very strict rules and regulations that try and enforce that balance.

Health Care Facilities can not just "decide to skip it" when it comes to protocols about infectious and contagious diseases. If they do, they risk losing their accreditation.

Here is the Joint Commissions latest recommendations, which include a reminder that this falls under already established standards which must be met in order to maintain accreditation.

http://www.jointcommission.org/issues/article.aspx?Article=bNSaHxs7eXC5KNKTEr1p6HInnh851az0ohgVLX1BCTw%3D

In the end, medical safety will override finances when it comes to this specific issue. No hospital board wants to be under the bright lights of the media when it comes to something as hot as this.

I object to your OP because I think it is an unnecessary scare tactic to promote the idea that hospitals are not establishing and abiding by protocols and are making purely financial decisions.


It's just not true.

[MineralMan]

19. You're welcome to object to my OP as much as you like.

[cbayer]

27. Thank! I wil anytime I think it is a FUD piece.

[MineralMan]

31. Be my guest. I will continue to post as I choose.

I'm not spreading FUD in this thread. I'm pointing out a problem with our for-profit healthcare industry. It is a real problem, and one that probably will not be corrected anytime in the near future. Occasionally it comes to the forefront. Usually, it's reflected in inadequate treatment and life-threatening errors that affect only individual patients. With Ebola, those errors have consequences beyond individual patients.

So, the bottom line is that I expect to see a few more mishandled Ebola cases before it becomes clear that better preparation is essential to all healthcare facilities. Eventually, most facilities will ramp up for it. Until a few more walk-in or ambulance cases show up in smaller or poorly prepared facilities, there will be similar issues and a few healthcare workers infected. Mistakes connected with poor practices and training occur all the time, but most only affect individuals and do not represent a risk to the rest of the community. Mostly, they are shrugged off, really. How do I know this? I've seen it multiple times directly. I have parents who are 90 years old and a mother-in-law who is 86. When they're in the hospital, I'm there, too, and I can see the haphazard concern about issues that should be more carefully handled. Ignored procedures for dealing with infectious organisms are a commonplace.

So, are you still in favor of prohibiting travel to the US from the affected W.A. nations?

[cbayer]

42. Oh, I completely agree with you that there is a massive problem

with our for profit health care industry. I feel pretty certain that most people here will completely agree with that.

What I object to is using Ebola as a scare tactic to try and make some point about that. As wrecked as our system is, it is stable enough to pretty much ensure that ebola will not become a crisis here. I will leave the scary ebola shit to the MSM and object to it here.

What would be interesting to ask is whether there will be any differences between for profit and not-for-profit facilities. Or if there is a difference between privately and publicly owned facilities.

My hypothesis would be that there would be no difference in this particular situation.

You have some anecdotal experience and while it is worth something, it does not lend itself to prognostications about ebola and the general health care system.

I was never in favor of prohibiting travel to the US from African nations. You must have me confused with someone else.

[liberalhistorian]

46. You must be very

naïve if you actually believe that.

[cbayer]

47. No, I am not naive at all and I do have a significant amount of experience in this area.

What is your take on this and what do you base it on?

[Dreamer Tatum]

58. You have this exactly correct. The OP was written without a shred of data

and you're being criticized for asking.

Many, many DUers look to a phenomenon and seek to attribute it to a narrative rather than to a specific fact, or they'll
take a very general fact and apply it broadly to make a point which they will not negotiate. It's intellectually weak at best,
and simply stupid at worst.

[cbayer]

64. Thanks Dreamer Tatum.

There is plenty to criticize hospitals about, but there are dedicated and very hard working clinical people in hospitals who do everything in their power to make things as safe as they can.

And this just looks like an attempt to cause a fury based on nothing.

[Avalux]

22. The words "For Profit" and "Medical Care" shouldn't be put together - ever.

What you point out is true; and unfortunately, only ONE case of Ebola made that glaringly obvious. Can you imagine if we suddenly had thousands of cases?

Sure the government issues guidance and regulations these hospitals have to follow, but they don't really take them seriously. They do the mandatory yearly training just to get it over with, then forget about it until next year (like a typical corporation).

I still think Duncan was sent home after his first ER visit partly because he wasn't a US citizen and didn't have insurance.

What kind of society are we when we don't treat public health as a priority?

[magical thyme]

25. I work at a not-for-profit

still pretty much the same thing. Somebody is getting rich, and believe me it's not the front line workers. And we are put at increasing risk by cost cutting decisions every day.

[joeglow3]

49. And I bet people are still bitching at how much you charge for services

[Fumesucker]

26. A society seriously at risk for a pandemic

To answer your question in the last sentence.

[MineralMan]

28. We used to have a much more robust public health system.

No longer, however. Still, the likelihood is incredibly small that thousands of Ebola cases would suddenly appear in the United States. As we're seeing, a few isolated cases are the extent of it. The first case that appeared with a patient presenting himself with symptoms in an Emergency Room was not handled ideally. That's really not surprising. The other cases in the United states, other than the two Texas healthcare workers, were known before they arrived at hospitals that were prepared and equipped for them.

While an outbreak with multiple patients is possible in Texas, the response to that will be very different from the response to the man who came to the ER at that hospital. I expect the cases to be well-contained and the number of them to be very limited.

Still, other isolated cases will probably appear, as travelers from the affected country arrive and develop symptoms after they get here. We have experience of one such case now, and more information. Preparations will be better for future cases that show up in ERs, in most cases. It takes time to ramp up an appropriate response, since such preparations rarely happen until an actual, proven need is recognized. The Texas case brings that home. Major cities will make preparations. Smaller communities which are at very low risk probably will not do so well with that, unless the situation grows more active.

[Avalux]

52. We need to think and plan BEYOND Ebola.

I see it as a canary in a coal mine - a warning signal that we'd better get our shit together because when a pandemic with a significant mortality rate does come along (and it will), we need to be ready.

[tblue37]

65. Of course, when you have people who have certainly been exposed, yet who decide to hop a plane to

visit family several states away before the 21-day incubation period is over, like the second Texas nurse who tested positive for Ebola just 12 hours after flying back to Texas, then the number or potential cases grows a bit.

Probably she didn't infect any of the 132 passengers on her flight back to Texas, and probably the other passengers the who boarded the plane during the 3 further flights it completed before being taken out of service will not be infected either. If that pans out, then no biggie. BUT if even one of those passengers becomes infected, then there is potential risk to everyone that person comes into contact with--and those whom those persons come into contact with.

[ileus]

33. I work for a non-profit 151 bed hospital.

The bottom line is still the only important item that's addressed properly.

not for profit doesn't mean "we care more"

[MineralMan]

36. As you say. The problem exists in non-profit facilities, too.

[magical thyme]

24. exactly. and it's worse than that...

Our lab director prides herself on her total lack of experience "on the bench."

Not once has she or the lab manager stayed through 2nd shift, never mind overnight, to see the conditions when we get crazy busy.

[MineralMan]

29. The Peter Principle at work.

[Fumesucker]

34. I read that book back in the 70's

Gets more true every year...

[MineralMan]

39. It sure seems to. That's why I have been self-employed

since 1974. I can't say that I've been wildly successful at it, but I've done OK. None of my businesses have ever had an employee. I've worked to keep them manageable with just me doing everything, from management to janitorial work. That's been one of my absolute rules. That has helped keep me sane, if not financially secure.

Would I do it differently, looking back from age 69? Not a chance. I like the variety of work.

[Avalux]

53. Regulations require an MD as a lab director; it's really just a name on paper.

A lot of lab directors don't care about what actually goes on in the lab; it's another feather they get to add to their CV.

[mnhtnbb]

43. As a former hospital administrator, I can tell you that your OP is partially correct.

But I disagree that it requires medical training to effectively run a hospital.
It does require sensitivity to the problems/issues of staff on the front lines providing direct patient care,
but it doesn't require a degree in any particular clinical specialty. I used to spend a lot of time dropping
in to the service areas under my management. Whenever I had administrative call for the weekend (covering the whole hospital), I would
stop by on Saturday morning or Sunday afternoon, just to see what was up around the hospital. I had a lot
of interesting conversations with staff that way--including areas that didn't report to me-- and all the department heads reporting to me knew that I could show up in their area at any time. We used to joke about it: I called it MBWA--management by
walking around.

The problem in this country is deeper than just the operation of hospitals. We have a business
model for the delivery of health care, that includes insurance. There is only so much revenue
that can be derived from providing hospital services. Without attention to the budget, the hospital
ends up in the red, which means cutting services, laying off staff, or closing its doors.

[liberalhistorian]

44. There are plenty of places where the top

spots are not occupied by MBA bean counters, but health care professionals, usually doctors, who think like MBA bean counters instead of using the ethical precepts and dictates of their profession. They are beholden to their corporate managers and act like it. That is almost worse than just being an MBA bean counter, frankly, because these fuckers know better and don't care, all they care about is money. They're like the "doctors" who work for insurance companies "reviewing" claims and denying them simply because they're told to do so to maximize profits for their employer. Linda Peno, the doctor who wrote "Damaged Care" and is now an anti-HMO, anti-for-profit-health-care activist, knows that all too well as a former medical reviewer for insurance companies.

In my rural state alone, there are several doctors who took a leave of absence from their profession so that they could earn an MBA focusing on "health care management", and they now help to run one of the two major health care monopolies in the state. Never mind that the ethical precepts of the medical profession have little to do with the greedy demands of for-profit health care.

[The empressof all]

45. An MD after your name doesn't make a hoot of difference when it comes to these decisions.

There are many MD's out there who are highly invested in cost cutting and the bottom line as it usually directly impacts their own pocketbook. I've seen plenty of MD's involved in Medicaid fraud, and cost containment schemes that put staff at risk. What's important in healthcare management is a team of professionals of all disciplines working together who are able to have honest and direct communication and strong unions to give voice from the trenches.

[joeglow3]

48. What is the answer?

Solve this and you solve a big part of the healthcare crisis. You acknowledge budget cuts cause this. We also all express shock about what hospitals charge for services. As someone who worked on multiple hospital clients in my days at a Big 4 firm, the management salaries are not near big enough to make a dent in the budgetary constraints, so cutting all them would not solve it.

It is not an easy answer. We demand top shelf services, but demand to pay next to nothing for it.

[Fumesucker]

51. We pay more than any other nation, still don't cover everyone and get poorer results than most

[joeglow3]

54. You didn't address the question asked.

[Fumesucker]

55. I don't have an answer, or at least one that's remotely likely to be actually implemented

What I was addressing this claim of yours.

We demand top shelf services, but demand to pay next to nothing for it.

[corkhead]

57. only because of how much ends up in the pockets of the investor class

[joeglow3]

59. Then we need to report to the IRS and get millions in whistle blower fees

All the clients I had were not-for-profits. Thus, there were no investors. The only people getting rich were the top level executives and, like I said, cut that to zero and it is a drop in the bucket.

[MineralMan]

56. I'm not competent to answer, really.

I'm an observer, not any kind of solution provider.

[Cal Carpenter]

60. This is bullshit: "We demand top shelf services, but demand to pay next to nothing for it"

We spend MUCH more and have tragically WORSE outcomes in health care compared to countries we consider peers.

We could spend LESS and get better care if we shifted the economics of our health care system. It goes far beyond the salaries of middle management.

You are spreading lies. And if I risk a jury by pointing that out then so be it because truth matters.

[joeglow3]

62. How do we spend less and get better results?

[Cal Carpenter]

63. If you are sincere, start here. If not, I'm not playing.

Google this: Why single payer saves money

Read some stuff on the first page.

(I edited out the hyperlink because I can't get it to format properly, but if cut and pasting or retyping a few words stops you from doing it, then you probably don't really care)

[kestrel91316]

61. No, no, it's all Obama's fault. And Frieden's. And the epidemiologists'.

[Rex]

66. Entropy.

Sometimes, no matter how many precautions you take - it still happens.