nor the necessary stop overs. West Africa maybe a little.
Apple to name just one, has one of their major manufacturing plants in China. They are part and parcel in many ways of the American economy. Ways that are not obvious nor readily known.
To stop travel would stop parts of commerce. That especially right now with tension over the Ukraine persisting and the European economy subsequently imploding, absolutely cannot be allowed. Global recession would occur.
Monitoring of passengers temps that I expect could occur eventually. But not till or unless ebola becomes endemic in China, which is unlikely.
depending on media reports for much of this stuff, and quite often the media is inaccurate in the details.
But what I ran a across most recently is even the blood and tissue samples of the initial patient were not kept segregated. They supposedly use some sort of tube type system to get their samples to testing within the hospital. And it is a collective system. So without segregation of samples you have the possibility for a whole new avenue of contamination and whole new groups of peoples exposed.
Hospitals have to be designed to segregate patients in isolation. A simple isolation room is not sufficient for this type of potential contaminant. Very basically isolation areas have to have entirely differing ventilation heating and waste disposal units than the rest of the hospital. If not, one patient may in theory contaminate a entire hospital depending on contagion.
Ebola is not such a contagious item, but it sounds like this hospital is not set up to handle a actual mass epidemiological event that requires segregation of patients.
There is no telling who could have been potentially exposed. Luckily for them (and us) ebola is pretty hard to get. But this could as well have been a deadly form of flu or worse.
I hope it is a wake up call.
I've mentioned this before but it sort of goes tho this point and my comment about cdc in general.
If the hospital is relying on cdc I wouldn't be too harsh on them. At our place we are set up or are setting up to test samples for Ebola in case the need arises. Cdc is very unclear on their guidelines on how to handle potentially infected specimens. For some things they're saying you have to work in BSL 3 which is a lot of PPE and safety precautions and for other things or at other times they say it's okay to use bsl2 which is almost, but not quite bench top. They're confused and I think it's because they're cobbling together stuff based on other pathogens. We've opted to treat all potential Ebola as bsl3 at very step but not all places are equipped to do so
I'm not reasonably doing anything and I'm not a virologist or someone working in testing labs. But I've sat in on a couple meetings to observe. So "we" doesn't mean me.
But to draw a bit of a parallel, though it is not a exact. On handling Hazardous Materials there exists a federal agency with which a responder to a incident may contact to find the necessary precautions and necessary actions to take to remediate the situation. This agency is available 24/7 by phone and internet.
And they are much used. However any manager of a incident may not depend upon the federal agency to do the mitigation of the incident for them. The proposals for handling such things are right and true but textbook answers to textbook scenarios. Management of such a incident must utilize various resources and this may be a primary resource but in no manner is the manager exempt from their responsibility of handling the incident due to a federal protocol being available.
Similarly the CDC is a resource. It's easy to think they may provide a protocol and have it followed as if it is a textbook but really this is not their functional responsibility. They are only a resource and cannot fill the hole that must be filled by responsible hospital management.
As the management of a hospital is responsible perhaps to see to it their employees may get flu shots to protect their patients. The CDC can reinforce the necessity by guidelines and such but really it is to the hospital to manage the requirement.
So to my view this is largely a individual hospital deficit. Why is the employe calling the CDC? This is the question I have. In a proper relationship management calls talks to and develops the proper response concurrent with CDC input and guidelines and then advises the employee of the outcome, the steps it must implement and hence the employee must implement to mitigate the circumstance of infectious disease containment.
Clearly this did not happen. The employe upon finding a fever does not even call the hospital but instead calls the CDC. And the hospital apparently did not make clear the requirement of the employe to remain in state and to monitor their vitals. Like a flu shot this is part and parcel of the employment. The employer can legally require these things and have the force of the law to back them. Once unemployed if the nurse chooses instead to quit as result then the state and federal agencies can step in. As they did with the family of the victim. If one of the passengers on the plane gets ebola by some rare event, the hospital is the responsible party for not implementing containment, not the CDC for not implementing as the employe is the hospitals charge not the CDC's.
So the CDC is as it is as you clearly display and I do not dispute.This however does not absolve the hospital from its charge on the employee. In this specific the extension to others is clearly to those employed by the hospital. If it was the general public I would say the CDC would bear more responsibility and liability.
Fatman
Micko : 10/15/2014 7:22 pm : link : reply
How can you possibly speak in absolutes like that? Scientist working in the field would never rule out the possibility of strains that could emerge with a modified transmission frequency. We simply don't know what lies ahead. Let's see how it spreads in the first world and we'll see.
What I've said is that the situation today is one of minimal risk. You know who is talking about the strains modifying? The Media and the talking heads they bring on to discuss Ebola.
They always are telling us the "What If's" and not the present situation. That's why I call it a fear mongering of sorts.
Every virus that arises, we constantly are told that it could mutate. Someday a serious one will, but is it really worth starting a panic over right now?
I'd rather hear in realities, and frankly that should be how the Media reports.
years and years ago, I was part of a state medical working group tasked to address the problems of containment of radiological waste spillage and contamination of personnel, subsequent to the movement of low level radioactive waste through NM. The Wipp project.
These very same issues of isolation and containment in relation to radioactive particles I find now presenting in the ebola outbreak.
We had to basically reengineer a level one trauma hospital, the only one in NM at that time(not me likewise as you mention I just sat in the meetings) for purposes of absolute isolation. This assisted largely by federal funds as Wipp was a federal issue.
Radioactive contaminant, terrorist agent such as a risen agent or ebola really the requirements for isolation are not very different.
All hospitals should be prepared to handle all of them and not depend upon the CDC to do it for them.
The CDC sucks but really that is not the reason to not allow them to be the final determinate of hospital action or inaction, liability and responsibility to the community they serve is.
if the virus did mutate almost undoubtably it would do so in a place where there are thousands upon thousands of those afflicted not in a place where the numbers are in the singles.
It is fear mongering, nothing more nor less, to sell viewership and thus as in all things in America adds and the buying of things.
Been around for hundreds of years that.
A mutation here is almost a impossibility considering the numbers of those infected. And keep in mind viruses may mutate to less harmful forms as well.
The swine flu in Mexico a couple of years back is one example of that.
There is a real threat here and it can as I mention be spread by coughing by saliva and such things coughed out and then found into a persons eye, and some other ways not yet mentioned in the media.
So there is really no reason to make up impossibles to sell the threat.
It exists but really is not the end of all. Think of it,…. it appears Nigeria of all places eradicated it in this latest manifestation.
His uncle wasn't cautious. He had direct contact with Ebola patients, he carried one to the hospital. If he hadn't entered the US there would be no cases of Ebola here. He didn't have a high enough fever when he went to the ER the first time, according to the CDC guidelines, that is why he was sent home. Not because he didn't have insurance. He also didn't have insurance the second time, and wasn't turned away then.
When you go into the ER, their goal is to stabilize you and send you home. Many people get released by the ER and then wind up back there a few hours or a day later. I did, and I have insurance. Even if you have insurance, there are rules for being admitted that the hospital and insurance companies agree to.
Shepard Smith tells it like it is... say what you want about this guy Â
Some speculate that this was a failure of the internal communications systems. Others have speculated that antibiotics and Tylenol are the standard protocol for a patient without insurance.
The hospital is not talking. Until then, we are all left to wonder. What we do know is that their error affects all of society. Their bad judgment or misjudgment sent my uncle back into the community for days with a highly contagious case of Ebola.
He's not blaming lack of insurance or even implying that.
Did you read the article before deciding he was looking for a payday?
yeah emergency rooms don't treat patients without insurance any differently
especially in a state like texas that has the most uninsured in the nation 22%
yeah emergency rooms don't treat patients without insurance any differently
especially in a state like texas that has the most uninsured in the nation 22%
please google the term
GOMER
Do you honestly think that if the hospital thought he had ebola they would have just sent him home? Do you know how many people show up at the ER with a fever, stomach pain etc? Do you want them all to be admitted?
His uncle wasn't cautious. He had direct contact with Ebola patients, he carried one to the hospital.
You know this how?
The nephew claims the dead guy says that was all a fabrication.
Ok, then how did he get Ebola?
Obviously he came in contact with someone. Does that automatically mean he was carrying a bleeding, shitting, vomiting woman to the hospital and licking his hands afterwards? Of course not.
A freaking nurse caught it. Someone that deals with contagions daily and has access to better PPE. But this guy was obviously careless? Hell, for all we really know, he caught it standing in line to board his plane when somebody sneezed on him.
The idea that you come from a country that has an epidemic Â
and you don't think you can get it is absurd. Blaming the hospital is absurd. He would have had no chance if he stayed in Liberia. To blame it on the hospital or no insurance or racism or whatever they come with next is absurd.
RE: The idea that you come from a country that has an epidemic Â
and you don't think you can get it is absurd. Blaming the hospital is absurd. He would have had no chance if he stayed in Liberia. To blame it on the hospital or no insurance or racism or whatever they come with next is absurd.
Where are they blaming the hospital for him having ebola?
They're blaming the hospital for sending him home knowing he was in West Africa and that he had a fever of 103- which is their fault, no?
the hospital says his fever wasn't that high and they were following CDC guidelines. Obviously that was wrong, but it's not the hospitals fault and it didn't have anything to do with insurance.
Please post back if you get any further info on transmission/contagion relative to symptoms. I'm very curious about the current threshhold of fever (100.4 apparently lowered now from 103!) as the point of risk to take treatment or quarantine actions.
To blame it on the hospital or no insurance or racism or whatever they come with next is absurd.
The only mention of any of that in what the nephew wrote is the insurance thing I quoted above- in which he just accuses them of fucking up and says we don't know why or how exactly.
Please post back if you get any further info on transmission/contagion relative to symptoms. I'm very curious about the current threshhold of fever (100.4 apparently lowered now from 103!) as the point of risk to take treatment or quarantine actions.
Thanks!
I can't find info on that and the people that i've asked don't have a good answer.
However, there is a very good article in today's NEJM that talks about the epidemic and discusses mortality rates etc. It actually addresses the rates question that montana and I mentioned yesterday. Their estimate is 71% mortality. One interesting finding was that there is an average of 5 days between when a person becomes symptomatic and when they're admitted to the hospital. That's pretty scary IMO. Of course, it's in Africa and not the US but they also found that the number was the same for regular people and health care workers. Since health care workers should be the more informed and culturally modern, that might (or might not) say something about how people would act here.
To blame it on the hospital or no insurance or racism or whatever they come with next is absurd.
The only mention of any of that in what the nephew wrote is the insurance thing I quoted above- in which he just accuses them of fucking up and says we don't know why or how exactly.
There have been a few reports of Jesse Jackson and John Wiley Price (a crazy Dallas councilman) claiming that Duncan died in large part due to neglect or non-use of experimental therapeutics completely due to his race.
I think the reason for the confusion on the fever is the CDC itself(no surprise there).
Reading through their literature today they list for medical health care professionals a fever of 101.5 symptomatic of ebola. However in the section on airline travel, in the general section(I did not peruse all potential documentation related to this) they state fever only. They then go about describing symptoms of a fever.
So it appears in general terms for airline travel any fever is a reason for a airline to deny the ability of a person to fly(accompanied with flu like symptoms and travel history). However in ER treatment Ebola is not suspected unless the symptoms are accompanied by a fever of 101.5.
A note on fever, some peoples normally have differing temperatures. It is rare but quite possible for someone to have a normal of 99.6 or 97.6. 98.6 is normal for about 6 billion of us but then we may have still millions that have normals which differ.Statistically it is very rare but it happens and environmental circumstances may in fact very greatly affect body temp. When cold we may drop a degree or 2 when hot up a degree or 2 as in when exercising .
Did insurance status have anything to do with the first patients medical ER treatment……. I would say absolutely not. Most admitting in hospitals ER's have separate personal doing the paperwork and they rarely if ever communicate with the medical staff. The nurses and docs don't have a clue if who they are treating is insured or not. Later on when admitted it is then that insurance comes into play.
There is some dispute on the temperature of the first patient in the ER. I have heard 103. If that is true he was released back to the community considering his history of travel inappropriately.
If that is true the hospital screwed up big time. As they did with their infection protocols when treating the patients allowing 2 nurses to get ebola.
I suspect it is true, this hospital is worse than the CDC, they seemingly really suck. the CDC as displayed by their contradictory statements on temperature which confuses and causes concern unnecessarily, just plain suck.
No offense to the docs and nurses working at the hospital nor the scientists and such at the CDC, this is most certainly a administrative issue.
They do advise health care peoples to call the CDC with questions on diagnosis of ebola but do not make any statements on their advise or protocols being mandatory or binding. To my read that establishes them as a resource but not a director of treatment in a professional health care context(rightly so I would say).
years and years ago the federal government found in necessary to establish a right to care for patients. Basically they enacted legislation that forced hospitals to care for all patients in a emergency context.
Subsequent to that hospitals found the necessity for care but no funds to pay for this care. A situation whereby they would lose cash on a daily basis and soon go out of business.
Varying solutions some based solely on the federal medicaid model some based upon state initiatives arose.
These solutions allowed hospitals to be paid back by state or local governments for no retrievable health care costs subsequent to the federal mandate for care.
The solutions by state vary greatly, in how the hospitals are paid. But ER visits are compensated for in all states by some manner by public funding of some sort. NM uses part of a land tax delegated to this
When admitted this no longer applies and degree of care is greatly affected by insurance coverage or lack of. In the ER I would say never.
some may be familiar with them and some not so much.
This is not like FEMA, boots on the ground, hands on people, who have done the job and are drawn from the real world.
Largely to my experience they are academics drawn from that type of environment. Great teachers, scientists epidemiologists, perhaps but these peoples are not ones you would choose to handle emergency situations.
This is not how their organization is set up nor functions as a emergency response unit.
These are peoples who you go to on advise on how to textbook, handle things. The real world as Bill mentions with his exception on tylenol and arthritics, is not textbook.
So they guide but can not manage.To expect them to do so causes problems, some of which we are seeing.
The local health care communities must handle this crisis by developing responses guided by CDC instruction, but not depending upon them to each and every extent.
If our most recent experiences in the ER is an indicator Â
sometimes not having insurance benefits you. Often times the mode of transport is by ambulance and people arriving in ambulances get bumped to the head of the line, no matter the underlying reason for coming to the ER in the first place.
but most ambulance/rescue crews will advise their patients if they need to go to the hospital by ambulance or not. One can absolutely refuse to go on their own to go by taxi or some other means and go by ambulance, but that is rare. Most places no longer provide bill free transport, regardless if the transport is by public entity or not.
Typically they are told up front, this ride costs money and you can save a bill by not going by ambulance(if they don't need to). Ambulances in most places are set up as separate entities from hospitals in a legal sense and bill separately.
But absolutely right, ambulance patients receive first treatment. It is assumed their conditions are worse then walkers in.
To blame it on the hospital or no insurance or racism or whatever they come with next is absurd.
The only mention of any of that in what the nephew wrote is the insurance thing I quoted above- in which he just accuses them of fucking up and says we don't know why or how exactly.
Cam, this is in the article
'But he was a man of color with no health insurance and no means to pay for treatment, so within hours, he was released with some antibiotics and Tylenol.'.
So which is it? They fucked up or they are racist and didn't want to treat him because he had no insurance?
Your patient just shows up from Africa with a fever a no insurance. Its low grade he's otherwise well. Suspecting a tropical disease and admitting him will cost the hospital big $$$, and lead to reviews about necessary or unnecessary admissions by ER attendings (especially if you're wrong).
What do think is a likely outcome?
If your same patient had insurance and admitting him and testing would be profitable to the hospital (wether your hunch was right or wrong) what do you think would happen?
In practice the ER staff is never critiqued on admissions unless there is a overt problem, like lots of peoples being admitted erroneously or potentially lots of people being not admitted.
The hospitals(some of them) have stats on how many patients percentage should result in admissions. Fall above or below that and they may study the issue to determine why. But that is a crew or shift study not a individual.
So docs have little fear of seeing their admissions being considered inappropriate by the rational of fee retrieval. A floor or speciality doc has no more pull nor weight in hospital administration than a ER doc. In fact the opposite is usually true as the ER docs position is very much harder to fill. And it is the docs who determine who is admitted and who is not. The nurses advise.
The billing is kept separate from the ER docs knowledge.
Docs have personal bias, and may for instance see a obvious homeless person being treated and refer him to a publicly run hospital in some places, but this is a personal bias and not a system bias.
Could that have happened to this guy…I'd say no probably not.The doc would not know by looking or talking with him if he was insured or not and has no reason to ask him. ASking him would in fact be inappropriate, by other than admitting or paperwork oriented staff. A medical professional person in a ER should never ask insurance status, it is simply not their job.So they don't do so. Other staff do so. They basically don't care.
When admitted…the whole story changes. Further treatment is absolutely determined by ability to pay and potential retrievability of monies.
In the ER no it is not that way. Never say never but 99.9% sure.
In one scenario, the aide workers who had ebola are admitted to Emory under the CDC's oversight - no problems, everyone gets better, and certainly none of the treating staff become infected.
In the other scenario, a guy with ebola walks into this hospital in Texas, but is discharged. Then he is readmitted, and not only does he die, but two of the nurses who treated him are infected, and a whole host of stories about the hospital's lack of preparedness seem to be trickling out.
It seems to me the hospital was just unprepared for this high risk/low frequency event.
hospitals largely have no economic interest in preparing for low frequency but high risk events.
Why redo your whole facility to provide for real isolation. Why train and certify peoples to perform in epidemic or potential epidemic situations that require isolation?
In NM with Wipp there was a economic benefit as Wipp related monies provided incentive. Remodel and establish protocols and you got fed funds, it was that simple. And Radiation directly translates to ebola and other things that require isolation.
Hospitals are largely for profit. Even if not publicly so they internally are devoted to cost containment.
This is one of the problems with a for profit insurance based health care system model in America.
The s hits the fan and there are going to be significant problems. This crisis is way way hyped and overblown ebola is just not that contagious.
What will happen when a real crisis like in 1918 deadly flu type thing occurs?
This is a wake up call, but it is to no avail.
As the ER eval is ongoing and pt says "I just came back from Africa" every ER doc knows to put tropical diseases at the top of their differential. Maybe not Ebola, but the thought had to have been there. Simple stuff. Once that possibility is raised, admission has to be considered. But the thought process doesn't end there. The ER has to find someone to admit him. So he will ask the patient "Do you have a primary?" At that point he will essentially know the guy is uninsured, and will consider admitting to house staff. He may think house staff is 1) overworked 2) incompetent 3) a financial burden or a combination of the above. Thinking along those lines he may back up a little and say its unlikely a disease of significance, just go home.
Sounds very plausible to me, and the lack of insurance was a contributing element.
But most commonly to my experience the ER doc will make the decision to admit or not, and then after that decide where to admit the patient, here, where his primary works out of, and all the rest.
Decide whether to admit depending on the patient having a primary or not….I'd say not.
Of course all docs will get a med history on making their decisions but really there presence of a primary or not is pretty insignificant medically in a case like this.
Some conditions mandate interaction with a primary such as past heart problems perhaps but the ER is basically making a pretty simple decision, where to put this guy.
Then the floor doc can interact with the primary. Could they ship this guy to another hospital where his primary works out of certainly…it happens all the time(by ambulance)
To decide not to admit….I'd say no it generally does not happen that way.
Possible I say again never say never but highly improbable.
One of the decisions hospitals make, as they largely assist with malpractice insurance, (it is generally part of the compensation package) is how many situations of litigation does any doc engage in yearly.
Quite a few litigations and they may decide not to renew, as the insurance becomes prohibitive a red flag is raised.
Again not all hospitals but many. Some areas such as pediatrics and obstetrics are known for having high rates of litigation. A ER doc not so much at all.
That way of thinking would lead straight to litigation, and the doc would potentially not have a contract renewal as result.
So the hospital and the doc would personally suffer, far more then if they denied admission Even in Texas.
So largely ER docs don't do things that way.
http://www.ustream.tv/recorded/53942765/highlight/563746
Apple to name just one, has one of their major manufacturing plants in China. They are part and parcel in many ways of the American economy. Ways that are not obvious nor readily known.
To stop travel would stop parts of commerce. That especially right now with tension over the Ukraine persisting and the European economy subsequently imploding, absolutely cannot be allowed. Global recession would occur.
Monitoring of passengers temps that I expect could occur eventually. But not till or unless ebola becomes endemic in China, which is unlikely.
But what I ran a across most recently is even the blood and tissue samples of the initial patient were not kept segregated. They supposedly use some sort of tube type system to get their samples to testing within the hospital. And it is a collective system. So without segregation of samples you have the possibility for a whole new avenue of contamination and whole new groups of peoples exposed.
Hospitals have to be designed to segregate patients in isolation. A simple isolation room is not sufficient for this type of potential contaminant. Very basically isolation areas have to have entirely differing ventilation heating and waste disposal units than the rest of the hospital. If not, one patient may in theory contaminate a entire hospital depending on contagion.
Ebola is not such a contagious item, but it sounds like this hospital is not set up to handle a actual mass epidemiological event that requires segregation of patients.
There is no telling who could have been potentially exposed. Luckily for them (and us) ebola is pretty hard to get. But this could as well have been a deadly form of flu or worse.
I hope it is a wake up call.
If the hospital is relying on cdc I wouldn't be too harsh on them. At our place we are set up or are setting up to test samples for Ebola in case the need arises. Cdc is very unclear on their guidelines on how to handle potentially infected specimens. For some things they're saying you have to work in BSL 3 which is a lot of PPE and safety precautions and for other things or at other times they say it's okay to use bsl2 which is almost, but not quite bench top. They're confused and I think it's because they're cobbling together stuff based on other pathogens. We've opted to treat all potential Ebola as bsl3 at very step but not all places are equipped to do so
But to draw a bit of a parallel, though it is not a exact. On handling Hazardous Materials there exists a federal agency with which a responder to a incident may contact to find the necessary precautions and necessary actions to take to remediate the situation. This agency is available 24/7 by phone and internet.
And they are much used. However any manager of a incident may not depend upon the federal agency to do the mitigation of the incident for them. The proposals for handling such things are right and true but textbook answers to textbook scenarios. Management of such a incident must utilize various resources and this may be a primary resource but in no manner is the manager exempt from their responsibility of handling the incident due to a federal protocol being available.
Similarly the CDC is a resource. It's easy to think they may provide a protocol and have it followed as if it is a textbook but really this is not their functional responsibility. They are only a resource and cannot fill the hole that must be filled by responsible hospital management.
As the management of a hospital is responsible perhaps to see to it their employees may get flu shots to protect their patients. The CDC can reinforce the necessity by guidelines and such but really it is to the hospital to manage the requirement.
So to my view this is largely a individual hospital deficit. Why is the employe calling the CDC? This is the question I have. In a proper relationship management calls talks to and develops the proper response concurrent with CDC input and guidelines and then advises the employee of the outcome, the steps it must implement and hence the employee must implement to mitigate the circumstance of infectious disease containment.
Clearly this did not happen. The employe upon finding a fever does not even call the hospital but instead calls the CDC. And the hospital apparently did not make clear the requirement of the employe to remain in state and to monitor their vitals. Like a flu shot this is part and parcel of the employment. The employer can legally require these things and have the force of the law to back them. Once unemployed if the nurse chooses instead to quit as result then the state and federal agencies can step in. As they did with the family of the victim. If one of the passengers on the plane gets ebola by some rare event, the hospital is the responsible party for not implementing containment, not the CDC for not implementing as the employe is the hospitals charge not the CDC's.
So the CDC is as it is as you clearly display and I do not dispute.This however does not absolve the hospital from its charge on the employee. In this specific the extension to others is clearly to those employed by the hospital. If it was the general public I would say the CDC would bear more responsibility and liability.
Micko : 10/15/2014 7:22 pm : link : reply
How can you possibly speak in absolutes like that? Scientist working in the field would never rule out the possibility of strains that could emerge with a modified transmission frequency. We simply don't know what lies ahead. Let's see how it spreads in the first world and we'll see.
What I've said is that the situation today is one of minimal risk. You know who is talking about the strains modifying? The Media and the talking heads they bring on to discuss Ebola.
They always are telling us the "What If's" and not the present situation. That's why I call it a fear mongering of sorts.
Every virus that arises, we constantly are told that it could mutate. Someday a serious one will, but is it really worth starting a panic over right now?
I'd rather hear in realities, and frankly that should be how the Media reports.
These very same issues of isolation and containment in relation to radioactive particles I find now presenting in the ebola outbreak.
We had to basically reengineer a level one trauma hospital, the only one in NM at that time(not me likewise as you mention I just sat in the meetings) for purposes of absolute isolation. This assisted largely by federal funds as Wipp was a federal issue.
Radioactive contaminant, terrorist agent such as a risen agent or ebola really the requirements for isolation are not very different.
All hospitals should be prepared to handle all of them and not depend upon the CDC to do it for them.
The CDC sucks but really that is not the reason to not allow them to be the final determinate of hospital action or inaction, liability and responsibility to the community they serve is.
It is fear mongering, nothing more nor less, to sell viewership and thus as in all things in America adds and the buying of things.
Been around for hundreds of years that.
A mutation here is almost a impossibility considering the numbers of those infected. And keep in mind viruses may mutate to less harmful forms as well.
The swine flu in Mexico a couple of years back is one example of that.
There is a real threat here and it can as I mention be spread by coughing by saliva and such things coughed out and then found into a persons eye, and some other ways not yet mentioned in the media.
So there is really no reason to make up impossibles to sell the threat.
It exists but really is not the end of all. Think of it,…. it appears Nigeria of all places eradicated it in this latest manifestation.
Have we sunken so low we cannot outdo Nigeria?
his only medication was a saline drip.
the family only heard about his death thru the news
and as i said previously... uninsured so he was sent home
Ebola victim’s nephew speaks out and criticizes hospital system - ( New Window )
When you go into the ER, their goal is to stabilize you and send you home. Many people get released by the ER and then wind up back there a few hours or a day later. I did, and I have insurance. Even if you have insurance, there are rules for being admitted that the hospital and insurance companies agree to.
story - ( New Window )
You know this how?
The nephew claims the dead guy says that was all a fabrication.
The hospital is not talking. Until then, we are all left to wonder. What we do know is that their error affects all of society. Their bad judgment or misjudgment sent my uncle back into the community for days with a highly contagious case of Ebola.
He's not blaming lack of insurance or even implying that.
Did you read the article before deciding he was looking for a payday?
especially in a state like texas that has the most uninsured in the nation 22%
please google the term
GOMER
Quote:
His uncle wasn't cautious. He had direct contact with Ebola patients, he carried one to the hospital.
You know this how?
The nephew claims the dead guy says that was all a fabrication.
Ok, then how did he get Ebola?
especially in a state like texas that has the most uninsured in the nation 22%
please google the term
GOMER
Do you honestly think that if the hospital thought he had ebola they would have just sent him home? Do you know how many people show up at the ER with a fever, stomach pain etc? Do you want them all to be admitted?
LOL. So HOT!
lol
Quote:
In comment 11922736 buford said:
Quote:
His uncle wasn't cautious. He had direct contact with Ebola patients, he carried one to the hospital.
You know this how?
The nephew claims the dead guy says that was all a fabrication.
Ok, then how did he get Ebola?
Obviously he came in contact with someone. Does that automatically mean he was carrying a bleeding, shitting, vomiting woman to the hospital and licking his hands afterwards? Of course not.
A freaking nurse caught it. Someone that deals with contagions daily and has access to better PPE. But this guy was obviously careless? Hell, for all we really know, he caught it standing in line to board his plane when somebody sneezed on him.
Where are they blaming the hospital for him having ebola?
They're blaming the hospital for sending him home knowing he was in West Africa and that he had a fever of 103- which is their fault, no?
Thanks!
The only mention of any of that in what the nephew wrote is the insurance thing I quoted above- in which he just accuses them of fucking up and says we don't know why or how exactly.
Thanks!
I can't find info on that and the people that i've asked don't have a good answer.
However, there is a very good article in today's NEJM that talks about the epidemic and discusses mortality rates etc. It actually addresses the rates question that montana and I mentioned yesterday. Their estimate is 71% mortality. One interesting finding was that there is an average of 5 days between when a person becomes symptomatic and when they're admitted to the hospital. That's pretty scary IMO. Of course, it's in Africa and not the US but they also found that the number was the same for regular people and health care workers. Since health care workers should be the more informed and culturally modern, that might (or might not) say something about how people would act here.
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To blame it on the hospital or no insurance or racism or whatever they come with next is absurd.
The only mention of any of that in what the nephew wrote is the insurance thing I quoted above- in which he just accuses them of fucking up and says we don't know why or how exactly.
There have been a few reports of Jesse Jackson and John Wiley Price (a crazy Dallas councilman) claiming that Duncan died in large part due to neglect or non-use of experimental therapeutics completely due to his race.
Reading through their literature today they list for medical health care professionals a fever of 101.5 symptomatic of ebola. However in the section on airline travel, in the general section(I did not peruse all potential documentation related to this) they state fever only. They then go about describing symptoms of a fever.
So it appears in general terms for airline travel any fever is a reason for a airline to deny the ability of a person to fly(accompanied with flu like symptoms and travel history). However in ER treatment Ebola is not suspected unless the symptoms are accompanied by a fever of 101.5.
A note on fever, some peoples normally have differing temperatures. It is rare but quite possible for someone to have a normal of 99.6 or 97.6. 98.6 is normal for about 6 billion of us but then we may have still millions that have normals which differ.Statistically it is very rare but it happens and environmental circumstances may in fact very greatly affect body temp. When cold we may drop a degree or 2 when hot up a degree or 2 as in when exercising .
Did insurance status have anything to do with the first patients medical ER treatment……. I would say absolutely not. Most admitting in hospitals ER's have separate personal doing the paperwork and they rarely if ever communicate with the medical staff. The nurses and docs don't have a clue if who they are treating is insured or not. Later on when admitted it is then that insurance comes into play.
There is some dispute on the temperature of the first patient in the ER. I have heard 103. If that is true he was released back to the community considering his history of travel inappropriately.
If that is true the hospital screwed up big time. As they did with their infection protocols when treating the patients allowing 2 nurses to get ebola.
I suspect it is true, this hospital is worse than the CDC, they seemingly really suck. the CDC as displayed by their contradictory statements on temperature which confuses and causes concern unnecessarily, just plain suck.
No offense to the docs and nurses working at the hospital nor the scientists and such at the CDC, this is most certainly a administrative issue.
They do advise health care peoples to call the CDC with questions on diagnosis of ebola but do not make any statements on their advise or protocols being mandatory or binding. To my read that establishes them as a resource but not a director of treatment in a professional health care context(rightly so I would say).
Subsequent to that hospitals found the necessity for care but no funds to pay for this care. A situation whereby they would lose cash on a daily basis and soon go out of business.
Varying solutions some based solely on the federal medicaid model some based upon state initiatives arose.
These solutions allowed hospitals to be paid back by state or local governments for no retrievable health care costs subsequent to the federal mandate for care.
The solutions by state vary greatly, in how the hospitals are paid. But ER visits are compensated for in all states by some manner by public funding of some sort. NM uses part of a land tax delegated to this
When admitted this no longer applies and degree of care is greatly affected by insurance coverage or lack of. In the ER I would say never.
This is not like FEMA, boots on the ground, hands on people, who have done the job and are drawn from the real world.
Largely to my experience they are academics drawn from that type of environment. Great teachers, scientists epidemiologists, perhaps but these peoples are not ones you would choose to handle emergency situations.
This is not how their organization is set up nor functions as a emergency response unit.
These are peoples who you go to on advise on how to textbook, handle things. The real world as Bill mentions with his exception on tylenol and arthritics, is not textbook.
So they guide but can not manage.To expect them to do so causes problems, some of which we are seeing.
The local health care communities must handle this crisis by developing responses guided by CDC instruction, but not depending upon them to each and every extent.
Typically they are told up front, this ride costs money and you can save a bill by not going by ambulance(if they don't need to). Ambulances in most places are set up as separate entities from hospitals in a legal sense and bill separately.
But absolutely right, ambulance patients receive first treatment. It is assumed their conditions are worse then walkers in.
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To blame it on the hospital or no insurance or racism or whatever they come with next is absurd.
The only mention of any of that in what the nephew wrote is the insurance thing I quoted above- in which he just accuses them of fucking up and says we don't know why or how exactly.
Cam, this is in the article
'But he was a man of color with no health insurance and no means to pay for treatment, so within hours, he was released with some antibiotics and Tylenol.'.
So which is it? They fucked up or they are racist and didn't want to treat him because he had no insurance?
What do think is a likely outcome?
If your same patient had insurance and admitting him and testing would be profitable to the hospital (wether your hunch was right or wrong) what do you think would happen?
In practice the ER staff is never critiqued on admissions unless there is a overt problem, like lots of peoples being admitted erroneously or potentially lots of people being not admitted.
The hospitals(some of them) have stats on how many patients percentage should result in admissions. Fall above or below that and they may study the issue to determine why. But that is a crew or shift study not a individual.
So docs have little fear of seeing their admissions being considered inappropriate by the rational of fee retrieval. A floor or speciality doc has no more pull nor weight in hospital administration than a ER doc. In fact the opposite is usually true as the ER docs position is very much harder to fill. And it is the docs who determine who is admitted and who is not. The nurses advise.
The billing is kept separate from the ER docs knowledge.
Docs have personal bias, and may for instance see a obvious homeless person being treated and refer him to a publicly run hospital in some places, but this is a personal bias and not a system bias.
Could that have happened to this guy…I'd say no probably not.The doc would not know by looking or talking with him if he was insured or not and has no reason to ask him. ASking him would in fact be inappropriate, by other than admitting or paperwork oriented staff. A medical professional person in a ER should never ask insurance status, it is simply not their job.So they don't do so. Other staff do so. They basically don't care.
When admitted…the whole story changes. Further treatment is absolutely determined by ability to pay and potential retrievability of monies.
In the ER no it is not that way. Never say never but 99.9% sure.
In the other scenario, a guy with ebola walks into this hospital in Texas, but is discharged. Then he is readmitted, and not only does he die, but two of the nurses who treated him are infected, and a whole host of stories about the hospital's lack of preparedness seem to be trickling out.
It seems to me the hospital was just unprepared for this high risk/low frequency event.
Why redo your whole facility to provide for real isolation. Why train and certify peoples to perform in epidemic or potential epidemic situations that require isolation?
In NM with Wipp there was a economic benefit as Wipp related monies provided incentive. Remodel and establish protocols and you got fed funds, it was that simple. And Radiation directly translates to ebola and other things that require isolation.
Hospitals are largely for profit. Even if not publicly so they internally are devoted to cost containment.
This is one of the problems with a for profit insurance based health care system model in America.
The s hits the fan and there are going to be significant problems. This crisis is way way hyped and overblown ebola is just not that contagious.
What will happen when a real crisis like in 1918 deadly flu type thing occurs?
This is a wake up call, but it is to no avail.
As the ER eval is ongoing and pt says "I just came back from Africa" every ER doc knows to put tropical diseases at the top of their differential. Maybe not Ebola, but the thought had to have been there. Simple stuff. Once that possibility is raised, admission has to be considered. But the thought process doesn't end there. The ER has to find someone to admit him. So he will ask the patient "Do you have a primary?" At that point he will essentially know the guy is uninsured, and will consider admitting to house staff. He may think house staff is 1) overworked 2) incompetent 3) a financial burden or a combination of the above. Thinking along those lines he may back up a little and say its unlikely a disease of significance, just go home.
Sounds very plausible to me, and the lack of insurance was a contributing element.
But most commonly to my experience the ER doc will make the decision to admit or not, and then after that decide where to admit the patient, here, where his primary works out of, and all the rest.
Decide whether to admit depending on the patient having a primary or not….I'd say not.
Of course all docs will get a med history on making their decisions but really there presence of a primary or not is pretty insignificant medically in a case like this.
Some conditions mandate interaction with a primary such as past heart problems perhaps but the ER is basically making a pretty simple decision, where to put this guy.
Then the floor doc can interact with the primary. Could they ship this guy to another hospital where his primary works out of certainly…it happens all the time(by ambulance)
To decide not to admit….I'd say no it generally does not happen that way.
Possible I say again never say never but highly improbable.
One of the decisions hospitals make, as they largely assist with malpractice insurance, (it is generally part of the compensation package) is how many situations of litigation does any doc engage in yearly.
Quite a few litigations and they may decide not to renew, as the insurance becomes prohibitive a red flag is raised.
Again not all hospitals but many. Some areas such as pediatrics and obstetrics are known for having high rates of litigation. A ER doc not so much at all.
That way of thinking would lead straight to litigation, and the doc would potentially not have a contract renewal as result.
So the hospital and the doc would personally suffer, far more then if they denied admission Even in Texas.
So largely ER docs don't do things that way.
So what you say could happen.
But the system actually works against, not for that happening.
So I cannot rule it out.