The real cause for alarm: For-profit health care

October 16, 2014

Nicole Colson analyzes the latest developments about Ebola cases in the U.S.

THE OCTOBER 15 announcement that a second health care worker at Texas Health Presbyterian Hospital in Dallas has tested positive for the Ebola virus set off the predictable cable news network frenzy--and calls from under-educated members of Congress to halt all flights between the U.S. and Western Africa.

The fears about Ebola are understandable--the disease continues to rage out of control in West Africa, according to the World Health Organization (WHO).

As of October 14, there were a total of 8,914 known Ebola cases and 4,447 deaths reported to the WHO, though officials warn these numbers are likely lower than the actual total. The mortality rate from the disease in countries like Sierra Leone, Liberia and Guinea--the three hardest-hit countries--is approximately 70 percent.

And the worst is still to come. By December, according to the WHO, there could be as many as 5,000 to 10,000 new cases of the virus per week in western Africa, where the disease has flourished because of poverty, crowded slum conditions, lack of health care providers and quarantine facilities, and lack of protective equipment for health care workers and burial teams.

The Dallas hospital where a patient died and two nurses contracted Ebola
The Dallas hospital where a patient died and two nurses contracted Ebola

But in the U.S., the real cause for alarm isn't the threat of an out-of-control epidemic. As Jon Stewart explained on The Daily Show, "Clearly the news anchors are having trouble drawing the distinction between a person contracting the disease after working in close contact with an Ebola patient and the inevitability of ALL OF US GETTING IT NOW!"

Instead, what we know about the death of patient Thomas Duncan and the diagnosis of Ebola in two nurses who treated him--26-year-old Nina Pham and 29-year-old Amber Vinson--should frighten us about the shortcomings of America's for-profit health care system, particularly when it comes to the safety of the health care workers who will be the first to deal with future cases.

AFTER THE announcement that a second nurse had been infected, the number of people being closely monitored for symptoms in the Dallas area rose to 100, including workers at the hospital and others who came in close contact with either Duncan or the two nurses.

The risk to the general population remains low--Ebola can only be transmitted through direct contact with the bodily fluids of an infected person. Even with a total of three cases now, Texans remain at a much higher risk of dying from the flu or contracting whooping cough, than of getting Ebola.

But Duncan's death and the infection of two health care workers is serious because of what it signals about the readiness of U.S. hospitals to protect patients and workers from a serious threat.

According to the Dallas Morning News, Duncan was suspected of being infected with Ebola on September 28 when he was admitted to a hospital isolation unit, and he developed severe vomiting and diarrhea that day. But workers didn't move from gowns and scrubs to hazmats suits until he actually tested positive for Ebola two days later. "The misstep--one in a series of potentially deadly mishandling of Duncan--raises the likelihood that other health care workers could have been infected," the newspaper reported.

Despite this, officials have so far laid the blame on the infected health care workers themselves.

At a press conference over the weekend, Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC) said Pham was infected as a result of her own "protocol breach"--implying that her own actions put her at risk. But as Bonnie Castillo, a registered nurse and a disaster relief expert at National Nurses United (NNU), told Reuters, "You don't scapegoat and blame when you have a disease outbreak. We have a system failure. That is what we have to correct."

Media reports have exposed how ill-prepared the Dallas hospital was to deal with a serious infectious disease. Duncan was reportedly left to sit for hours in an open area of the emergency room, and nurses lacked proper protective equipment while treating him.

The hospital still hasn't fully explained why Duncan was at first sent home with useless antibiotics before finally being admitted for treatment. Administrators backtracked on their initial claim that an error in the hospital's electronic records system was the reason not all health care workers who treated him knew he had recently been in Liberia.

Some of Duncan's family members now question whether the fact that Duncan was African played a role in his being denied proper treatment at first. At a press conference at the headquarters of Rainbow Push in Chicago, Duncan's mother and nephew wondered why Duncan wasn't moved immediately to Emory University--which successfully treated Dr. Kent Brantly and Dr. Nancy Writebol, two American health care workers who contracted Ebola while working in Africa.

Another obvious question was asked by Dallas County Commissioner John Wiley Price before Duncan died: Did the fact that he didn't have health insurance play a role in his receiving substandard treatment? "Presbyterian is a boutique hospital next to a little Ellis Island," Price told the Washington Post, referring to the largely immigrant neighborhood where the hospital is located. "If you don't have insurance, you're not going to get treated. That's the elephant in the room."

THE NURSES' union National Nurses United (NNU) responded bitterly to the implication that RNs failed to follow proper protocols and that's what caused the additional infections.

On a conference call with reporters, NNU Co-President Deborah Burger described the concerns of nurses at the hospital, who "said they were forced to use medical tape to secure openings in their flimsy garments and worried that their necks and heads were exposed as they cared for Duncan," according to an Associated Press report.

RoseAnn DeMoro, executive director of the NNU, said nurses at Texas Health Presbyterian, who could not speak publicly for fear of losing their jobs, had tried to demand that the hospital take action, but were thwarted. When a nurse supervisor demanded that Duncan finally be moved into isolation, the supervisor faced resistance.

As the Los Angeles Times described the charges leveled by the NNU:

They described a hospital with no clear guidelines in place for handling Ebola patients, where Duncan's lab specimens were sent through the usual hospital tube system "without being specifically sealed and hand-delivered. The result is that the entire tube system, which all the lab systems are sent, was potentially contaminated," they said.

"There was no advanced preparedness on what to do with the patient. There was no protocol; there was no system. The nurses were asked to call the infectious disease department" if they had questions, they said.

The nurses said they were essentially left to figure things out for themselves as they dealt with "copious amounts" of body fluids from Duncan, while wearing gloves with no wrist tapes, gowns that did not cover their necks, and no surgical booties. Protective gear eventually arrived, but not until three days after Duncan's admission to the hospital, they said.

According to the NNU, as of October 12, a survey of more than 1,900 nurses across the country found:

-- 76 percent still say their hospital has not communicated to them any policy regarding potential admission of patients infected by Ebola

85 percent say their hospital has not provided education on Ebola with the ability for the nurses to interact and ask questions

37 percent say their hospital has insufficient current supplies of eye protection (face shields or side shields with goggles) for daily use on their unit; 36 percent say there are insufficient supplies of fluid resistant/impermeable gowns in their hospital

39 percent say their hospital does not have plans to equip isolation rooms with plastic-covered mattresses and pillows and discard all linens after use; only 8 percent said they were aware their hospital does have such a plan in place

Nor is it only nurses and health care workers who feel they are being needlessly exposed to risk. Some 100 workers at New York's LaGuardia Airport went on strike over the issue on October 8.

The workers, airplane cabin cleaners contracted through the company Air Serv, are seeking to unionize and say they are sometimes exposed to hypodermic needles and bodily fluids, including blood and feces, without proper protective equipment. The workers are paid as little as $9 an hour and say that the number of cleaners per job has been cut in half--and the time allotted to clean each plane has been reduced from 45 minutes to as little as 5 minutes.

The media whipped up a further frenzy about the fact that Amber Vinson, the second nurse infected with Ebola, took a commercial flight from Cleveland to Dallas on October 13, despite the fact that she had a low-grade fever.

Vinson reportedly called the CDC several times--and was told she could travel since her fever was not high enough to put her in the "high risk" category of having contracted Ebola. She is now being transferred for treatment at Emory University Hospital, at least in part because workers at Dallas Health Presbyterian have threatened a walkout.

AS NNU pointed out in a statement, because the U.S. lacks a national health care system, preparedness for a crisis like Ebola is woefully uneven from hospital to hospital.

In a statement, NNU Co-President Jean Ross stated, "There needs to be a uniform national standard. When you have fragmented islands of private hospitals that can do their own thing, you are left with them doing their own thing, doing just-in-time care, and that is not going to save us from something like Ebola.

Dr. Robert Murphy, director of the Center for Global Health at Northwestern University, seconded the idea that the lack of a coordinated and standardized national health care system in the U.S. increases the possibility of such a threat. Speaking to the New York Times:

Dr. Murphy said that the American public health system is a "state-oriented" one, in which state public health departments have the primary responsibility for fighting the outbreak of an infectious disease like Ebola. The CDC, he said, acts as "a central clearinghouse and a reference center, and can provide guidelines and recommendations and assist the states in implementing these policies. But it's strictly up to the states as to whether they follow those guidelines or not."

The neoliberal, for-profit approach to health care has impacted the ability of agencies to fight Ebola in other ways.

The budget for the CDC, for example, was $6.8 billion for the 2014 fiscal year--approximately the same as it was in 2010. This represents a budget cut when inflation is factored in. And, according to the New York Times, "The National Institutes of Health saw its budget decrease to $30.1 billion in the 2014 fiscal year from $31.2 billion in the 2010 fiscal year."

The idea that critical government agencies in charge of protecting the public health could have their budgets slashed in the richest country on earth is absurd.

The problem isn't unique to the U.S., either. In Spain, where nurse's assistant Teresa Romero Ramos contracted Ebola after treating a priest with the disease, government officials blamed Ramos herself. Madrid's regional health minister Javier Rodríguez stated on television, "You don't need a master's degree to explain to someone how you should put on or take off" a protective suit.

As unions representing health care workers have pointed out, due to budget cuts that have fallen hard on workers and the poor, Madrid's infectious disease center had been all but dismantled as part of a government cost-cutting plan. The unions also say health care workers haven't received proper training on how to properly remove protective suits.

Ebola has been a known disease and threat since 1976--yet no effective vaccine or widely available treatment options exist. That's another absurdity in a world where pharmaceutical manufacturers routinely come up with new cosmetic treatments and erectile dysfunction medications.

Why the upside-down priorities? Profit, pure and simple. "There have been no drugs to do the job because developing them is extremely expensive, and, until now, the major pharmaceutical companies have not seen enough of a market," the BBC reported.

Meanwhile, Dr. Francis Collins, head of the National Institutes of Health, says that budget cuts have harmed research into a vaccine for Ebola. "NIH has been working on Ebola vaccines since 2001. It's not like we suddenly woke up and thought, 'Oh my gosh, we should have something ready here,'" Collins recently told The Huffington Post. "Frankly, if we had not gone through our 10-year slide in research support, we probably would have had a vaccine in time for this that would've gone through clinical trials and would have been ready."

Once again, the health and safety of human beings have been trumped by the irrational priorities of a for-profit system.

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