There are lingering suspicions that Ebola victim Thomas Eric Duncan, who was treated at Texas Presbyterian Hospital in Dallas, was given substandard care due to his ethnicity and lack of health insurance. While that might seem unfair, some previous behavior by the ‘leadership’ of Texas Presbyterian suggests that would be par for the course (boldface mine):

The lawsuit Patricia Lawson filed Tuesday against Texas Health Presbyterian Hospital of Dallas is a straightforward discrimination claim. Lawson, a 64-year-old surgical systems supervisor with two decades’ experience at the hospital, says Presby fired her in October 2012 for being too old and a woman.

The hospital didn’t admit that, of course. No sensible HR manager would fire a member of a protected class without first scrounging up some legally defensible justification. So, when the hospital told Lawson she was fired, it said it had caught her violating Texas Health Resources’ code of conduct.

“More specifically,” the lawsuit says, “[Lawson] was told she was fired for giving information regarding customary pricing for a surgical procedure to a doctor.”

To review, Presby didn’t fire Lawson because she was old, which would be illegal. It canned her because she provided information on what potential patients might expect to pay, which is totally kosher.

Once you factor in the costs of the lawsuit, it probably would have been cheaper to offer her an early retirement buyout package. So the leadership is not only a bunch of dickheads, but they’re stupid dickheads. They’re so stupid they can’t even be trusted to do what is in their own financial self-interest.

The weak link in our public health response to any outbreak that few want to talk about is health administrators, including executive officers. Consider this report from Florida by a nurse who works in the hospital chain formerly run by Republican governor and awful human being Rick Scott (boldface mine):

My wife is an ER nurse at a major urban hospital owned by the Hospital Corporation of America, the hospital chain once run by Rick Scott. It’s the largest for-profit medical system in the world, and is of course also notable for its ‘creative billing’ practices in the largest Medicare fraud settlement in history. Scott was booted from the CEO position following that fraud investigation, so he’s not directly responsible for current conditions in those hospitals.

But it is obvious to those who work there that the combination of lax training and toxic labor relations ‘leaders’ like him have brought to the company are emblematic of a big problem for US hospitals if a major outbreak of ebola or other infectious disease occurs. My wife’s ER has an ‘ebola cart’ with some lightweight protective gear and written instructions for putting on a PPE, but the instructions are a loose bundle of papers and the pictures don’t match the gear in the cart and has inaccuracies that put them at serious risk. It’s an object of gallows humor for the staff. That’s the totality of their training or preparedness so far… They have gone months and months without a nurse education director because no one wants to deal with their management and take the position. Her coworkers are clear that they will refuse to treat an ebola patient because they have woefully inadequate training in the correct procedures and lack proper gear.

And yet the head of infectious disease at this hospital went on the local news to proclaim the hospital was ready to receive ebola patients safely. They obviously didn’t bother to speak to a single nurse on the front lines… So many of our hospitals are run by lunatics like Rick Scott who seek only the highest profit margin. They do not invest in training, they build charting mechanisms that are good for billing but not treating patients, they constantly fight with their unionized employees, they lie to the public, etc, etc. We like to imagine that competent, highly-skilled medical institutions like Emory will save us, but we have way more Dallas Presbyterians in this country than we have Emorys. You can see exactly this managerial incompetence—and toxic labor relations—woven through the statement released by the nurses at Dallas Presbyterian today.

Roy Poses, after detailing the utter incoherence of the Texas Presbyterian leadership, concludes (boldface mine):

Covering up information vitally needed by health care professionals, other institutions, the government, etc to better manage a potentially fatal disease that is already epidemic in other countries appears completely unethical. Doing so to preserve the reputation of managers seems reprehensible. But the implication of the recent stories is that is what happened….

What may be a big surprise to many Americans is how untrustworthy health care leaders, and in particular the managers of Health Texas Presbyterian hospital and its parent system, Health Texas Resources now appear. After all, USA Today published on October 14, “Texas Health Presbyterian was a respected, renowned hospital.” While even people at respected, renowned institutions make mistakes when confronted with sudden, unfamiliar problems, should not the institution’s leaders at least be trusted to in their public pronouncements?

Instead, it appears that the leaders appeared tremendously overconfident, and worse, may have silenced employees from raising concerns that could have reflected badly on leadership. This occurred in a context in which transparency was imperative so that other people who might have to deal with Ebola patients might be better prepared….

We have seen many examples of hospital executives who seemed vastly impressed by their own brilliance, egged on by board members who were themselves executives of other organizations, and by marketing and public relations functionaries dependent on these executives for their own career advancement. In particular, we have posted examples of hospital CEOs and other top executives making millions of dollars a year based on their supposed “brilliance,” or “visionary” capacity, at least according to the board members who supposed to be exercising stewardship over their institutions, and the public relations people they hired. Such brilliance has often been asserted, but rarely been explained or justified (The latest example was here, and much more discussion is here).

Most such ostensibly “brilliant” hospital executives had no direct experience in clinical care, public health, or biomedical science.

Making hospital leaders feel entitled to make more and more money regardless of their or their institutions’ performance seems to be a recipe for “CEO Disease,” leading to disconnected, unaccountable, self-interested leaders. Hospital leaders suffering from the CEO disease may be particularly willing to countenance suppression of any facts or ideas that might raise doubts about their brilliance.

So the leadership of Texas Health Resources may in fact be very typical of that of large non-profit hospital systems. THR is such a system.

Looking back at the healthcare battles of 2009, what was frustrating is that what was called the healthcare debate was, for the most part, a health insurance and economics debate. There wasn’t much attention paid to whether the resulting healthcare edifice would actually help sick people. Add to that the fetishization of efficiency–which is the antithesis of public health preparedness*–and Texas Presbyterian, in hindsight, seems rather predictable.

*Public health infrastructure is like insurance: it’s a complete waste of money until you need, then you’re damn glad you have–unless it turns out not to be any good.