Looking Back at the Post-Gerbeding CDC

In 2009, Dr. Richard Besser, an infectious disease specialist at the CDC, was made acting director after Dr. Julie Gerberding (who wasn’t very good) left. I was one of the few people who thought he would have made a good director. Instead, Frieden was appointed. If you look back over the CDC’s last year or so, having an ID specialist knowledgeable about hospital infection control and biopreparedness at the helm looks, more and more, like a good idea.

Though I could just be fighting the last battle.

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Those Budget Cuts Certainly Didn’t Help Our Preparedness

theres-your-problem

The state of our public health infrastructure is, well, kinda like the rest of infrastructure (boldface mine):

But here at home, two programs that deal directly with emergency preparedness for hospitals have been cut. The CDC’s emergency preparedness program, which provides funding and staff in state and local health departments. In just the last six years, more than 45,700 jobs were lost in state and local health departments because of federal funding cuts. Additionally, the Hospital Preparedness Program, a state-federal cooperative administered by the Department of Health and Human Services has been slashed. In 2003, its budget was $520 million. In 2014 and 2015, it’s $255 million.

Those are two programs which should have been ready in Dallas, Texas, (or anywhere else in the country) to help Texas Presbyterian respond immediately and effectively to an Ebola patient showing up on its doorstep. We don’t know what their role in this case was, if they had one. But we do know that both programs have been decimated by Republicans who have held the federal budget hostage for the last six years.

Let’s add one more program to the list: AHRQ, the Agency for Healthcare Research and Quality. Republicans have tried killing this agency, whose task is to improve hospital care. It’s not entirely clear why, but concerns that comparative effectiveness studies (how well one treatment works versus another) have been floating around since Obama proposed the ACA (‘Obamacare’).

Nuts. And it might just kill people.

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Links 10/17/14

Links for you. Science:

Ebola: What can we learn from an N of 1? (excellent)
Safer fecal bacteriotherapy
They may be killer whales, but they can speak dolphin
In defense of anonymous peer review
Nigeria’s hard-earned lesson for quashing Ebola

Other:

Can Feminism Save Marriage? With Americans marrying later and less often, marriage as we know it is in transition. Feminism, not tradition, is the way forward.
People Kept Complaining This Restaurant Sucked, Look What They Found Out… (hint: cellphones)
10 things female students shouldn’t have to go through at university
Wonderful Property Rights Dispute In San Francisco
New York – Circa 1915 colorized.
Liberia already had only a few dozen of its own doctors. Then came Ebola.
It’s not the little things
All in the Family
My Family and Other Extremists
A surprising new argument against using kids’ test scores to grade their teachers
The distinctive morality of ebola
Republicans Are Far More Critical of American Schools Than Democrats
Shocker: Leading Atheist Richard Dawkins Finally Admits Religion Isn’t the Problem in Mideast
#Gamergate Trolls Aren’t Ethics Crusaders; They’re a Hate Group

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Penn Theater, Formerly

Observed on Pennsylvania Ave., Southwest D.C.:

Penn

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Something to Know About Texas Presbyterian Hospital

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.

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Links 10/16/14

Links for you. Science:

Stem cell research offers hope on type 1 diabetes
No you’re not paranoid – there is a bias against publishing marine conservation papers
Old drug may be key to new antibiotics
The Vicious Duck That Beats the Crap Out of Anything That Moves
Infection-Control Experts React to New Texas Ebola Case

Other:

The war on Isis defies logic
Controversial: Should Workers Be Paid For Time They Spend at Work?
There is a simple lesson in this Ebola outbreak, and we need to learn it
The New York Times Dream Pension Plan: Lower Benefits and Higher Contributions In Economic Downturns
David Leonhardt Wonders Why Its Cold In the Winter and Wages Aren’t Rising
Ebola “Fear Mongering” Critiqued by Medical Anthropologist
Educating kids isn’t rocket science. It’s harder.
Journalists Should Stop Exalting Loyalty Among Elites: Former cabinet secretaries owe allegiance to the American public and the truth, not the presidents who appointed them.
What if the Ebola Outbreak Occurred During the Government Shutdown?
The right’s scary Ebola lesson: How anti-government mania is harming America. It’s time to admit the truth: People who cut health funding and don’t like government have not helped this crisis
Key Democrats, Led by Hillary Clinton, Leave No doubt that Endless War is Official U.S. Doctrine
The fight to save the last Ebola-free district in Sierra Leone
This Week In “Duh”

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Continental

Or maybe it’s the understudy for the Batmobile? Observed at 18th and Church Streets:

Continental

A closer view:

Continental

The rear closeup:
Continue reading

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