As Second Dallas Nurse Diagnosed with Ebola, Are U.S. Hospitals Failing Healthcare Workers?

October 15, 2014
Image Credit: National Nurses United

As a second healthcare worker at Dallas’ Texas Health Presbyterian Hospital tests positive for Ebola after caring for patient Thomas Eric Duncan, the Centers for Disease Control has identified what it calls a "large group" of other workers who may still be at risk. Ebola patients are also being treated at the Nebraska Medical Center and the Beth Israel Deaconess Medical Center in Boston, but so far no workers there have contracted the virus. This comes as the country’s largest nurses union, National Nurses United, says hospitals across the country are largely unready to take in Ebola patients and have failed to adequately train healthcare workers and provide necessary protective gear. In a conference call Tuesday, the union’s co-president Deborah Burger said nurses at the Dallas hospital described having to use medical tape to secure openings in their flimsy garments, and were worried that their necks and heads were exposed as they cared for a patient with explosive diarrhea and projectile vomiting. We are joined by the co-president of National Nurses United, Karen Higgins, who works as an intensive care unit nurse in Boston, and hear from Democracy Now! co-host Juan González, who reports on the nurses’ concerns in his latest column for the New York Daily News.


This is a rush transcript. Copy may not be in its final form.

JUAN GONZÁLEZ: We begin today’s show looking at the spread of Ebola worldwide and here in the United States. On Tuesday, the World Health Organization said nearly 9,000 people have now contracted the virus, mostly in West Africa, and that it has a death rate now of 70 percent. They estimated there could be up to 10,000 new Ebola cases per week in the coming months, up from a current 1,000.

This morning, authorities announced a second healthcare worker at Texas Health Presbyterian Hospital has tested positive for the disease after caring for Ebola patient Thomas Eric Duncan in Dallas. The Centers for Disease Control has identified what it calls a "large group" of other workers involved in Duncan’s care who may be at risk.

This comes as the country’s largest nurses union, National Nurses United, says hospitals have failed to protect workers from the virus. In a conference call Tuesday, the union’s co-president, Deborah Burger, said nurses at the Dallas hospital described how they had to use medical tape to secure openings in their flimsy garments and were worried that their necks and heads were exposed as they cared for a patient with explosive diarrhea and projectile vomiting. Burger outlined how the hospital lacked the proper protocol to handle Ebola cases.

DEBORAH BURGER: When Mr. Thomas Eric Duncan first came into the hospital, he arrived with a temperature that was tested with an elevated temperature but was sent home. On his return visit to the hospital, he was brought in by ambulance under suspicion from amongst his family he had Ebola. Mr. Duncan was left for several hours, not in isolation, in an area where other patients were present. Subsequently, a nurse supervisor arrived and demanded that he be moved to an isolation unit, yet faced resistance from other hospital authorities. Lab specimens from Mr. Duncan were sent through the hospital tube system without being specifically sealed and hand-delivered. The result is that the entire tube system, which all the lab specimens are sent, was potentially contaminated.

There was no advance 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. The infectious disease department did not have clear policies to provide either. Initial nurses who interacted with Mr. Duncan wore generic gowns, used in contact-droplet isolation, front and back, three pairs of gloves with no taping around the wrists, surgical masks with the option of an N95 and face shields. Some supervisors said that even the N95 masks were not necessary.

JUAN GONZÁLEZ: That was National Nurses United co-president Deborah Burger. The union conducted a survey in the past few days of some 2,000 healthcare workers in 46 states and found more than 70 percent said they were not given adequate training about Ebola. More than a third said their hospitals lacked sufficient supplies of face shields and fluid-resistant gowns to handle patients with the Ebola virus. Today, the union has organized a national telephone conference call for 3:00 p.m. Eastern time, with more than 6,400 nurses already registered to participate.

AMY GOODMAN: On Tuesday, the Centers for Disease Control and Prevention announced it’s setting up an Ebola response team for hospitals with Ebola patients. This is Director Dr. Thomas Frieden.

DR. THOMAS FRIEDEN: [The second thing that] we will be doing, starting today, is establishing a CDC Ebola response team. For any hospital anywhere in the country that has a confirmed case of Ebola, we will put a team on the ground, within hours, with some of the world’s leading experts in how to take care of and protect healthcare workers from Ebola infection.

AMY GOODMAN: For more, we go to Boston, where we’re joined by Karen Higgins, co-president of National Nurses United. She works as an intensive care unit nurse in Boston. And, Juan, you are also covering this. Today’s column in the New York Daily News, "We are Not Ready!"

JUAN GONZÁLEZ: Yes. Well, I participated in the conference call that was held by National Nurses United last yesterday—late yesterday with some of the nurses who had been involved in the Dallas hospital where Duncan died. And they were not identified, because the union clearly said that they didn’t want repercussions on them, and they only communicated by email to the union members, but they participated in the phone call. And it was an astounding litany of lapses at the hospital that these nurses claim occurred. And so, I’m glad that we have Karen Higgins here, the co-president of National Nurses United. If you could talk to us about how—the union’s decision to have this press conference and to bring these front-line caregivers to have their voices heard in the national debate and the press coverage of what’s going on with Ebola?

KAREN HIGGINS: Well, I think we needed to bring them forward, and I was glad that they did, and I know it was not easy for them to do it, because we are still, across this country, hearing—and as we heard from Dallas hospital—that, you know, we’re ready, we can take any patient that comes in with Ebola. And I think—you know, then the finger pointing that, oh, the nurse must have broke protocol, and this is why this happened. And the issue is, no, you just did not—you were not and are not prepared to take these patients. There is a higher level of what these patients require for care, as far as protective equipment and as far as training, and we did not do it. And the concern we have is that, you know, Dallas can be repeated in any hospital, and especially, I would say, the vast majority of hospitals in this country, who will continue to say they’re ready and will put us in the same—you know, into the same situation, unless we take this on and make sure that everybody is trained and getting the best equipment we can possibly give them.

AMY GOODMAN: After news emerged that Nina Pham had contracted Ebola, Thomas Frieden, the director of the Centers for Disease Control and Prevention, said the transmission was the result of, quote, "a breach in protocol." Let’s go to a clip.

DR. THOMAS FRIEDEN: We don’t know what occurred in the care of the index patient, the original patient in Dallas. But at some point there was a breach in protocol, and that breach in protocol resulted in this infection.

AMY GOODMAN: Frieden later apologized for suggesting the nurse was at fault. We haven’t heard anything from the doctors there. Karen Higgins, can you respond?

KAREN HIGGINS: Well, I think that, you know, unfortunately, everybody is trying to not respond, I think, I think out of fear more than anything. But I think that, you know, he was wrong to make that statement. And it is a system problem, but it’s a system that is going to be a problem unless we do something more to give us a, actually, standard of practice that we do with all these patients. This can be contained. Atlanta contained it. They have had no breach in any of their protocols, or had any spread of the disease, and they’ve been taking care of patients. So we know it can be done, if it’s done right.

The problem is, as we already in every hospital know, they’re not. And the nurses are very clear on that, and I think you’ll even hear more when people are on tonight talking about it. They don’t feel ready. They don’t feel they have the equipment. And on top of it, the most important thing is, I need to be trained, and I need one-on-one training. I don’t need an email. I don’t need a videotape. I don’t need a memo. I need one-on-one training, and I need to know that when we’re removing and putting on this equipment, we’re doing it safely, but that I also have the equipment that keeps me safe. And that is not just for nurses, but for all health—you know, all employees that have to have any contact with this patient.

JUAN GONZÁLEZ: And, Karen Higgins, I’m wondering if you could comment on some of the allegations of the nurses on what actually happened in the days when Thomas Eric Duncan was at the Texas hospital. They talk about the fact that he came in an ambulance—this is the second time he had come to the hospital—with his family saying that they believed he had Ebola, and yet he was kept for hours in the emergency room among other patients, not isolated immediately. And even when a nurse supervisor complained and said he has to be put in isolation, that there was resistance from her supervisors to that. They talk about hospital supervisors coming in and out of the isolation unit without proper protection. They mention that the specimens for Mr. Duncan were sent through the tube system of the hospital to the labs, rather than being properly sealed and delivered, hand-delivered to the lab, which could possibly contaminate the entire tube system of the hospital. And also, what you mentioned about training, they say that the only training that was offered to them prior to this was a voluntary training, not even a required training, and it was largely just a seminar like any other seminar that they’re given at the hospital. The importance of these lapses in terms of what now seems to be the spread of the virus to at least two health workers and maybe more?

KAREN HIGGINS: Well, I think that, again, it was a perfect storm. It was set up. That, you know, the hospital says, "We are ready for infection," well, we are ready for infection, we’re just not ready for this kind of infection. We were not ready for Ebola, and we were not ready with the precautions that are actually needed to isolate these patients. And it’s really, you know, frustrating, and we are angry. We put everybody at risk when we don’t do things right. And they did not do things right. They did not do the proper training, which is the biggest piece to this. If you train nurses, if you train healthcare workers, not only to be able to pinpoint that somebody has that disease, but to pinpoint that you can isolate them and put them on precautions and do everything you possibly can, wearing precautions to take care of that patient, this would not have happened. And it did happen.

And as I said, you know, we’re hearing from nurses across the country that, you know what, it would be the same scenario, that they’re not doing enough training, that there is a level of infectious disease that we’ve always done training for, but not to this level. And if we’re going to see the possibility of having another patient that has Ebola in another hospital, we have to up the game. We need to be able to take care of that patient way beyond the level that we have our normal training at. And, you know, we need the guidance—not just the guidance, we need a standard of practice so that if we know, from this point on, in every hospital, and not just accept the fact that they keep saying we’re prepared, but we need to mandate that they have a certain level of care, that they have a certain—you know, a level of equipment that is the safest equipment we can use, but that we’re also invested in doing one-on-one training, that we’re doing it one to one, that we are repeating the training, that we are doing drills, that we are doing everything we possibly can, not only to protect those that are taking care of that patient, but to make sure that this never happens again and that somebody else gets infected inside of a hospital because they were taking care of somebody.

AMY GOODMAN: I want to turn to comments made by Marla Weston, the CEO of the American Nurses Association.

MARLA WESTON: We do know is that the process of putting on the protective equipment, taking off the protective equipment, is really detailed and must be done rigorously each and every single time. So I think it’s important for us to understand exactly what happened. Did something go wrong? Or is the protocol—need to be modified? So, until we really know exactly what happened, it’s hard for people to know how to fully protect themselves.

AMY GOODMAN: Your response, Karen Higgins?

KAREN HIGGINS: Well, I mean, you know, again, I think people were waiting to hear what went on. I don’t—I hate to say that most nurses are not surprised at what went on, that they did not have the proper equipment, that there was no real training. And I appreciate now CDC stepping up and saying that they would bring people in if somebody is diagnosed with Ebola. But again, that’s not enough, because we need to be on top of it before that. CDC can be there in a few hours. Well, you know what? There’s going to be a period A, a few hours where somebody has to be—you know, actually picked up that there’s a concern that they have Ebola, then they need to be isolated. All of this should be already going into effect before CDC arrives. And then it would be very helpful to CDC to help them progress from there, but you still have to be prepared for somebody coming in.

And most hospitals in this country, again, other than maybe Nebraska and Atlanta and a few others, are not; nowhere are we nearly prepared to take on this issue. And we need to step the game up, and we need to mandate that you do the right thing, and you do what needs to be done, and you provide the equipment, and you provide the education. And you know what? We can isolate this. We know it can be done. We’ve seen it done in Atlanta. We’ve seen it done in Nebraska. There has been no one showing up because—

AMY GOODMAN: Nebraska has treated a few Ebola patients—


AMY GOODMAN: —and have had no healthcare workers come down with illness, and the patients are all getting better.

KAREN HIGGINS: That’s exactly, and the same goes with Atlanta. So we know it can be done. We just need everybody to make a commitment, and we need CDC to make a stand that we are following the same kind of protocol as far as equipment and actually the rigorous training, because it is true—taking it off and putting it on. And what we actually—they recommend is not only having the good equipment, but to have somebody else always be with that person when they’re dressing and when they’re undressing to make sure that they are safely doing it. And that should be another commitment.

AMY GOODMAN: Nurse Higgins, we have to break, but we’re going to come back with you, as well as another guest. Karen Higgins is co-president of the National Nurses United. She works as an intensive care unit nurse in Boston, where she’s speaking to us from. We’ll be back in a minute.

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