Will Ebola Vanquish the MBAs Who Run Our Hospitals?

Yves here. This discussion from the BBC gives a damning picture of the performance of the supposedly “best of all possible worlds” US health care system has been in dealing with Ebola:

The Dallas Presbyterian Hospital treated one Liberian, Thomas Duncan, who died. From caring for him, two nurses have now contracted the disease.

Nearly 80 health workers are under observation. It is claimed by the biggest nursing union that those charged with his care did not have the right protective clothing, flesh was exposed, there were no clear guidelines of what to wear, how to wear it, and how to disrobe.

The US Centers for Disease Control and Prevention (CDC) concedes that it is possible flesh was left exposed when treating Duncan. And that is why among those nearly 80 still under observation, no one can rule out the possibility that there will be further cases.

This is a crude, and damning, statistic but so far Medecins sans Frontieres (Doctors without Borders) has treated thousands of people in West Africa with Ebola, and has seen 16 medical workers contract the disease. This hospital in Dallas has treated just one patient, and has two sick healthcare staff.

Note how the BBC contacted an organization with actual experience in treating Ebola. How many US news organizations have interviewed Medecins sans Frontiers? Lambert and I haven’t seen a single mentions of them in the large number of Ebola-related stories we’ve read between us. Given how deeply embedded exceptionalism is in the American psyche, odds are high that the CDC hasn’t talked to them either.

This sorry performance looks even worse when you read a New York Times story on how the hospital handled the outbreak. Even with thin details and image-burnishing efforts by PR giant Burson Marsteller, staff clearly had no idea what to do and their improvisations often increased risks. Ironically, Presby, as it is called locally, is also described as the Neiman Marcus of hospitals, with a stellar local image and a Margaret Perot wing. But while it does well with treatments for the affluent, like heart surgeries, emergency care is another matter:

In Medicare’s most recent ratings, the hospital scored well on surgery, obstetrics, and cardiac and stroke care. But it did less well, below state and national averages, on assessments of its emergency department. For instance, it took an average of 52 minutes for an emergency patient to be seen by a doctor or nurse, twice the state and national averages.

One of the things we’ve mentioned occasionally about the short-sightnedness of the “crush ordinary workers and squeeze government so that it becomes incompetent and no one will want to pay for it” is public health risks. Wealthy people can’t avoid contact with people at the bottom of the economic food chain: servants, yard men, hospital orderlies, service staff in restaurants. They might be able to insulate themselves from bad economic and political results of their looting schemes, but they can’t escape the ravages of infectious diseases. Remember, FDR was a polio victim. And this has been brought home earlier than we might expect by a medical facility that caters to the well-heeled becoming the American ground zero for a disease from poverty-stricken West Africa.

The article below goes into considerable, damning detail about the considerable mismanagement of Duncan’s case and how it demonstrates how short-sighted it is to have MBAs run hospitals. These details have become public despite a gag order having apparently been put in place on the staff of the hospital that treated the first patient, hospital, Texas Health Presbyterian. Imagine what we don’t yet know.

By Roy Poses, MD, Clinical Associate Professor of Medicine at Brown University, and the President of FIRM – the Foundation for Integrity and Responsibility in Medicine. Cross posted from the Health Care Renewal website

Introduction 

News and opinions about Ebola virus are swirling around the US, fueled by a tragic epidemic in West Africa, and fears that more infections could appear here.  On October 6, 2014, I posted my concerns that despite a tremendous amount of confidence expressed by government officials and health care leaders, our dysfunctional health care system might have trouble containing Ebola virus.  Less than two weeks later, my concerns do not seem so extreme.  The first patient to be diagnosed with Ebola virus in the US has died.  Two nurses who cared for him now have the virus.

There seem to be millions of words on paper and on the internet about Ebola appearing every day.  So I certainly do not want to try to deal with the problem in all its aspects.  I do want to revisit a particular set of issues from my October 6 post: the hazards posed by generic management deluded by business school dogma running health care institutions in the time of Ebola.  In particular, my focus is the management of the US hospital at which one patient died, and two nurses were infected, based on what has come out since October 6.

The Incoherence of Hospital Leaders 

On October 6, we noted that the hospital, Texas Health Presbyterian, part of the Texas Health Resources hospital system, had issued conflicting and confusing statements about why the first Ebola patient, Mr Thomas Eric Duncan, was sent home from the hospital when he first presented.  The first specific statement by hospital managers was that there had been a problem with the hospital’s electronic health record (EHR), as had been suspected by my fellow Health Care Renewal blogger, InformaticsMD.  Then the hospitalretracted that statement, but provided no explanation with which to replace it.

Since then, there have been more inconsistencies in statements made by hospital managers.

Fever or No Fever?

First hospital managers said Mr Duncan arrived without a fever, but then review of his medical records indicated his temperature was as high as 103 degrees F while he was in the hospital, a fever high enough that it might reasonably have prompted admission given his other symptoms, even if Ebola was not a concern.  (See this Dallas Morning News story.)

Readiness for Ebola Patients?

Hospital managers assured the public they were ready for Ebola virus patients, e.g., in the Dallas Morning News story of September 30, 2014 

When Ebola arrived, they were ready.

The staff at Texas Health Presbyterian Hospital of Dallas did a run-through just last week of procedures to follow if the deadly virus landed in Dallas.

We were prepared,’ Dr. Edward Goodman, an epidemiologist at Texas Health Presbyterian, said Tuesday in a news conference. ‘We have had a plan in place for some time now in the event of a patient presenting with possible Ebola. We are well-prepared to deal with this crisis.’

Presbyterian said it is following recommendations from the U.S. Centers for Disease Control and Prevention and the Texas Department of Health in responding to the patient, described as being ‘critically ill’ at the hospital in northeast Dallas.

All precautions are being taken to protect doctors, nurses and others in the hospital, officials said.


Sadly, this statement soon seemed, as one politician once said, inoperative. an October 14 Washington Post article described how hospital health professionals had to essentially make up their procedures as they went along.

The hospital that treated Ebola victim Thomas Eric Duncan had to learn on the fly how to control the deadly virus, adding new layers of protective gear for workers in what became a losing battle to keep the contagion from spreading, a top official with the Centers for Disease Control and Prevention said Tuesday.

‘They kept adding more protective equipment as the patient [Duncan] deteriorated. They had masks first, then face shields, then the positive-pressure respirator. They added a second pair of gloves,’ said Pierre Rollin, a CDC epidemiologist.

Also,

He said the hospital originally had no full-body biohazard suits equipped with respirators but now has about a dozen. Protocols evolved at the hospital while Duncan was being treated, he said: ‘Collecting samples, with needles, then you have to have two people, one to watch. I think when the patient arrived they didn’t have someone to watch.’

Worse, in the last 24 hours, there have been reports by anonymous people said to be nurses at Texas Health Presbyterian that the hospital was clearly not ready, per the Los Angeles Times,

The nurses’ statement alleged that when Duncan was brought to Texas Health Presbyterian by ambulance with Ebola-like symptoms, he was ‘left for several hours, not in isolation, in an area’ where up to seven other patients were.  ‘Subsequently, a nurse supervisor arrived and demanded that he be moved to an isolation unit, yet faced stiff resistance from other hospital authorities,’ they alleged.

Duncan’s lab samples were sent through the usual hospital tube system ‘without being specifically sealed and hand-delivered. The result is that the entire tube system … was potentially contaminated,’ they said.

The statement described a hospital with no clear rules on how to handle Ebola patients, despite months of alerts from the U.S. Centers for Disease Control and Prevention in Atlanta about the possibility of Ebola coming to the United States.

‘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, but that department didn’t have answers either, the statement said. So nurses were essentially left to figure things out on their own as they dealt with ‘copious amounts’ of highly contagious bodily fluids from the dying Duncan while they wore gloves with no wrist tape, flimsy gowns that did not cover their necks, and no surgical booties, the statement alleged.

‘Hospital officials allowed nurses who interacted with Mr. Duncan to then continue normal patient-care duties,’ potentially exposing others, it said.


In response, the official hospital statement (authored by one Wendell Watson, “a Presbyterian spokesman,” according to the AP) contained vague assurances, but no specific responses to the allegations, 

‘Patient and employee safety is our greatest priority, and we take compliance very seriously,’ the hospital said in a statement. ‘We have numerous measures in place to provide a safe working environment, including mandatory annual training and a 24-7 hotline and other mechanisms that allow for anonymous reporting. Our nursing staff is committed to providing quality, compassionate care, as we have always known, and as the world has seen firsthand in recent days. We will continue to review and respond to any concerns raised by our nurses and all employees.’

So while hospital officials (and local and national politicians and government leaders) kept up reassuring statements that our sophisticated, high-technology hospitals were totally ready to deal with a disease like Ebola, the reality appeared far different.  

Other Inconsistencies

According to a USA Today story, other inconsistencies included hospital statements about the date Mr Duncan’s diagnosis was confirmed, and whether or not the hospital was diverting ambulances.

Were Health Professionals Silenced?

Of course, given the suddenness of the arrival of Ebola in the US, the acuity of the first patient, and the general atmosphere of panic, initial confusion in public statements however critical the information they were meant to contain may be, is understandable.

However, there are now allegations that hospital management was not merely confused, but trying to keep critical information secret, and the allegations do not seem incredible. 

In a Washington Post story on October 12, about how many US hospitals seem not well prepared for Ebola infected patients, appeared this from Bonnie Castillo, director of Registered Nurse Response Network, part of the union, National Nurses United,

Castillo said the union has been trying to contact nurses at Texas Health Presbyterian Hospital, where Thomas Eric Duncan, the Liberian man diagnosed with Ebola, died Wednesday.

‘That hospital has issued a directive to all hospital staff not to speak to press,’ Castillo said. ‘That is a grave concern because we need to hear from those front-line workers. We need to hear what happened there. … They have them on real lockdownThere is great fear. This hospital is not represented by a union. Our sense is they are afraid to speak out.’


The Los Angeles Times story included,

The Dallas nurses asked the union to read their statement so they could air complaints anonymously and without fear of losing their jobs, National Nurses United Executive Director RoseAnn DeMoro said from Oakland.

The October 14 Washington Post story noted

the labor organization National Nurses United read a statement that it said came from nurses at the hospital who ‘strongly feel unsupported, unprepared, lied to and deserted to handle their own situation.’

The AP story of October 15 stated,

The Presbyterian nurses are not represented by Nurses United or any other union. DeMoro and Burger said the nurses claimed they had been warned by the hospital not to speak to reporters or they would be fired.

The AP has attempted since last week to contact dozens of individuals involved in Duncan’s care. Those who responded to reporters’ inquiries have so far been unwilling to speak.

 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.  

Why Hospital Managers May Not Deserve Our Trust 

The US has had no recent experience with any disease like Ebola.  So that mistakes, sometimes very serious ones, were made in the management of the first Ebola patients is not a big surprise.
  
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.

On the other hand, based on what we have been posting on Health Care Renewal for nearly 10 years, the conduct of the Texas Health Resources leaders should have come as no surprise.  On Health Care Renewal we have been connecting the dots among severe problems with cost, quality and access on one hand, and huge problems with concentration and abuse of power, enabled by leadership of health care organizations that is ill-informed, incompetent, unsympathetic or hostile to health care professionals’ values, self-interested, conflicted, dishonest, or even corrupt and governance that fails to foster transparency, accountability, ethics and honesty. 

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.  A Dallas Morning News article about Mr Doug Hawthorne, the Texas Health Resources CEO who just retired in September, 2014, stated

In 1997, Doug Hawthorne helped reshape the health care industry in North Texas by leading the creation of Texas Health Resources, an alliance of Presbyterian Healthcare Resources, Harris Methodist Health System and Arlington Memorial Hospital.


By 2014,

 With more than 22,000 employees in fully owned and joint venture operations, Texas Health is one of the largest care providers in North Texas. For its 2012 fiscal year, it had $3.7 billion in total operating revenue and $5.3 billion in total assets.

For leading this system, Mr Hawthorne made a lot of money, although apparently no recent data is available on his compensation,

He was among the most highly compensated not-for-profit CEOs in the region. For 2012, the most recent information available, his base salary was about $1 million and his bonus was about $1.1 million.


It should be no surprise that to justify this compensation, Mr Hawthorne was proclaimed a visionary.  According to the Dallas/ Fort Worth Healthcare Daily, Mr Hawthorne was inducted in 2014 into the Texas Business Hall of Fame.  At that time,  

A healthcare visionary, Mr. Hawthorne is at the helm of one of the largest faith-based, nonprofit health care delivery systems in the United States, Texas Health Resources,’ the Hall said in a release announcing the induction.


Yet Mr Hawthorne had no direct patient care experience, public health experience, or biomedical or clinical science experience.  Mr Hawthorne is on the board of directors of the LHP Hospital Group Inc, a for-profit that provides capital and services to non-profit hospitals.  The official bio, posted by LHP stated his educational background only included

B.S. and M.S. degrees in healthcare administration from Trinity University in San Antonio.


Furthermore, as we mentioned earlier, the current CEO of Texas Health Resources, Mr Barclay E Berden, who has only been on the job since September 1, 2014, also was hailed by system board of trustees for his “unique leadership strengths.”  His current compensation is unknown, but I would guess is likely over $1 million/year.  He highest degree is a MBA, and like his predecessor, had much experience in hospital management, but apparently none in clinical care, public health, or biomedical science. 

Summary 

Texas Health Resources’ recent CEOs have been paid millions, and hailed for their brilliance, despite a lack of any direct experience in health care, public health, or biomedical science.  Leaders convinced of their own brilliance may live in bubbles that prevent penetration of any ideas or facts that may challenge that brilliance, making them thus susceptible to hubris. 

So should we have been surprised that the leadership of the first US hospital system to directly confront Ebola de novo seemed more concerned with polishing their supposed brilliance than with transparently providing the information that other people who have to confront Ebola in the future so greatly need?

No, but one tiny silver lining to the time of Ebola is that it may make it glaringly obvious that we need true health care reform that focuses on reforming the leadership of big health care organizations. In particular, we need leadership that is well-informed about health care and public health; that upholds the values of health care professionals, specifically by putting patients’ and the public’s health ahead of their own remuneration; is willing to be held accountable; and is honest and unconflicted.

Allowing the current dysfunction to continue, while it will be very profitable to the insiders who run the system, will continue to enable tragic outcomes for patients and the public.  

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124 comments

  1. ella

    No, the MBA’s will find a way to monetize the Ebola crisis. There is far too much money to be made from the sickness of others for the health care industry to change. Tragic.

    1. Septeus7

      They already have monetized this palnned outbreak see GlaxoSmithKline and their rabies based Ebola vaccine. Ebola is just part of the plan.

    2. Park Nihrs

      Please see the passionate doctor rant (mine) and NIH link at:
      http://www.nakedcapitalism.com/2014/10/200pm-water-cooler-101614.html#comment-2333632

      and see Septius7 below

      Typical – a friend’s wife was dying of cancer, he went bankrupt despite having “health” insurance for her chemo, bought her a few more months, and then learned that the chemo, and most of the protocol was developed at NIH.
      So, Ebola: What’s Glaxo-Burroughs-WellbutinXL-Labs-Smith-Kline-JPM-Organ-Goldman-Sachs_GE-Imaging-Siemens-Harvard-U-MedSchool-Amazon got to do with it?

    1. abynormal

      NEW YORK (The Borowitz Report)—There is a deep-seated fear among some Americans that an Ebola outbreak could make the country turn to science.

      In interviews conducted across the nation, leading anti-science activists expressed their concern that the American people, wracked with anxiety over the possible spread of the virus, might desperately look to science to save the day.

      “It’s a very human reaction,” said Harland Dorrinson, a prominent anti-science activist from Springfield, Missouri. “If you put them under enough stress, perfectly rational people will panic and start believing in science.”

      Additionally, he worries about a “slippery slope” situation, “in which a belief in science leads to a belief in math, which in turn fosters a dangerous dependence on facts.”

      At the end of the day, though, Dorrinson hopes that such a doomsday scenario will not come to pass. “Time and time again through history, Americans have been exposed to science and refused to accept it,” he said. “I pray that this time will be no different.”

      1. MyLessThanPrimeBeef

        On the other end of the spectrum, those who worship Science as their God believe this is their ‘Flood,’ as those against Science will drown, and only hard core Scienticians will survive.

      2. McMike

        Problem is, those who shroud themselves in science and expertise have gutted it in favor of neoliberal profiteering. The hospitals are corrupt and unable to handle new challenges, the CDC inept and most interested in appearing in control.

        “Trust us we’re the experts” will prove hollow and false. And it is taking science down with it.

        1. James

          What you said – my thoughts exactly. Science ain’t exactly riding high on the wave of public opinion (due to inept practices in that bastion of progressive belief, Tejas no less!) at this point. But that was a rather humorous take on things above.

  2. Vatch

    Should the ebola crisis vanquish the MBAs who run our hospitals? Of course. Will it? Well, did the Great Financial Collapse of 2008 vanquish the giant banks and their overpaid ethics-free executives?

    1. PQS

      +100

      Did the collapse of Iraq and the total failure of the entire middle east “new” American Century project cause the downfall of any public figure involved? Or are they still lauded as Important People with Important Visions of the Future?

    2. Carla

      This seems relevant: as a dues paying civilian (non-physician) member of Physicians for a National Health Program, I just received a letter from PNHP today “Please help us raise $60,000 to train a new generation of medical students and physicians to take the lead in advocating for single payer in their communities, the media and the medical profession.”

      Given the general situation, I decided I’d better ante up.

      BTW, anyone can join Physicians for a National Health Program to support single-payer national healthcare. For non-physicians, the annual membership is $40.

      1. James

        Single payer will always be a non-starter in the US. And should the idea ever actually take hold, the same entrenched interests that are resisting it now would make damn sure that it would be a failure in whatever watered down form it finally emerged. Shoot, even the military’s long since effectively abandoned it. “Single payer” in the US means that you’re rich enough to pay cash, at least as long as “current arrangements” apply. What the coming continued collapse portends in that regard remains to be seen.

      2. NY Geezer

        Carla, yours is an insightful response. It is obvious that our current fees for services health care system encourages profit seeking hospital corporations to deny medical services to the sick.

        Before Ebola struck the US, it was not obvious that denying medical services to the sick could impact the general population’s health. But mindlessly sending Duncan home with a prescription for antibiotics to treat the his Ebola infection endangered the public health.

        The additional harm to the public’s health that has occurred from the hospital’s actions to reduce its expenses and conceal the health exposure risks those actions have caused is not just an outrage. It is overwhelming proof that our current fee for services system needs to be replaced by a single payer system.

        We need to replace greed for profits with the higher calling of service to the public as the primary driver of our health care system.

  3. jgordon

    “What may be a big surprise to many Americans is how untrustworthy health care leaders… now appear.”

    While it was sinking, could anyone have been said to be any trustworthy leaders on the Titanic? Regardless of status and position, those who were not only out for themselves were delusional and clueless. Add in a generous helping of incompetence and you have the Titanic in a nutshell. This analogy effectively describes not just the Dallas Presbyterian Hospital, but also America as a whole. Today, the best bet for self/family/group-preservation is to view everything with extreme cynicism and trust no one you don’t personally know. The alternative is empty life boats while people drown in freezing water.

    1. Brindle

      Ohio doing its part in promoting “untrustworthy leaders”.
      ODH is the Ohio Dept. of Health:

      —But as we reported in early August, Governor John Kasich recently ousted Medical Doctor Ted Wymyslo as head of the ODH, replacing him with Rick Hodges, a former Republican state rep and lobbyist who is neither a medical doctor nor an expert in public health.—

      http://www.plunderbund.com/2014/10/16/can-kasichs-unqualified-health-director-save-ohio-from-the-ebola-crisis/

    2. James

      I dyed in the wool cynic after my own heart! How refreshing!

      And yes, the century-ago analogies are beginning to come in bunches, aren’t they? From WWI to the Titanic and the financial shocks and shenanigans of the capitalist oligarchs, if one were inclined to believe in reincarnation one might tend to conclude a group of souls had come back around to face the same circumstances in a slightly different guise at a slightly higher level once again just to see what they’d learned. Evidently, not so much.

      It’s almost as if we Americans are trying to collectively prove that we just don’t get it with respect to pretty much everything these days. And I know the social academics (who are themselves bought off by capitalist influence at every turn) would preemptively term that cognitive bias, but I stand by that assertion all the same. For me, I only see corporate capitalist influence/corruption everywhere all of the time now. And I know I might be considered paranoid by some, but I’m certainly not delusional.

      In the end, we not only subscribe to, but literally swim in the worldview/operational paradigm of our times. It not only surrounds us, but permeates our very beings, like it or not. And corporate capitalism is proving itself every single day to be the corrosive, malignant, monster that we observe borne out in every single aspect of our daily lives. Why we can’t seem to “get that” at this late stage remains somewhat a mystery, but my guess is that, given its ubiquity and no reasonable alternative (both very much planned well in advance!), not to mention the ever-present US MIC enforcement arm, we’ve simply given up hope.

  4. MrColdWaterOfRealityMan

    The modern MBA philosophy of “good enough to be profitable” is not going to work with Ebola.

    This should be a wake-up call. Medicine can not be “Wal-Marted” (i.e. made just good enough to sell and not one bit more), without consequences fatal to us all, including MBAs.

    1. J-Ho

      Well, Wal-Mart is definitely trying to get into the revenue generating areas of healthcare anyways.

      I work at a small community hospital in a mid-sized city that’s part of a larger regional HMO and leadership is constantly harping on about how we’re going to be competing with the large discount retailers for revenue in the future. Which, of course, requires more and more pressure on management to extract money from individual departments and intimidate staff.

      These are dark times for anyone in healthcare who is committed to patients, clinical quality or a career centered on meaningful connections to your fellow human beings. We all work the assembly line now.

  5. Sufferin' Succotash

    Another $50 for Doctors Without Borders.
    Makes more sense than any political contribution I can think of.

    1. DJG

      Just sent a donation to Doctors Without Borders, too. Right now, they are among the few making sense. Check out the Oxfam web site–another successful charity group with a plan.

  6. RUKidding

    Will Ebola make any significant changes in our pathetic, horrible, and failing health care system in the USA? Possibly, but my bet would be: only for the worse.

    I mean when the head of the CDC approves a nurse with a fever flying on a commercial plane… well, clearly these worthless, incompetent, overpaid POS don’t know WTF they’re doing; don’t really care anyway bc they’re RICH, so EFF the peons.

    I think we’re screwed. Good luck to us all. Hate to be Debbie Downer but not feeling particularly optimistic today. Will the MBAs change? No, they’ll find some way to get bonuses and salary increases. Isn’t that the way it works here? Those that fail at the top get a lotta money for their big-time failures. No consequences except for golden handshakes. I don’t see that changing anytime soon.

    1. curlydan

      Unfortunately, the CDC and most other government agencies are increasingly catching the neoliberal disease of spending and training cuts.

      Most companies can’t grow the top line, so they achieve EPS growth by cutting expenditures, lowering wages, and buying back stock. This strategy seeps into the government world with budget cuts, austerity, and tax breaks for the rich individuals and corporations that prevent budget growth for most departments.

      I think the CDC or the nurses in Texas could have made better decisions if they worked in environments that weren’t obsessed with cost cutting and actually gave a crap about training and decision making. Unfortunately, there are few business or government entities that actually operate where training and service take a distinct priority over EPS or cutting budgets to make leaders happy.

      A lot of these issue come back to dumb ideas of “maximizing shareholder value”

    2. HotFlash

      Debbie Downer, meet Polly Pessimist and Rhoda Realist. We figure that the point is to reduce population significantly (mostly Us, but selected Them, if thehy can get them). So, no, They won’t find the vaccine in time to save Us.

    3. Sam Adams

      The truly funny part of all the comments about MBAs is nobody mentioned the business and law professors who inculcated the ideology of ‘good enuf fer next quarter.’ Now, bleed out.

  7. Dino Reno

    Do you believe me or your own lying eyes? That’s the mantra of the technocrats who now run things everywhere where the system is failing. The author refers to the several “inconsistencies” as told by hospital management.
    Every official statement here, no matter from what source in government or business, now tells a thousand lies. When you hear the truth told occasionally in any of these staged settings, it so shocking, so scandalous that you know that person’s career is over.
    Is this constant coverup due to exceptionalism or complete and utter incompetence or both? Are these the lies we must constantly hear to keep this brittle system together so near the breaking point? When I hear the truth more clearly spoken by officials from China and Russia, it blows my mind how far we’ve fallen. We are in the land of pretend.

    1. sufferin' succotash

      Nearly a century after becoming a world power the USA still lives in a bubble. It takes something akin to Pearl Harbor, the Iran Hostage Crisis, 9/11, videotaped beheadings or Ebola to make Americans look up, say “Huh?” and briefly recognize that there’s a big world out there where things like wars, epidemics, revolutions and various fanaticisms actually happen. The rest of the time it’s like nothing outside of Peoria has any real existence whatever. It’s the sort of world-view, or maybe world non-view, that the US could get away with as long as it held the high cards and most of the chips. But that game is coming to an end, if it indeed hasn’t already, and the big question now is whether Americans can learn or relearn how to live by their wits.

  8. nobody

    Ten days ago the The Dallas County prosecutor was considering criminal charges against Thomas Duncan. “It’s the issue of holding someone accountable,” said Debbie Denmon. The office was considering aggravated assault charges.

    http://www.washingtonpost.com/news/post-nation/wp/2014/10/07/dallas-county-prosecutor-considering-criminal-charges-against-ebola-patient-in-texas/

    Maybe now that Duncan’s dead they can look into felony charges against Jim Berg (interim hospital president and chief operating officer at PHD, and “a Fellow in the American College of Healthcare Executives [who] holds a master’s degree in hospital and healthcare administration from Saint Louis University, where he also received a bachelor’s in management sciences”) and his crew.

    http://www.texashealth.org/body.cfm?id=829

    1. Carla

      I’ll bet Jim Berg is already in Canada.

      Where, irony of ironies, after he’s paid several hundred thousand dollars to get in (depending on his age), he’ll probably eventually be covered by Canada’s national healthcare, called medicare (for all).

      1. Carla's best friend

        I cannot believe how idiotic and uneducated some people are … are you sitting at home with foil on your head worried that the government is stealing your thoughts? You actually blame the hospital administrator for a clinical decision (hind-sight shows a poor decision) made by an ER physician? CEO’s and administrators manage the financial side of the hospital – not the clinical decision making of every healthcare worker. Sometimes bad things happen in the world of healthcare – physicians are not always right. But based upon the information they are given (if the patients are honest – which reports state the initial patient may not have been) they make the decision on how to treat. Is the physician going to call the CEO each time there is an admit to ask how to proceed? If people like you are in America voting and shaping our country, maybe I will join Mr,. Berg in Canada. Maybe I will seek felony charges against you for posting such responses.

        1. Yves Smith Post author

          You really do not understand business or operations. Management establishes protocols and procedures. And a CEO is ultimately responsible. It also appears you did not read the post. Presby has a history of lousy ER response times and is not well rated in that category. That is the result of management decisions regarding staffing and acceptable response times.

    2. Code Name D

      WTF?!?! That sounds like something the Onion would publish. “Man charged with crime coming to hospital sick.”

      I notice that the neo-cons are frothing at the mouth regarding the open boarders and how we need to seal them before them dirty brown people manage to sneak across the boarder and unknowing spread Ebola… to Mexico.

      You just can’t make this shit up.

  9. OhIngardail

    The USA is no more exceptional in the quality of its hospital administrators than in anything else; when a man with suspected Ebola arrived at Lewisham Hospital (South London, UK) recently, staff panicked and ran off, leaving the man untreated and unquarantined.
    One of the reasons why trained medical staff behaved this way, it was claimed, was that the business managers who run the UK National Health Service allocate protective gear in line with the perceived risk; that is, if someone turns up in A&E with a 10% chance of Ebola, staff only get low grade (ie “10%”) protective equipment, perhaps on the assumption that if the disease escaped through that estimated 10% risk, the resulting outbreak would only infect 10% of the the population ir would normally, or kill 7% rather than 70% of those infected.
    No developed health service needs MBAs, accountants or risk managers *running* health services, because they make asinine decisions blinkered by their own form of magical thinking. Biology will always defeat ideology.

  10. petal

    Have been having an ongoing “discussion” with a friend in public health in a New England state. She continues to express loads of confidence in our health care system (“best in the world” and all that), and in the CDC. I am now sitting back silently watching things unfold to the contrary, and seeing all of the cracks exposed. The more I hear about how things were handled at the hospital in TX, the more concerned I get (having experience working with multiple infectious nasties in a lab environment). It should spur discussion and changes in how the health system is run, training regimes and protocols, and who exactly runs hospitals but I’m not optimistic. This situation is a poster child for and is really highlighting so much that is wrong.

    If anyone is interested, there was a symposium the other day at Hopkins and the video has since been archived-click on the link. It was very good, learned a lot, and there was good discussion about public health in the US and Africa. I think another commenter had posted the link that morning, so a big thank you to that person. Might be good to have paper and pen handy to jot stuff down to look up after. Cheers.

    1. redleg

      Watch this, and listen to the Doctor and staff describe their experience treating this outbreak in Liberia. Pay close attention to what the doctor says about theory vs. practice, because this is something that cost-conscious managers would have to take into account (no pun intended).
      http://www.youtube.com/watch?v=WOkDsGPhn48

      1. petal

        That was really fascinating-thank you for posting it. It kind of nicely dovetails with some of the things discussed in the Hopkins talks.

  11. McMike

    We can call it the “Kunstler Threshold Moment”.

    The moment that the tattooed nascar masses realize that their institutions are hopelessly broken, have overreached exponentially, are couldn’t manage their way out of a paper sack.

    1. James

      Point taken, but I read a lot of Kunstler, and I’m not sure that his tattooed NASCAR references are always on point. He’s pretty astute on most things, but his rather sheltered, upstate NY bohemian lifestyle, and observations are a bit stale, to say the least.

      More likely, this is the point that the east coast, Ivy League educated, decidedly effete elite begin to suspect that they just might not be insulated from the harsh realities in which the rest of us live.

      And that’s a GOD-DAMNED GOOD THING in my opinion!

  12. Beans

    The upside of the Ebola tragedy may be the introduction of Americans to the fact that MBA’s, politicians and policy folks run the healthcare industry, not doctors. Most patients do not realize this. Average Joes trust the healthcare system because they trust their doctor. When average Joes realize that those providing medical care are muzzled and that the great and powerful hospital grand poobah’s on the top floor (and on Wall Street) are really running the show, we may finally see public pressure to tap the brakes on this runaway train.

    The bumbling, contradictory press releases by the Presbyterian administrators contrasted with the coherent and downright frightening statements by those representing the healthcare workers at Presbyterian are revealing. Today, Presbyterian has issued a public apology of sorts for screwing up big time. Is anyone naïve enough to think that this public admission of faulty would have arisen without unfortunate exposure and infection of 2! of their own workers?
    http://healthcare.dmagazine.com/2014/10/16/texas-health-resources-deeply-sorry-for-errors-leading-to-ebola-misdiagnosis-additional-cases/

    1. McMike

      So, you think perhaps the next time teachers are pitted against charter advocates, or union reps are pitted against company PR flacks, or consumer advocates are pitted against bank lobbyists, or fractivists are pitted against company chemists… the average joe is going to have a light bulb go off, and realize that they guy getting paid the most to talk is the one who is most full of crap?

      1. Beans

        Just like the old saying “there are no atheists in foxholes”, perhaps there are no partisans in hospital beds. Few people don’t end up on the receiving end of healthcare at some point, so maybe the average joe will develop a self protective BS detector as a result of the Ebola story.
        But I do get your point, McMike.

    2. James

      I think many if not most do realize at this point, but they just don’t feel they can actually do anything about it. A feeling largely reinforced by the vagaries of ObamaCare.

      What they definitely do confuse however, is exactly who all the MBA’s are working for. I use my elderly mom in Iowa as a sounding board, and she still spouts all the Republican talking points in resistance to ObamaCare verbatim. I.E.; the “granny death determination boards” and all the rest. When I try to tell her the private Insurance Execs are doing that anyway, and always have been, it falls on deaf ears.

      In the end, HealthCare really is better termed WealthCare, for that’s what it is. A fact that ObamaCare was only meant to – quite successfully – institutionalize.

  13. James

    http://www.youtube.com/watch?v=th3cA5XlRWM

    Turns out ol’ Barclay Berdan’s a VIP, a fine Christian man and a leader (and not a micro manager!), and a 2013 Collier Award winner! I feel better already! Maybe we could just send donations straight to him?

    The Archdruid’s two most recent posts addresses the lunacy of relying on such empty suits for anything more than self-congratulatory videos like the one above. What a typical freaking suit! Can’t live with ’em, can’t just shoot ’em up with Ebola virus (yet)!

  14. Roger Bigod

    Currently the ratio of “administrators” to physicians is 10:1. Not many decades ago it was 1:1.

    Until this changes (i.e. never) we are so FUBAR.

    1. Code Name D

      Maybe the administrators will server as buffers to slow the contagion? Surly the free market will stop it. If that fails, we can start throwing lawyers at it.

  15. jj

    All of the news reports on this case have been such a contrast to those from the other hospitals in Atlanta and Nebraska – and the word “money” just kept going through my mind. Texas never seems to want to invest the dollars to do things the right way. I suspect we’ve only scratched the surface on the protocol failures. There was a time in the 80’s when people got fed up with accountants making medical decisions at HMOs, and HMOs became very unpopular. It would be good to see more reform, though I think it’s not just MBAs, but the large salaries at hospitals and insurance companies that need to be curtailed.

  16. af

    As distressing as it is to read about the Dallas Hospital, here is a kinda / sorta feel good article. It comes from a Teaching Institution: University of Kansas http://www.kctv5.com/story/26775426/hospital-officials-kansas-city-patient-at-risk-for-ebola?clienttype=generic&smartdevicecgbypass

    I realize that not all hospitals, especially that don’t teach will more often than not, ignore or neglect Infection Control and disaster training, but this type of hospital usually finds the money to actually look at the entire process and allows for people to speak up and point to flaws in their plan.

    This Hospital appears to have its stuff together.

    Logic would dictate that people who believe they may be contaminated should contact a healthcare facility by phone and request information on how to proceed – but that would also require hospitals admit if they were actually prepared or what area medical facility was capable of providing treatment.

  17. path to nowhere

    Do the EMT personnel have the proper PPE and training to deal with Ebola? Can they refuse to put people into the ambulance if they think they are infected?

  18. doubter

    Google “Transformation Mountain” with “Texas Health Resources”.

    They’ve been climbing Transformation Mountain.

    “Some Texas Health Resources executives are reaching for the sky as they implement their 10-year strategic plan begun in 2007.

    Just a few years after they started referring to the plan as the climb up “Transformation Mountain,” several executives at the Arlington-based system decided to do just that. Since then, they’ve trekked 19,336 feet up Mount Kilimanjaro in Tanzania, 14,410 feet up Mount Rainier in Washington state and 15,554 feet up Mount Elbrus in Russia. “ http://www.modernhealthcare.com/article/20140531/MAGAZINE/305319957

      1. doubter

        Go ahead and do the search I suggested. I leave it for you to decide if those powerpoints and other documents are actually available to look at or are indeed “Confidential & Proprietary – All Rights Reserved by Texas Health Resources. For Internal Use Only”. Because if they are really confidential and proprietary then they wouldn’t be posted on the internet. Right?

        Transformation Mountain is causing a flashback to John Stewart’s Bullshit Mountain.

      2. GlassHammer

        I don’t suppose you have a link to the “The Rise and Fall of the Learning Organization”?

        Lord knows I need such a document.

    1. James

      Makes me want to renounce my own MBA (a study in the heart of darkness!), admittedly granted by a second rate State University for pretty much showing up.

      But the bullshit of which you speak really harks back to the whole “Quality” movement in America, fronted mostly by Moorman “pioneer”/marketer Stephen Covey on the back of W. Edwards Deming’s genuine work.

      Slogans, bullshit, and marketing! What makes the corporate capitalist world go ’round!

  19. susan the other

    Amazing. And disgusting. “CEO Disease,” is a term I think I love. Just a note for followup on the aerosol question: There’s a good article on paulcraigroberts.org which advocates respirators; confirms ebola remains viable in the air up to 90 minutes.

    1. James

      Thanks. I read PCR quite a bit as well.

      I think the operative quote is this: “It is entirely possible that the current ebola strain spreads by other means than past ones. The inability of public officials to admit mistakes could result in an epidemic in the US.”

      And that’s just common sense.

  20. kevinearick

    Head Start: Herds, Ann Rand, & Atlas

    If you inspect the record, looking at what the intellectual commodities said about the physical commodities, and compare it to what actually happened, you will see that the herd is noise, and from that noise their scapegoats have made a lot of money, on anxiety, getting them all nowhere, but increasingly shrill as their assumptions have been proven false.

    We are not exploring space because the political majority with feudalist agendas doesn’t want to explore space, other than to go deeper and narrower into the artificial scarcity cave, with specialization, in a conspiracy of shared stupidity. Of course if you develop the necessary technology, the herd will be happy to commandeer it, to the end of humanizing the universe.

    Individuals, blamed under civil law to protect the herd status quo, are not bad, evil, or stupid. Herds are, because they spend all their time trying to reach consensus, assuming that they can control the environment beyond their shrinking cage, instead of adapting. Spend no more than 10% of your time doing what the Romans do, and the Romans will do the opposite.

    Gravity is arbitrary, and the longer you swim in it, the more capricious and malicious it becomes, because it migrates away from the critical path, based upon false assumption proliferation, always getting further behind in time. An hour on earth is not the same as an hour on Mars or Saturn, and certainly not inside the Sun or another galaxy.

    Economics is economics, wherever you go. The very act of extrapolating past assumptions to project the future is a self-fulfilling prophesy, an enormous waste of time that has so far exceeded five thousand years. Don’t expect labor to take majority consensus, or any of its derivatives, with anything more than a shrug.

    Like anything else, if you want to explore the universe, you have to do it yourself. In the meantime, expect the new world order to continue imploding, with increasing efficiency, and technology built for the purpose. Pick up your blinders on the way into the event horizon, drop them when you are ready to leave, and everything else will take care of itself.

    If you have a worthy project, creating wealth for future generations, labor will be the least of your problems. The corporations, including the Fed, have no worthy projects, so they can only buy back their stock, liquidating into lost purchasing power. It’s a global phenomenon, so you are looking at the global common, foundation feudalism, which the politicians – public, private and non-profit, cannot consider.

    Write a program to pool personalities like tl:dr into event horizons, comparing what they expected to actual, with flow on the margin. The critters are tracking themselves, complaining about fascism, which consumes the herd every time, because agendaism is a waste of time.

    Assumptions are like diapers for adults. Enjoy your life, building your own instrument, to educate yourself. Peace comes from within; words and numbers are derivatives. You world is what you choose to make of it, and the political majority always finds itself at war, in the back of the cave, where it cannot escape its obligations, by default.

    As you can see, I have given you a big head start, and a lot of people, those dependent upon the closed extortion system, who feel that females should not be trained, don’t like it. Too bad; leave the RE queens living on entitlement to eat their drought.

    Pop

  21. Generalfeldmarschall von Hindeburg

    Don’t worry about this. The Markets will take care of it. Because Private Enterprise is always more efficient than…something else. Pluck out thine eyes and all that stuff. There is no god but Zardoz and Schumpeter is his prophet.

    Seriously, I had a conversation just before the market meltdown with an old childhood friend who got into this private hospital management and deploying simple logic had zero effect on penetrating the midwestern working class certainty that People With Big Money were always smarter than the fools at the CDC. And what could go wrong, after all?

    1. James

      Belief trumps reality time and time again. No sarc intended. Although, admittedly, reality always wins out in the end. Funny that.

  22. optimader

    The CDC is not intrinsically evil as some may posit. and I think it is inappropriate to demonize it.

    The organizational behavior of the CDC is shaped by the pressure points from the political process that funds it (or not) and it responds w/a bureaucracy that administrates the BS output metrics to survive. I am CERTAIN some if not all medical professionals at the CDC are frustrated and would love to lop off much of the Admin function that is structurally in place to:
    1.) fulfill Fed. mandated REAMS AND REAMS of reporting mumbo jumbo;
    2.) Oversee the execution of POLITICALLY driven initiatives that suck funding away from the CDC’s core mission (disease control), funding programs that probably belong elsewhere.

    “Note how the BBC contacted an organization with actual experience in treating Ebola…. odds are high that the CDC hasn’t talked to them either.” — I know for a fact that the CDC has (medical doctor) Ebola experts in and out of Africa since this summer, one of whom the CDCrecruited is colleague of a friend that is an Infectious Disease Specialist (medical doctor) in Annapolis. SO it would be UNLIKELY the CDC is are interacting with their Medecins sans Frontiers colleagues in country.

    Clearly the CDC has communication and execution issues which combined with superficial media and instant amateur Ebola experts makes for spectacular news.

    Americans have a tendency to be impatient for technological magic bullets to be instantly in place. So when media froths unsupported speculation about scientifically unproven transmission modes (say, cough aerosols) the tendency is to perceive the CDC as unresponsive or ignorant, eg: why aren’t ALL medical responders equipped with Level A HAZMAT SUITS!?!?! (–that they can quickly become heat stroked in), when in fact the experts in the trenches are far more concerned about allocating resources to deploy RELAVANT PPE and training to frontline caregivers so they are appropriately equipped with garments gloves tape face sheilds ect ect ..

    RE: The Dallas Presbyterian Hospital, Yeah their entire media presentation is framed in terms of liability deflection, no surprises here.. The way the hospital (hospitals) is(are) run, again like the CDC, the are a product of how the Federal government intervenes and funds them .
    The fact that hospitals have “MBAs’ and Admin people that seem like an army of blunt instruments is a consequence of how government has intervened in healthcare. I ALSO have a friend in Cali who is responsible for ALL the Federal and State mandated reporting, and it is FUBAR beyond belief. For example they have constant “quality improvement” metrics ( read cost containment) annual goals, like they are a knob factory, that are arbitrary annual % that must be achieved at the risk of having Federal Medicare/Medicaid funding removed. The fact that Hospitals are Administratively astructured w/ the organizations they have, strictly speaking, is a product of the regulatory environment the operate in.

    1. skippy

      The regulatory environment they operate in is shaped by industry opti, which is a bizarre blend of McNamara and screen writing metaphysical narrative. The government is just a clearing house for these metrics to be disseminated from.

      skippy… tho I seems you’ve hit on the nerve underlining the state I was observing yesterday, legal liability and refutation of practices. That might cost money and future profits…. scary shit….

      1. optimader

        “The regulatory environment they operate in is shaped by industry” True that, I was think in terms of the operational end that workerbees are in. Hospital Admin and actual care providers, their roles are defined b the regulatory moving target, that indeed the Industry at large purchases.

        1. skippy

          “regulatory moving target, that indeed the Industry at large purchases.”

          That’s a bit nebulous opti and grounded in a dialectal style unlike you.

          Seems we down under are importing the purchasing style you speak off, from first responders to critical floor staff. Just think of response times and bio hazard protocol conflict.

          Skippy… Can you imagine a highly placed person of regional authority making the statement, wrt knowledgeable and experienced personnel, concerned about the diminished duty of care – wellie… “out with the old and in with the new”.

      2. optimader

        “I was observing yesterday, legal liability and refutation of practices. That might cost money and future profits…. scary shit…. ” Yes indeed.

        The hospital “prefers” a patient that is brought in by an ambulance rather than a walk-in wounded due to, I understand, different teir medicare/medicaid billable rates. Bottom line, if you ever need emergency care, best you at least hop in an ambulance in the Hospital parking lot because you will flow into the system quicker than the sad sacks slumped over in chairs in the ER queue.

        My mom became acutely ill in the middle of the night recently and the folks are savvy, due to my sisters professional immersion in the arcane medical/hospital admin/insurance juggernaught, that a different level of care will be afforded when brought in by the meat-wagon. That said, we’re sitting there visiting (guarding) the next day and the Nurses Aid rather than an RN comes in and tries to put a blood pressure cuff on the arm w/ IV plumbing, followed by the RN w/ meds that were all 2x proper dosage (not his fault, a good guy actually, he checked for stroke properly as a matter of routine, turns out the meds were incorrectly noted on her chart).. Happened to be tolerable over-dosages but just as easily might not have been. And this was in one of the better hospitals in the area. Bottom line it’s a sad assessment , but someone in Hospital is way better w/ a professional in the family as a health advocate running shotgun.

        http://www.cdc.gov/nchs/fastats/injury.htm
        Morbidity
        •Number of medically attended injury and poisoning episodes in the noninstitutionalized population: 37.4 million
        •Episodes per 1,000 population: 121.2

        All firearm deaths
        •Number of deaths: 32,351
        •Deaths per 100,000 population: 10.4
        ~~~~~~~
        http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx
        “Using a weighted average of the 4 studies, a lower limit of 210,000 deaths per year was associated with preventable harm in hospitals. Given limitations in the search capability of the Global Trigger Tool and the incompleteness of medical records on which the Tool depends, the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm.”
        ~~~~
        deaths:210,000
        deaths per 100,000 population: 66.2 (low limit)

        US Ebola related deaths: 1 (so far)
        deaths per 100,000 population: 0.0003

        File Under: A wiser person than I needs to triage medical/social health funding

        1. Skippy

          Hay don’t go making me all misty eye and nostalgic for light reading of IMF White papers on worker morbidity.

          Skippy… 6 pack even

    2. James

      To simplify, the CDC is an overly complex bureaucratic structure to support the overly complex bureaucratic structure above it (the US Gov), both in service of poorly understood, overly complex international bureaucratic structures above them, supporting an overly human-populated earth that absolutely no one actually planned for.
      Into this mix, a poorly understood, but extremely competent viral entity has evolved and asserted its independence to, thus far at least, pretty much “do what the fuck it wants.”
      But other than that, the otherwise overly complex and no doubt well-meaning bureaucratic structure mentioned above is pretty much “all over it”? Does that pretty much sum it up?

  23. optimader

    I ALSO have a friend in Cali who is responsible for ALL the Federal and State mandated reporting *** for a major hospital in the State***, and it is FUBAR beyond belief ..

  24. Nobby

    I am in Hamburg, Germany and my wife is a surgeon at the hospital treating an Ebola patient (flown in from Sierra Leone). The patient is in a world famous clinic for Tropical diseases and the nurses are all highly trained in managing the risk of contamination. The real problem with patients in the late stages of the disease is what they term ‘crash and bleed-out’. In essence the patient shits and vomits pints of brown sludge which is teeming with the virus (the virus causes cells to burst open so the blood is oxidised and turns brown and the virus breaks into smaller pieces ready to find new cells.) They are receiving fluids and blood transfusions. The nurses will be responsible for cleaning this up, changing sheets etc and as such need full bio suits, plus a secondary layer. They then need to go into a decontamination area where others (also wearing suits) need to clean them. They then go to a second decontamination area to remove the second layer. It’s almost insane how careful you need to be and way beyond the scope of a normal hospital.

    It’s not just the issue about how dangerous the virus, but also the enormous quantities of highly infectious fluids the patient is releasing.

    1. Lambert Strether

      Hmm. I recall reading that end-stage ebola symptoms are a lot like cholera, and that Bangladesh is the leader in that protocol. They don’t use beds with sheets, but beds that allow the fluids to drain directly to a mat on the floor, which is periodically removed. FWIW!

      1. James

        Ebola, a hemorrhagic fever, literally drains every last fluid right out of you, including your blood. Imagine losing 5-7 litres of fluid per day and where that must come from. Hint: your bowels can’t hold NEARLY that much, for long at least. You literally die of desiccation and the resulting massive organ failure that follows. Must be a lot like dying of thirst, which is no picnic either.

  25. Everythings Jake

    Nothing vanquishes the MBAs. We have MBA-ified the United States from near top to bottom w/ a focus on so-called “efficiency” and short-term shareholder profit, without any consideration for “externalities,” i.e., all the many other stakeholders whose lives may be greatly affected, or even long-term consequences to the shareholders. As far as I can see, if a mistake, error, or offense occurs on one MBA’s watch, the solution is just to replace him with another MBA, who will have a similar world view, but isn’t tainted (and even the tainted MBA will probably land somewhere else and do quite well). And for both, everything simply comes down to cost-benefit analysis, as it does for the bigger fish that own the joint. Do we think that concern for those 2 nurses will survive the 24 hour news cycle? Unlikely. Americans have a great capacity to forget. Not incidentally, an examination of how the city, including its well to do handled a plague in the late 19th century in Montreal is well examined in this 2010 Canadian Documentary.

  26. Lambert Strether

    Let’s play Neo-liberal Mad Libs!

    [T]he conduct of the _______ [1] leaders should have come as no surprise. … [W]e have been connecting the dots among severe problems with cost, quality and access on one hand, and huge problems with concentration and abuse of power, enabled by leadership of _______ [3] organizations that is ill-informed, incompetent, unsympathetic or hostile to _____ [3] professionals’ values, self-interested, conflicted, dishonest, or even corrupt and governance that fails to foster transparency, accountability, ethics and honesty.

    For example:

    [1] Texas Health Resources

    [2] health care

    [3] health care

    But:

    [1] any large university

    [2] educational

    [3] education

    I think you’ll find this handy template works for many institutions right now. It’s a generic, systemic problem.

    We might think of ebola as the neo-liberal Katrina, because it indicts an entire “MBA misleadership class” for malfeasance, as opposed to a single President or political faction.

    1. James

      Not sure where you’re going with this Lambert, but I’m pretty sure it’s not as simple as an either/or argument. Obama, for one, is simply a benign stooge in most arguments, so I certainly don’t blame him, at this point at least.

      Ebola is still an emerging threat that hardly anyone actually understands at this point, so it’s really anyone’s guess right now. Not that we’re not wont to place blame anyway. And not that MBAs in general aren’t worthy of scathing rebuke for that matter as well of course!

      1. Lambert Strether

        I don’t see why you’re not sure:

        It’s a generic, systemic problem.

        and

        indicts an entire “MBA misleadership class”

        seem plain enough.

        Obama is not mentioned; why bring him up? Where is the either/or? And as far as “placing blame,” you have been reading the posts, right? We know enough to place plenty of blame immediately; the nurses at Texas Presbyterian certainly do.

      2. James

        And I think it’s worth adding that it’s not that so many presumably well meaning institutions should or even could know what’s currently going, but that so many presume or assert to know, when they in fact they obviously don’t. Sometimes, in the absence of a factual clue, even in the face of possible great panic, its best to just admit that fact and move on, especially when the facts on the ground bear that out. Cognitive dissonance! It’s a bitch!

      3. Code Name D

        As Lambert said, Obama is not mentioned here, why bring him up. Obama had nothing to do with this and so one can not lay any blame at his feet.

        That said – Obama has been crowing rather loudly about his vaunted healthcare reform. He is extremely proud by the number of new insurance contract that have been issues and is absolutely certain that we will eventually start to see healthcare cost start to come down – not this year apparently, like he predicted – but soon.

        Now that we have an actual crises – we realize just what Obamacare is actually worth – nothing. Of course it’s unfair to hold it accountable for this, Obamacare only deals with insurance. This has to do with actually healthcare delivery.

        This is when I (wish I could) smack the Obamacare apologists over the forehead and scream at the top of my lungs, “You moron! That was the whole point of demanding for healthcare reform in the first place! Where the hell is the god-damned reform!!!”

        For years critics of Obamacare have been shouted down at every turn. Even in regards to reforming insurance, it’s complex and flawed. But insurance reform barely made the list for reformers who were far more concerned with point-of-care systems which would have to bear the brunt of any outbreak. The current collapse of the system is hardly breaking news. Contagion outbreaks at hospitals are more the rule rather than the exception. Ebola hasn’t exposed any thing about the system that activists’ haven’t been screaming about for decades now.

        But Obama insisted on a free-market model for healthcare. But the market simply can not deal with this kind of crises. Markets can not anticipate needs, and the only way to have checked Ebola early was by having preparations in place. Markets can only serve those with money, turning poor people into carriers. Markets demand efficiency, but preparing for disaster demands elasticity. Markets function through trial an error, which we do not have the luxury of when it comes to a crisis. Markets are competitive, but medical science demands collaboration. Markets places money extraction above all else, but healthcare in the face of an outbreak needs to focus on medical practices, not profit models. I could go on.

        As I said, Obama didn’t do any thing wrong to cause Ebola. But Obama turned his back on the kind of real reform we needed to deal with Ebola. In that regard, hell yes I hold him accountable. What good is an online market exchange – when people are dying by real world virus?

  27. KFritz

    Not to be too nitpicky, but FDR seems to have contracted his illness, not by mingling with the hoi polloi, but by swimming in the Bay of Fundy–and there’s room to doubt the diagnosis of polio.

  28. Duane McDonald

    The problem with wearing protective gear occurs when you disrobe/get out of the gear.
    In the military i was on a team that trained and monitored people getting into and out of the Chemical Warfare protective Ensemble.
    Properly donned this works and will protect you.
    If you have been exposed to chemical agents, most dangerous liquid, if you do no doff the gear correctly you will be exposed.
    I would hazard a guess that the same is true of the gear to protect from Ebola.

      1. James

        Especially when you’re removing it often. Most people, until they’re subjected to it, don’t realize how often they need to at least partially get out of such gear due to the day to day exigencies of life. Think sweat, overheating, need to pee, need to crap, need to sneeze, etc. It’s not like you just put this stuff on and stay in it for 8-12 hours with no issues. It’s horrible!

      2. Optimader

        Sticky tape manipulation while wearing nytril gloves isnt a happy task but i would suppose a protective garment with the gloves secured w/ tape could be removed as an”assembly” so to speak. Clearly there are people that know the hygenic procedure to shed the contaminated garments or their would be more dead frontline care providers?
        More power to them, a nasty buisness to be confronted with.

    1. James

      Prior military as well. And the “plus” side with chemical agents was that, provided they didn’t kill you in short order, they were at least not persistent. Quite the opposite with Ebola. The exposure you get inadvertently today will almost certainly kill you and others tomorrow. Quite a different animal indeed!

  29. Duane McDonald

    Shakspeare is alleged to have said first kill all the lawyers, could that apply also to the MBA’s?

    1. Yves Smith Post author

      Actually that “kill the lawyers” remark is widely misrepresented. It was a defense of lawyers. The people who wanted to kill them were basically planning a coup, and getting rid of pesky lawyers that would interfere with their looting would be necessary.

  30. Rosario

    Edward Bernays would be proud. Checklist for successful business PR:

    1) Presentable spokesperson (preferably “white” male with full head of hair but can change based on “context”)
    2) Confident message (easy and dumb)
    3) Lie, lie, lie, lie, lie (again easy and dumb)

    1. Beans

      You do realize that you have just described the generic US politician, no? So it follows that successful PR and successful politics follow the same checklist.

  31. Jim in SC

    $1.1 million in pay for a non-profit hospital that size is peanuts. The CEO of Carolinas Health System in Charlotte, NC, was nearly $5 million last year, including bonus. The CEO of a 64 bed non-profit in Maine made $800,000. Get with the times!

  32. ian

    I don’t like MBA types either, but the connection between the “MBA manager types” and the bungling of Duncans case seems really weak in this article. Its not at all clear to me that they had much to do with it.

      1. ian

        Yes, I did, as a matter of fact.Sorry if I didn’t draw the same conclusions as you did.
        I’m not talking about the aftermath (not talking to press) which is pure corporate CYA, but the actual mishandling of Duncans admission. What, specifically, did these ‘MBA types’ do that caused Duncan to be misdiagnosed?
        Is it referring to the lack of preparedness? How many hospitals in this country _are_ set up for it? It’s not exactly a disease we’re familiar with here in the US.

        Or is it “…‘Subsequently, a nurse supervisor arrived and demanded that he be moved to an isolation unit, yet faced stiff resistance from other hospital authorities,’” ? Who are these “other authorities”? Its kindof vague.

        If anyone comes off badly, it’s the medical, not administrative heads at the hospital. They are the ones that should get the protocols right.

          1. Carla's best friend

            It looks like ian gets it … but Code Name D is reaching (conspiracy theorist?). The MBAs are in charge of financial matter not daily clinical (medical) decisions. Is Obama to blame anytime something goes wrong in America? Per your logic, he’s in charge …

            1. Yves Smith Post author

              No, you do not understand, do you? As the Health Care Renewal blog has documented, as have other sites, the MBAs are in charge and set care and staffing priorities and standards. They are most assuredly the bosses and are in charge. See this post for starters:

              http://www.nakedcapitalism.com/2013/05/coming-corporate-control-of-medicine-certain-to-make-socialized-medicine-look-even-better.html

              Please stop spreading false information. You clearly don’t understand how hospitals operate. And if you had been paying attention, MBAs have also been taking control of and generally ruining other types of not for profits, starting with higher education.

              1. Carla's best friend

                It’s obvious that you understand business – having an MBA yourself. But you do not understand healthcare. I have worked in healthcare for 20 years (clinical not business) – including many years working in a hospital and seeing first hand how they do operate. Until you have first hand knowledge of this, do not pretend that you are the expect and condemn anyone else’s comments. It also doesn’t help to reference a blog written by yourself to support your statement. I trust my judgement and experience in making clinical decisions and I trust an MBA to make the financial decisions. Its always easier to point the finger of blame than it is to help find the solution. If things are so bad, maybe you should help find the solution (use your power for good).

                1. Yves Smith Post author

                  First, I suggest you read more carefully. The blog post in questions contains lengthy quotes from top health care industry experts who have vastly more perspective on this than you do. Second, your experience is likely in all of one hospital and is probably dated. You keep asserting that “all MBAs do is finance.” Sorry, they run the place. The fact that you are so ignorant of hospital administration is shocking, frankly.

  33. bernard jenkins

    As more Americans are exposed to Ebola, Ebola will expose the American Hellthcare system as the massive and destructive criminal enterprise it has become over the past decades. We do not have health care, we have Profit Care. The general patient population is merely the trigger that sets the rigged wheel of fortune spinning. We enter the hellth care system with dollar bills stuck all over us. As we pass through the twisted, corrupt system those dollars are peeled off our body until we are finally broke and/or dead. And because nobody ever got out of life alive and only cartoon characters never get sick, what we have is a perpetual money machine run by greedy ghouls. No hellth insurance company ever gave me a single aspirin. But they skim 30 cents of every dollar peeled off our body. Dedicated but stressed out doctors and nurses have almost no time to practice medicine as patients are stacked up in waiting rooms like so many airplanes over O’Hare airport. Specialists are forced to hard sell their skills like Glengarry Glen Ross real estate hustlers. Or pimp for pharma and device manufacturers. And when things go wrong as they too often do, we are bamboozled by corporate shenanigans, hospital administration lies and a full-bore public relations propaganda barrage of hoo-haa. Alas, Ebola or not, as far as seeing universal single payer health care in our lifetime, we should live so long!

  34. sd

    Question: did the nurses continue to treat other patients as well? The article mentions monitoring other nurses but what about monitoring other patients who may have come in contact with the infected nurses while in the hospital?

    It feels like Ebola tells two friends, who tell two friends, who tell two friends, and soon enough all of Dallas is infected.

  35. indio007

    “Wealthy people can’t avoid contact with people at the bottom of the economic food chain: servants, yard men, hospital orderlies, service staff in restaurants.”

    Well, we can’t have that!
    Let me introduce you to C3PO…..

  36. vlade

    Ah, it does me good to hear about MsF from US – they were dealing with Ebola long before anyone else, amongst other things trying to use traditional healers to educate the population so as to limit the spread…

    Anyways, going to the MBA stuff – I met a UK hearth surgeon who was doing an MBA and his reason was “so that I can tell when my managers are bulshitting me”

  37. TarheelDem

    When will we realize that multi-provider hospital systems don’t manage care, they create massive overhead in executive salaries?

    What ever happened to real action to deal with possible biological terrorist attacks after the anthrax attack on two Democratic Senators to ensure passage of the PATRIOT Act? Apparently those actions went the way of the TSA. Boondoggle equipment and research and no practical changes in hospital protocols to quickly identify anomalous infections at the ER. And what does to continual budget cutting of CDC say about the seriousness with which politicians took biological terrorism, a scary scenario that was the subject of many grandstanding performances?

  38. Alan

    The CEO’s of hospitals need to be physicians, or nurses. This keeps the institution patient-centered.
    The gag orders on nurses are unconscionable.

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