Some U.S. hospitals weigh withholding care to Ebola patients

I know,....another Ebola thread


For those of you who are tired of them,.(I understand)....please move along. For those still interested, read on..

The article is rather long, so I just posted a few paragraphs.

(Reuters) - The Ebola crisis is forcing the American healthcare system to consider the previously unthinkable: withholding some medical interventions because they are too dangerous to doctors and nurses and unlikely to help a patient.

Officials from at least three hospital systems interviewed by Reuters said they were considering whether to withhold individual procedures or leave it up to individual doctors to determine whether an intervention would be performed.

Ethics experts say they are also fielding more calls from doctors asking what their professional obligations are to patients if healthcare workers could be at risk.

U.S. health officials meanwhile are trying to establish a network of about 20 hospitals nationwide that would be fully equipped to handle all aspects of Ebola care.

Their concern is that poorly trained or poorly equipped hospitals that perform invasive procedures will expose staff to bodily fluids of a patient when they are most infectious. The U.S. Centers for Disease Control and Prevention is working with kidney specialists on clinical guidelines for delivering dialysis to Ebola patients. The recommendations could come as early as this week.

source

The American healthcare system cannot handle Ebola in large numbers. Flu season is arriving soon (for many it's here already), I can't wait to see the number of false alarms, blind panic that will happen this season.

Man from West Africa with a simple case of food poisoning. *Call the CDC*

Yup, this will be quite the flu season. S + F

If they establish the 20 hospitals, that means a hell of a lot of patients would have to be transported. Who could afford that? It's not going to be a free ride. And for doctors to withhold care...What the hell?

I find the fact that doctors verifying the ethical ramifications of personally refusing a patient to be more significant.

The people in the hospital are the ones that make a difference. If they decide not to bother, there is no treatment.

Finally, some smart reactions.

Duncan completely overwhelmed a 900 bed big city hospital, required a reported 70 personnel relating to his care (24/7 nursing, technicians, physicians, custodial and dietary, plus others), and ended up the ER was put on diversion because everyone he was in contact with initially had to be put into voluntary quarantine, so they lost a whole rotational shift right there... then there's the domino-issues of the two nurses and one lab tech and their (idiotic) plane flights and cruise ship trip and the whole knock-on effects of that. What if they all had been infectious at that point? We'd have over 1000 people infected, with the virus filtering out from there to 10s of thousands, etc.

It wouldn't take more than 5 Ebola patients to completely overwhelm an entire city's medical system.

FIVE. I was saying this back in July, and I'm still saying it. This is a disaster waiting to happen and perhaps it already has. Seems like the news has been truncated ever since the Ebola Czar was appointed and I don't think we're getting the whole story anymore. The news coming out of the MSM is oddly muddled.

I agree, the US is ill prepared to deal with the outbreak of a level 4 contagion. And unfortunately, the hospitals do not have the equipment or the designs to handle such.

And the African villages would simply make everyone stay indoors, shut down the markets, have one person deliver fresh food to each hut, and avoid go near any hut where food hadn't been taken in. Worked for thousands of years until fast and rapid modern transportation was introduced to the country.

Signal fire has it right on the money......
The medical system would break down even over here where we are so...so civilised....
There isn't enough staff or money to deal with this kind of outbreak, even if there were enough resources....(which there isn't)
I totally agree with the assessment...........Ebola = chaos over here too......

What Ebola patients, since the Czar came in I haven't seen a single new case or anyone being suspected of being tested, has anyone else?. It is either hush hush or they were able to stop it as they said they would. ...

a reply to: whatnext21

Things have become awfully quiet lately,...haven't they?

a reply to: sdcigarpig
Our hospital has a whopping 40 hazmat suits. But unless some intensive in-services are done (not yet) again and again and again, and caregivers are taught how to disrobe, it's just a number imho.

a reply to: MrLimpet

Yes indeed, latest report from WHO is not quite so rosy however, closing in on 10,000 cases confirmed and nearly 5,000 deaths. However, there is no update on the two nurses in the US.
Ebola Response Roadmap

SUMMARY
A total of 9936 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in five
affected countries (Guinea, Liberia, Sierra Leone, Spain, and the United States of America) and two previously
affected countries (Nigeria and Senegal) up to the end of 19 October. A total of 4877 deaths have been reported.
The outbreaks of EVD in Senegal and Nigeria were declared over on 17 October and 19 October 2014, respectively.
EVD transmission remains persistent and widespread in Guinea, Liberia, and Sierra Leone. All but one
administrative district in Liberia and all administrative districts in Sierra Leone have now reported at least one
confirmed or probable case of EVD since the outbreak began. Cases of EVD transmission remain lowest in Guinea,
but case numbers are still very high in absolute terms. Transmission remains intense in the capital cities of the
three most affected countries. Case numbers continue to be under-reported, especially from the Liberian capital
Monrovia.
Of the countries with localized transmission, both Spain and the United States continue to monitor potential
contacts. On 21 October the single patient with EVD in Spain tested negative for the disease for a second time.
Spain will be declared free of EVD 42 days after the date of the second negative test unless a new case arises
during that period.
On 22 October 2014, WHO convened the third Emergency Committee on Ebola under the International Health
Regulations (2005)

a reply to: MrLimpet
ITA. Nothing but feel good news, as if Ebola has already been licked (pun intentional) in the US. True, horrific non-medical events keep happening with alarming frequency, and the coverage has been good, but I've noticed a change in tone about Ebola. Tom Frieden has been hushed. To appease the maddening crowd, a few travel tweaks were rolled out. Wasn't the stock market up today? In less than a week, Ebola has the aura of a far-away problem.The Ebola Czar is like a cat in a litter box, busily burying offensive matter. As a result, some smaller hospitals may start to feel complacent again. Or perhaps that's why some wish to opt out? I just don't know.

originally posted by: whatnext21
a reply to: MrLimpet



Yes indeed, latest report from WHO is not quite so rosy however, closing in on 10,000 cases confirmed and nearly 5,000 deaths. However, there is no update on the two nurses in the US.

Ebola Response Roadmap

SUMMARY

A total of 9936 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in five

affected countries (Guinea, Liberia, Sierra Leone, Spain, and the United States of America) and two previously

affected countries (Nigeria and Senegal) up to the end of 19 October. A total of 4877 deaths have been reported.

The outbreaks of EVD in Senegal and Nigeria were declared over on 17 October and 19 October 2014, respectively.

EVD transmission remains persistent and widespread in Guinea, Liberia, and Sierra Leone. All but one

administrative district in Liberia and all administrative districts in Sierra Leone have now reported at least one

confirmed or probable case of EVD since the outbreak began. Cases of EVD transmission remain lowest in Guinea,

but case numbers are still very high in absolute terms. Transmission remains intense in the capital cities of the

three most affected countries. Case numbers continue to be under-reported, especially from the Liberian capital

Monrovia.

Of the countries with localized transmission, both Spain and the United States continue to monitor potential

contacts. On 21 October the single patient with EVD in Spain tested negative for the disease for a second time.

Spain will be declared free of EVD 42 days after the date of the second negative test unless a new case arises

during that period.

On 22 October 2014, WHO convened the third Emergency Committee on Ebola under the International Health

Regulations (2005)

Thank goodness for local news. Nina Pham is still in good condition and there was a statement from Amber Vinson's family that she is 'Ebola-free'. Huh? I thought she was worse off than Pham? Something weird is going on!

***The tests on Nina Pham's dog was negative!

originally posted by: Iamthatbish
I find the fact that doctors verifying the ethical ramifications of personally refusing a patient to be more significant.

The people in the hospital are the ones that make a difference. If they decide not to bother, there is no treatment.

I honestly can't say I blame them.

They risk not only their own lives, but possibly the lives of their spouses, children, loved ones. That is a hard decision to make.

You must remember that doctors refuse patients regularly, they normally refuse due to not taking medicaid or medicare or Obamacare, or any insurance they don't want to deal with. So refusing care is fairly normal in the US outside of the ER. The ER department of a hospital itself is obligated to care, but individual doctors and nurses do not have the same obligation the hospital itself does. The hospital is obligated to keep them in the hospital and to ask Doctors and Nurses to care for them, but can do nothing if the Doctors or Nurses quit rather than care for Ebola patients. There is a thread by Nurses you can look at where this is discussed in depth on ATS.

The only ethical dilemma the US will face is whether or not to force Doctors and Nurses to work at gun point or threat of jail time (which many may choose rather than risk their family's health) for refusing to go near an Ebola patient. That will be the real dilemma.

Not wanting to commit possible suicide and murder of their own family's by caring for an Ebola patient is something I can empathize with, much more than just not liking the insurance a person has. These are genuine concerns for health care workers, one that we can not lightly dismiss or poo poo as not going to happen.


As to the concerns of other posters to this thread, it is quite possible that the government and hospitals are keeping any new patients a secret, on a need to know basis only. The one case in Denver nearly ruined the hospital at least short term. I imagine other hospitals saw that and if they have a case will keep it as secret as possible to stay out of the news and to avoid harming their hospitals. The government knows a election is coming up and admitting to new cases would further add to the suicide of the Democratic Party by their incompetence in handling this and many many other issues. Have you noticed how quiet they are keeping the rise in drug resistant TB that was brought in this past summer with the illegal immigration wave, where the immigrants were given plane rides and bus rides to anywhere they wanted to go in the US? I have seen bits and pieces of news about it here and there, enough to know that it is being kept under wraps for sure, like the Enterovirus that is paralyzing and killing children, thanks to the immigrants Obama shipped to all 50 states.

I think they are smart to do this and have said from the beginning that the infected should all be in one place and the efforts on their care, and personnel and supplies for such, focused there. We saw what happened when Tex Pres tried. Most other hospitals would probably to as poorly or more poorly.

Clearly the government has a contract with Phoenix Air to fly patients to one area, and other than with Duncan, it is in essence what they have done so far.

Somehow ~ this one managed to slip through.

A doctor who recently returned from West Africa is being evaluated at Bellevue Hospital, law enforcement sources told NBC 4 New York.

The doctor, who two sources said worked with an aide group treating patients in West Africa, began to feel ill Thursday and called 911. He was transported from a building on 147th Street between Broadway and Amsterdam Avenue to Bellevue, law enforcement source said.

The doctor returned to New York about 10 days ago, the sources said.

source

a reply to: drwill
The question should be asked: How many hospitals, have the necessary hazmat suits, the negative pressure rooms/wings and the staff that is trained to deal with such?

Those three items are the main questions that should be asked and we get answers to. The staff needs to be able to correctly get into and out of the hazmat suits, and have the proper decontamination protocols in place. The rooms that said infected persons put into should be a negative pressure room/wing as to prevent the spread of and mitigating the chances of such spreading to others, and then there is training.

While some hospitals may have the necessary stuff to deal with an outbreak, if Dallas showed the country anything, it is that the public hospitals are not prepared to deal with an outbreak of a level 4 pathogen. And that is just from one person, what if 2 or 3 people show up at different hospitals, all having Ebola, then what?

And the doctors are also correct, at what point can they refuse service if there is a chance that neither they or their staff is prepared or has the necessary training to deal with such.

a reply to: sdcigarpig

Here is what an RN in Oakland has to say.

Nurses Say U.S. Hospitals Aren't Adequately Prepared To Handle Ebola Patients

"We’ve been asking for training for protocols and we have not gotten it,” said Katy Roemer, RN, a nurse at Kaiser Oakland and a member of National Nurses United. "Pieces of paper are being handed to us with minimal instructions on it, and it’s not adequate to deal with a virus like Ebola.

Roemer’s experience is reflected thousands of times over in a survey conducted by NNU, which asks more than 2,000 nurses if their hospital has adequately prepared for Ebola. Seventy-six percent say their hospital hasn’t told them about any admission policy for Ebola patients. Eighty-five percent say their hospitals haven’t provided a forum for nurses to ask questions about their Ebola protocols. ”

source

a reply to: grandmakdw

Everything you say makes perfect sense. Until you recall that Ebola mirrors so many other ailments. That's my concern.

I wouldn't hire a person for a job if they didn't understand the job. We don't allow out garbage men to leave trash because its gross. People in the medical community need to understand what they were educated and hired to do. If they don't like it, they shouldn't just quit. They should change careers.