Wednesday, October 1, 2014

Pay Attention to Dallas' True Ebola Scare


Texas is scoring some major media attention with this Ebola scare.

First it was Dr. Kent Brantly, the missionary doctor who'd done his medical residency in Fort Worth before heading off to Liberia, where he contracted the disease.

Now, its a Liberian national who's being treated in a Dallas hospital for Ebola, and represents America's first case of the virus's entry into the country.  This man purportedly came to visit relatives in Dallas, and first visited the ER at the city's prestigious Presbyterian Hospital last Friday.  But he was discharged, only to be admitted on Sunday.

The patient's sister has told the media that she and her brother made sure the people treating him Friday knew he'd just arrived in America from Liberia.  You know - the country that is one of three that have become the epicenter of our planet's current Ebola scare?  But he was released anyway, which officials at Presbyterian now admit was a mistake.  Apparently, there was miscommunication among the members of the ER team treating the Liberian, and the connection between his nationality and his "presenting" the symptoms of Ebola wasn't sufficiently made.

Yesterday evening, during a live press conference from Presbyterian, carried by all of the local news channels here in the Fort Worth - Dallas area, an official with the hospital insisted that the patient wasn't "presenting" the appropriate symptoms during his first visit to the ER, but now, we know that the official himself was misinformed.

Or... was he misinforming us?

What are the chances that, since this patient was a Liberian national, presumably on a tourist visa to the United States, and probably with negligible health insurance to pay for his treatment, Presbyterian's ER staffers figured he was more of an economic liability to them the longer they kept him last Friday?

When he returned on Sunday, different staffers may have figured they actually had an explosive case on their hands, and that the money angle of their caring for him depended more on avoiding a massive lawsuit if the world found out they'd sent him home two days earlier to minimize costs?

Or, did his insurance provider tell the folks at Presbyterian on Friday that they weren't going to pay for anything more, and to send him home?  We've all heard how insurance companies dictate the care that doctors can - and can't - provide.  What could Presbyterian have done then?  After all, they have a right to be paid for the care they provide, right?

As far as the actual Ebola part of this story is concerned, the media is using every opportunity at its disposal to foment considerable anxiety about the presence of Ebola in a major hospital in a large city like Dallas.  Compounding the sensationalism of the case are reports that the patient had come in contact with several school-aged children here in Dallas, and a few worried parents have begun pulling their kids out of the affected schools in the district.

So, to repeat what has already been preached by everybody from Governor Rick Perry (!) to medical experts at hospitals across the country, here is how you catch Ebola:

  • Ebola isn’t as contagious as more common viruses like colds, influenza, or measles.
  • It spreads to people by contact with the skin or bodily fluids of an infected animal, like a monkey, chimp, or fruit bat. Then it moves from person to person the same way. Those who care for a sick person or bury someone who has died from the disease often get it.  
  • Other ways to get Ebola include touching contaminated needles or surfaces.
  • You can’t get Ebola from air, water, or food.  A person who has Ebola but has no symptoms can’t spread the disease, either.       - from WebMD

Contrary to what many people in the media are doing, there is no reason to panic.  Dallas' Presbyterian Hospital is well-staffed and well-equipped to care for this patient, even though they sent him home the first time he went to them seeking treatment.  As a resident of the greater Fort Worth - Dallas area, I have no fear whatsoever that I'm going to get Ebola from this patient of theirs, or anybody he came in contact with here in our area.

What concerns me about his case - and I wasn't going to write about it until I learned of Presbyterian's mistake - has to do with the larger financial aspects of how patients pay for their care, how hospitals determine the patients they're going to admit for closer monitoring, and how our insurance industry and Obamacare may be setting up our healthcare professionals for failure when it comes to cases like this.

Of course, a lot of details in this particular case are still unknown, and will likely remain that way, due to patient confidentiality laws.  But what if this Liberian national came to America without robust health insurance coverage?  Does Liberia have First-World health insurance plans, or even European-style socialized medicine?  How would whatever coverage this Liberian may have work here in a private, for-profit hospital like Presbyterian?  What if this case was a lot worse, and dozens of foreign nationals had come here with similar diseases?

Okay, we've probably got the treatment part of the healthcare plan covered - at least, when we're not kicking patients out of the ER's doors.  But who determines when care is needed, and who pays for it?  Maybe it sounds crass to ask, but everything costs something, right?  If Presbyterian intentionally discharged this Liberian Friday because of insurance or money issues, that's a problem, isn't it?  For all of us?

Hopefully the healthcare folks at Presbyterian would be particularly concerned about a foreign patient complaining of Ebola's symptoms, and would want to go the extra mile to make sure that patient was not being released into the community with the potentially lethal disease.  Let's hope theirs was a genuine mistake of miscommunication.  However, if people want to be scared about this case, this is what they need to be scared about:  the propensity of a for-profit hospital to weigh financial concerns over what should be obvious concerns about the disease they might be carrying, whether it's Ebola, or anything else.

Indeed, in our increasingly cross-cultural world, American-centric healthcare will likely become less and less effective - not to mention morally respectable - as in-country insurers and actuaries try to turn a profit by treating sick people who may be exposed to a plethora of exotic complications.

Yes, American healthcare will still focus predominantly on Americans, and our particular medical issues, but can we afford to ignore health issues from across the world, or pretend as though they don't affect us?  As Dallas' Ebola case proves, a disease is only one international airplane flight away from our shores.  Fortunately, with Dallas' contained Ebola event, the dangers appear fairly minimal, even if, with the CDC involved, we taxpayers may be picking up most of the tab.  But what about next time?  Are America's healthcare payment mechanisms ready?

The answers to those questions are what this Ebola "scare" in Dallas needs to be exposing, right?
_____

Update 10/3/14:  Apparently, for the past three years, Presbyterian has had a dismal record when it comes to having ER patients being readmitted after apparently being released too early.  And here's a classic line from an overly-defensive hospital administrator:   “We don’t have any staffing issues in our [emergency room.] It’s a very busy place.”  Well... duhhh... if it's a busy place, do you have enough staff to handle it all?


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