Are California Hospitals Prepared For Ebola?

MAUREEN CAVANAUGH: This is KPBS Midday Edition, I am Maureen Cavanaugh. When Southwestern College closed a building last week and what turned out to be a hoax about it below, concern about the virus spreading was gripping the nation. Now, emotions have calmed a bit. People previously under quarantine are being cleared. And Ebola patients in the US seem to be doing better. But one group is still sounding the alarm about Ebola. It's nurses. California's largest nurses union met with Gov. Brown yesterday, they say that no hospitable in the state is prepared for people a patient's. Today we will talk about the level of training and preparation for Ebola and other infectious diseases in California hospitals. I would like to welcome my guests, Michael Jackson and Thomas Novotny. MICHAEL JACKSON: Thank you for having me on the show, and think you for letting us get the message out to the public. MAUREEN CAVANAUGH: Dr. Novotny, welcome back to the show. THOMAS NOVOTNY: Thank you very much, it is always good to see you. MAUREEN CAVANAUGH: Michael, Rosanne DeMorrow, head of the nurses union, made headlines yesterday when she said no hospital in California is prepared to treat an Ebola patient. Do you agree? MICHAEL JACKSON: I do agree. The guidelines from the CDC have continuously changed over the last couple of weeks about what is appropriate for protecting healthcare workers. MAUREEN CAVANAUGH: Isn't training for contagious disease control part of what hospitals do? MICHAEL JACKSON: It is, absolutely, especially when you have new disease on the horizon, you know you need education, hands-on training, which is what we are stressing, hands-on training and appropriate PPE. MAUREEN CAVANAUGH: PPE being the gear you're wearing? MICHAEL JACKSON: That's correct, personal protective equipment. MAUREEN CAVANAUGH: Is it your and the union's contention that whatever training has gone for Ebola and some other infectious diseases has not been in person enough, that enough teamwork involved, a little too much like something you would fill out on the Internet, is that right? MICHAEL JACKSON: That's absolutely correct. The organization we have been out on front on the infectious disease issue for some time. Even before Ebola, it was H1N1. We were out front then, stressing that hospitals needed to provide appropriate N95 masks and training appropriate to the disease. MAUREEN CAVANAUGH: Did they? MICHAEL JACKSON: After we got out and started sounding the alarm, hospital started making headway, but not completely, because hospitals are a business, and often times they are going to take the cheapest route. MAUREEN CAVANAUGH: I want to read part of a statement that the California Hospital Association issued in response to the claims that the state is unprepared. Statement reads in part that Californians can be reassured that universal precautions are in place to screen and identify infectious diseases. You can read the full statement on the our website. Your response to that? MICHAEL JACKSON: That is what sounds like a coordinated response amongst the American Nursing Association and the Hospital Association. They represent business interests of the hospital. And the ANA, the American Nursing Association, they do not represent the front-line healthcare worker or nurse. MAUREEN CAVANAUGH: I want to ask you both a question. Let me start with Dr. Novotny. I think there is some confusion about whether hospitals have to follow the CDC guidelines that they put out for healthcare workers treating Ebola patients. Are the CDC and lines mandatory? THOMAS NOVOTNY: Not in law, because that would have to be passed by legislature. In terms of reference, the CDC is the best public health reference that we have. They have certainly had to adapt to this new challenge, but they have come up with more stringent recommendations and they expect hospitals to accommodate these. MAUREEN CAVANAUGH: When we were learning about this, about this situation developing in Texas at Presbyterian Hospital, a lot was said about the CDC, the issue these best practices guidelines when it comes to protective gear and how to handle these things, but there are no standards that all hospitals can conform to. Is that right? MICHAEL JACKSON: That was correct. First, my heart and our hearts from the organizations go out and applaud those nurses for coming out and being heroes and shedding light on this and being outspoken. From that we understand, there were protocols given to the hospital that say follow these guidelines. It as the doctor says, the CDC is not a regulatory body. They do not have the power to enforce. This is why my organization, National Nurses United has been gathering a petition on our website to get a letter to President Obama so he can use executive authority to mandate hospitals to follow the guidelines. MAUREEN CAVANAUGH: For instance, the CDC put out guidelines for healthcare workers treating Ebola this week. To your knowledge, to hospitals in San Diego have the kind of protective gear that the CDC is advising healthcare workers to wear when treating Ebola patients? MICHAEL JACKSON: From what I understand copy PEs will have to be upgraded in some facilities. They will have to get the PPE's that cover the skin completely. They will have to purchase the suits that are impermeable to bodily fluids, blood and virus. MAUREEN CAVANAUGH: So they don't have them? MICHAEL JACKSON: Not currently, from what I understand. MAUREEN CAVANAUGH: Doctor Novotny, what has been your reaction to the news that those nurses in Dallas contracted Ebola after treating an infected patient? Did you think that something like that could happen in in apparently well-respected US hospital? THOMAS NOVOTNY: Well, you would not expect it. There is one regulatory agency involved in hospitals, the joint commission on accreditation of hospitals, which credits hospitals and allows them to be able to bill Medicare and Medicaid etc. so that they have standards. I think they would also include infectious disease control standards. They all have processes in place, whether they were sufficient to the challenge is certainly in question. I do not think we would have expected that to happen, although given the nature of this disease, and we did not have much experience with it. It has certainly never been a challenge in a US hospital. We have had other infectious disease challenges, sometimes those have not been very well-managed either, so each time as Michael and I were talking about earlier, it is appropriate to do reflection and say what went wrong? Note precisely the failures of those nurses, that can be fixed and corrected. It needs educational process, more than a website or a pamphlet, it has to be a drill. This is where the currently recommended hospitals have accommodated this and been drilled to respond. MAUREEN CAVANAUGH: Staying with Ebola for a moment, when it comes to a disease like Ebola, with a hospital under paired to accept an Ebola patients, is it because there is a certain amount of complacency that we do not expect we will ever see that kind of disease here? And it takes up too much time and is not cost-effective to prepare for it? THOMAS NOVOTNY: That's an interesting question, and I don't know the answer. We do not expect to see Ebola cases. There has been modeling now to see what we can do to predict other emerging cases. It is likely that there will be two or three cases from each country coming to the United States. Hopefully now there will be an opportunity to detect them at the entry point so we do not get them in the hospital, and manage them on the full continuum of the response. MAUREEN CAVANAUGH: What were the other infectious diseases you were mentioning that hospitals found themselves challenged to try to control, and had to reevaluate procedures about? THOMAS NOVOTNY: I think there is always risk for the spread of influenza among hospital staff and between patients. There are certainly tuberculosis risks that can be brought, even into the intensive care nursery recently. Just about anything, but I think there are a lots of responses that hospitals make and infection control nurses are appointed in each hospital to manage and control these things. There are investigations done by the state health department and the CDC to understand hospital-based infections. There are a lot of efforts on many fronts to reduce risk. MAUREEN CAVANAUGH: The nurses union met with the governor yesterday. Do you know what the union is asking the state to do? MICHAEL JACKSON: We met with Governor Brown yesterday and it was a productive meeting, from what I understand. He told us he would be in the working mode. He is meeting with the top health officials from the state, and he will be working on a plan, and we are very confident in that. But what we are asking for is the same thing we're asking President Obama, to use his executive authority to mandate hospitals in the state of California to follow the strictest, stringent guidelines. And California we would like to be the leader in the nation. We have the largest population of nurses here in California with almost 420,000 nurses, that is pretty significant. MAUREEN CAVANAUGH: Are you only speaking about Ebola, or does this also translate to preparation and handling of others? MICHAEL JACKSON: It should translate to any infectious disease. Look here in San Diego, we are sending by the loss of one of our future leaders in San Diego State. Our hearts go out to that young lady and her family and her students, and her classmates. MAUREEN CAVANAUGH: The student who recently died of meningitis? MICHAEL JACKSON: Correct. It can be any virus, Ebola is not the only deadly virus out there. MAUREEN CAVANAUGH: When it comes to patients in the US who have contracted Ebola, or have been brought here with the disease, it seems that the supportive treatment and the blood plasma that survivors have gotten is working, would you agree? THOMAS NOVOTNY: I don't think we can say for sure. There is not sufficient evidence. They have not done a clinical trial. If I were in a bowl a patient, I would say give me anything that might work and take it gladly. But they really do not have the evidence to really say one way or another. Supportive treatment for sure is beneficial, and that is what is lacking in the worst cases in Africa. MAUREEN CAVANAUGH: If indeed so many patients here have survived, some of them receiving blood plasma and some receiving experimental drugs, but all of them receiving supportive care, if the supportive care turns out to be the mainstay of recovery, is that possible in West Africa? THOMAS NOVOTNY: Not undercurrent conditions. There is a shortage of health manpower, equipment, supplies, and facilities. The military is building hospitals that will not be done until the end of September. The supportive care being provided is heroic, even the limitations with MSF and all of the increased numbers of international volunteers, but it is very insufficient, especially since they are addicting tens of thousands of new cases to occur. MAUREEN CAVANAUGH: With the nurses in California have rallied now about getting the protective gear that they need and to get training in place in case an Ebola patients shows up in California, what is your overall idea of how prepared California hospitals are, or how good they are, in dealing with infectious diseases in general? Are there gaps that you see that need to be fixed? MICHAEL JACKSON: There are gaps in the system currently. It is such a profit driven system. It costs money to drive that machine, and hospitals are profit driven. That will be their focus. MAUREEN CAVANAUGH: Would you have spoken out as a group without the Ebola scare? MICHAEL JACKSON: We have been on the forefront before Ebola ever came to the headlines. We were out there with H1N1. Years ago. Before the bullet crisis broke here in the United States in August, we were out with our petition, and our survey, from around the country, to see if hospitals are prepared. We were also doing actions in Las Vegas before the nurses even became sick, getting our message out there with the registered nurse response network. Anytime there is a disaster, National Nurses United sends nurses to these areas, when it is safely possible. Such as hurricane Katrina and Haiti. We have been sending nurses to disaster ridden areas. We see Africa as a disaster ridden area. We do not look at it as it is just an African problem, we are a global nation with global problems. MAUREEN CAVANAUGH: Following up on Michael's point and your point previously that there are models trying to predict where people from west Africa, or how many mites unsuspecting we get on a plane and get to the United States, have Ebola and bring it to the country. Are there also models on how the virus and the spread of the disease is going to continue in West Africa? Is that still exponential and out of control? THOMAS NOVOTNY: It is, and the models are still looking at the worst-case scenario of up to one .4 million cases by January. Has not slowed. At least there has been some success. We can look at Nigeria as a place we have actually controlled and where it could have really gotten out of control. I was really worried that had escaped into the northern parts of material with much less acceptance of medical care that it might have really done damage. But they managed to keep it under control. That is a model of success, and I think we should look at that. I think we should also recognize there have been several cases here in the United States treated successfully at hospitals without spread. There is a model to make sure it works, and I think looking at what works is also worthwhile. MAUREEN CAVANAUGH: Thank you both for speaking with me. I have been speaking with Michael Jackson and Thomas Novotny.