Was CDC Too Quick To Blame Dallas Nurses In Care Of Ebola Patient?
Dallas nurse Nina Pham was discharged from a National Institutes of Health hospital in Maryland Friday, where doctors confirmed she was free of the Ebola virus.
Pham's colleague Amber Vinson is also said to be free of Ebola, though she remains in a hospital in Atlanta.
While their progress is being cheered, many nurses around the country still feel their profession unfairly received blame for the errors in treating Ebola in Dallas.
The Monday-morning quarterbacking began in the first press conference when health officials conceded Ebola patient Thomas Eric Duncan had been to Dallas Presbyterian Hospital previously. He had been evaluated, misdiagnosed and released.
It was acknowledged that Duncan had told the ER nurse during his first visit he had just come from Africa. But then it was implied the nurse messed up his travel history in his chart.
"A travel history was taken, but it wasn't communicated to the people who were making the decisions," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said at the press conference. "They dropped the ball; hopefully this will never happen again."
But according to Dr. Daniel Varga, chief clinical officer for Texas Health Resources, a network of 25 hospitals that includes Presbyterian, that wasn't true. In fact, the nurse did put the information about Duncan's travel from Africa into the doctor's chart. He just didn't see it.
"We had that piece of information in the electronic health record," he said. "It was there to be found."
So it certainly wasn't the nurses' fault. But they heard blame again when Pham contracted Ebola from Duncan. Centers for Disease Control and Prevention Director Tom Frieden speculated she had infected herself.
"There was a breach in protocol and that breach in protocol resulted in this infection," Frieden said. "When you have potentially soiled or contaminated gloves or masks or other things, to remove those without any risk of any contaminated material touching you is critically important and not easy to do right."
It's just as likely that nurses Pham and Vinson were contaminated while they cared for Duncan. For the first two days Presbyterian's medical staff treated the extremely sick and Ebola-effusive patient without the protection of the fully hooded hazmat suits the hospital had on hand.
The next day, Frieden said he'd gotten an "earful" from nurses around the country about his comments.
"I want to clarify something I said yesterday," he said. "Some interpreted that as finding fault with the hospital or the health care worker, and I'm sorry if that was the impression given. That was certainly not my intention."
As the Ebola crisis deepened in Dallas, National Nurses United, the largest nurses union in the country, raised the alarm that hospitals across the country were not prepared to cope with the deadly virus. They came to the defense of the critical care nurses who had cared for Duncan.
"Well, see the thing is you have to look at the culture of most hospitals," said Deborah Burger, president of National Nurses United, who has been a registered nurse for 43 years.
"Whenever they're trying to assign blame it always it ends up down at the nurses' level or other health care worker," she said. "That is not unusual for that to happen. So we weren't surprised; we were just angry."
Even after apologizing, Frieden nevertheless implicated a nurse again. When Vinson was diagnosed with Ebola, she had just returned from a trip to Ohio on a passenger jet.
"She was in a group of individuals known to have exposure to Ebola," Frieden said. "She should not have traveled on a commercial airline."
But the part Frieden left out was that Vinson had been in regular contact with hospital and CDC officials and had been given permission to fly back to Dallas. When that little tidbit came to light, it put the spotlight right back on the hospital and the CDC.
But the damage was done. Vinson is said to be furious at how she was vilified and has hired a lawyer.
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Transcript
ROBERT SIEGEL, HOST:
We mentioned the good news about the two nurses who contracted Ebola in Dallas - Nina Pham was discharged today from an NIH Hospital in Maryland, free of the virus. Her colleague, Amber Vinson, is also said to be Ebola free but she's still hospitalized in Atlanta. Their progress is being cheered but NPR's Wade Goodwyn says nurses around the country are still smarting, feeling that their profession was unfairly blamed for the errors in Dallas.
WADE GOODWYN, BYLINE: The Monday-morning quarterbacking began in the very first press conference, when health officials conceded Ebola patient Thomas Eric Duncan had been to Presbyterian Hospital in Dallas before. He'd been misdiagnosed and released. It was acknowledged that Duncan had told the ER nurse during that first visit that he'd just come from Africa. But then it was implied the nurse screwed it up. Here's Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, at the press conference.
(SOUNDBITE OF PRESS CONFERENCE)
ANTHONY FAUCI: The travel history was taken but it wasn't communicated to the people who were making the decision. They dropped the ball but hopefully this'll never happen again.
GOODWYN: But according to Dr. Daniel Varga, chief clinical officer at Presbyterian's Hospital System that wasn't true. In fact, the nurse did put the information about Duncan's travel from Africa into the doctor's chart. He just didn't see it.
(SOUNDBITE OF ARCHIVED RECORDING)
DANIEL VARGA: We had that piece of information in the electronic health record. It was there to be found.
GOODWYN: So it certainly wasn't the nurses but it happened again when it was announced nurse Nina Pham had contracted Ebola from Duncan. CDC Director Tom Friedan speculated she'd infected herself.
(SOUNDBITE OF ARCHIVED RECORDING)
TOM FRIEDAN: There was a breach in protocol and that breach in protocol resulted in this infection. When you have potentially soiled or contaminated gloves or mask or other things to remove those without any risk of any contaminated material touching you is critically important and not easy to do right.
GOODWYN: In fact, it's just as likely that nurses Nina Pham and Amber Vinson were contaminated while they cared for Duncan. Why? Because for the first two days, Presbyterian's medical staff were asked to treat the extremely sick and Ebola effusive patient without the protection of the fully hooded hazmat suits the hospital had on hand.
(SOUNDBITE OF ARCHIVED RECORDING)
FRIEDAN: I want to clarify something I said yesterday.
GOODWYN: The next day, CDC Director Tom Friedan said he'd gotten an earful from nurses around the country.
(SOUNDBITE OF ARCHIVED RECORDING)
FRIEDAN: Some interpreted that as finding fault with the hospital or the health care worker. And I'm sorry if that was the impression given. That was certainly not my intention.
DEBORAH BURGER: Well, see the thing is is that you have to look at the culture of most hospitals.
GOODWYN: Deborah Burger has been a registered nurse for 43 years and is the president of National Nurses United, the largest nurses union in the country. As the Ebola crisis deepened in Dallas, they raised the alarm that hospitals across the country were not prepared to cope with the deadly virus and they came to the defense of the critical care nurses who'd cared for Thomas Eric Duncan.
BURGER: Whenever they are trying to assign blame it always ends up down at the nurses level or other health care worker. That is not unusual for that to happen. So we weren't surprised. We were just angry.
GOODWYN: Even after apologizing, CDC director Tom Friedan nevertheless implicated a nurse again. When Presbyterian Hospital nurse Amber Vinson was diagnosed with Ebola, she'd just returned from a trip to Ohio on a passenger jet.
(SOUNDBITE OF ARCHIVED RECORDING)
FRIEDAN: She was in a group of individuals known to have exposure to Ebola. She should not of traveled on a commercial airline.
GOODWYN: But the part CDC Director Friedan left out was that Amber Vinson had been in regular contact with the hospital and CDC officials and was given permission to fly back to Dallas. When that little tidbit came to light, it put the spotlight right back on the hospital and the CDC. But the damage was done. The brave young nurse is said to be furious at how she's been vilified and has hired a lawyer. Wade Goodwyn, NPR News, Dallas. Transcript provided by NPR, Copyright NPR.
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