Ebola and Texas Heath Presbyterian: Human tragedy turns to PR nightmare

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Jake Dean

Dr. Edward Goodman, epidemiologist at Texas Health Presbyterian Hospital of Dallas, initially said the hospital was well prepared for the first Ebola case diagnosed in the United States. Now, hospital officials say health care providers at that facility made some mistakes.

Bill Hethcock

Staff Writer- Dallas Business Journal

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Texas Health Presbyterian Hospital Dallas will at the very least go down in medical history as the place where Liberian Thomas Eric Duncan was diagnosed with the first case of Ebola in the United States, and the place where Duncan eventually died.

It's also the place that misdiagnosed Duncan initially and sent him back into the community, contagious, with an antibiotic powerless against the disease. And Presbyterian is the place where two nurses who provided care for Duncan developed Ebola themselves despite wearing protective gear.

The events of the past month at the hospital called "Presby" by its doctors, nurses and patients have left those health care workers operating at the intersection of human tragedy and a public relations nightmare.

The long-term impact on the hospital and its image is impossible to quantify, but potentially significant, said Dan Mendelson, CEO of Avalere Health, a Washington, D.C., consulting firm.

"It can be as large as the fate of the hospital and, on the other side, it can be a positive if they deal with it well," Mendelson said. "The public at this point understands that this is a highly difficult, aberrant situation, and the question becomes, how does Presbyterian deal with that?"

Step one on the public image recovery path seems to be saying you're sorry.

Presbyterian apologized for making "mistakes" in a letter published in full-page ads in two local newspapers Sunday.

"The fact the Mr. Duncan had traveled to Africa was not communicated effectively," said the letter, written by Texas Health Resources CEO Barclay Berdan. "For that we are deeply sorry."

Arlington-based THR owns Texas Health Presbyterian Hospital, where Duncan visited three days before he was admitted and diagnosed with Ebola. Duncan died Oct. 8.

The ad, placed in the Dallas Morning News and Fort Worth Star-Telegram, admitted that the hospital made mistakes in part because "training and education programs had not been fully deployed before the virus struck."

Nurses from Presbyterian gathered outside the hospital Monday afternoon to address the media. The nurses said they are experts at their jobs and don't want to be judged by this one instance. They said they are proud that the hospital has owned up to its mistakes.

Presbyterian earlier on Monday began accepting ambulance traffic that had been being diverted to other hospitals because of Ebola concerns — a move that returned the emergency department to full operation. The department had remained open for patients not arriving by ambulance.

Signs point to a diminishing role for Presbyterian in the fight against Ebola. Dallas County Judge Clay Jenkins says the staff is physically and emotionally drained and depleted because of the watch list, which still includes 75 health care workers who came in contact with Thomas Eric Duncan while working at Presbyterian.

Instead of having Presbyterian continue serving in the go-to role for Ebola, Parkland Hospital now will set up a Go Team, including 50 medical specialists who can assist at any local hospital. There are plans to identify a new hospital as the primary Ebola facility, Jenkins said.

Jenkins' position was a departure from last week, when he said he was "pushing" Ebola patients to Texas Health Presbyterian because he does not want Baylor University Medical Center, Parkland, Methodist Dallas Medical Center or other Dallas-area hospitals to be associated with the virus.

Presbyterian has seen a plunge in patients and doctors selecting to have elective surgeries and other non-emergency procedures done at the hospital, and Jenkins, the elected official who oversees emergency services for the county, does not want other Dallas County facilities to suffer a similar admissions decline, he said last week.

The Texas Health Presbyterian experience will play an important role in how Ebola cases are handled nationwide moving forward, said Dr. Dan Hanfling, consultant on emergency preparedness and response and a former vice-chair of the National Academy of Sciences Institute of Medicine committee on establishing standards of care in disaster situations.

One key question will be whether patients who test positive for Ebola are treated in their local hospital or sent to one of four specialty facilities nationwide, Hanfling said. The facilities are Emory University Hospital in Atlanta, Nebraska Medical Center in Omaha, St. Patrick Hospital in Montana and the National Institutes of Health in Maryland.

"Every hospital in the country is going to have to be able to identify (Ebola) patients and take the initial steps to isolate these patients and protect their staff," Hanfling said. "Discussions are under way with regard to whether every hospital should be expected to manage the complexity of care involved with taking these patients or whether there is an opportunity to identify selected facilities that might be a bit more robust in their capabilities and have the means for managing such cases.

Hanfling is not convinced that a breach in protocol by Presbyterian caused the two nurses to contract Ebola.

"Maybe the protocol itself was inadequate," he said.

Kevin Troutman, partner in law firm Fisher & Phillips' Texas offices and the chair of the firm's national Healthcare Practice Group, said knowing how to handle patients with infectious disease is a complex process.

"People have to be trained and oriented — especially new employees," he said. "They have to have the necessary protective equipment. They have to know how to use it."

The case also shows how important it is for health care workers to recognize and immediately report Ebola cases, he said.

Dallas health care appellate lawyer David M. Walsh said the Presbyterian experience also shows that hospitals need to make sure that caregivers are literally on the same page when it comes to sharing patient information.

"Presby has got what seems to be a PR nightmare in front of it," Walsh said. "People are mad about what went on. They're taking it pretty hard in the press right now."

Bill covers health care, law, education and general assignments. Subscribe to our email newsletters.