“It’s An Object of Gallows Humor for the Staff”

TPM Reader JM on Rick Scott, hospital preparedness and the “Ebola cart” …

I have a perspective tying together today’s big news brouhahas. My wife is an ER nurse at a major urban hospital owned by the Hospital Corporation of America, the hospital chain once run by Rick Scott. It’s the largest for-profit medical system in the world, and is of course also notable for its ‘creative billing’ practices in the largest Medicare fraud settlement in history. Scott was booted from the CEO position following that fraud investigation, so he’s not directly responsible for current conditions in those hospitals.

But it is obvious to those who work there that the combination of lax training and toxic labor relations ‘leaders’ like him have brought to the company are emblematic of a big problem for US hospitals if a major outbreak of ebola or other infectious disease occurs. My wife’s ER has an ‘ebola cart’ with some lightweight protective gear and written instructions for putting on a PPE, but the instructions are a loose bundle of papers and the pictures don’t match the gear in the cart and has inaccuracies that put them at serious risk. It’s an object of gallows humor for the staff. That’s the totality of their training or preparedness so far. As we all now know, PPEs are not easy to put on and take off correctly. Even though nurses all have experience with standard droplet control (they see TB and HIV all the time), ebola is a special case. They have gone months and months without a nurse education director because no one wants to deal with their management and take the position. Her coworkers are clear that they will refuse to treat an ebola patient because they have woefully inadequate training in the correct procedures and lack proper gear.

And yet the head of infectious disease at this hospital went on the local news to proclaim the hospital was ready to receive ebola patients safely. They obviously didn’t bother to speak to a single nurse on the front lines. I’m not particularly panic-y about ebola, even though obviously the family members of ER personnel have a lot at stake in ebola preparedness. But I think that this situation will be the weak link in any major national response. So many of our hospitals are run by lunatics like Rick Scott who seek only the highest profit margin. They do not invest in training, they build charting mechanisms that are good for billing but not treating patients, they constantly fight with their unionized employees, they lie to the public, etc, etc. We like to imagine that competent, highly-skilled medical institutions like Emory will save us, but we have way more Dallas Presbyterians in this country than we have Emorys. You can see exactly this managerial incompetence—and toxic labor relations—woven through the statement released by the nurses at Dallas Presbyterian today. Also see the head of National Nurses United on All In With Chris Hayes for a similar perspective.

To put it bluntly: we’ve entrusted our national medical system to the managerial competence and goodwill of the Rick Scotts of the world, and that is much scarier than a podium fan.

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