AUSTIN, Texas — The Texas Task Force on Infectious Disease Preparedness and Response, formed by Governor Rick Perry in response to the Ebola crisis, held its first official public hearing on Thursday, to hear testimony from several panels of witnesses representing hospitals, university health systems, associations of medical professionals, public health agencies, and other experts. The Task Force, headed by Dr. Brett Giroir, the executive Vice President and CEO of the Texas A&M Health Center, has had numerous meeting since they were formed and announced their initial recommendations earlier this month.
Giroir opened the hearing by mentioning the hearing by mentioning the initial recommendations, and described the purpose of the day as to discuss those ideas in more detail, as well as to gather additional recommendations from the witnesses regarding their various areas of expertise. Giroir said his top priority was to determine “best practices” to meet the various challenges that an outbreak of a contagious disease like Ebola could present to the state’s health care system, and to share that information efficiently.
Dr. David Lakey, the Texas Department of State Health Services Commissioner, opened his remarks expressing sympathy for the family of Thomas Eric Duncan, the first patient to be diagnosed with Ebola who died earlier this month, as well as praising nurses Nina Pham and Amber Vinson, who had contracted the disease from Duncan. This is “an unprecedented time,” said Lakey, and the “rest of the nation is looking at Texas” to see how the state would respond.
The first panel of witnesses were representatives from several major hospitals and university health systems Managing Ebola and thwarting its contagious nature was a “terrible challenge,” said Dr. Raymond S. Greenberg, the Executive Vice Chancellor for Health Affairs for The University of Texas System. Greenberg mentioned that the medical waste generated from treating Duncan — 91 containers’ worth — had been sent to a special decontamination facility at the University of Texas Medical Branch in Galveston. Greenberg praised the Galveston community for remaining calm and not panicking about the waste material being sent there, and noted that it had been safely transported, received, treated, and disposed of, without problem. He also identified financial issues as a challenge the task force would need to address, predicting a “considerable ongoing expense” for the state.
The recommendations of Dr. Alexander Eastman, the Interim Medical Director at UT Southwestern Medical Center Trauma Center and Parkland Memorial Hospital, focused mainly on screening and communications. Personnel at Parkland and UT Southwestern had experience setting up field hospital facilities after Hurricane Katrina, and both hospitals had implemented advanced screening processes in August, based on a CDC advisory. Since August, Parkland had screened over 87,000 patients for Ebola based on travel history, medical symptoms, and personal contacts.
Eastman strongly urged the task force to establish a secure communications network with a clear chain of contacts, saying that the rapid sharing of new developments was crucial and that there would not be time to vet people who need the information before each time it was distributed. Moreover, providing timely and accurate information to the public was an “essential part of our mission,” said Eastman, recommending a daily briefing schedule. Eastman also identified Parkland, UT Southwestern, and Methodist Hospital System as partners that were operating facilities that were “ready today” to receive and effectively treat an Ebola patient.
Dr. Robert Phillips, the Executive Vice President and Chief Medical Officer at Houston Methodist praised Texas Presbyterian Hospital for its transparency in sharing vital information with health system personnel and public health officials, even being willing to admit mistakes. “Unfortunately, the information we may have on Ebola is imperfect,” said Phillips, noting the challenge of fighting these diseases in a highly mobile, globally connected world. “The first patient could have walked through the door of any of our facilities.” In Phillips’ view, the best practices for screening and treating patients would involve small, specially trained teams, and, once a diagnosis was made, removing the patient from the hospital or doctor’s office to a specially designated Ebola treatment facility. He also recommended research into the most effective types of personal protective equipment (PPEs) and various methods for putting on, using, and removing the PPE gear.
The Chief of Infectious Disease at the Baylor University Medical Center at Dallas, Dr. William Sutker, also emphasized how crucial efficient communication networks were. He wanted to see more regular updates provided to the hospitals, and approved of the idea of a formalized central communications structure. “Not to throw stones,” said Sutker, “but the overall response of the CDC has been slow,” noting that they had wanted to start training designated employees on proper PPE use, but had faced delays actually getting any of the equipment to their hospital. They had seen similar delays obtaining the face masks used during H1N1 flu outbreaks, but this was especially frustrating.
Dr. Joseph B. McCormick, the Regional Dean of the UT Health School of Public Health, Brownsville Regional Campus, spoke of the challenges fighting diseases like Ebola in a large, highly mobile and interconnected world population. Globalization was not going away, McCormick said, saying that this was now “our modern world.” McCormick cautioned against over reliance on regional centeres, noting that patients could present anywhere, and broad training was needed across the health care system, recommending recruiting volunteers among health care workers, to organize into small, focused, well-trained groups. He also sought to put Ebola in perspective, saying that “influenza’s the one that scares me the most.”
Dr. Ron Cook, D.O., the Chair of the Department of Family and Community Medicine at the Texas Tech University Health Sciences Center and the City of Lubbock’s Public Health Authority, said that his facility was as “prepared as best we can be,” mentioning that they had had an opportunity to test the system when a man from the Ivory Coast showed up with lethargy and diarrhea, but no fever. According to Cook, they were actually already planning a drill that very day, and then had a real world case they had to handle instead. The experience of treating this Ivory Coast patient — who turned out to be negative for Ebola — was helpful, showing holes in their process, as well as the invaluable experience gained with hands-on work, whether in a drill or with actual patients. Cook urged the task force to organize and conduct more real time drills.
During the Q&A period, Eastman described how “incredibly disruptive” a single Ebola patient could be to regular hospital operations. While Duncan was being treated at Texas Presbyterian, its ER was totally shut down, and other area hospitals saw a spike in traffic that was diverted to them. Greenberg mentioned that the national capacity with the CDC facility at Emory Hospital in Atlanta, and two other hospitals in the country was only a total of 19 beds, and plans needed to be made to expand that. Giroir agreed, noting that “this is everybody’s problem” and they could not control where Ebola patients might present themselves.
The second panel was public health authorities, and Dr. Thomas Schlenker, the Director of the San Antonio Metropolitan Health District, spoke first. Schlenker identified budget challenges as a major problem for his agency, saying that he had only four epidemiologists on staff, so even sending one at a time to the CDC in Atlanta for advanced training would critically limit their capacity. He also discussed some of the practical experience his agency had, including contact tracing in tuberculosis cases, and one example of a dead bat found on an elementary school playground that necessitated screening a number of children for rabies exposure.
Dr. David E. Persse, the City of Houston EMS Physician Director, discussed the challenges caused by the requirements of the federal HIPAA health privacy laws, and identified a need for a way for hospitals to share information without compromising patient confidentiality. Persse also recommended an expansion of the quarantine power beyond state authorities, to include local health officials as well. Giroir later noted that this would require legislative action and was one of the issues the task force was studying.
Eric Epley, the Executive Director for the Southwest Texas Regional Advisory Council, Texas Trauma System, shared his ideas for some practical logistics on how they could best communicate, including identifying documents by a number, not a title, describing how conference calls often dragged out as everyone sought to keep highly technical documents straight. He also recommended keeping conference calls at a consistent time every day and having the hospitals designate officers to share information with each other.
The final panel was representatives from various associations for health professionals. Cindy Zolnierek, the Executive Director of the Texas Nurses Association, appreciated Lakey’s comments thanking nurses Pham and Vinson, saying that nurses “are on the front lines” of this crisis. Zolnierek also emphasized the importance of sharing information without blaming, noting that fears of litigation can create a hesitation to share critical information.
Dave Pearson, representing the Texas Organization of Rural and Community Hospitals, noted that rural hospitals faced special challenges in situations like this. In Texas, the hospitals in his organization serve about 15 percent of the population but cover about 85 percent of the geography. If an Ebola patient shut down one of their ERs like treating Duncan did at Texas Presbyterian, area residents could end up having to drive hundreds of miles to get to another hospital.
Dr. Ben Raimer with the Texas Public Health Association and Ted Shaw, Chief Executive Officer of the Texas Hospital Association, told the task force they hoped they would draw lessons that would be useful beyond Ebola, and focus on public health education issues like the importance of hand washing and immunizations. Twenty thousand people die every year from the flu, said Shaw, urging people to get flu shots. Giroir responded that he had just gotten his flu shot, administered by one of his students.
Giroir closed the hearing thanking the witnesses and emphasizing that they knew that hands-on training had to be a priority. “Having a website or a piece of paper isn’t enough,” he said. Giroir also praised the witnesses for recognizing that while “there’s always an issue of resources and funding,” he was glad that they were not simply pointing to more money as the solution, but rather that they needed more flexibility with their budgets and ways to use their budgets more efficiently. “This is the new normal,” he said, with complicated challenges from global diseases, but was confident they would rise to the challenge.
The task force is scheduled to share a first draft of its findings and recommendations with the Governor and Legislature by December 1. Breitbart Texas will continue to follow this story.
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