Hospital's Ebola blunders feed fear: Our view

Let us count the ways that Texas Health Presbyterian Hospital has screwed up since encountering the nation's first case of Ebola three weeks ago:

• When Thomas Duncan, 42, first arrived at the hospital's emergency room feeling ill and feverish, he told a nurse that he had been to Liberia, epicenter of the Ebola outbreak. Yet the hospital kept him waiting for hours with other patients. When he was finally examined, doctors missed the Liberia connection, rejected a nurse's pleas that he be isolated, misdiagnosed his Ebola-like symptoms and sent him home with antibiotics — all despite massive news coverage about the threat.

• When Duncan returned three days later, his illness was finally diagnosed and he was isolated, but the hospital botched containment protocols — if it even had protocols to botch. An organization representing the hospital's nurses says it did not. The protection failed, infecting at least two workers.

• The hospital and the federal Centers for Disease Control and Prevention moved quickly to identify people who had been exposed. But, incredibly, those people were left free to travel around the country. One boarded an airplane with a mild fever, and the hunt is now on for others whom she might have infected.

If you think hospital administrators are shamed by all this blundering, you'd be wrong. At a news conference Wednesday, Daniel Varga, chief clinical officer for the hospital's parent company, Texas Health Resources, said he sees no "systematic institutional problem."

Even more implausibly, he insisted that the most recent case shows the hospital's "ability to intake those folks, get them into isolation, and manage them has been very effective."

Sure it does. And the moon is made of green cheese.

The point of this is not to flog Presbyterian, though a few lashes might help snap Varga and other administrators back to reality. Rather, it is to probe whether the hospital's dismal performance exposes more widespread weaknesses that could turn a few inevitable, isolated cases of Ebola into something much worse.

From the earliest days of the crisis, CDC Director Tom Frieden has been relentlessly reassuring. He has insisted, among other things, that the nation's hospitals could identify and isolate Ebola patients — the indispensable first line of defense against an outbreak.

The Dallas experience raises doubts. Texas Presbyterian is a big institution in a big city, so there's little reason to believe it's uniquely ill-prepared.

Frieden and his agency have belatedly come to recognize this. They've sent a highly trained team of outbreak specialists to help the hospital straighten itself out, and in the wake of the nurse's misbegotten plane ride, they're tightening rules for people who have been exposed.

This is progress, but the holes in the system are not something the CDC can magically fill. The threat is too diffuse. Rather, the primary responsibility lies with each hospital. Every one of them should be reacting aggressively to Presbyterian's travails, under intense local news media scrutiny — and tapping the CDC's knowledge and resources.

Frieden, meanwhile, would be well advised to make his optimism less blind. You'd be hard-pressed to find medical authorities who disagree with his assessment that the Ebola crisis can be contained, and that there's time to prepare. But it's time that the nation's hospitals and CDC need to spend more effectively than they have so far, lest the bravery of nurses and doctors on the front lines go for naught.

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