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Lawmakers Question "Breakdown" in Ebola Case

As the first known Ebola patient in the U.S. continued to fight for his life at a Dallas hospital, public health officials and doctors told Texas lawmakers in the state Capitol on Tuesday that an outbreak of the virus is extremely unlikely.

By Neena Satija, The Texas Tribune and Reveal
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As the first known Ebola patient in the U.S. continued to fight for his life at a Dallas hospital, public health officials and doctors told Texas lawmakers in the state Capitol on Tuesday that an outbreak of the virus is extremely unlikely and that the state is well-prepared to contain it. 

But some members of the Senate Health and Human Services Committee were not easily persuaded, questioning what some have called a botched response to the initial diagnosis of Thomas Eric Duncan, a Liberian who began showing symptoms of the virus while visiting his girlfriend in Dallas. 

"I'm trying to figure out where the breakdown was," said state Sen. Larry Taylor, R-Friendswood, referring to an initial misdiagnosis that led Texas Health Presbyterian Hospital in Dallas to send Duncan home with antibiotics even though he had told hospital employees he was traveling from Ebola-stricken Liberia. "That should have been setting off alarm bells," Taylor added. 

State Sen. Charles Schwertner, R-Georgetown and the chairman of the committee, said he was concerned about "the separation between the best-laid plans [for containing infectious diseases] and what actually occurs." 

Kyle Janek, Texas' health and human services executive commissioner, emphasized to lawmakers that it isn't easy to contract Ebola — bodily fluids must be exchanged — and that the state is capable of preventing an outbreak. “I believe Texas is well-positioned to handle this event," he said. 

Still, the handling of the case so far has exposed potential vulnerabilities in Texas' public health infrastructure that "require pretty intensive investigation," said Dr. Brett Giroir, the chief executive officer of Texas A&M University's Health Science Center, who is chairman of a task force on infectious disease preparedness that Gov. Rick Perry announced yesterday.

Giroir said that "hospital preparedness and improved diagnostics" is one area the task force will explore in light of the initial misdiagnosis of Duncan.

He also said there will have to be a review of how waste from Ebola patients and those close to them is destroyed. Giroir noted that dozens of 55-gallon drums needed to be removed from the East Dallas apartment where Duncan was staying and that a significant amount of waste is also generated in the hospital where he is being treated. Delays in getting state permits to transport and dispose of the waste resulted in Duncan's girlfriend and three family members being quarantined in the apartment alongside the soiled materials.

“This has been a major logistics issue that had the potential to interfere with patient care because of the accumulation of waste within the hospital facility," he said. 

Gary Weinstein, chief of critical care medicine at the Dallas hospital treating Duncan, testified at the hearing. He did not address any missteps that may have been made by the hospital in initially misdiagnosing Duncan, despite questions about it from Taylor. 

“Clearly there are things that we have learned, and have learned, and will continue to learn," Weinstein said, adding that the hospital is reviewing what happened and will make its review available to the public when it is finished. 

Communication was one issue Weinstein said needed to be addressed, since "there are so many people involved in [Duncan's] care," including public health officials on the local, state, and federal level.

Schwertner also mentioned Texas' decentralized health system, which was discussed in a recent Sunset Commission report. Local health departments take the lead in most public health situations, he said, which makes coordination difficult in the event of an outbreak of an infectious disease like Ebola.

“I think it speaks to the need for improvement in the chain of command and collaboration and coordination," he said. 

Giroir said all of those issues would be looked at by the task force, which Perry has asked to provide recommendations by December on how to better handle potential outbreaks of infectious diseases. Other areas of concern include how to better treat those who are identified as having come into contact with Ebola patients, after criticism of how Duncan's girlfriend and family members were treated. 

“These are not contacts, they’re people," Giroir said. “These people may need social services, mental health services."

He added that dozens of different languages are spoken in the neighborhood where Duncan was staying. A report in The Dallas Morning News suggested that many others in the East Dallas apartment complex could not read public notices about Ebola that were passed out to them because they don't speak English. 

State Sen. Jane Nelson, R-Flower Mound, said she wanted Texas to be a model for others states in dealing with public health emergencies and that more work needed to be done.

"I think it’s very important that we reexamine our preparedness," she said. "This has been a real wakeup call.”

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