U.S. officials trying to set up a network of hospitals in this country to care for Ebola patients are running into reluctance from facilities worried about steep costs, unwanted attention and the possibility of scaring away other patients.
“They’re saying, ‘Look, we might be willing to do this, but we don’t want to be called an Ebola hospital. We don’t want people to be cancelling appointments left and right,’ ” said Michael Bell, director of laboratory safety at the Centers for Disease Control and Prevention.
The reticence, although perhaps not surprising, complicates government efforts to ensure that the country can effectively treat people with Ebola and contain possible outbreaks. Just a few facilities in the United States have special biocontainment units, which are ideal for treating Ebola, and they can handle only two or three patients at a time. And the case of Thomas Eric Duncan, the Liberian man who was initially misdiagnosed at a Dallas hospital and died, shows how easily a community hospital can stumble.
Of the 5,000 hospitals in the United States, dozens have volunteered to treat Ebola patients. As of mid-November, CDC infection-control experts had visited 41 facilities in 12 states and the District of Columbia, according to agency Director Thomas Frieden.
But it is not clear how many medical centers will pass muster and whether the number will be enough for the administration to meet its goal of establishing an adequate network of Ebola-ready facilities. Bell said the government would initially like to have “a couple dozen” facilities in the network.
The Obama administration’s $6 billion emergency funding request for Ebola, which includes $154 million for hospital preparedness and support, envisions at least one designated facility in every state, and additional ones in New York City; Washington, D.C.; Chicago; Los Angeles; and Puerto Rico. The White House wants Congress to approve the request by Dec. 11, when current government funding runs out.
In trying to set up the network, federal officials, working with state health departments and local hospitals, are taking a three-step approach. The first priority is to find hospitals near five international airports — John F. Kennedy in New York; Newark Liberty; Washington Dulles; O’Hare in Chicago and Hartsfield-Jackson in Atlanta — that travelers from Guinea, Liberia, Sierra Leone and Mali are required to use when arriving in the United States.
Among the hospitals designated in that category are Johns Hopkins, Rush University Medical Center in Chicago and Bellevue in Manhattan.
The next priority would be to designate hospitals in communities that are home to large numbers of West African immigrants. The last group would be hospitals in states that do not have other Ebola-capable facilities.
Ten people have been treated for Ebola in the United States, and federal officials say the number of future cases is likely to be extremely small — in large part because airport screening and follow-up monitoring allows health authorities to spot possible cases and refer them to hospitals for treatment.
Hospital experts note that academic medical centers may be the best prepared to take on the task of caring for Ebola patients because they already treat the most complex cases. California, New York, Maryland, Virginia and Illinois are among the states that have designated regional trauma centers affiliated with medical schools to provide specialized Ebola care. New York has designated 10 hospitals. Health officials in the District and Georgia have identified hospitals but declined to name them.
The handful of U.S. hospitals that have treated Ebola patients have discovered that doing so can be costly, requiring around-the-clock care involving scores of nurses and other health workers. That would be a big challenge for many hospitals, where staffing is often stretched thin.
Adding to the burden is the widespread media attention that accompanies treating an Ebola patient and the potential loss of revenue if other patients steer clear of the facility. There is also the constant worry that a mistake could result in employees’ becoming infected.
“Right now, there honestly isn’t any incentive, and that’s part of the problem,” said Jeffrey Engel, executive director of the Atlanta-based Council of State and Territorial Epidemiologists. “Why would I get in line for that if I were a private-sector business?”
The need to shore up U.S. hospital preparedness became clear after Duncan’s illness was not correctly diagnosed when he first went to Texas Health Presbyterian Hospital Dallas. Duncan died Oct. 8, and two nurses who cared for him were infected but recovered.
More than 100 hospital health-care workers and other contacts were monitored for 21 days for possible exposure. In one case, the U.S. Coast Guard used a helicopter to deliver a blood test kit and protective gowns to a worker on a cruise ship so she could be tested.
The crisis affected the Dallas hospital’s bottom line. From Oct. 1 through Oct. 20, a period in which the emergency room was closed for nine days, emergency-room visits plunged and net revenue dropped, according to financial disclosure documents filed by the hospital’s parent company.
A spokeswoman for Texas Health Presbyterian said that patient volumes for most services have returned to average levels for this time of year but that emergency department volume remains below previous levels.
Most of the 10 Ebola cases in the United States were treated at three hospitals with biocontainment units — Nebraska Medical Center, Emory University Hospital and the clinical center at the National Institutes of Health in Maryland.
Those hospitals would be “overwhelmed by even a modest surge of 10 to 20 patients,” Bryce Gartland, vice president of operations for Emory University Hospital, said in a Nov. 7 letter to Congress in support of more federal funds.
Emory, which treated four patients, spent close to $1 million in direct costs to care for “a single high-intensity patient,” Gartland said. Nebraska Medical Center, which cared for three patients, said its direct costs from its first two patients surpassed $1 million. The “opportunity cost” of taking 10 beds out of service — part of infection control — was another $148,000, hospital officials have said.
Under the Obama administration’s budget request, there are no additional funds to reimburse the hospitals that have already treated Ebola patients. “I don’t know that every hospital out there would want to get into this business, to be honest with you,” Sen. Mike Johanns (R-Neb.) told Health and Human Services Secretary Sylvia Mathews Burwell during a congressional hearing.
So far, the costs have been handled by the hospitals and private insurers. “To date, it has not been an issue that has come to us,” Burwell said. “If this is something that [Congress] wants to discuss as part of this funding, we’re happy to entertain that.”
She added that the goal is for an Ebola patient to be within eight hours of treatment anywhere in the United States.
Last week, Sens. Edward J. Markey (D-Mass.) and Rob Portman (R-Ohio) introduced a bill that would use $125 million to fund regionally designated “Ebola treatment hubs” to care for patients and cover unpaid expenses.
Some of the biggest challenges for hospitals involve logistics. Where should patients be isolated to prevent infection? How should staffs be trained in wearing full-body protective gear? How should Ebola-related waste, which requires special disposal, be handled?
Beyond logistics, hospital executives are worried about the stigma of being known as Ebola treatment centers, said James Blumenstock, who oversees health security for the Association of State and Territorial Health Officials.
Hospitals and the public need to “get beyond that initial fear factor,” he said. “People should not be fearful that a good, strong medical center is willing to accept an Ebola patient as well as meet other community needs.”