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First Ebola Patient Diagnosed in U.S. Dies

Liberian Thomas Eric Duncan, the first person diagnosed with Ebola in the U.S., died in Dallas Wednesday. As Ebola continues to spread in West Africa, where more than 3,400 people have died of the disease, five of the busiest US international airports will begin enhanced screening measures to find travelers infected with Ebola. Forum will discuss how prepared the Bay Area is for a possible Ebola outbreak and what the U.S., and the world, can do to contain the disease.

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PBS NewsHour

Go inside a U.S. hospital preparing for more Ebola cases


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JUDY WOODRUFF: Now: how hospitals are preparing for possible Ebola cases in this country.

A judge in Maine ruled today against state officials who sought to quarantine nurse Kaci Hickox, who returned from West Africa after working with Ebola patients. Hickox has no symptoms and has refused to observe a voluntary quarantine. But the judge did say she must continue to be monitored for symptoms and must coordinate any travel with state officials.

The debate over that case comes as hospitals are scrambling to prepare for any future Ebola patients.

In New York state, Governor Andrew Cuomo designated eight hospitals that need to be ready.

The “NewsHour”‘s Megan Thompson visited one of those hospitals in Manhattan.

MEGAN THOMPSON: On Wednesday afternoon, staff was buzzing at the Mount Sinai Hospital on Manhattan’s Upper East Side. In a special ward, doctors, nurses and security were prepping at top speed for a dreaded scenario: someone with Ebola walking through their doors.

Dr. David Reich is the hospital’s president.

So, you have been at this hospital for 30 years. Have you seen anything like this before?

DR. DAVID REICH, President, Mount Sinai Hospital: There’s really nothing like this that’s ever been dealt with at this hospital before. And, in fact, I would say that, of all the hospitals in New York City, there really is nothing — there has really never been anything quite like this.

MEGAN THOMPSON: New York’s first case of Ebola last week, at nearby Bellevue Hospital, only added to the pressure. Mount Sinai is a top-notch hospital, but Ebola represents a whole new challenge.

The first thing that greets you when you walk in the door, big new signs in 13 languages. They say, “If you have symptoms and have traveled, tell us immediately.”

MAN: So, this is an isolation room in part of the emergency department.

MEGAN THOMPSON: Possible Ebola cases can be isolated here. Luckily, the only patient today is a mannequin used for training. So far, there have only been a handful of false alarms in the entire Mount Sinai system. But, until now, this hospital didn’t really have another place outside of the E.R. to provide long-term care for an Ebola patient.

Last week, this section of the hospital was part of the cardiac critical care unit. But, in just a matter of days, Mount Sinai has transformed it into a brand-new unit to care for possible Ebola patients. They’re still finishing it up, but they say that if somebody walks into the hospital today who might have Ebola, they’re ready for them.

DR. DAVID REICH: And we have completely walled it off.

MEGAN THOMPSON: The new unit is sealed off. And while Ebola is not an airborne disease, a negative pressure system and heavy-duty air filters are in place as extreme precautions.

Special protocols are followed to get rid of all waste. And this new communications system will allow staff to monitor and talk to patients without having to get close.

DR. DAVID REICH: The facility is in some ways only the smallest part of this. Creating a team that is competent and confident in their skills to care for a patient with this deadly disease that provides extreme risk to health care workers, that is the real challenge for us.

MEGAN THOMPSON: So, Mount Sinai conducts training regularly to make sure the staff is prepared. An expert from the CDC is here to consult. One of the most important and new procedures to learn is how to put on the protective personal equipment.

WOMAN: I’m going to read out the safe work practices.

MEGAN THOMPSON: Nurses train with a coach and a checklist. There are special coveralls and thigh-high plastic booties, a respirator, hoods, goggles, a second gown, two sets of rubber gloves, and a face shield. Every detail is rehearsed, down to the type of knot securing the smock.

WOMAN: We have to make sure we’re hydrated before we suit up, if you need to use the bathroom, because it’s going to take time for us to do that again.

MEGAN THOMPSON: Plus, it’s just hard to work draped in all that plastic and rubber.

DR. DAVID REICH: We did a simulation last Thursday with the CDC watching us. After about 45 minutes, they were exhausted, they were soaked in sweat. It’s very clear that anything that we take for granted in terms of normal functions in an intensive care setting is so much more difficult.

MEGAN THOMPSON: So staff practice maneuvering around in all the gear.

MAN: Spray everything with bleach.

MAN: Keep everything nice and calm and stable.

MEGAN THOMPSON: And during simulations, they troubleshoot to find holes in their systems. Here, a doctor pretends to be an Ebola patient who accidentally tore off the nurse’s gown.

MAN: She comes out on her own.

MEGAN THOMPSON: The team must figure out how to react.

MAN: The patient needs to understand that they cannot pull on you.

MEGAN THOMPSON: And then there’s taking off the protective gear. What might seem like a simple act could actually be the most dangerous, because this is when exhausted nurses and doctors could accidentally contaminate themselves.

The hospital is constructing another isolation unit outside that will eventually be the primary Ebola care center. But all in, the new units will only be able to handle about three patients at a time. And that could pose a problem if the outbreak grows dramatically worse.

Hospital officials wouldn’t provide specific numbers, but it’s clear the costs for all this will be considerable.

Dr. Kenneth Davis heads the entire Mount Sinai system.

DR. KENNETH L. DAVIS, CEO and President, Mount Sinai Health System: This is expensive. The drill — the drilling, the equipment, the construction, it’s all not been budgeted. And in hospitals like ours, which have a very large percentage of patients who are largely Medicare or Medicaid, the margins are very narrow. So, we’re ultimately going to be looking for federal, state, local help.

MEGAN THOMPSON: While all of this might look like something out of a sci-fi movie, Dr. Davis says, everyone needs to remember to stay calm.

DR. KENNETH L. DAVIS: What separates this from anything else we have ever seen is the degree of anxiety, almost hysteria, that’s in the population about this. Let’s remember, there is one case in New York. There are less than a handful of cases in the United States. And the cases are, by and large, health care workers.

MEGAN THOMPSON: For weeks to come, Mount Sinai’s health care workers will continue to practice the new procedures, procedures they hope they will never have to use.

For the “NewsHour,” this is Megan Thompson reporting from New York.

The post Go inside a U.S. hospital preparing for more Ebola cases appeared first on PBS NewsHour.

Medicare paid for drugs after patients had died, report finds

Photo by Flickr user Images_of_money.

Photo by Flickr user Images_of_money.

WASHINGTON — Call it drugs for the departed: Medicare’s prescription program kept paying for costly medications even after patients were dead.

The problem was traced back to a head-scratching bureaucratic rule that’s now getting a second look.

A report coming out Friday from the Health and Human Services Department’s inspector general says the Medicare rule allows payment for prescriptions filled up to 32 days after a patient’s death — at odds with the program’s basic principles, not to mention common sense.

“Drugs for deceased beneficiaries are clearly not medically indicated, which is a requirement for (Medicare) coverage,” the IG report said. It urged immediate changes to eliminate or restrict the payment policy.

Medicare said it’s working on a fix.

Investigators examined claims from 2012 for a tiny sliver of Medicare drugs — medications to treat HIV, the virus that causes AIDS — and then cross-referenced them with death records. They found that the program paid for drugs for 158 beneficiaries after they were already dead. The cost to taxpayers: $292,381, an average of $1,850 for each beneficiary.

Medicare’s “current practices allowed most of these payments to occur,” the report said.

Of 348 prescriptions dispensed for the dead beneficiaries, nearly half were filled more than a week after the patient died. Sometimes multiple prescriptions were filled on behalf of a single dead person.

Investigators don’t know what happened to the medications obtained on behalf of dead people, but some may have been diverted to the underground market for prescription medicines. The report said HIV drugs can be targets for fraud since they can be very expensive; one common HIV drug costs about $1,700 for a month’s supply, it said.

Medicare is the government’s premier health insurance program, providing coverage to about 55 million seniors and disabled people. Prescription coverage delivered through private insurance plans began in 2006 as a major expansion of the program. But it’s also been a target for scams.

The report did not estimate the potential financial impact across the $85 billion-a-year Medicare prescription program known as Part D. But investigators believe the waste may add up to millions of dollars. Investigators don’t know what happened to the medications obtained on behalf of dead people, but some may have been diverted to the underground market for prescription medicines. “The exposure for the entire Part D program could be significant,” said Miriam Anderson, team leader on the report. “The payment policy is the same for all drugs, whether they are $2,000 drugs to treat HIV or $4 generic drugs.”

In a formal response, Medicare agreed with the investigators’ recommendations.

“After reviewing this report, (Medicare) has had preliminary discussions with the industry to revisit the need for a 32-day window,” wrote Marilyn Tavenner, the Obama administration’s Medicare chief.

Medicare had originally maintained that the date of service listed in the billing records could instead reflect when a pharmacy submitted bills for payment. That billing date might have actually occurred after a prescription was filled, since some nursing home and institutional pharmacies submit their bills in monthly bundles.

However, the inspector general’s investigators found that about 80 percent of the prescriptions for dead beneficiaries were filled at neighborhood pharmacies, undercutting Medicare’s first explanation. As for the remainder, the investigators said they didn’t see any reason pharmacies can’t report an accurate date of service.

Investigators said they stumbled on the problem during an examination of coverage for AIDS drugs dispensed to Medicare beneficiaries. Sexually transmitted diseases are an increasingly recognized problem among older people.

That earlier investigation raised questions about expensive medications billed on behalf of nearly 1,600 Medicare recipients.

Some had no HIV diagnosis in their records, but they were prescribed the drugs anyway. Others were receiving excessively large supplies of medications. Several were getting prescriptions filled from an unusually large number of pharmacies.

Prescription drug fraud has many angles. When the high price of a drug puts it out of reach for certain patients, it can create an underground market. And some medications, like painkillers and anti-anxiety pills, are constantly sought after by people with substance-abuse issues.

The post Medicare paid for drugs after patients had died, report finds appeared first on PBS NewsHour.

Soldiers and civilians face different Ebola protocols

A Maine State Police officer walks in front of the home where Kaci Hickox is staying with her boyfriend Theodore Michael
         Wilbur on Oct. 30, 2014 in Fort Kent, Maine. After returning from Sierra Leone where she worked with Doctors Without Borders
         treating Ebola patients, nurse Hickox publicly challenged a quarantine order by the state of Maine. She has twice tested negative
         for Ebola and says she will lead a normal life unless she feels ill. Photo by Spencer Platt/Getty Images

A Maine State Police officer walks in front of the home where Kaci Hickox is staying with her boyfriend Theodore Michael Wilbur on Oct. 30, 2014 in Fort Kent, Maine. After returning from Sierra Leone where she worked with Doctors Without Borders treating Ebola patients, nurse Hickox publicly challenged a quarantine order by the state of Maine. She has twice tested negative for Ebola and says she will lead a normal life unless she feels ill. Photo by Spencer Platt/Getty Images

WASHINGTON — A U.S. soldier returning from an Ebola response mission in West Africa would have to spend 21 days being monitored, isolated in a military facility away from family and the broader population. A returning civilian doctor or nurse who directly treated Ebola patients? Depends.

The Pentagon has put in place the most stringent Ebola security measures yet, going beyond even the toughest measures adopted by states such as New York, New Jersey and Maine and much further than the guidance set by the federal Centers for Disease Control and Prevention for travelers returning from the afflicted region.

“I have one responsibility and that is the security of this country,” Defense Secretary Chuck Hagel said Thursday. “And that means the security of our men and women and their families.”

He called the Pentagon’s step a “smart, wise, prudent, disciplined, science-oriented decision.”

Yet, the policy far surpasses federal government standards. The CDC recommends that only people at the highest risk — those who’ve had direct contact with an Ebola patient’s body fluids, for example — avoid commercial travel or large public gatherings for 21 days. Anyone who develops symptoms would be hospitalized immediately.

The differences are partly a function of the military’s unique role, the constitutional authorities granted to individual states and the federal government’s desire not to discourage health care workers from volunteering to help confront the deadly Ebola virus at its source in Sierra Leone, Liberia and Guinea.

But the varying approaches have raised questions about whether and how different levels and agencies of government are coordinating the response to Ebola in the United States.

For now, the questions are mostly academic.

Only one Ebola patient has died in the U.S. and he contracted the disease in Liberia. Two nurses who were infected by that patient have recovered and have been declared Ebola-free. One doctor who recently returned from treating Ebola patients in West Africa has been diagnosed with the virus and is being treated at a hospital in New York.


  • The Pentagon: Returning troops would have to undergo a 21-day quarantine even though their jobs do not require them to be in contact with Ebola victims. The military facilities could be in the U.S. or overseas. Already a group of 42 returning soldiers, including a two-star Army general, are in supervised isolation at a military base in Vicenza, Italy.
  • The states: Not all have developed responses, but among those who have New York, New Jersey, California, Illinois, Georgia, Florida and Maine are imposing 21-day quarantines for health care workers and other travelers from West Africa who had direct contact with people with the Ebola virus but show no symptoms of the disease.
  • The federal government: The CDC recommends 21-day isolation and monitoring for people who show no symptoms but who have had direct contact with an Ebola patient’s bodily fluids, either through exposure or a needle prick, for instance. For those who have been in close contact with patients but have not been directly exposed to a patient’s fluids, the CDC recommends daily self-monitoring for 21 days. Those recommendations are supposed to serve as guidelines for state policies.


Defense officials maintain that the Pentagon rules are necessary because even through troops will not treat Ebola patients, they will spend more time in the Ebola hot zone than health care workers.

Gen. Martin Dempsey, chairman of the Joint Chiefs of Staff, said the U.S. troops comprise the largest portion of the U.S. contingent in Liberia and will be staying there for six months at a time, compared with the 30-day to 60-day stays for U.S. civilian health care workers. Pentagon officials also note that the troop presence in West Africa will likely grow to up to 4,000 over time.

“Being in the hot zone is like being in a war zone; the longer you’re there the greater the chances of being injured or killed,” said James G. Hodge Jr., a professor of public health law at the Sandra Day O’Connor College of Law at Arizona State University.


It’s a question some military spouses are certainly asking. Rebekah Sanderlin, a board member of the Military Family Advisory Network, said she hasn’t heard complaints about the 21-day policy for service members. But, she added: “There is a lot of confusion over the quarantine policy because the military and civilian guidelines do not match. I do think if a quarantine period is justified for one group, it is justified for all.”

Hodge, who is western director of the Network for Public Health Law, notes that service members, unlike civilians, can have their liberties curtailed. As White House spokesman Josh Earnest noted this week, “There might be some members of the military who think that the haircut that’s required may not be their best, but that’s a haircut that they get every couple of weeks because it is in the best interest of their unit and it maintains unit cohesion, and that is a policy of the military.”

President Barack Obama has urged states to consider how their policies will affect the willingness of civilian doctors and nurses to volunteer for Ebola work in West Africa. Unlike those civilians, Obama said this week, the troops are not there voluntarily. “It’s part of their mission that’s been assigned to them by their commanders and ultimately by me, the commander in chief,” he said.


The biggest Pentagon deployment is in Liberia with 1,000 troops. There are about 120 in Senegal, where they operate a staging base for operations in Liberia. Dempsey said Thursday that the troop presence is intended to grow to about 4,000.

As for civilians, since the CDC began tracking travel from West Africa, it has detected fewer than 100 people a day entering the United States, most of them U.S. citizens or legal permanent residents, according to CDC Director Thomas Frieden. He said about 5 percent have been identified as either health care workers or someone who had been in contact with an Ebola patient, but not exposed to bodily fluids.

Seven out of 10 of those returning civilians go to six states: New York, Maryland, Pennsylvania, Georgia, New Jersey and Virginia.


Pentagon officials say any individual diagnosed with the disease would be transferred to the United States for treatment. Right now, however, there is only one aircraft designated to transport a sick individual from West Africa to the U.S. and it can only hold one person at a time and make only four trips a week, according to Maj. Gen. Lariviere, who testified before the House Oversight and Government Reform Committee last week.

He said the Pentagon has a plan for isolation pods that could carry 15 people at a time inside C-17 military transport planes. He said purchase of those pods would not begin until January.

The post Soldiers and civilians face different Ebola protocols appeared first on PBS NewsHour.

Doctors face tough treatment choices in the midst of the Ebola crisis


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JUDY WOODRUFF: Next: a closer look at the growing human toll Ebola is taking on the communities of West Africa, the epicenter of the current outbreak.

We have two updates from New York Times reporters who are working in the region.

The first is from Ben Solomon, who filed this video report from inside an Ebola treatment center in the countryside east of the Liberian capital, Monrovia.

GARMAI CYRUS, Psychosocial Officer and Nurse: What I see in the faces of the patients? Fear. Fear of the unknown. Right beside them, friends die. It’s so, so frightening. Is this how I’m going to end up, too?


GARMAI CYRUS: My job is to help them to see, amidst Ebola, that there’s still hope.


GARMAI CYRUS: I come here every morning. We sing to build up our hopes, then get prepared.

I’m a nurse. I’m a mental health clinician. And I work here as a psychosocial officer. When I go in, I’m like an aunt to them inside. Most of them refer to me as big sister.

It’s within my spirit to give care, do it without touching or so, but there are other things that we can do, like build their hope, make them to feel more confident that they can come in here and walk out.

At the moment, we are discharging. We have one patient who her test proved negative, and so we had to discharge her out.

What gives me the most, most hope, people come in here so frustrated and sick, and, after, they walk out of here. It makes me feel that I’m working and I’m able to do something. It makes me happy. It makes me feel fulfilled.

JUDY WOODRUFF: That report prepared by reporter Ben Solomon.

Sheri Fink has also been reporting from Liberia for The New York Times. In addition to her journalist credentials, she’s also a medical doctor. I spoke with her a short while ago over Skype from Monrovia.

Sheri Fink, welcome.

You have been writing some very moving stories recently, the overwhelming tragedy, but also some very tough decisions that the doctors have to make. Talk about that.

SHERI FINK, The New York Times: Yes.

One of the doctors here named Steven Hatch, he speaks of it as Solomonic decisions, and, really, every day brings some of these tough choices. Ebola treatment units, in a way, they’re kind of simple. They’re not a lot of advanced care that’s offered. In fact, it’s sort of a protocol. Every patient gets a mix of medicines when they come in to cover things like, you know, a coinfection with something like malaria.

Sometimes, you know, Ebola can reduce the effectiveness of the immune system. So people even get antibiotics, even though Ebola is a viral disease. So you would think it’s sort of simple fluids and some of these extra medicines, but, in fact, there are all these choices that have to be made.

For example, if you have somebody who tests negative, but then they develop symptoms while they’re in the suspect ward, well, then, you know, it’s possible that they still will turn positive. So do you keep them there and possibly expose them to other people who have Ebola in order to test them again?

And, you know, all these difficult choices come up, even with children. That’s another example, where, you know, a parent tests negative air, a child tests positive. So what do you in that situation?

JUDY WOODRUFF: You wrote about a mother who died, a pregnant woman who died and had to make a decision about what to do with the infant when it was born.

You also wrote about another mother who lost an infant and how she struggled with an infection and her treatment.


I think these were two of the more really heart-rending stories. I guess there are stories like that every day. And they really sort of emphasize why the doctors and nurses who I have been chronicling for the last few weeks, they feel a lot of joy when people survive.

But they get — over time, they realize that what the world has to offer for people who have Ebola just isn’t quite there. So even take the pregnant woman. It turns out that Ebola is very highly — you know, it’s even more fatal in people who are pregnant, and, you know, just the tragedy of that alone.

This particular woman, they didn’t know if she had Ebola. She hemorrhaged after having a spontaneous childbirth of an eight-month-old — eight months into her pregnancy. And she went from hospital to hospital while she was still alive, while she was, you know, struggling to survive.

No hospitals would let her in, because that’s kind of a classic presentation with Ebola, and highly infectious, obviously, if there’s blood. So finally, the car with her parents and the lady and her baby make it to the Ebola treatment unit. And, by that point, she had passed away. But the doctors and nurses had to struggle with this decision of, what do we do with this infant?

They had no idea. Could the infant be positive? There’s not a lot of science around that or data or information, because we just haven’t studied this disease as much as it would have been good to do. So they made the best choice they could. They sent the baby home with the grandparents, and you know, with gloves, with formula, in the hopes that they could give the child a chance at surviving.

The child died three days later. And then two weeks after that, the mother, who had helped deliver her — the grandmother who had helped deliver her daughter’s baby and had cared for the baby ended up coming down with Ebola and dying in the clinic. So these are the sort of — like, if you stay there long enough, you see how this disease moves through families that way.

And, again, it’s those high-risk contacts, the real contact with the body fluids that seems to be the theme over and over again.

JUDY WOODRUFF: Right. Just — just terrible.

Finally, Sheri Fink, the last story you wrote, despite all this, is surprisingly low numbers of patients being treated in these newest hospitals around Monrovia, where you are.

SHERI FINK: Actually, it seems to be a pattern across the country.

Now we have the WHO saying that there really has been, they believe, a slowdown in that upsurge in infections. And they really emphasize it’s not a reason to pull back on any of the plans, because there are large swathes of the country that don’t have treatment units.

And that’s part of what the U.S. is doing is trying to build and staff these treatment units that are in distant parts of the country, where there’s not great surveillance. There aren’t good options for people who have no access to cars, no cell phone service, and just — also just these really bad roads, frankly.

So, right now, it’s hard for them to be safe. You know, you have a family member who is sick. If you have to wait two days to get somebody to get them to a treatment unit, or if they die, to have a safe burial, that’s really tough.

So what the numbers are suggesting is there is some positive news, that some of these interventions that we have seen so much work on in the last few weeks and months may be starting to slow this epidemic, which is great news, but certainly not a reason to let up, according to the experts here.

JUDY WOODRUFF: Sheri Fink reporting from the front lines there in Liberia, we thank you.

SHERI FINK: Thanks a lot.

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