Tag Archives: Obama

Heads in the Sand: Obama, the CDC and Claims of Ebola Preparedness

Thousands of people have travelled from West Africa to the US in the last 6 months.  While the CDC and others throughout the Obama administration continue to reassure everyone that the US is 100 percent prepared for an outbreak,  potential cases and exposures continue to surface all across the country.  In Dallas, the first confirmed case of Ebola remains in critical condition.  Even more concerning is the fact that the patient initially presented to the Emergency Room with a fever at Texas Health Presbyterian Hospital (and even though he provided a high risk travel and exposure history) we was sent HOME.  Initially, the hospital blamed the fact that he was sent home with high risk features (his records documented the fact that he had just travelled from Liberia) was that there was a “technical glitch” in the electronic medical record and that physicians were unable to access the data obtained by the triage nurse.  Days later, the hospital rescinded their comments and admitted that the data was there for anyone involved in the case to see but in fact, no one even noted his West Africa travel history and released him from the ER.  These missteps resulted in the potential exposure of nearly 100 contacts AND the isolation of several family members.  But today, the director of the CDC, Dr. Tom Frieden, continues to proclaim on the national media that the US is well prepared and that all local healthcare agencies have policies and procedures in place to avoid major outbreaks and exposures.

Really?  Its Time for the CDC and our administration to get its collective head out of the sand!  

According to the WHO, the number of Ebola cases is expected to continue to rise sharply in the month of October.  The CDC estimates that there may be as many as 1.4million cases before the current outbreak is over.  Others worry that the disease is now so far out of control in West Africa that it will soon become endemic.  Currently, most families in West African countries actually spend nearly 80% of their monthly income on food–now prices are increasing and food is becoming even more scarce.  As West African nations become increasingly economically challenged by the outbreak, it is likely that many will flee the country illegally (and untracked and unscreened)–resulting in further spread of disease and wider contact with individuals from other nations.  The first US case admitted to lying on his immigration forms before fleeing Liberia and would have been considered high risk due to close contact with family members with documented Ebola.  At this point, the CDC and its leadership continue to proclaim that they are “looking at possible actions” to help prevent the entry of Ebola into the US.  However, there are no specific plans in place and no real travel protocols have been established.  US air carriers admit to confusion about what to do and how best to screen passengers.  One particular airline has told its employees to treat all bodily fluids on flights as potentially infectious.

Now certainly, we should not panic.  I agree that the US is better equipped to handle an outbreak of an infectious disease than any other country in the world.  We have state of the art isolation facilities, an abundance of medical resources and the wisdom of many of the worlds’ brightest physicians.   Our advantages in treating any potential Ebola cases in the US are huge—However, we must put policies and procedures in place NOW–not after more cases appear stateside.

What steps can we take to prevent Ebola spreading in the US?  First, we need to make sure the virus does not arrive here–and when it does we must have a plan in place to isolate and contain any potential carriers

 

  1. Initial standardized screening of people travelling from endemic countries must be set into place now.  We must consider travel bans and Pre Flight 21 day quarantines prior to travel to the US in order to ensure that no patients with disease are inadvertently admitted to the US.
  2. Airline personnel must have standard protocols in place should a passenger become sick–isolation equipment and protective gear must be readily available and crews should be provided with specific training designed at protecting themselves as well as other passengers.
  3. Improved education for healthcare providers, emergency department personnel and first responders.  We must put protocols for response in place that are easily implemented when confronted with a suspected case.  Travel history and exposure history must become the first line of defense–we cannot afford to send a high risk patient home again.
  4. Immigration and Passport control should also screen all high risk travelers (from endemic countries) upon entering the US as well.  Those that are considered to pose a risk must be quarantined upon arrival for 21 days.
  5. Private industry resources must be focused on the mass production of vaccines such as ZMAPP and other potentially life saving drugs. While government should play a role in development and deployment, the private sector should be leading the charge in order to avoid the inevitable slow downs associated with government led initiatives.  These drugs should be fast tracked and studied while being put to use in West Africa.  While the science behind their effectiveness is solid thus far, there have not been nearly enough clinical trials and standard safety and efficacy trials put in place.   However, these drugs must be tested in practice in areas of outbreak.  We do not have time to await months to years of clinical trials in healthy subjects.

So, where is our government in all of this?

At present, both the Obama administration and the CDC continue to downplay the threat of Ebola in the US.  I fear that while government rhetoric continues to highlight the absolute preparedness of the US in the case of an outbreak, the reality of Ebola cases in the US (the one documented case thus far was sent home from the Emergency Room with a fever) are quite concerning.  I wonder if we could quickly coordinate an effective response should more cases arise?  The situation in Dallas–while contained now, had the potential to spread to more than 100 people during the initial presentation of the patient.  Today, the President will meet with the director of the CDC.  It is my hope that we will soon put policies in place to protect Americans from the spread of the disease.

We must Act rather than discuss.  We must Prevent rather than respond.

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Sex, Lies and Healthcare Reform: The Current (Sad) State Of The (Un)Affordable Healthcare Act

This week, the US House of Representatives finally got the opportunity to question Secretary Kathleen Sebelius and examine the debacle that is the Affordable Care Act.  Unfortunately, the Secretary of Health and Human Services spent most of the 3 hour session skirting around the issues and tossing blame to other government agency bureaucrats, government contractors and of course the GOP.  When repeatedly pressed, she did in fact admit responsibility for the failed rollout but stopped short of admitting that the ultimate responsibility falls upon the Commander in Chief, President Barack Obama.  Like any good soldier in a politically appointed job, she protected her boss from the fallout of the TRUTH.  However, in spite of the Secretary’s claims of ignorance during her testimony, Lawmakers on the House committee as well as the American people were able to begin to better understand why the ACA has been such a disaster:

1. A complete lack of leadership on the part of the President and his appointees.

2. A complete lack of understanding of the law by the very people who drafted and now champion the legislation.

3. A complete lack of understanding of process of healthcare delivery in the US today

For example, numerous provisions have already been delayed and many more are likely to be postponed in the future.  The mandates on some businesses, the out of pocket expense caps, and now the individual mandate–just to name a few.  Throughout the process there have been many misleading statements made by the President and his political colleagues both in the White House and on Capitol Hill.  No less than 6 different statements were made by Mr Obama forcefully claiming in 2009 while addressing the American Medical Association:

If you like your doctor, you will be able to keep your doctor, period, If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.”

Obviously the hundreds of thousands of insured that are now being dropped by their insurance plans and forced into the exchanges are proof that these statements are in fact not true.  In addition, there is mounting evidence that the White House as well as Secretary Sebelius knew about these issues with potential coverage loss for quite some time.  An IRS document from 2010 (during the time in which the President was making such bold statements about coverage) suggested that this may in fact not be the case.  This document clearly states that an estimated 40-60% of individual policyholders would be dropped from their plans due to the ACA.  An article in yesterday’s Washington Post awards the administration with “Four Pinocchios” for making untrue claims about his cherished ACA.

We are a nation built on certain guaranteed Freedoms–in particular freedom of choice, freedom of religion and freedom of speech–we are slowly losing our way in the healthcare debate.  Those with a particularly stringent religious beliefs concerning premartial sex and birth control practices are now forced to purchase products that supply contraception.  The Catholic Church–whose believers practice natural family planning–are being forced to provide their employees with funding for birth control.  Our government has clearly overstepped its bounds.  Those who are healthy and have little need of expensive insurance policies are now forced to pay for benefits they may not really need.   The entire success of the ACA system requires that those who don’t need medical care pay for those who do–a unique system for transferring wealth.

Ultimately, costs will  continue to rise.  As evidenced by a report filed by Sebelius’s very own HHS in September 2013, most will see a significant premium increase.  The average male in the US today who enters the exchange will see a 99% increase–the average female will see a 67% increase.  In some states such as North Carolina where I reside, the average man will pay a 350% increase in premium.  Rather than closing the wealth gap in the US, the ACA will actually result in the development of two divergent classes of Americans with respect to healthcare–Those with wealth will be able to pay out of pocket for concierge medicine–they will have access to whatever they need, whenever they need it as long as they can continue to pay.  The rest of America will be lumped into the dysfunctional and bureaucratic Obamacare system.

I am sadly disappointed by my government–those in charge have slowly chipped away at my noble profession–Medicine is in jeopardy of no longer being a form of art–soon medical care will be an automated system carried out by a group of mindless lemmings.  The doctor-patient relationship which has been the core of good medical care is in danger of extinction.  I am a firm supporter of providing healthcare to those who cannot afford it–just not at the cost of Freedom.  I can only hope that those in power in Washington will respect the basic tenets of our democracy and, most importantly, put legacy and ego aside and do what we do best as doctors–put patients first.