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CDC tightens safety rules at U.S. hospitals treating patients with Ebola

CDC tightens safety rules at U.S. hospitals treating patients with Ebola

The U.S. Centers for Disease Control and Prevention tightened safety rules nationwide for all hospitals that treat patients with Ebola after two nurses contracted the infectious disease when treating a Dallas hospital patient who died earlier this month from the virus.

In addition, the CDC said it will send a rapid-response team to assist any hospital in the country that diagnoses another Ebola patient.

Even before the CDC took action last week to quell the national panic, officials at Texas Health Presbyterian Hospital Dallas admitted mistakes were made and said the facility changed its procedures on handling patients with diseases such as Ebola.

The two nurses contracted the virus after treating Thomas Eric Duncan, who was exposed to Ebola in Liberia and died from the disease earlier this month at the Dallas hospital.

While Texas allows employers to opt out of its workers compensation system, a spokesman for Texas Health Presbyterian said the hospital does have workers comp insurance. The spokesman said the hospital is covering the cost of medical treatment and other expenses for the two nurses, who were moved to two of the five U.S. hospitals specially trained and equipped to treat patients with Ebola.

However, the hospital spokesman would not disclose which insurer or insurers provide its workers comp coverage, or whether the hospital expected the coverage to pay for the nurses' medical treatment.

Ebola would be compensable under workers compensation like other illnesses and injuries that can occur within the course and scope of a health care worker's employment, workers comp industry experts say.

Because of its spread through bodily fluids and its 21-day incubation period, it's significantly easier to prove Ebola was contracted on the job than other infectious diseases to which health care workers are exposed.

“Unlike the flu, which you can get anywhere, it's highly unlikely that a caregiver is going to get Ebola outside of his or her work,” said Joe Paduda, principal of Madison, Connecticut-based Health Strategy Associates. “I don't think any insurance company or any judge would say, 'Oh, you can't prove that came about because that nurse wasn't working in the (emergency room).' ”

Workers comp insurers including Chubb Corp., The Hartford Financial Services Group Inc., Liberty Mutual Insurance Co. and Travelers Cos. Inc. declined comment.

“There's likely only going to be a small number of cases, but each one of those cases could have a significant financial impact” and negatively affect an employer's workers comp experience rating, said David C. Kurtz, Boston-based partner at Constangy, Brooks & Smith L.L.P. “You're talking about such catastrophic claims and … such expensive treatment that you may in fact hit those limits and move into the reinsurance realm.”

Given how workers comp is priced, with many programs being loss-sensitive, premiums could increase if employers file Ebola-related claims, said Robert Hartwig, president of the New York-based Insurance Information Institute Inc. However, that might not be the case if insurers think employers have taken steps to curtail risks from Ebola.

“Let's say an employer has a poor year with respect to its workers compensation losses because of slip-and-fall injuries or motor vehicle accidents employees are involved in,” Mr. Hartwig said. “The insurer might have good reason to believe there's a serious issue here and it's going to take time to resolve. Whereas something like an employee or two infected by Ebola, it may be the case that the health care facility has adopted new treatment protocols and it may be viewed that the risk of an additional exposure is minimal.”

It costs thousands of dollars a day to treat one patient with Ebola, experts say. It can cost an estimated $1,000 an hour alone to maintain the isolation treatment rooms, said JoAnn Sullivan, San Jose, California-based senior vice president and managing consultant at Marsh Risk Consulting's workforce strategies practice. That's in addition to the cost of ancillary services, medications, disinfecting and cleaning, and — in the case of the Texas Health Presbyterian nurses — airlifting and transporting them to hospitals that are specially trained to treat patients with Ebola, Ms. Sullivan said.

Other workplace safety lessons learned from the Ebola cases at Texas Health Presbyterian include the need to have proper equipment available at every access point and the importance of taking a hands-on approach to training, Ms. Sullivan said.

“You cannot do this type of training by reading a sheet,” said Tom Fuller, assistant professor and safety program director at Illinois State University in Normal, Illinois.

Most nurses treating Ebola patients have not been taught how to properly use personal protective gear without cross-contaminating themselves or the floor, said Mr. Fuller, who's also a health care working group member of the Falls Church, Virginia-based American Industrial Hygiene Association. “And you might have to practice it a few times before you get it down.”

Included in the CDC's safety rules for hospitals issued last week are step-by-step instructions about properly putting on and removing personal protective equipment to avoid health care workers contracting the disease.

Dr. Daniel Varga, chief clinical officer and senior executive vice president at Texas Health Resources, the parent company of the Dallas hospital, said in a statement to the media last week that Texas Health Presbyterian is taking a more “proactive, intensive and focused'' approach to train hospital workers based upon the best available information to treat patients who contract Ebola.

“Where we fell short initially was in our ability to detect and diagnose (the disease),” Dr. Varga said.

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