Dallas Declines to Declare an Emergency

     DALLAS (CN) – Weighing public fears of Ebola and civil liberties, the Dallas County Commissioners Court on Thursday declined to declare a local emergency or impose control orders on health care workers who cared for the late Thomas Eric Duncan.
     With approval of Gov. Rick Perry, such a declaration would give Dallas County Judge Clay Jenkins and Mayor Mike Rawlings authority to control access to the disaster area and the movements of the area’s occupants.
     Calls for such a declaration have grown from the public as two of Duncan’s nurses have tested positive for Ebola.
     During a special meeting Thursday afternoon, Commissioner John Wiley Price said such a declaration “may or may not accomplish what we expect” due to “other issues looming.”
     “We need to probably move cautiously with this declaration,” Price said. “It is in our toolbox, but I’m not sure if it is prudent.”
     Jenkins said a declaration would allow Perry to set up a district disaster center, but one is already up and running in Garland.
     “Things that have been needed, like control orders, those are things we’ve been able to work out with health workers to keep them from travelling,” Jenkins said. “There is no need to use extraordinary powers.”
     Jenkins said there is “nothing in a declaration” that would help him, and that Perry feels the same way.
     “It’s a very serious situation but we need to keep it in our toolbox,” Jenkins said. “Because there is a very good working relationship with federal, state and local authorities, we don’t feel like we need it at this time.”
     Jenkins said that instead of placing control orders on the 75 medical contacts at Texas Health Presbyterian Hospital Dallas where Duncan was treated, the contacts will enter into voluntary agreements with Dr. David Lakey, commissioner of the Texas Department of State Health Services.
     Under the terms of the voluntary agreements , the Presbyterian Hospital contacts who directly cared for Duncan agree to twice-a-day monitoring, including temperature checks, with at least one of the sessions being a face-to-face encounter.
     “No individual health care worker who entered the first Ebola patient’s room can go to any location where members of the public congregate which includes but is not limited to restaurants, grocery stores, theaters or other places where the public may be in attendance or gather, throughout the entire 21 day time period that follows the individual’s last exposure,” the agreement states. “Any health care worker that does not adhere to monitoring or any of these other measures may be subject to a communicable disease control order.”
     The Presbyterian Hospital contacts also agree to not go on long-distance trips on airplanes, ships, long-distance buses or trains.
     “Local use of public transportation (e.g. taxi, bus) by asymptomatic individuals should be discussed with the public health authority,” the agreement states.
     “These documents are an agreement between [the Presbyterian Hospital contacts] and Lackey, to stay away from places people congregate – which they are happy to do – and stay away from public transportation,” Jenkins said.
     Calls for court-imposed orders have grown after it was revealed that nurse Amber Vinson flew from Cleveland back to Dallas on Frontier Airlines Flight 1143 on Monday morning – one day before she reported to Presbyterian with a fever and was isolated .
     Rawlings told the commissioners the focus now should be on the Presbyterian contacts, not the 48 original contacts of Duncan. He expressed his disappointment in the confirmed Ebola infections of Vinson and nurse Nina Pham, but does not feel court-imposed travel bans are the answer.
     “We have been successful with the 48 individuals who came into contact with Mr. Duncan,” Rawlings said. “We were disappointed to hear the hospital was not as successful. … We must make sure [the Presbyterian contacts] are safe and those they come into contact with as well. We should ask them to voluntarily agree to restrict their travel, to make sure they monitor themselves and stay away from all public places. if they do that, we will know instantaneously if their temperature spikes and we will take measures accordingly.”
     Rawlings urged the commissioners to not “dial this up to another level” with a declaration, that “a lot of other people will suffer in this process.”
     “We have to make sure 99.9 percent of people are safe and we do not want to harm them,” Rawlings said. “And we want to make sure our business enterprise continues to go. Contracts on convention business have a force majeure clause on them; if we do that other people will be harmed as well.”
     Jenkins sought to remind the public the 75 Presbyterian employees under self-monitoring are not pariahs, but “hometown healthcare heroes.”
     “These are people who chose a career to make their lives work public heath, to serve their fellow man,” he said. “These aren’t criminals. These aren’t risks to our community. They are not diseased characters; they are disease contacts.”
     Jenkins said the Presbyterian workers are in the “unenviable position of a scary waiting period.”
     “They need to feel an outpouring of compassion and appreciation, they don’t need to feel like ‘others’ we need to declare martial law on,” he said.
     Jenkins defended Vinson’s decision to fly from Dallas to Cleveland and back after caring for Duncan, saying she had called the Centers for Disease Control and Prevention in Atlanta before she boarded her flight back to Dallas and was not told to not take the flight. She has been transferred from quarantine at Presbyterian to Emory University Hospital in Atlanta.
     “Amber is in a city where she doesn’t know anybody [and is] in a plastic bubble,” Jenkins said. “We need to keep in mind who these people are that we are talking about.”
     Commissioner Mike Cantrell reiterated his concerns that local cities need to know if a home they are responding to houses an Ebola contact, so they can be prepared.
     Jenkins said a solution has been worked out where such a home will be flagged in the computer systems of first responders if they are indeed called to respond.
     Presbyterian officials said that Pham will be moved to the National Institutes of Health Clinical Center in Bethesda, Md. after consulting with her and her family.
     “With many of the medical professionals who would normally staff the intensive care unit sidelined for continuous monitoring, it is in the best interest of the hospital employees, nurses, physicians and the community to give the hospital an opportunity to prepare for whatever comes next,” Presbyterian spokesman Wendell Watson said Thursday.
     The hospital steadfastly defended its procedures and handling of Duncan, after weeks of criticism for releasing him with only antibiotics during his first emergency room visit, only to admit him two days later when he developed symptoms of Ebola.
     The hospital said Thursday that accusations of unpreparedness by union National Nurses United “do not reflect actual facts” from medical records and interactions with caregivers.
     The union claimed Duncan was placed in a room for hours with other patients during his second visit while hospital officials were hesitant to place him under quarantine.
     “Our hospital followed the Centers for Disease Control guidelines and sought additional guidance and clarity,” Presbyterian officials said in a statement. “When Mr. Duncan returned to the Emergency Department, he arrived via EMS. He was moved directly to a private room and placed in isolation. THD staff wore the appropriate personal protective equipment as recommended by the CDC at the time.”
     Regarding allegations that the hospital’s pneumatic tube delivery system was used to transport Duncan’s specimens, the hospital said closed specimens bags were used and put inside a plastic carrier that travel through the system.
     “At no time did Mr. Duncan’s specimens leak or spill – either from their bag or their carrier – into the tube system,” the hospital said.
     On Wednesday, Presbyterian announced it will designate a room to employees who wished “to avoid even the remote possibility of any potential exposure to” family, friends and the public.
     “We are doing this for our employees’ peace of mind and comfort. This is not a medical recommendation,” Watson said. “We want to remind potentially affected employees that they are not contagious unless and until they demonstrate any symptoms, yet we understand this is a frightening situation for them and their families.”
     School officials in Ohio and Texas scrambled Thursday to close and clean at least seven schools and several school buses due to students and staffers being on the same flight or plane as Vinson.
     The Belton Independent School District in central Texas closed North Belton Middle School, Sparta Elementary and the Belton Early Childhood School on Thursday for cleaning.
     Superintendent Susan Kincannon said Wednesday night that two students were aboard the Monday flight to Dallas.
     “I’m frustrated that we didn’t learn until late tonight that the CDC was re-evaluating the health risk,” she said in a statement. “The health and safety of our students is my first priority.”
     Parents of the unidentified students will voluntarily keep them home for the 21-day Ebola incubation period.
     Officials with Solon City Schools in suburban Cleveland announced the closing of Solon Middle School and Parkside Elementary School for Thursday.
     District spokeswoman Tammy Strom said that an unidentified staff member from the middle school flew from Dallas to Cleveland the morning after Vinson’s return flight from Dallas. Frontier Airlines officials confirmed that the plane on which Vinson flew to Dallas stayed at Dallas-Fort Worth International Airport Monday night before flying back to Cleveland the next day.
     Solon school officials decided to close and clean the schools despite not being able to confirm if the staffer flew on the same aircraft as Vinson, Strom said.
     Officials with Royse City Independent School District northeast of Dallas announced Davis Elementary and Ruth Cherry Intermediate schools will be closed on Friday out of an “abundance of caution.” An unidentified nurse who treated one of the infected Presbyterian nurses lives with students from both of those schools.
     “This person has been classified as ‘low risk,'” the district said in a statement. “As a symptom-free person, there is no risk to anyone in their household or to anyone in their household attending school.”

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