Staff at the US Hospital where a nurse caught Ebola had flimsy, ill-fitting protective gear, leaving their skin exposed to diarrhea and projectile vomiting from an infected man, according to a damning list of allegations from a nurses union.
Hazardous waste was allegedly piled up to the ceiling at Texas Health Presbyterian Hospital, in Dallas, where 26-year-old nurse Nina Pham caught the virus from victim Thomas Duncan who died last week.
Health workers were told to "interact with Mr Duncan with whatever protective equipment was available," even as he produced "a lot of contagious fluids," the National Nurses United said.
Nurses were forced to use medical tape to secure openings in their flimsy garments, worried that their necks and heads were exposed as they cared for the patient who had diarrhea and vomiting, said Deborah Burger from the union.
Duncan was not isolated from other people despite having the virus. His medical records said that when his Ebola was suspected but unconfirmed, a doctor wrote "using the disposable shoe covers should also be considered."
At that point, by all protocols, shoe covers should have been mandatory to prevent anyone from moving contagious body fluids around the hospital.
The union says that Thomas Duncan was left in an open area of an emergency room for hours, and the nurses treating him worked for days without proper protective gear. Even today, it claims, some hospital staff do not have proper equipment to handle the outbreak.
Duncan's lab samples were allowed to travel through the hospital's tubes which deliver medical samples, exposing them to contamination, the list says.
One of the nurses at the hospital has tested positive for Ebola and is hospitalised but "in good condition" and Texas health officials today announced that a preliminary test indicated a second, unidentified health care worker at the hospital had been infected with the disease.
"There was no advance preparedness on what to do with the patient, there was no protocol, there was no system," Burger said.
Even today, Burger said, some hospital staff at the Dallas hospital do not have proper equipment to handle the outbreak.
"Hospital managers have assured nurses that proper equipment has been ordered but it has not arrived yet," she said.
The union alleges that:
- Duncan was kept in a non-isolated area of the emergency department for several hours, potentially exposing up to seven other patients to Ebola.
- Patients who may have been exposed to Duncan were kept in isolation only for a day before being moved to areas where there were other patients.
- Nurses treating Duncan were also caring for other patients in the hospital.
- Preparation for Ebola at the hospital amounted to little more than an optional seminar for staff.
- In the face of constantly shifting guidelines, nurses were allowed to follow whichever ones they chose.
RoseAnn DeMoro, executive director of Nurses United, said the allegations came from "several" and "a few" nurses, but she refused repeated inquiries to state how many.
She said the organisation had vetted the claims, and that the nurses cited were in a position to know what had occurred at the hospital. She refused to elaborate.
Wendell Watson, a hospital spokesman, did not respond to specific claims by the nurses but said the hospital has not received similar complaints.
"Patient and employee safety is our greatest priority and we take compliance very seriously," he said in a statement. "We have numerous measures in place to provide a safe working environment, including mandatory annual training and a 24/7 hotline and other mechanisms that allow for anonymous reporting."
He said the hospital would "review and respond to any concerns raised by our nurses and all employees."
The Presbyterian nurses are not represented by Nurses United or any other union. DeMoro and Burger said the nurses claimed they had been warned by the hospital not to speak to the media or they would be fired. They did not specify whether the nurses making the claims were among Duncan's caregivers.
The Associated Press said it has attempted since last week to contact dozens of individuals involved in Duncan's care. Those who responded to reporters' inquiries have so far been unwilling to speak.
David Wright, deputy regional administrator for the US Centers for Medicare & Medicaid Services, which monitors patient safety and has the authority to withhold federal funding, said his agency is going to want to get all of the information the nurses provided.
"We can't talk about whether we're going to investigate or not, but we'd be interested in hearing that information," he said.
CDC officials did not immediately respond to requests for comment.
Duncan first sought care at the hospital's ER late on 25 September and was sent home the next morning. He was rushed by ambulance back to the hospital on the 28th of September. Unlike his first visit, mention of his recent arrival from Liberia immediately roused suspicion of an Ebola risk, records show.
The CDC said Tuesday 76 people at the hospital could have been exposed to Duncan after his second ER visit. Another 48 people are being monitored for possible exposure before he was hospitalised.