While residents of the city are getting back to their normal routines in the wake of an Ebola scare, it may take a while for Texas Health Presbyterian Hospital to recover.
The fallout from Ebola is hitting Arlington-based Texas Health Resources in its pocketbook.
Last week, Moody's Investor Service downgraded the hospital system's long term debt rating outlook to developing from positive. The shift in the rating action was directly tied to concerns about litigation related to Ebola cases, according to Moody's report.
"The developing outlook reflects the uncertainty on the system's long term financial performance, impact on financial resources and litigation risk following recent cases of Ebola at one of the system's flagship facilities."
Despite the change, THR's Aa3 and Aa3/VMIG1 ratings remain the same. Presbyterian Hospital Dallas, the site where Ebola became a real health threat in the U.S., accounted for 13% of the system's net patient revenues in 2013.
New financial disclosures from THR show that revenue, ED visits, surgeries, and the daily hospital census at its Dallas hospital all fell beginning October 1, just a few days after Ebola patient Thomas Eric Duncan was admitted.
In addition to the financial hit, any new Ebola cases that hit Dallas will no longer be routed to THR's Presbyterian Hospital Dallas.
Venue Shift
Texas Governor Rick Perry announced earlier this week that patients presenting with Ebola in Dallas and surrounding areas will be treated at Methodist Campus for Continuing Care, which is part of the Dallas-based Methodist Health System, a six-hospital nonprofit system.
Parkland Hospital and UT Southwestern Medical Center are providing resources to Methodist, including manpower, personal protective equipment, and laboratory equipment. The new Ebola Treatment and Infectious Disease Bio Containment Facility will take up an entire floor at the campus, which is located in Richardson, a suburb of Dallas and less than 10 miles away from THR's Presbyterian Dallas hospital.
A second Ebola treatment facility will be located in Galveston at the University of Texas Medical Branch there. Dallas County Judge Clay Jenkins cited healthcare worker fatigue at THR as a reason to send future Ebola patients to another hospital.
In a statement, THR offered a somewhat unemotional response to the news that they would no longer be where Ebola patients would come for treatment.
"As the first U.S. hospital to face the challenge of both diagnosing and treating Ebola patients, Texas Health Presbyterian Hospital Dallas will continue to share our learnings with health officials at all levels of government, our fellow hospitals and the broader health care community."
As a resident of Dallas, a city that will now forever be synonymous with ground zero for the Ebola outbreak in the U.S., I can say that some of the fear and panic that was playing out on our television screens with hourly updates has subsided.
Local Drama
While the drama played out nationally and internationally, Dallas area residents were privy to press conferences with the CDC and constant video streams from the hospital and two local residences. It was not the same as watching CNN or the other national news networks.
We were watching our healthcare workers, our mayor, and other leaders attempt to calm the city down. Even as a seasoned reporter who knows better than to succumb to unfounded fear and panic, I could see how quickly and easily the two emotions could overwhelm you to a standstill.
The city and its residents are moving again, guardedly.
The first wave of people being monitored for Ebola because of their contact with Duncan were given a clean bill of health on Monday; no new infections have been reported in a week, and one of the infected nurses, Nina Pham, has been upgraded from fair to good. So far, there is no official word on the condition of Amber Vinson, the second nurse who also tested positive for Ebola, though her family says the hospital has told them Vinson no longer has Ebola.
But while residents of the city are getting back to their normal routines, it may take a while before THR and its employees can, especially with the financial news this week. Its Dallas hospital campus is no longer diverting ambulances from away from its emergency department. That is the most significant sign that the hospital is returning to regular operations.
And a nurse I know who works at Presby, as it is known to locals, told me that the workers are rallying behind the hospital leaders and are not upset with the guidance they received to care for Duncan.
A nurse's union has been sharply critical of THR's care of Duncan, citing piles of medical waste and improperly protected nurses. THR issued a point-by-point rebuttal of the union's suggestions, and a number of nurses from Presby held a news conference on Monday citing their confidence in THR and its leadership.
Reaction and Fallout
It's hard to tell what the fallout will be at Texas Health Resources because of its missteps in the handling of the first Ebola case in the U.S. The hospital's leadership has acknowledged its mistakes in both a congressional hearing on its response as well as a full page letter to the community that was published in Sunday's newspapers, signed by newly-minted CEO Barclay Berdan.
"Although we had begun our Ebola preparedness activities, our training and education programs had not been fully deployed before the virus struck."
THR may be shouldering most of the blame, but the hospital shouldn't be the only target. In an audio webcast from the New England Journal of Medicine, Arjun Srinivasan, MD, associate director for Healthcare Associated Infection Prevention Programs in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention, acknowledged that all the initial guidance it gave hospitals personal protective equipment to protect healthcare workers from contracting Ebola was based on the outbreak in Africa.
"Training on the use of protective equipment is not something that we have focused on previously in U.S. hospitals," says Srinivasan.
The CDC has since updated its guidance to U.S. hospitals for donning and doffing personal protective equipment, and using respirators or masks when caring for an Ebola patient, as well as other precautions.
Ebola: Health Officials Try to Quell Front Line Fears
Srinivasan says that all U.S. hospitals have to be able to respond to an Ebola threat, though he agrees with those who have called for designating a smaller number of hospital facilities as Ebola treatment centers.
While THR struggles to rebound from the public perception of its mistakes with Ebola, healthcare peers who are in the very complicated business of treating infectious disease, have more compassion.
Dennis Deruelle, MD, FHM, an infectious disease doctor who is also the national medical director of acute services for IPC The Hospitalist Company, says the Ebola virus arriving in the U.S. should be a wake-up call to all hospitals to do a better job at managing the spread of other infections.
"We have to vigilant about infection control," says Deruelle. "We're not as vigilant about gowning and gloving. It's not a stretch to say we haven't been vigilant."
Jacqueline Fellows is a contributing writer at HealthLeaders Media.