Ebola Death in Dallas Suggests Need For Closer Connection Between Hospitals and Public Health

By Dennis Archambault

Recent questions about the appropriate emergency treatment of an ebola patient in Dallas raised broader concerns about the relationship between public health and the  private hospital system. Nearly two years ago, Hospital Progress magazine, published by the Catholic Health Association, devoted an entire issue to population health http://www.chausa.org/publications/health-progress/issues/january-february-2013, with a specific article on the need to improve the relationship between the local public health department and hospitals. As health systems assume greater responsibility for improving the health of its immediate population, not just those within their patient population or desired market segments, the relationship between public health agencies — and community health advocates — becomes even more important.

The New York Times on Oct. 11, published an account that questioned the appropriateness of releasing Thomas Eric Duncan — a Liberian man who died of the Ebola virus in Dallas — with a temperature of 100.1 http://www.nytimes.com/2014/10/11/us/thomas-duncan-had-a-fever-of-103-er-records-show.html?_r=0. He was prescribed antibiotics and Tylenol for pain, which Duncan identified as eight on a scale of 10. Hospital officials were quoted by the Times as saying that Duncan’s symptoms were “not severe’ on his first visit and that many communicable diseases have the same symptoms as Duncan’s. Except, Duncan had recently come from Africa.

Texas Health Resources, which manages the hospital — Texas Health Presbyterian Hospital, says it is reviewing the case and is making changes in its intake process to better screen for the disease. This case underscores the importance of community-based medicine, specifically when public health issues have an impact on the health of individuals treated in hospitals and private medical practices. A closer relationship between private hospitals and their public health agencies would help identify emerging issues that impact their patients. (Note: MLive has published a report indicating that Washtenaw County and area hospitals have connected on this issues. http://www.mlive.com/news/ann-arbor/index.ssf/2014/10/washtenaw_county_public_health_7.html#incart_m-rpt-2)

In his article, “Introducing Public Health: Your New Partner,” in the January-February 2013 edition of Health Progress, Edwin Trevathan, M.D., M.P.H., asks “Why are public health and health care so separated? Like any two cultures that have grown apart, it is complicated. We have different languages and different terminology. We have different modes of dress… We are different from one another, but we need each other.

“For decades, U.S. public health and health care have had separate revenue streams, and so operated in relative isolation from each other. In my opinion, this failure to connect health care with public health is the most important reason why we pay more for health care than any nation on earth, with worse outcomes than most of our peer countries. With health care costs soaring, revenues shrinking and, finally, the realization that our current system is not working, now is the time for public health and health care to become acquainted.”

In times of a potential emerging crisis, it’s imperative that public health and health care not only become acquainted but become partners. The community needs assessment process is a good opportunity for public health and health systems to collaborate to determine need and assemble the resources to meet it.

Dennis Archambault is director of Public Affairs for the Detroit Wayne County Health Authority