On individual versus institutional responsibility for workplace injuries

A comment on personal versus institutional responsibility by Suzanne Donovan, an infectious disease specialist at Olive View-UCLA Medical Center, who spoke on NPR on Sunday about the Texas health care worker now infected with Ebola:

And I think it’s really important that there is no finger-pointing at the healthcare worker so that the healthcare worker did something wrong because this is all about training and having the appropriate equipment. …

I think in a country like the United States, where there’s very few cases, the environment is very safe and the equipment is readily available. I find that very disconcerting that a healthcare worker had an exposure and is infected. I think we need to look at the processes that occurred in that institution and ensure they never happen again.

Author: Jyllian Kemsley

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  1. A lesson I learned from years of teaching chemical emergency response is that donning and doffing of high level (A or B and sometimes C) PPE requires a written procedure, a checklist, a watcher running the procedure following the checklist and tons of practice.

    It appears that the Omaha hospital has this level of protocol in place and follows it.

    It is important that the CDC figure out where in the procedure the exposure occurred and that the healthcare system learn from it.

    I have 3 physicians in my core family and I understand the stresses they face daily.

    We in the chemical emergency response area have learned much that could help the healthcare industry – how do we communicate our knowledge and skill?

  2. I think all Suzanne Donovan did was point the finger at the institution and not the individual, which is just the opposite of what she’s instructing everyone else not to do. She’s assuming a lot to somehow blame “the process” and not the nurse. It’s a 50/50 guess. Ultimately, it’s the individual’s responsibility, and thus the individual’s fault. Donovan even admits that “the environment is very safe and the equipment is readily available”. This statement implies that “the training [environment] is sufficient and that the appropriate PPE was administered.

  3. @William Rubin, Donovan clearly was talking about the general medical environment “in a country like the United States” (as opposed to Liberia, Sierra Leone, & Guinea) when she used the “safe environment” phrase. She was not trying to say Texas Presbyterian was somehow safe for the two nurses who contracted Ebola. Those are not contradictory realities…in fact they reinforce the point that processes at Texas Presbyterian (as opposed to processes at other non-transmitting hospitals) that are likely to blame.

    When you state “Ultimately, it’s the individual’s responsibility, and thus the individual’s fault.” do you mean ultimately the individual nurses suffered negative health effects not the hospital, therefore they should have done everything they could (perhaps demanding better training) to protect herself?

    According to this kind of logic, short of premeditated murder by employer, a person only ever has themselves to blame when injured on the job.

    I hope you were trying to say that the flawed processes ultimately are carried out by the individual nurses and that the hospital didn’t affirmatively infect them.
    But even that generous interpretation is problematic because responsibility doesn’t stop at physical actions.
    The reality is people show up to do a job, to do something. In exchange for doing that thing, they are compensated. It is assumed and spelled out (both in law and in contracts) that they should not be injured when following their employers instructions. To claim some folksy wisdom otherwise ignores legal, contractual, and logical realities. Employees are employees (and not independent contractors) and their employer takes on the job injury responsibility when the employee doesn’t have independent control over how their work is done. The nurses were very clearly being given ever changing instruction (to treat Duncan a specific way, to use this particular PPE, and how to care for him) by their employer (see http://www.latimes.com/nation/la-na-ebola-dallas-20141014-story.html). If the nurses clearly did not follow their employers instructions do you think they would still be employed? Do you think the hospital wouldn’t have trumpeted that? Both entities (hospital & nurse) had VERY strong incentives not to permit transmission. All evidence points to both parties trying hard to avoid transmission. Yet transmission occurred under the employers direct instructions to the nurses of how to prevent it. If that isn’t on the job liability I don’t know what is.