podesta_email_14277.txt

podesta-emails 2,059 words email

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for this write up. Sent from my iPad Begin forwarded message: From: POLITICO Pro <[email protected]<mailto:[email protected]>> Date: October 16, 2014 at 7:58:49 PM EDT To: <[email protected]<mailto:[email protected]>> Subject: CDC chief survives trial by fire on Hill Reply-To: <[email protected]<mailto:[email protected]>> CDC chief survives trial by fire on Hill By David Nather and Brett Norman 10/16/14 7:56 PM EDT Tom Frieden is getting a lot of public scoldings for all of the missteps in the handling of the Dallas Ebola cases — and there have been plenty of them. But so far, the criticisms don’t appear to be rising to the level where the director of the CDC needs to worry about his job. Frieden came through a three-hour House hearing Thursday with some bruises but also with his ability to function as director seemingly intact. The past few weeks haven’t been kind to the confident, science-driven Frieden, the former New York city health commissioner who has fought tobacco use there and tuberculosis in India. Over and over again, Frieden told Americans that the U.S. public health system was ready to handle any Ebola cases. And one mishap after another has made it clear that, at least in Dallas, the public care system wasn’t even close to ready. At Thursday’s hearing, lawmakers from both parties vented their frustrations at Frieden. Republicans on the Energy and Commerce Subcommittee on Oversight and Investigations demanded to know why the Obama administration wasn’t considering flight restrictions from the most severely hit west African countries. House Majority Whip Steve Scalise (R-La.) forced him into a stuttering, dodgy exchange about whether the White House had ever discussed it. Even Diana DeGette of Colorado, the panel’s top Democrat, angrily demanded to know whether Americans could be sure that hospitals would actually check for Ebola the next time a patient who has traveled to West Africa walks in with a fever and vomiting. And yet, by the end of the hearing, none of the subcommittee members had called for Frieden to resign. In fact, the chairman, Tim Murphy of Pennsylvania, specifically said he wants Frieden to stay. The CDC chief should improve transparency and acknowledge missteps, Murphy said after the hearing, but “I think he needs to stay in there. Get the job done and get to work.” Frieden may have showed a bit of impatience at times, and looked more tired than he has at some of his public briefings. But he didn’t suffer the same indignities as recently departed Secret Service chief Julia Pierson, who had little choice but to quit after a brutal Sept. 30 trip to the Hill, or former Health and Human Services Secretary Kathleen Sebelius, who was regularly humiliated with calls for her resignation at hearings on the Obamacare website disaster. There have been some calls for Frieden to resign, including GOP Sen. David Vitter of Louisiana<http://www.vitter.senate.gov/newsroom/press/vitter-impose-immediate-travel-restrictions-fire-cdc-director> and Rep. Steve King of Iowa on Thursday — but they’re not the kind of lawmakers who can make life too miserable for the White House. Frieden’s not off the hook with public health experts. They say he has been overconfident in his claims about the readiness of U.S. hospitals, and that he was too quick to blame the infection of Nina Pham, the first of two nurses who caught Ebola after treating the Dallas patient, on a “breach in protocol<http://www.cnn.com/2014/10/13/health/ebola-nurse-how-could-this-happen/index.html>” — a statement they say sounded like he was blaming the nurse. But they also give Frieden credit for being flexible and willing to switch gears quickly — including updating the CDC’s original guidelines for treating Ebola guidelines, which have been widely criticized<http://www.nytimes.com/2014/10/16/us/lax-us-guidelines-on-ebola-led-to-poor-hospital-training-experts-say.html?hp&action=click&pgtype=Homepage&version=LedeSum&module=a-lede-package-region®ion=top-news&WT.nav=top-news&_r=0> by infectious disease experts as inadequate. They also say Frieden is a widely respected public health expert who has already performed a tremendous service by flagging the seriousness of the Ebola outbreak in West Africa, visiting the region himself to sound the alarm within the Obama administration. “It took his trip to really raise the importance of this issue, and that’s incredibly important,” said Jeffrey Levi, executive director of the Trust for America’s Health. “He’s been a strong leader, a very forceful leader, very confident about what he thinks should be done and not afraid to say it,” Levi said. Matthew Myers, president of the Campaign for Tobacco-Free Kids, who worked with Frieden on anti-smoking initiatives during Frieden’s days in New York , describes him as a “no-nonsense,” science-driven health expert who asks tough questions and “won’t take a soft answer for an answer.” “I have not met another public health official who digs as deep into the science as he does, demands answers and then moves as rapidly” to implement them, Myers said. To some degree, Frieden had to project confidence. His job as CDC director is to calm the public, not start a panic. But some public health experts say the Dallas hospital clearly wasn’t ready, because it had not practiced and run drills the way U.S. hospitals should have been doing for months. Frieden’s claims that the country’s hospitals were prepared to handle the virus “was an instance of overconfidence,” according to J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies, who has worked closely with Frieden on global health initiatives. But to Frieden’s credit, Morrison said, “he’s shown a level of self-criticism and humility in admitting mistakes and correcting course.” That includes upgrading the agency’s instructions to hospitals to make sure health care workers really are covered head to toe when treating an Ebola patient. After Pham was infected, the CDC this week updated its guidance to hospitals, now recommending full body suits that cover the head and neck, and strict procedures for how to take them off after an encounter with an Ebola patient. “I think in retrospect, everyone wishes that the amount of protection needed was recognized earlier, and the same with the strict protocol of gowning and ungowning” the protective equipment, said Paul Jarris, executive director of the Association of State and Territorial Health Officials, which helps coordinate communication between the CDC and state and local public health officials. “The health care infrastructure in Africa was weak and there was a belief that it couldn’t happen here,” he said. “But the pathogen doesn’t care about the quality of the health care infrastructure. There is no room for error with this pathogen.” Eric Toner, a senior associate at the Center for Health Security at the University of Pittsburgh Medical Center, said that Frieden has been an effective communicator as the face of the government’s outbreak response, openly sharing the facts with public as he understood them. The problem is “some of the messages have been wrong,” Toner said. He noted that the claim that any hospital could handle an Ebola patient was undercut at the outset when the handling of the first case was botched in Texas. Having the tools to do a job, he said, was not the same as having the experience to get the job done. “I think they said that because every hospital has an isolation room and every hospital has gowns and gloves and guidance, that they could do it,” Toner said. “But there’s a big difference between having those things and being able to use them with a highly lethal disease.” Frieden has also been criticized for his “breach of protocol” quote in referring to Pham’s infection, although he quickly walked that back. “Number one, he kind of got ahead of the investigation. Number two, he didn’t account for the possibility that the protocol itself might be deficient,” said one public health expert who specializes in infectious diseases. At Thursday’s hearing, Frieden turned the spotlight on the hospital rather than the nurse — suggesting that there was “some variability” in the Dallas hospital’s use of protective gear in the critical first two days of the treatment of the patient, Thomas Eric Duncan. But despite the “fumbles” in the CDC’s early response to the first domestic case, Toner said Frieden was “extraordinarily well-qualified and competent” to manage the CDC’s response and “is the one who should be out there, talking to the public.” In particular, public health experts say early career experience as a disease detective at the CDC and his work in the field battling tuberculosis in New York City, and later for five years in India with the World Health Organization, are strong credentials for managing the Ebola effort. “In India, you don’t hear anyone refer to him as anything less than a miracle worker,” said Myers. In that job, he said, the naturally impatient Frieden had to learn to work with a health care bureaucracy that never responds quickly to anything. After his work in India, Frieden became the New York city health commissioner in 2002, under Mayor Michael Bloomberg, and turned his attention to reducing the number of NYC smokers. He held that job until 2009, when President Barack Obama brought him to Washington to run the CDC. In most of his public briefings on Ebola, Frieden has been the voice of reassurance, declaring what virtually all public health experts thought: that U.S. hospitals were fully prepared because the American health care infrastructure was so much better than the resources in West Africa. Every time, he declared his confidence in science: We know how the disease works, he said, and we know how to stop it from spreading. But his tone changed at a briefing on Sunday, when Frieden confirmed that Pham had been diagnosed with Ebola. Despite Frieden’s repeated reassurances that the country’s hospitals were ready to “stop Ebola in its tracks,” not only had a hospital badly botched the initial handling of the patient — sending Duncan home despite his travel history and symptoms, only to admit him days later once he was critically ill — now a person taking care of him had been infected. Frieden, usually confident and calm, sounded exceptionally somber. He said the agency was directing Texas Health Presbyterian to keep the number of people caring for the stricken nurse to “an absolute minimum” and only perform essential procedures. Since then, Frieden has kept his comments about the Dallas hospital to a minimum, and Myers said he’s not surprised that Frieden hasn’t been more openly critical: “He wouldn’t do that.” But other public health experts believe that Frieden, and the rest of the CDC, are paying the price because the public expects them to have more control over how rigorously the Dallas hospital and others follow the protocols for treating Ebola. “The disconnect in a lot of minds is that because it’s the CDC, and because he is such a forceful presence, people assume there’s a command and control situation, and there’s just not,” said Levi of the Trust for America’s Health. And whatever missteps have happened in the handling of the Dallas cases, most public health experts still believe Frieden is the right man for the job. “It would be a huge shame if he came out of this damaged in his standing and his influence, because we’re not going to do better than him to run this organization at this moment,” Morrison said. “We need a strong leader and he’s it.” Jennifer Haberkorn contributed to this report. To view online: https://www.politicopro.com/go/?id=39626 You've received this POLITICO Pro content because your customized settings include: Health Care Topic: Congress; Health Care Topic: Public Health; Health Care Topic: White House. To change your alert settings, please go to https://www.politicopro.com/member/?webaction=viewAlerts. ________________________________ This email alert has been sent for the exclusive use of POLITICO Pro subscriber Tamera Luzzatto. Forwarding or reproducing the alert without the express, written permission of POLITICO Pro is a violation of federal law and the POLITICO Pro subscription agreement. Copyright © 2014 by POLITICO LLC. To subscribe to Pro, please go to www.politicopro.com<https://www.politicopro.com>. ________________________________