EbolaTexas officials question state preparedness for an outbreak

Published 9 October 2014

Following the death of Texas Ebola patient Thomas Duncan, many leaders in Texas are considering whether the state is prepared to handle a more wide scale public health emergency. The problem, analysts say, is that many local health departments in the state are run autonomously, and have split funding between local, state, and federal sources. As a result, they are not often all held to the same standard, and these disparities could be what would ultimately lead to disjointedness and failure to respond properly to an outbreak.

Following the death of Texas Ebola patient Thomas Duncan, many leaders in Texas are considering whether the state is prepared to handle a more wide scale public health emergency.

The virus has already killed more than 3,000 people in West Africa, and that number is expected to grow as the number of cases increases.

As theTexas Tribune reports, state officials report that Texas response teams are well-equipped to handle the cases and potential hospital quarantines. At a recent press conference to discuss the case, Governor Rick Perry (R) told reporters that he was confident.

“There are few places in the world better equipped to meet the challenge that is posed in this case. We have the health care professionals and the institutions that are second to none,” he said.

Miscommunications and mistakes — including the release of Duncan from the hospital following the first time that he had admitted himself — are leading some to reconsider.

“We don’t really have a unifying construct for public health in Texas that’s comprehensive,” said Dr. Eduardo Sanchez, the former commissioner of the Texas Department of State Health Service (DSHS) and the current chairman of the Texas Public Health Coalition, “The system is not as connected as it could be.”

The problem, as outlined by Sanchez, is that many local health departments in the state are run autonomously, and have split funding between local, state, and federal sources. As a result, they are not often all held to the same standard, and these disparities could be what would ultimately lead to disjointedness and failure to respond properly.

The Sunset Advisory Commission, tasked with finding inefficiencies in state departments, released a report that found that the “roles and responsibilities of DSHS and local health departments remain undefined.”

“In the event of a public health emergency…the resources necessary to adequately respond to that are not all in the control of the health department,” added Sanchez, “You have to have the money and the authority — whether it’s informal or formal – to actually lead a response and take care of business.”

It is estimated that there are 129 local health departments in Texas, but that number is not certain because the state does not track departments which it does not fund. Only sixty-five local departments received DSHS funding in 2013, and are the only ones subject to more direct standards and codes

“The Texas model requires a high level of collaboration and coordination between the state and local health departments,” concluded the Sunset Advisory Committee report.