Analyze

“Under a 1986 federal law titled the Emergency Medical Treatment and Labor Act (EMTALA), hospitals are required to treat people who come to the ED presenting with an emergency medical condition, defined as a condition that, without treatment, will likely lead to serious impairment or death. … EMTALA is one of the largest federal mandates to provide services to have gone unfunded (Friedman 2011); costs instead fall on states and local health care systems.” 481

“In bringing ethnographic attention to hot spotting as a technique of governance, we find that it provides lifesaving humanitarian interventions while operating within the racialized structures of violence that produce continual life crises. The institutional rationality of hotspotting and the encounters of care that it produces illustrate the often-contradictory role of medicine in the lives of poor people: both caring and coercive, it intertwines care and violence.” 475; “we conclude by suggesting that economic investment and return are becoming a reigning logic in the governance of poverty, generating hot spots as sites of interest for both policing and health care and decentering normative assessments of deviance, illness, and social problems” 476; “Neoliberal social assistance, as it is practiced in the health care safety net, is conceptualized as an “investment “in the population, as a strategic and targeted deployment of basic resources, one that promises to generate a return on investment for the state or health system in the form of cost savings.“ 485

 The authors examine the practice of “hot spotting,” a form of surveillance and intervention through which health care systems in the US intensively direct health and social services towards high-cost patients.  Health care hot spotting is seen as a way to improve population health while also reducing financial expenditures on healthcare for impoverished people. The authors argue that argue that ultimately hot spotting targets zones of racialized urban poverty—the same neighborhoods and individuals that have long been targeted by the police. These practices produce “a convergence of caring and punitive strategies of governance” (474). The boundaries between the spaces of healthcare and policing have shifted as a “financialized logic of governance has come to dominate both health and criminal justice” (474).

The policy was the multi-tiered approach designed by New York City officials in the event of an Ebola case. This included designation of eight hospitals as being care centers for Ebola cases, teaching non-designated hospitals or care centers how to identify Ebola candidates, communication with transportation services (both EMS and non-EMS), and running unscheduled drills to practice handling scenes with an Ebola candidate (the example given was someone falling ill in a subway car). The poly aimed to standardize the approaches and protocols used when dealing with a possible Ebola case. It focused on minimizing the excessive risk to citizens, EMS personnel, and healthcare workers in the event of a patient with Ebola. The policy also sought to train and drill these protocols, including unscheduled calls (mentioned above) and continued inspections to ensure preparedness. The obvious end goal was to minimize the possibility of wide-spread infection, either through improper handling or failed detection of an Ebola case.

Several leaders from various New York State agencies convened to outline plans for this policy. This included Governor Andrew M Cuomo, State Health Commissioner Dr. Howard Zucker, State Police Superintendent Joseph D'Amico, Port Authority Executive Director Pat Foye, and representatives from health care centers and agencies around the state.

The policy applies to New York state citizens, health care workers, EMS personnel, and leadership within health care centers. Additionally, the policy has parts that effect transportation agencies and their employees. In many ways, due to Ebola's nature and the nature of New York as a major metropolitan area, these policies will also have a global effect.

As described by Governor Cuomo, Dallas was the first major US city to see an Ebola case. This, in turn, allowed New York leadership to have some semblance of what methods did or did not work when trying to contain the disease. Moreover, the policy was implemented in response to the major Ebola outbreaks occurring at this time. This included those within Africa, Europe, and cases seen in Dallas. Moreover, the policy follows the city's "Safe-than-sorry" methodology discussed by Governor Cuomo; he, along with other state and city leaders, believed assuming an Ebola outbreak would occur within the state would give them the best chance of mitigating its effects and minimizing disease spread.

The Ebola outbreak is, by its very definition, a matter of public health. The outbreak presented a danger to the global health community and resulting policies dealing with this epidemic were public health policies. That being said, the policy in place mostly served as a protocol mostly for agencies of New York in the event the epidemic spread. It focused on standardizing the practices of health, transport, and government agencies in the event of an outbreak; it did not focus on individuals already effected with the disease, but more so on preventing the spread of the epidemic. 

The policy does not make any specific mentions of how to deal with vulnerable populations. However, if one were to consider the nature of New York, it can be argued that the city's entire population is vulnerable to outbreak. As a hub of trade, finance, travel, and business, New York is at a considerably higher risk than a city without this high metropolitan activity. The policy does include measures on how to treat individuals who show signs and symptoms in public locations, but does not mandate testing or health checks for individuals involved in transport, travel, or who have limited access to health care (the homeless).

While there was criticism of the policy (see the Washington Post's rebuttal), the policy appeared to be well received until implementation of quarantine for returning health care workers. This, and the backlash, caused the policy to be revised and invited confusion about guidelines. Leaders may have lost political points by staying firm with their guidelines, but chose to revoke their initial decisions-- leading to confusion and worry in the general population.