U.S. State Dept memo on bringing foreign Ebola patients to America

Barack Ebola logoTwo weeks ago, on October 17, 2014, Judicial Watch, the non-partisan D.C.-based citizens watchdog group, claimed that the Obama administration is actively formulating plans to admit Ebola-infected non-U.S. citizens into the United States for treatment within the first days of diagnosis.

Doing so would require special waivers of laws and regulations that currently ban the admission of non-citizens with a communicable disease as dangerous as Ebola.

Judicial Watch’s source said the Obama administration is keeping from Congress this illegal plan that endangers the public health and welfare of Americans.

Now, the watchdog group’s initial report is confirmed to be true.

From Judicial Watch, Oct. 29, 2014:

This several media outlets have confirmed JW’s story, attributing the information to an unclassified State Department report. It spells out a plan to rush foreigners into the U.S. for Ebola treatment […] It would cost $300,000 to treat each patient and another $200,000 for transportation, the State Department memo shows. […]

In the aftermath of the document’s leak, senior administration officials have anonymously come forth to say there are “absolutely no plans” to transport foreign Ebola patients to be treated in the U.S. What should Americans believe?

Judicial Watch will continue covering and investigating this scandal and has filed Freedom of Information Act (FOIA) requests with the Department of Defense(DOD) and the Occupational Safety and Health Administration (OSHA). Specifically, JW is demanding that the DOD reveal its plans for evacuation of American personnel in Africa and OSHA’s plans for response to the Ebola outbreak as well as expressions of concern by agency personnel relating to the deadly virus. Additionally, JW is seeking information about the cryptic carrier Phoenix Air, which has been transporting Ebola-infected patients and has significant Pentagon contracts.

The Washington Times claims to have a copy of the State Department memo, but published only select sentences and paragraphs from the memo. Leave it to a UK newspaper, The Daily Mail, to publish the actual memo in its entirety.

Below are screenshots I took of the 4-page memo, “Admitting Non-U.S. Citizens to the United States for Treatment of Ebola Virus Disease.” An easier-to-read text version of the memo follows the screenshots. (You can also read the memo for yourself on Scribd or from CODA’s media library.)

Click page to enlarge

Ebola memo1Ebola memo2Ebola memo3Ebola memo4The memo on Scribd does not enable copying so that I can then paste the memo into this post. In the interest of public service, I copied the memo by typing each word, sentence, paragraph, and punctuation mark into the copy-enabled text below. Words in bold are from the memo; I supplied the red color to emphasize important sections.

SENSITIVE BUT UNCLASSIFIED – PREDESICIONAL

Admitting Non-U.S. Citizens to the United States for Treatment of Ebola Virus Disease

Purpose: Come to an agreed State Department position on the extent to which non-U.S. citizens will come to the United States for treatment of Ebola Virus Disease (EVD). A cleared paper is urgently needed for circulation to the interagency and NSC for a policy decision.

Recommendation: The State and DHS devise a system for expeditious parole of Ebola-infected non-citizens into the United States as long as they are otherwise eligible for medical evacuation from the Ebola affected countries and for entry into the United States.

Issue: The United States needs to show leadership and act as we are asking others to act by admitting certain non-citizens into the country for medical treatment for Ebola Virus Disease (EVD) during the Ebola crisis. The greatest stated impediment to persuading other countries to send medical teams to the Ebola-afflicted countries in West Africa has been the lack of assured medical evacuation and treatment for responders who may be infected with Ebola virus.

State Department contracted evacuation capacity has so far been sufficient to evacuate all Americans and several other international responders with EVD. (Spain, the UK, and Italy have each evacuated one or two of their own citizens.) Of those evacuated, all American citizens have come to the United States for treatment; all others have gone to Europe, where Germany is so far the only country to accept non-citizens with EVD for treatment. Several countries are implicitly or explicitly waiting for medevac assurances for their responders before committing to send medical teams; assurances are also essential to encouraging individuals to volunteer. (The scope of who is eligible for medical evacuation is the subject of another paper.)

There are four essential elements to every medical evacuation:

  1. Medical evacuation capacity;
  2. Overflight, refueling, and landing permission;
  3. A hospital able and willing to treat the patient; and
  4. Funds to backstop reimbursement, about $200,000 for medevac and $300,000 for treatment per case.

What is at issue here is point 3. As noted, Germany is so far the only country to accept non-citizens for Ebola treatment; Norway has offered to accept EU citizens in addition to its own. We will be working with the European Commission’s Humanitarian Aid and Civil Protection Office (EC ECHO) and with individual countries to impress on them the necessity of opening treatment beds to non-citizens in order to enable and sustain a robust Ebola response. Since it is several hours closer to West Africa by air, Europe is also a preferable treatment destination for medical reasons. We are exploring other destinations as well, and establishment of the Monrovia Medical Unit by the United States and the Kerry Town, Sierra Leone facility by the UK should reduce the need for medevac as they begin to prove themselves effective treatment centers.

There will also be cases where the United States will be the logical treatment destination for non-citizens. For example, we have an obligation to assist non-citizen employees and contractors of U.S. agencies and programs, as well as NGOs and private firms based in the United States. Non-European Ebola response partners (e.g., Australia) consider the U.S. a better destination as well. UN staff permanently employed at headquarters in New York are another category to consider. U.S. legal permanent residents (LPRs) would also expect to come back to the United States. If, as expected, the United States deploys aircraft capable of evacuating more than one patient in the near future, there are likely to be occasions where one patient on a flight is a U.S. citizen and another is not.

U.S. Medevac Capacity: The U.S. Department of State has a contract with a commercial aviation company, Phoenix Aviation, which has the capability to safely transport patients with contagious disease using a specialized aeromedical biocontainment system.  A mechanism has been established for the U.S. government to provide reimbursable medical evacuation services to support countries and International Organizations in their efforts to address the Ebola crisis. Because of the specialized air transport and medical precautions required for Ebola Virus Disease (EVD) the Department of State is assisting with evacuations of U.S. citizens infected with Ebola virus from West Africa whenever possible. State has assisted with medevac of several citizens with EVD back to medical facilities in the United States, in keeping with the U.S. government’s longstanding role of facilitating emergency medical care for U.S. citizens through the State Department, including bringing them home to receive potentially life-saving treatment for serious illness.

The U. S. government is also working with organizations like the UN Office of Ebola Special Envoy David Nabarro, the World Health Organization, and the European Commission, as well as with several countries, on medevac options for Ebola victims. In addition to U.S. citizens, we have assisted with the medevacs of four health care workers out of West Africa with confirmed Ebola cases who are citizens of other countries — three were evacuated to Germany and one to France. Any costs associated with evacuations are the responsibility of the patient or their parent organization. They are not funded by U.S. taxpayers — although the financial guarantees required of U.S. citizens are somewhat less stringent than those for non-citizens.

So far all of the Ebola medevacs brought back to U.S. hospitals have been U.S. citizens. But there are many non-citizens working for U.S. government agencies and organizations in the Ebola-affected countries of West Africa. These may be local employees of U.S. Embassies or third country national health care workers who are working for agencies like CDC and USAID. These workers are playing a critical role in the battle against the Ebola outbreak. Many of them are citizens of countries lacking adequate medical care, and if they contract Ebola in the course of their work they would need to be evacuated to medical facilities in the United States or Europe. Thus far Germany is the only country that has accepted citizens of other countries for treatment of EVD in their hospitals.

U.S. Treatment Capacity: Many hospitals in the United States have the technical ability to treat Ebola patients. However, experience with Ebola cases would minimize the risk to health care workers, and the medical community should consider how best to distribute patients. In addition to Emory University Hospital in Atlanta and the University of Nebraska Medical Center, which have both accepted patients, the National Institutes of Health Clinical Center has expressed willingness to do so.

Legal Authorities and Implementation Requirements: State L notes that the legal and procedural constraints outlined below do not determine the policy outcome. If the U.S. government decides to restrict entry to the United States for non-U.S. citizen Ebola patients, it cannot attribute the outcome to legal and technical issues. At the same time, the mechanism for admission for non-U.S. citizen is not the usual visa process, and normally takes much longer than the time available to an infected Ebola patient, so setting up a mechanism that is ready to move would be essential.

To optimize clinical outcomes and give patients their best possible chance of recovery, air medical transportation of EVD victims should occur in the first five days of illness, with proportionately greater benefit the sooner it can be accomplished. Operationally that requires an almost immediate request for medevac and approval for travel to the United States, as the medevac process itself is a two-day journey. This presents a challenge, since under INA § 212(a)(1)(A)(i), (implemented by 42 C.F.R. § 34.2(b) and Executive Order No. 13295, as amended) Ebola Virus Disease is a communicable disease of public health significance and grounds for visa ineligibility. In order to permit the travel of such an individual, either an INA § 212(d)(3)(A) waiver of ineligibility or prior approval of parole pursuant to INA § 212(d)(5)(A) would be required from the Department of Homeland Security. (Note: legal permanent residents of the United States would not normally be ineligible to enter because they have an infectious disease, and counter enter on their “green cards” in most cases.)

Given the length of time necessary to obtain a waiver of ineligibility, or individual parole, as well as potential difficulties in securing the travel document for an infected individual, issuance of a properly annotated visa/boarding foil pursuant to a waiver request or parole is not a likely option. The Visa Office recommends the development and implementation of a mechanism similar to the one used for the African Leaders Summit (when technical issues precluded the issuance of visas), under which State worked with DHS to arrange expeditious port-of-entry waivers in advance of travel.

A pre-established framework would be essential to guarantee that only authorized individuals would be considered for travel authorization and that all necessary vetting would occur. The precise language and structure would be jointly developed by the Department of Homeland Security and the Bureau of Consular Affairs.

~End of memo~

~StMA

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17 responses to “U.S. State Dept memo on bringing foreign Ebola patients to America

  1. Reblogged this on Fellowship of the Minds and commented:

    We now have the actual State Department memo recommending the “expeditious” importing of Ebola-infected non-citizens into the United States for medical treatment. It would cost $300,000 to treat each patient and another $200,000 for transportation — expenses that the State Dept. claims will be borne by the patient or their parent organization, and NOT by U.S. taxpayers. But do you actually believe the Obama administration? I don’t. Since when has Obama actually told the truth about anything? Or have we forgotten his grand promise of “If you like your health insurance, you can keep your insurance,” or “your health insurance premium will actually go down with Obamacare”?

    Then there is the graver matter of intentionally bringing into the United States even more people who are Ebola-infected — as if the case of “Patient Zero” Liberian Thomas Eric Duncan, who infected two nurses, isn’t enough — and thereby increases the likelihood that the deadly hemorrhagic virus contaminate and infect more Americans.

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  2. Make the Affordable Health Care Act applicable world-wide!

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  3. Pingback: U.S. State Dept memo on bringing foreign Ebola patients to America | necltr

  4. I STILL don’t see how THIS makes more sense than shipping a half dozen sets of everything we currently use to treat Ebola to the most infected Countries,and treating them THERE. The air transports could set down and stop at the distant end of the runways,off-load the gear,turn around and leave,having never been closer than a mile from any potential infection source. Those who have BEEN there treating infected people could be trained to use the equipment and handle the skills WE would have provided here,by a video link.
    Closing off ANY take-offs,Commercial OR private,from infected Countries (even Americans) without complete 21+ day (I’ve read that a 2 MONTH incubation period is possible,and I’D err to the cautious side,if given a choice.) quarantine,followed by blood work and a check up by a Dr. skilled and trained in Ebola treatment,and preceded by a signed and notarized statement of good health to travel from the Dr.,would make it much harder for anyone to bring infection into the US. We ALSO need to close our Borders,(land and sea) to anyone who hasn’t complied in a similar manner. I truly don’t believe this is a case that can allow ANY potential risk to enter the Country,and the way our “president” has mis-handled this,so far,gives me VERY little faith that it’ll be stopped in time.

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  5. I have no fundamental objection to this as long as the eligibility is confine to Third Country Nationals (TCN) – people who are non-US citizens and not citizens of a West African country. Africans should be treated in Africa, but medical personnel from (say) Mexico, Columbia, Norway, Japan, etc. could be treated US facilities as long as space is available and the hospitals involved have the ability to treat the number of patients involved. Setting up a whole Ebola unit to treat 2 patients in Mexico or Brazil, for example, would not be cost effective. It might be desirable to set up 2 facilities in Europe, (Spain and Germany have them already) one in the UK and 5-6 in the USA.

    Economies of scale would work here as well. Rather than refitting a dozen hospitals in a dozen countries, treating several patients at a time in 5-6 hospitals would be more cost effective.

    Of course there ill be objections from the “peasants with pitchforks,” but I see no danger to the US populations from admitting 20-30 Ebola patients per year using strict isolation procedures in a hospital facility specifically set up to handle Ebola patients. Ebola is not easy to transmit and poses nothing like the danger that (say) plague, smallpox or even an especially virulent strain of influenza would present.

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    • “Of course there ill be objections from the “peasants with pitchforks,” but I see no danger to the US populations from admitting 20-30 Ebola patients per year”

      Scientists disagree. But then I’m sure you think you know better. From the Associated Press:

      Top medical experts studying the spread of Ebola say the public should expect more cases to emerge in the United States by year’s end as infected people arrive here from West Africa, including American doctors and nurses returning from the hot zone and people fleeing from the deadly disease…. scientists have made educated guesses based on data models that weigh hundreds of variables, including daily new infections in West Africa, airline traffic worldwide and transmission possibilities.

      This week, several top infectious disease experts ran simulations for The Associated Press that predicted as few as one or two additional infections by the end of 2014 to a worst-case scenario of 130.

      “I don’t think there’s going to be a huge outbreak here, no,” said Dr. David Relman, a professor of infectious disease, microbiology and immunology at Stanford University’s medical school. “However, as best we can tell right now, it is quite possible that every major city will see at least a handful of cases.”

      Relman is a founding member of the U.S. Department of Health and Human Services advisory board for biosecurity and chairs the National Academy of Sciences forum on microbial threats.

      But then Dr. Relman must be one of those “peasants with pitchforks” for whom you have such disdain and contempt.

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      • 130 cases was described as the “worst case” scenario, not intended as a definitive answer. My estimate of 20-30 may have been a “lowball” figure. Neither I nor Dr Relman has a magic crystal ball that tells us the we will have 11, 56 or 126 cases of Ebola in the US in the next year. I do not believe that Dr Relman has called for travel ban, has he?

        And 130 cases of Ebola among 300+ million people is not a catastrophe.
        A serious problem, certainly, but we have handled worse. And handling 10 cases of Ebola in one facility is not nearly as expensive a handling 10 cases in 10 facilities. And if we have (say) 2 patients from Mexico, 1 from Columbia, 2 from Chile and 1 from Japan, it would make good sense to treat all of them in one US facility.

        The “peasants with pitchforks” are the people who want to close the borders, ban anybody who has been to Africa from entering or returning to the US, and putting returnees into tents in parking lots or putting them in what amounts to maximum security prisons.

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        • So-are you STILL okay with 130 cases in 300 million if YOU or a family member is among them?

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          • I’d write more,but I have to go sharpen my PITCHFORK.

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          • Ha Ha Ha Ha!

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          • My family and I are in far greater danger of being killed by a drunk or doper on the road that we are of being exposed to one of 130 Ebola patients scattered around the country. I am retired, so, in theory, I could stay in my house 24/7, talk to my family on Facebook, by groceries on the internet and hire some kid to bring in the mail form my mailbox.

            But I throw caution to the winds and drive my car to the grocery store, the bank, post office, community meetings and social occasions with family and friends. Call me a daredevil, but I won’t let a few drunks and dopers keep me a prisoner in my own home.

            I have, in fact, volunteered to work with my county health department in the event that there is an Ebola problem in my local area. But the US medical system can cope with a few Ebola patients without risking a mass outbreak. In fact the people treating Ebola patients are probably more at risk of being run over, shot or mugged on their way to and from home than they are of catching Ebola.

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          • You’re missing the point. Concentrate,and think carefully about this: Are 130 cases ACCEPTABLE LOSSES to YOU,even IF you or one of your relatives is one of those 130 infected people? And if you think “the US medical system is prepared for Ebola,” Good Luck to you. I’m disabled,and I don’t share your confidence. I’ve seen little evidence that they could handle ANY cases of Ebola and promise a good result. BTW-it’s past lunch time-you’d better go feed your Unicorn.

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        • “The ‘peasants with pitchforks’ are the people who want to … put returnees into tents in parking lots or putting them in what amounts to maximum security prisons.”

          It certainly is helpful that you define who those “peasants with pitchforks” are. But who’s proposing to put returnees (from Africa) into “what amounts to maximum security prisons”? Your source, please.

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  6. Reblogged this on Centinel2012 and commented:
    Obama is either insane, demented or demonic take your pick.

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  7. He’s ALL THREE.

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  8. Again my greatest concerns are that Obama, Kerry and other cabinet members will not be afflicted. Not a Christian sentiment but they are miserable phonies who are ruining America.

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