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'The Rachel Maddow Show' for Thursday, October 16th, 2014

Read the transcript to the Thursday show

Date: October 16, 2014

Guest: Bradley Britigan, Colleen Nelson

HAYES: That is ALL IN for this evening. Rachel`s shows -- "RACHEL MADDOW
SHOW" starts right now.

Good evening, Rachel.

RACHEL MADDOW, MSNBC ANCHOR: We could just call it Rachel Show. Save them
some troubles.

HAYES: I got excited because I was -- I got excited because the clock was
ticking and I was going to hit it on the zero which all weirdly makes me
feel good like I put a button on the day and so that I -- I rushed it.

MADDOW: I`ll just call you "ALL" with Chris from here on out.

HAYES: All right.

MADDOW: All right. Our thanks to you at home for joining us this hour.
Very happy to have you with us. This is a very busy news night. This is a
very full news day that all of a sudden became very full of late news at
the end of the day. The president late tonight made some extensive remarks
on the fight against Ebola.

We`re going to have more on that in a moment, including the late news
tonight about where America`s current Ebola patients are being treated. As
of right now, none of them are being treated in Dallas any longer. So
we`re going to have much more on that coming up later in the show. As well
as an unrelated story we`ve got tonight for you late in the show about
bravery. Incredible bravery in the great state of Alabama.

It`s a story that you absolutely will not believe. That`s coming up at the
end of tonight`s show. There`s a lot, a lot to report today. But we`re
going to begin tonight with some breaking news out of Washington, D.C.
This is a surprise, out-of-nowhere development. But NBC News has confirmed
tonight that Vice President Biden`s son, Hunter Biden, was kicked out of
the Navy Reserves earlier this year after he tested positive for cocaine.

This story was broken late this evening by the "Wall Street Journal." Vice
President Biden, I should tell you, has two sons. The older son is Beau
Biden, he`s the more well-known of the vice president`s son. Beau Biden
serves as the attorney general of Delaware. He`s planning to run for
governor of Delaware in 2016.

Beau Biden is not the son in this report. It is the vice president`s
younger son. He is the one who got discharged from the Naval Reserves
after failing a drug test. That son again is named Hunter Biden.

Hunter Biden had made a somewhat unusual decision to join the military
after he turned 40 years old. He`s now 44 years old. He was accepted into
the Naval Reserves in 2012. He got his commission as a public affairs
officer in May, 2013. When he joined up Hunter Biden had to get a special
waiver from the Navy for two things. The first was his age. He was
signing up at an age much later than most people do.

The other waiver, apparently, at least according to the "Wall Street
Journal," is that he had some sort of drug-related incident as a young man
which the Navy was aware of and they decided to give him a waiver form so
that he could sign up.

We`re told that that type of waiver for a minor drug incident, that`s not
that uncommon when somebody is signing up for the military no matter what
age they are. But now, late tonight, we are learning that Hunter Biden`s
very brief military career is over and he is out. And that he left under
these very surprising circumstances.

We`re told tonight that he failed this drug test last year. In mid 2013,
during a drill weekend. And he was discharged in February of this year.
So this isn`t something that just happened. But we are just learning about

The timing here does raise a question of why this news is coming out now.
This is not something that happened recently. It happened months ago. Why
are we finding out now?

The Navy is describing this as a private personnel matter. They say they
would never under any circumstances be a case where they`d talk about
something like this publicly. They say they`d never provide public details
on Mr. Biden`s discharge or any discharge of a junior officer under
circumstances like this. It`s a private matter.

But after the "Wall Street Journal`s" report tonight, Hunter Biden himself
did put out a statement publicly apologizing, saying how embarrassed he is
by this. Mr. Biden`s quote -- Mr. Biden`s statement saying, quote, "It was
the honor of my life to serve in the U.S. Navy. I deeply regret and am
embarrassed that my actions led to my administrative discharge. I respect
the Navy`s decision. With the love and support of my family, I`m moving

But, again, this news tonight, breaking news, is that Joe Biden`s -- Vice
President Joe Biden`s younger son, Hunter, Hunter Biden was kicked out of
the military this year after he tested positive for cocaine.

This was already a heightened moment for the administration. Obviously,
with the Ebola crisis, with the undeclared war against ISIS, with the
elections less than three weeks away, now this new bombshell about the vice
president`s son has landed late this evening in the "Wall Street Journal."

Joining us now is Colleen Nelson, White House correspondent for the "Wall
Street Journal." She and her colleague Julianne Barnes broke this news
just a short time ago.

Miss Nelson, congratulations on the scoop. Thank you for being here to
help us understand it.

Thank you for having me.

MADDOW: Are there any further details that you haven`t written up yet for
the "Wall Street Journal"? Or is there -- are we going to learn anything
further about why this is public news now even though it happened months

NELSON: Well, I think this is public news now because we heard some -- a
little something about it and decided to pursue a tip and track down this
information. But if not for that, I don`t think we would probably have
ever heard about this. Certainly the White House wasn`t planning to
announce this.

As you noted, the Navy isn`t going to make this information public. And so
I think that if not for somebody trying to track it down, it probably would
have just kind of faded away quietly.

And there was some attention when Hunter Biden joined the Navy, there was a
little bit of news coverage about the fact that he was joining the Navy and
it was notable that he was 42 at the time. But there hasn`t been a lot of
follow-up about whatever happened to Hunter Biden being in the Navy

MADDOW: In terms of the vice president here, obviously he`s spoken with
pride about both of his son`s military service. Obviously his older son,
Beau, had much more extensive military service than Hunter Biden did. Has
there been any reaction from the vice president`s office? Have they been
willing to talk to you about why this wasn`t made public before or given
any reaction to the reporting?

NELSON: Well, the vice president`s office has not been willing to comment
so far. But you`re right. Both of Biden`s -- Joe Biden -- Vice President
Joe Biden and his wife Jill have talked often about how much pride they
have in being a military family. They refer regularly to Beau Biden`s
deployment in Iraq. And they talk about how important military service is.
And so it`s clear that military service is something that is near and dear
to their hearts.

And when Hunter Biden signed up for the Navy, Jill Biden said publicly that
she was very excited to stand with her son when he was commissioned. And a
couple of months later, Joe Biden speaking at an inaugural ball, sponsored
by the American Legion, joked about it and he said, you know, we have a lot
of bad judgments in our family. And he said, for example, my son Hunter
just joined the Navy over the age of 40, he said, but he`s going to be an

And so they both were very quickly to point out publicly that he had joined
the Navy when that happened in 2012.

MADDOW: In your report tonight in the "Journal," you say that when Hunter
Biden signed up, he received a waiver because of a drug-related incident
when he was a young man. Do we know anything else about either that
incident or whether that was a serious matter or an unusual thing for the
Navy to grant a waiver about?

NELSON: We don`t know a lot of details about that. It happened a number
of years ago. And so there are scarce details. There are scarce records
related to it. But we do have confirmation that there was a drug offense
that could have precluded him from joining the Navy. And so he -- and so
he sought and received a waiver for that drug offense.

The military says that it`s not that uncommon for such waivers to be
granted particularly for one-time, relatively minor offenses. So certainly
it was some number of years ago, but there was a history of some drug
episode in Hunter Biden`s past.

MADDOW: Colleen Nelson, White House correspondent for the "Wall Street
Journal" breaking the news tonight that Vice President Biden`s son, Hunter,
was kicked out of the Navy Reserves last year or earlier this year for
testing positive for cocaine last year.

Miss Nelson, thanks very much for helping us understand this scoop of yours
tonight. I really appreciate your time. Thank you.

NELSON: Thank you.

MADDOW: All right. Again, this story just breaking in the "Wall Street
Journal" tonight. The vice president`s younger son Hunter, he apparently
has been out of the military since earlier this year. We did not know
that. Nor did we know why. Which apparently was a failed drug test for
cocaine mid last year.

All right. We`ve got much more ahead on this very busy news day.

President Obama weighed in on the Ebola situation late tonight in extensive
remarks. And we`re just learning, for the first time tonight, we are about
to be hearing directly from the first nurse to be diagnosed with the
disease in the United States. We have new tape that is of that nurse. And
we`re going to have that for you in just a moment. More on that plus that
incredible story of bravery out of the American south tonight. Please stay
with us.


MADDOW: We`ve just been told that we`ve got some new tape that`s just
coming into the
Control room right now. Remarkable footage that we did not expect of Nina
Pham. Nina Pham is the first doctor -- excuse me, the first nurse in Texas
to be known to be infected with Ebola during the treatment of Thomas Eric
Duncan, the first Ebola patient diagnosed in this country.

Tonight, Nina Pham is on a plane. She`s leaving Texas Health Presbyterian
which is not only where she works, but where she treated Thomas Eric
Duncan, where she got infected and where she has been treated since she
first started showing symptoms on Friday. So she started showing symptoms
on Friday. She`s now six days in to being symptomatic with Ebola.

That sort of timing, at least typically, in terms of the natural
progression of the disease, puts her out of very crucial time, a fragile
time, sort of a crossroads in the natural progression of this disease as to
whether or not you are going to recover and your immune system is going to
be able to handle it or whether you are going to decline.

And after roughly this amount of time with symptoms, if patients are going
to decline, they typically decline fast. That`s why it is remarkable that
we`ve just received this footage.

Do we have it?

This footage which is from Texas Health Presbyterian, this is as she was
leaving Texas Health Presbyterian in Dallas tonight to get on a plane and
go to the NIH, to go to Bethesda in Maryland and be treated at their
specialty unit there. Watch.


DR. GARY WEINSTEIN, NIH: Thanks for being part of the voluntary team to
take care of our first patient.


WEINSTEIN: It means a lot. This has been a huge effort by all of you

PHAM: Yes.

UNIDENTIFIED FEMALE: Don`t cry. Don`t cry.

WEINSTEIN: Yes. And we`re really proud of you. All right.

PHAM: Come to Maryland, everybody.

WEINSTEIN: Party, party in Maryland?

PHAM: Party in Maryland.



WEINSTEIN: Do you need anything?

PHAM: I don`t think so.



WEINSTEIN: There`s no crying.


WEINSTEIN: Well, happy tears are OK.

PHAM: Yes.

WEINSTEIN: Otherwise no tears. No crying. It`s not allowed.



PHAM: I love you, guys,

WEINSTEIN: We love you, Nina.



MADDOW: Remarkable footage just released from Texas Health Presbyterian
Hospital in Dallas. Nina Pham who again is the first nurse who have -- to
become infected at work while she was involved in the treatment of the
Ebola patient Thomas Eric Duncan there. She is the first person to have
known -- to be known to have become infected with Ebola in this country.
Where she got infected is her work site which is, until tonight, where she
was being treated.

You see the health care workers in there, including the one speaking to
her, you could hear the distortion there speaking through the mask.
Obviously, they`re wearing full, personal protective equipment which has
been so much of the discussion about how to safely treat Ebola patients.
But, again, there`s Nina Pham.

That`s the first that we have seen her since she became ill, to see her
able to communicate with and react to her co-workers there, her co-workers,
who are now treating her. It`s heartening especially that she is -- given
that she is six days into being symptomatic with this disease.

Again that footage, just coming in tonight. And we`re told that Nina Pham,
who you see there in that footage, tonight is on her way to Bethesda, on
her way to the National Institutes of Health where they will continue her
treatment there in one of the nation`s few, few specialty biocontainment

When I say few, I mean it. And we`ve actually got some new reporting on
that coming up next. Stay with us.


MADDOW: One of the reasons why modern medicine works, one of the reasons
we have a reasonable expectation that we can go to the doctor or even have
surgery and expected to come out cured is this thing.

Behold the autoclave. The basic idea is simple. It circulates for several
minutes really hot, pressurized steam around whatever objects you have put
into the autoclave. In so doing, that super hot steam kills anything
living on the surface of those objects. Autoclaves can use just water.
They can sometimes use specialty solutions.

But the basic idea is that simple one about heat and steam. The water is
heated to something like 250 degrees Fahrenheit, it circulates that super
hot pressurized steam inside the machine. So if you put like your used
scalpel inside the autoclave, the super hot, pressurized steam will kill
all the microbes living on that scalpel. Anything living.

So after it`s been cleaned and autoclaved, you can be confident that
nothing from patient number one will be transferred to patient number two
by way of that scalpel.

Modern medicine has had the autoclave to work with since the late 1800s
when this impressively bearded hipster, Charles Chamberland, invented it in

Autoclaves. Again, invented in the 19th century. They are part of the
reason why we expect that the equipment doctors use to treat us won`t
spread disease. Autoclave technology changed modern medicine. It`s part
of what defines medicine as modern. And it turns out that technology is a
key factor right now in us trying to get through the current ordeal that we
are facing in modern medicine in this country.

It`s been alleged by nurses from Texas Health Presbyterian Hospital in
Dallas that one of the major problems in that hospital`s treatment of the
first Ebola patient diagnosed in the U.S., one of toughest challenges for
that hospital in dealing with him was what to do with all the medical waste
created by treating that patient.

Ebola is a messy disease. The way it progresses in the human body, people
sick with the disease expel a lot of fluids. And that creates a lot of
waste. Hospital linens, protective clothing, medical equipment, towels,
you know, all of that stuff has to be treated as highly contagious once
it`s been used in the treatment of a patient with Ebola.

At Texas Health Presbyterian, some nurses have come forward to say that the
hospital had a hard time getting control of that issue logistically. A
nurse interviewed on the "Today" show today said infectious waste from the
first Ebola patient at that hospital filled up a whole room set aside for
it and was piled up to the ceiling.

And this seemed to be both a dangerous thing and a somewhat traumatic thing
for the health workers who were trying to take care of that patient while
also trying to avoid getting infected themselves. The hospital didn`t know
what to do with their wastes.

Even once they incinerated that waste, even when some of the potentially
contaminated belongings of that Ebola patient were completely incinerated,
one Louisiana-based waste management company refused to fulfill their
contract. Refused to come pick up the incinerated ashes because they said
they are still too scared of even the safely incinerated waste.

And that`s partly just fear and hysteria and Louisiana officials doing
nothing to correct that misperception and make clear that fully incinerated
waste was OK. But that also happened in part because it hadn`t been worked
out ahead of time. Right? There was no plan in place from the beginning
to deal with the issue of what you do not just with this human being who`s
been infected, but also what you do with all the physical stuff that may be
dangerous to other people because of contact with the virus.

There was no plan in place in Dallas to deal with all of that stuff. And
what to do with the waster created in the process of treating Ebola has
been a really big problem and it probably would be a really big problem for
lots of hospitals around the country if they had to deal with it. It has
been a big problem.

There are also, however, places where it has posed any problem at all. At
the biocontainment unit. At the University of Nebraska Medical Center in
Omaha, they have got it figured out. That unit is one of the preeminent
facilities for treating highly infectious diseases in this country.
They`ve already treated one Ebola patient who recovered. Another one is
there now, it`s the freelance cameraman working for NBC News who got the
disease in Liberia.

And with those two patients under treatment so far, they`ve had zero issues
with waste disposal. And that is because in Omaha, they autoclave
everything. Everything.

Shelly Schwedlem is the nursing director of that unit. Watch.


in the unit is autoclaved out. So when it comes out of the unit, whether
that`s linen or trash, it`s completely decontaminated. And then it goes to
the waste drain.


MADDOW: OK. When we think of an autoclave, we usually think about it
being used to clean hard stuff, right, or scalpels or clamps or other tough
equipment, right? Surgical equipment and stuff? Well, at the facility in
Omaha, they do autoclave all of that stuff. But they also autoclave
clothing, towels, linens. They autoclave the trash.

Everything that comes in contact with this patient or his body fluids --
his or her body fluids, they consider potentially contaminated. And so
they use that process invented in the 1800s to decontaminate everything,
every single thing involved in the patient`s care.

This Omaha facility is one of a very small number of units like this across
the country. These units that have set the standard for excellence in
dealing with this highly infectious disease, treating patients well and
treating them safely. The Omaha unit has only been around for nine years.
But they practice for this stuff. They train for this stuff regularly.
They know how to do this stuff. They`ve got the systems in place.

But that unit was not built solely for Ebola. It was built to treat a
whole variety of highly infectious and deadly diseases. Small pox, SARS,
tuberculosis, the plague. The most lethal diseases in the world including

And at that unit in Omaha, they`ve got 10 beds in which they can offer
treatment for those diseases. Highly specialized care. Safe care. They
have 10 beds to treat everything they are capable of treating. But when it
comes to treating patients with Ebola, even at this gold standard, state-
of-the-art, best-in-the-world facility, it turns out there is some fine
print. And in the fine print for us as a country, there is some
uncomfortable news, some uncomfortable math, about what even they are
capable of.

It turns out how many patients have access to care at this kind of world
class facility? There`s what they call a rate-limiting factor for that.
And it has to do with the trash.


SCHWEDLEM: The autoclaving is a rate-limiting factor, for now. I know
that there`s a lot of work across the country to try to work on the waste
management issue and how to better manage that because autoclaves aren`t
something that every hospital have.

UNIDENTIFIED MALE: How many can your autoclave system right now handle how
many Ebola patient?

SCHWEDLEM: Oh, probably two to three.

UNIDENTIFIED MALE: What would it takes to amp that up?

SCHWEDLEM: Well, right now, we`re not even autoclaving around the clock.
So we have a lot of capability to increase that at this time.

UNIDENTIFIED MALE: To increase it beyond three?

SCHWEDLEM: No, we think that that`s probably about the right level.


MADDOW: Increase it beyond three? No. The facility that is arguably the
most prepared in the country, and therefore, in the world, to treat Ebola?
They can handle three patients. Three. Three total. Because that`s how
much Ebola waste that facility can autoclave and safely deal with. So it`s
three beds. Three beds total to treat Ebola in Omaha.

There`s one patient there right now, the NBC freelance cameraman, he`s
being treated in Omaha. So in Omaha, one of their three total beds is
taken. Two more potential spots there.

Around the country, we have three other facilities who are specialized in
treating highly infectious diseases. Outside of the one in Nebraska,
there`s also the one in Emory. They also have three beds in which they say
they can treat Ebola patients. Two of those beds are currently in use.
They`ve got two Ebola patients at Emory right now.

One American worker for the World Health Organization who`s been there for
over a month and whose name has not been released. And also the second
nurse who contracted the disease in Dallas. She was transferred to Emory
last night. So at Emory, two out of their three beds are taken.

Then there`s the National Institutes of Health in Bethesda, Maryland. They
have a capacity, a total capacity of two beds to treat Ebola. Their very
first Ebola patient is en route right now. Nina Pham, the first nurse, who
contracted Ebola while caring for that patient in Dallas, she`s going to be
there tonight.

So that`s two beds at NIH, one in use as of tonight. That means they`ve
got one more spot available.

And, at St. Patrick Hospital in Missoula, Montana, that`s the fourth of
four. That`s the other specialized unit for highly infectious disease in
our country. They say they are able to treat one Ebola patient at a time.
They have one bed for Ebola. Nobody is in that bed right now. And that`s

So here`s where the math gets alarming. That means nine beds total for
specialized Ebola care in this country. Nine beds total is our national
capacity in terms of these high-end, specialty units that we know can do it
more safely than anybody else in the world. Nine beds total available.
Four of them are already in use.

So our expansion capacity, in case there are any more cases, five for the
whole country. That`s a very small number of beds. That`s a very small
number of patients who could be handled at once. In places that we are
confident we know, we know how to handle them. Not much room to grow
there. And we may have to be ready to grow.


SYLVIA BURWELL, HHS SECRETARY: I think there may be other cases. And I
think we have to recognize that as a nation.

DR. ANTHONY FAUCI, NIAID DIRECTOR: We have a case now and it is entirely
conceivable there may be another case.

JUDGE CLAY JENKINS, DALLAS COUNTY, TX: At the hospital, we have a
situation involving 77 people, two of which have tested positive for Ebola.
We are preparing contingencies for more. And that is a very real

THOMAS FRIEDEN, CDC DIRECTOR: If they develop Ebola, we hope no more will,
but we know that`s a possibility, since two individuals did become
infected, others may.


MADDOW: Others may. CDC Director Tom Frieden testifying today before
Congress. One of many health officials warning that we should not be
surprised when and if more people, more American health care workers who
treated that first Ebola patient in Dallas end up with Ebola themselves.
And that`s totally apart from the issue of people contracting it elsewhere
in the world and then ending up here when they get diagnosed.

They are telling us to expect more. Question then becomes where are they
going to go? The only non-specialist unit that has treated Ebola in this
country, not because they asked for it, because it arrives on their
doorstep and their did their best, is this community hospital in Dallas
where the first patient was treated. That patient died and in the process
of treating him, that hospital managed to get at least two of their healthy
health care workers infected in the process of treating them. And God
bless them, and the whole country is praying for these 70 plus health
workers from Dallas who have now all been isolated.

But all of those health workers have been isolated, that also means that
Texas Health Presbyterian is now down 70 plus staff members who can`t come
to work because they`re in isolation. 70 plus stuff members, the very
people who have been selected at that hospital to work on this very
difficult case. They are now down all of that staff. They are reeling
from the impact this has had on them so far. And they are readying
themselves for other potential cases in their community. That`s part of
the rationale for moving nurse Nina Pham out of treatment at Texas Health
Presbyterian Hospital tonight. Part of the rationale for moving her is not
just that they want her to get great care at the NIH and Bethesda, they
want Texas Health Presbyterian to be ready in case more health workers from
that hospital are diagnosed because they got infected by caring for Thomas
Eric Duncan.

That is the only non-specialist facility in the country to have dealt with
this Ebola outbreak and their experience has been devastating.

If it turns out, as the experts are warning us, if it turns out that
several more people are infected with this disease, where are they going to
go for treatment, ultimately? Can we ramp up the number of specialty units
that we have? We`ve got five available beds in the whole country in those
specialty units right now. Nine beds total, four taken. Can there be more
of those units? Can we upscale what those units can do? Can we replicate
those units quickly? Can we get more out of the existing units? Is it
possible? Logistically, is it possible? Can the Omaha, Nebraska, bio-
containment unit start running its autoclave 24/7. Could that get us
higher than the stated three-bed capacity that`s estimated by their nursing
director? What can we do to up the capacity at Emory or at NIH, if we

At Missoula, they say they can take only one patient with the current
stuffing levels that they`ve got. They say if they had more staff, not
more equipment, but more staff, they think they could get up to a capacity
for three beds. They need more staff to be able to offer that capacity.
Can we get them more staff? Shouldn`t we do that now? It seems like we as
a country should be able to get them more staff.

What would it take to get more of these units on line? Are we comfortable
as a country with having a margin right now of five total beds to expand

The Omaha bio-containment unit in Nebraska was built after 9-11. It was
built after 9-11, it`s only been around for nine years. It exists because
Congress made money available for biological disaster preparedness after 9-
11. This isn`t terrorism. It`s public health. Do we spill the same
amount of urgency? That unit exists now and is treating an Ebola patient
now because of that money, which is motivated by the fear of terrorism.
And there were many times when it seemed nuts to spend all of that money on
something we may not ever need to use as a country. Oh, sorry, it didn`t
turn out like we expected it to. But thank god we spent that money.
Because now that we really, really need it, it is here and the staff is
trained and they`re doing what they know how to do. How do we make that
bigger? How do we replicate Omaha? Is it possible to do that? How do we
do it and how quickly can we do it?



this very seriously at the highest levels starting with me and my entire
team is been essentially deputized to work with Health and Human Services
and CDC. And that includes, by the way, the Department of Defense and our
national security teams. We understand why it`s important for us to
provide assurances to the public. That folks are taking this very
seriously and they are. And, obviously because of the two nurses getting
sick, that has made people that much more concerned.


MADDOW: President Obama in the Oval Office tonight with his top team
working on the Ebola crisis, the president making extensive and unscripted
remarks about the nation`s response to Ebola so far. You heard at the end
of his remarks, though, that we just played, him referencing the nurses who
became infected while caring for the first patient to have been diagnosed
with Ebola in this country, in Dallas. The first nurse to have become
infected. The first one to have her diagnose confirmed, is Nina Pham. A
young nurse in her 20s in Dallas. She has been treated at Texas Health
Presbyterian since she first came down with her first symptoms this past
Friday, six days ago. Tonight, she was moved to the NIH, to National
Institutes of Health`s facility in Bethesda. But before she got on the
plane tonight, they shot this remarkable video inside her hotel room at
Texas Health Presbyterian showing her interacting with her coworkers.
Remember, she works there as well as being treated there. Talking with her
co-workers about her own condition. It`s pretty remarkable footage.



UNIDENTIFIED PERFSON: Party. Party to Maryland.







UNIDENTIFIED PERSON: Please no crying.

PHAM: No crying.


PHAM: I love you .


PHAM: Love you.


MADDOW: Again, that footage tonight from Texas Health Presbyterian. That
is the first nurse to have known to become infected while taking care of
the first Ebola patient diagnosed in this country. That was shot tonight
before she was transferred from Texas Health Presbyterian to a specialized
unit at the National Institute of Health in Maryland. That NIH unit is one
of the very few units set up as a - essentially a specialty facility for
dealing with highly infectious diseases.

Joining us now is a doctor from another one of those specialized units in
this country, Dr. Bradley Britigan. He`s the infectious disease specialist
and dean of the College of Medicine at the University of Nebraska Medical
Center where they can treat three Ebola patients at a time and where they
have already been involved in treatment of two patients. Doctor Britigan,
thank you very much for being here. I really appreciate your time tonight.

Certainly. It`s a pleasure to be with you.

MADDOW: Can I ask you first if you can give us any sort of update on the
current patient who has been treated most recently at the unit at Nebraska?

BRITIGAN: You know, he continues to have a slow improvement. Is doing
well and I think, as already has been reported, eating some solid food and
basically continues to make progress.

MADDOW: In terms of the capabilities of the unit there at the University
of Nebraska and there`s three other units around the country that are
always cited as being essentially in that top tier of being able to deal
with highly infectious diseases. There`s a very small number of beds if
you add them all together in terms of the number of patients that could be
treated in a specialist facility like yours. Should that worry us in terms
of the ability of patients to get top tier level care if we do get a number
of people diagnosed, maybe under the circumstances in which these nurses
were infected in Dallas?

BRITIGAN: Well, I mean, it is a concern, at least in the short run. The
real question, I think as you eluded to in some of the earlier parts of the
show, is how quickly we can ramp up and provide similar capabilities in
other facilities around the country.

MADDOW: How quickly could we? I mean I know that having spoken with
another medical professional from your facility, having studied something
about what makes you different, it seems like what you`re doing is not
something that`s technologically infeasible for other facilities. It`s
more a matter of practice, training, comfort with essentially the protocols
so that they can be followed to a tee and without error. It seems like
something that would take a long time to develop in other places.

BRITIGAN: Well, I mean, it does depending upon the level of preparedness
in the background of the individuals. You know, at certain institutions.
Certainly practice makes perfect. Practice can be ramped up. It really is
kind of like - a little bit like flying an airplane. You have a very
strict checklist of things that you have to do and specific orders - and
order and be watched very carefully doing it and making sure you`re doing
it right. So there is that back-up. But again, there`s no substitution
for practice.

MADDOW: Do you think your experience, given the way that you`ve seen your
health professional perform in this very top tier facility that you
oversee. Do you feel like if the country is going to need to upscale the
number of places in which we are comfortable having Ebola patients treated,
in which we feel like where they are getting the top level standard of
care, would it make more sense to try to bring regular community level
hospitals up to a standard that is safe? Or would it make more sense
especially that has to happen in the short term, to try to scale up from
the places where it is working? To build in more beds at a facility like
yours to try to get more beds on line at a place like Missoula or some of
these other units. Strategically, how would you approach it if you had
that decision to make for the country?

BRITIGAN: Well, I mean I think it`s a difficult question to answer,
without knowing exactly what the infrastructure is like at many other
facilities around the country. You know, as you eluded to it, part of it
is having the physical structures to do that. And there`s nothing, at
least in terms of taking care of patients with Ebola, because it is not
passed as an airborne disease. It`s largely having a location where the
individual can be isolated and taken care of in a separate location. The
real challenge, though, is as you eluded to, is training the staff to be
able to take care of them safely. As well as dealing with some of the
infectious waste, as well as the transportation of laboratory specimens and
things safely to the laboratory. So, each, you know, hospital will be
different in terms of that capability. You know, we`ll know a little more
about our training methods. We are actually since our first patient
arrived several weeks ago, we`ve actually are a staff of 40. We`ve had
somewhere between 20 and 30 additional people volunteer to be trained to
work in that facility.


BRITIGAN: So that, you know, we are really ramping up and we`re going
through a training process ourselves with new staff. They are not involved
in any of the patients thus far, and they won`t be until they are - very
confident that they`re ready. But we have some experience in terms of
training new individuals.

MADDOW: Doctor Bradley Britigan, dean of the College of Medicine at the
University of Nebraska Medical Center. Thank you for helping us understand
that. I did not know that about people volunteering to get involved in new
patient care at this point. It`s very heartening to hear. Thank you, sir.

BRITIGAN: Thank you.

MADDOW: All Right. It is amazing that given that we`ve just had two
health care workers infected in this country, more health care workers are
saying I`ll get in there. I`ll do it. It`s amazing. We`ll be right back.


MADDOW: Sometimes the news gods decide that today`s news will have a
theme. The news gods decided that for today, the theme of the news is
personal bravery. In lots of countries including the tiny Gulf nation of
Bahrain, you can go to prison for insulting the king. In 2012, a woman in
Bahrain went to prison for two months for tearing in half a picture of
Bahrain`s king. She`s already gone to prison for this. Her father is in
prison for life because he participated in demonstrations against the king
in 2011.

Well, now this week she was back in court for a hearing related to the
charges against her. In front of the judge at that court hearing she said
this, she said "I`m the daughter of a proud and free man. My mother
brought me into this world free, and I will give birth to a free baby boy,
even if it is inside our prisons. It is my right and my responsibility as
a free person to protest against oppression." And then standing right
there in court in front of the judge up on charges of tearing up a picture
of the king, she tore up another picture of the king in court. They
arrested her on the spot. This happened Tuesday, the "New York Times"
reported it today. She`s more than eight months pregnant. Bravery.
Bravery. Whether you agree with her or not, bravery. And more to come on
the subject of bravery tonight. Stay with us.


MADDOW: The theme of today`s news is bravery. Meet David Mensink, 27
years old. I`m no expert on these things, but obviously a hunk. Army
Staff Sergeant, volunteered in the Army for EOD, explosive ordinance
disposal. He told the Army press office recently that the reason he
volunteered for that is because "EOD technicians directly defeat our
current enemy`s weapon of choice." And that is generally true of what EOD
squad guys do when they`re serving in places like Afghanistan, like
Sergeant Mensink has. But that is not generally what they have to do when
they`re home in Alabama. Staff Sergeant David Mensink is from Seale,
Alabama. He`s currently based at Fort Benning in Georgia, not far from the
Alabama state line. And at 1:00 a.m. on Friday night, Staff Sergeant
Mensink and his EOD team at Fort Benning, they got a call from the police.
By that point, police in Birmingham, Alabama, had a whole block of that
city shut down. They have local police on hand, the ATF, the FBI, the
Alabama state version of the FBI, they had two local police forces there.
They had a campus police force there, but with all those agencies on site,
they realized that what they needed that they didn`t have on hand was the

And the reason they needed the Army and Staff Sergeant Mensink is because
an old dude in rural Alabama, was, I quote here, "tinkering with some kind
of explosive device." And it became lodged inside his leg. Some random
old dude was playing with grenades, tinkering with grenades, we don`t know
exactly what kind it was. The grenade didn`t explode while he was
tinkering with it, but it did lodged, it basically fired itself into his
thigh. The guy called 911, paramedics took him to his local hospital in
Walker County, Alabama. The Baptist Medical Center there was like
seriously, you have a live grenade embedded inside you? You might explode.
You can`t come here. You have to go to a level one trauma center. The
poor local paramedics and the ambulance with this guy who I think might
explode at any minute, they leave Walker County, drive their potentially
going to explode passenger to the University of Alabama Hospital in
Birmingham. And at UMB, that hospital, too, is like OK, this patient might
explode, you can`t bring him inside here.

The hero paramedics agree to stay in the ambulance with the guy even as the
hospital kept the ambulance barricaded 30 feet away from the building.
There have been an initial X-ray of the guy`s leg that showed that what was
stuck in his thigh appeared to be a 40 millimeter grenade. Which meant
that if it`s detonated, it not only would have killed the guy, it would
have blown apart the ambulance and everybody else inside it. And so 1:00
in the morning, with the paramedics many hours into this, right, having a
hard time keeping the guy calm and still inside the ambulance, they have
everybody on scene that they can possibly think of. But ultimately, they
realized they needed to call somebody who might conceivably have dealt with
a battlefield weapon like this before. And so they called Fort Benning.
They sent Alabama state troopers to the Georgia state line and Staff
Sergeant David Mensink and three other members of his EOD team, they raced
to the state line after they got that 1 a.m. call. Troopers met them at
the Alabama border, gave them a flashing red light escort. I don`t know
how fast it is, but it was about a 150-mile trip and they made it much
faster than the speed limit would allow. They arrived at the hospital
shortly before dawn. The guys from Fort Benning handed their body armor
into the ambulance, to the paramedics who had been with the guy, with the
grenade longed in his leg all that time.

This is one of the paramedics. See the name on the front of his - says
Matthews. Paramedic`s name is not Matthews. His name is Cameron Padbury.
One of EOD team of soldiers, who came from Fort Benning, Sergeant First
Class Tyrone Matthews handed over his own body armor to the paramedic who
would not get out of the ambulance. He wouldn`t leave his patient. Staff
Sergeant Mensink then got into the ambulance, looked at the grenade
embedded in the guy`s thigh and saw from his medic training that it was so
deeply wedged in the man`s thigh that the man`s femoral artery was exposed.
So they were going to need a doctor. Time to do surgery on the guy with a
live grenade stuck into his leg. They got a doctor from UAB to volunteer
to go climb into the ambulance with the guy who might explode at any
minute. The doctor brought a scalpel, the doctor made an incision into the
man`s thigh right next to the live grenade stuck in there and then, quote,
calmly and confidently, the staff sergeant reached into the incision in the
man`s thigh and removed the grenade by hand, careful not to twist it or
turn it. And the guy is fine. I mean, obviously the guy is not fine, he
plays with grenades. But after shooting the grenade into his thigh up
against his femoral artery and finding the bravest paramedics on earth who
refused to leave him and stayed with him in the ambulance for eight hours
while they thought he might explode at any minute, and then finding a UAB
doctor willing to climb into that ambulance and do field surgery on the
live grenade, and after calling in the Afghanistan vet EOD techs of the
U.S. Army to identify the grenade and then the staff sergeant who agreed to
reach in by hand and pull it out of his thigh and render it safe, yeah,
after that, the guy is fine. How was your Friday night?

The grenade turned out to be a 40 millimeter m-713 smoke grenade, one that
shoots off smoke to mark a place on the battlefield. Nobody knew that`s
the kind of grenade it was until they had it out of the guy`s leg. The guy
himself didn`t know that. Iraq and Afghanistan veterans sometimes lament
that the skill set they develop at war on the battlefield is not a skill
set that is appreciated back home, particularly by potential employers. In
Alabama right now, I think that worry is inoperable. Bravery. Theme of
the day.



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