It’s been exactly one year since the CDC confirmed that Thomas Eric Duncan had Ebola. He had flown from Liberia to Dallas to visit his fiancé, and became the first person diagnosed with the deadly virus on American soil.

During his stay at Texas Presbyterian Hospital in Dallas, two nurses also fell ill with Ebola. Duncan died, but the nurses survived, as did a handful of Americans who fell ill in West Africa but were transported back to the United States for care.

The Ebola outbreak in West Africa, and its spillover into the U.S., forced hospital officials to take a hard look at their readiness for a serious epidemic.

Within months the CDC designated 55 hospitals nationwide as future Ebola treatment centers, including two in Texas: the University of Texas Medical Branch, in Galveston, and Texas Children’s Hospital in Houston.

For many of these hospitals, preparing to care for Ebola patients meant renovating rooms and increasing training and simulations for staff. But Texas Children’s has built an entirely new unit for kids — a biocontainment wing with eight beds at its facility in suburban Houston.

“A year ago in the United States, there were only twelve beds for the entire country for patients that had a need to be isolated in a biocontainment unit,” says Dr. Judith Campbell, medical director for infection control and prevention at Texas Children’s. “And, not surprisingly, zero of those beds were designated for children.”

The biocontainment unit is still under construction. Dr. Judith Campbell, a specialist in pediatric infectious disease, explains that a “pass-through window” will allow health workers to make some deliveries without having to don and doff the entire protective outfit. Carrie Feibel/Houston Public Media hide caption

itoggle caption Carrie Feibel/Houston Public Media

Campbell helped design the special pediatric unit, which the hospital began planning after Duncan’s death. The $16 million project, which includes a separate area with 10 regular pediatric beds, was paid for out of the hospital’s capital funds and $1 million in donations.

Each of the eight patient rooms in the biocontainment unit has an antechamber, where doctors and nurses will put on protective gear, gloves and ventilated hoods. After treating the child inside the room, they will leave through a separate door and enter a third room, where they strip the equipment off.

The whole time, nurses will observe through large glass windows.
“So, if there’s any question, they can say ‘Wait, stop. You need to clean your hands again.’ Or ‘Wait, stop. Let’s take this glove off more carefully,’ ” Campbell explains.

The unit has its own biosafety laboratory, so infected blood samples never have to be carried to other parts of the hospital. There’s also a separate medical waste room, where carts full of used clothing and equipment can be wheeled inside 6-foot autoclaves. And, after every shift, medical workers will shower before leaving the unit.

Hospital officials say Ebola was the catalyst for the decision to build, but the unit is designed to handle any globe-trotting superbug.

“These rooms are equipped to take care of TB, MERS, pandemic influenza, bird flu and even a pathogen that we might not know what it is yet,” Campbell says. “That’s why we wanted to build something with the highest level of isolation ability.” Before designing the unit, teams from Texas Children’s visited adult biocontainment units at hospitals in Atlanta and Omaha.

The medical architecture in the new unit is impressive, says Dr. Amy Arrington, a pediatric intensive care specialist, but staff preparation is crucial, too. The initial training included 16 hours of learning how to maneuver in the awkward biocontainment suits – while still maintaining the emotional warmth and reassurance that’s part of caring for a child.

Workers are still about a month from finishing up the 8-bed isolation unit at Texas Children’s Hospital. The unit’s goal is to provide for the special physical and emotional needs of kids with highly infectious diseases. Carrie Feibel/Houston Public Media hide caption

itoggle caption Carrie Feibel/Houston Public Media

“I describe it as a space suit,” Arrington says. The suit “has footies and arm holes and covers you up completely.” Doctors and nurses who volunteered to work on the unit had to relearn skills — such as inserting IVs while wearing the suit.

“When you put three pairs of gloves on, you (can) lose sensation in your hands because they’re so tight,” says Arrington, “But you really lose that tactile feel that as physicians and nurses is really important in taking care of any patient, let alone a child.”

Kids can be especially vulnerable to infectious diseases. During the Ebola outbreak in West Africa, children died at a higher rate than adults.

As pediatricians and parents know, sick children not only need close monitoring, but also encouragement to eat and drink, and comfort when they are scared and confused. That can be harder in a pediatric biocontainment room — the parents of a very sick child will probably not be allowed inside.

But Campbell says Texas Children’s Hospital is ready for that challenge, too. At least six doctors or nurses will be assigned to each child, and one of them will act as a family liaison. The kids will also be able to use tablet computers to talk with their families via video chat, and will be able to see them through the large windows.

The hospital is also developing a special doll that will wear a mini-version of the same biocontainment suit the doctors and nurses wear.

The goal there, Campbell says, is to soothe even the youngest kids, and help them understand, “Yes, we’re dressed up a little differently, but … their little doll has similar attire on.”

The pediatric isolation unit is to be ready to accept patients in late October, with a formal ribbon-cutting expected in November.

This story is part of NPR’s reporting partnership with Houston Public Media and Kaiser Health News.

As a doctor who provides medical care to Boston’s homeless population, James O’Connell and his colleagues are used to working in unusual locations. “We are basically visiting them in their homes, which are often under bridges, down back alleyways [and] on park benches,” O’Connell tells Fresh Air‘s Terry Gross. “It’s been an education for us over these years.”

O’Connell is president of the Boston Health Care for the Homeless Program, which provides health care services at over 65 sites, including adult and family soup kitchens, detoxification units and corrections facilities. He writes about his practice in a new memoir, Stories from the Shadows: Reflections of a Street Doctor.

O’Connell has been caring for Boston’s “rough sleepers,” or homeless, since 1985. He says that homeless patients suffer from the same chronic and acute illnesses as the general population — with one crucial difference. “What we see … frequently, are regular issues that have been neglected for years and years,” he says. “So we see the natural history of illness that is usually interrupted by good preventive care.”

Over the years, O’Connell has seen the ravages of untreated frostbite, AIDS and diabetes, as well as the effects of profound isolation and extreme loneliness. But he has also witnessed a courage and resourcefulness in his patients.

“These are people who are nameless and faceless when they are sitting out in the street,” he says. “But when you get to know them, they are stories of great courage, of struggles against unbelievable adversity. … I think I probably would’ve been a broken person had I lived through what they lived through.”

Interview Highlights

James O’Connell is the president of the Boston Health Care for the Homeless Program. He is also an assistant professor of medicine at Harvard Medical School. Roger Farrington/BHCHP hide caption

itoggle caption Roger Farrington/BHCHP

On suspending judgment

I remember what came across is that whatever I thought of someone, when I first met them or first walked by them, it rarely panned out once I got to know them, and the stories that emerged from these people, what they have lived through and as you learn, each one is very different from another, but each one has a remarkable story. … I hope in these stories what emerges is the real resilient spirit of people who have really, really been dealt a bad hand in life and suffer from all those social determinants of poverty.

On the result of homeless people not receiving good preventive health care

We … see the end stage of many things. We often see pneumococcal pneumonia, for example, which probably should’ve been treated on Day 1 or Day 2; by Day 7 or Day 8 it can be very, very devastating. …

As we learned the hard way … these are people who were struggling to survive outside on the streets. They’re interested in just being safe today or just getting the next meal or just getting a bed for the night. Taking care of an infection in their foot or diabetes or their hypertension is way down the list of priorities, which, of course, is really difficult for us doctors who think that should be the top of the list.

On the extreme illnesses he’s seen

We see dramatic things that I never saw in medical school or often even in the textbooks. During this past year [we] have watched a man who had been outside for a very long time who has a pretty difficult psychotic disorder who got frostbite on both feet, really severely, came into our respite facility where we cared for him and he elected to not do surgery, and we spent the past year watching his feet fall off from auto-amputation, which is what happens at the end stages of frostbite. Most of our staff, including our nurses, had never seen anything as dramatic as that.

We will also see tuberculosis, things that you would be used to seeing in a Third World country much more than an inner city of a very medically rich world. We see all of the end stages of AIDS neglected because people were not able to get to treatment. … If you are caring for a homeless population, you are really seeing the really both exotic illnesses as well as the end stages of chronic, common illnesses.

On hidden homeless communities

Even after I had been doing this job for almost 15 years thinking I knew every nook and cranny of the city of Boston, somebody pointed out to me that there were 20 people living in a tunnel under Copley Square. …They came out only at nighttime; they spent their days down in the tunnels. And I remember going down there and meeting all these people for the first time and being stunned that most of them had been there the whole 20 years that I had been out. We always think we know a lot, but we keep our minds open to finding there’s always a new place where someone can be.

On trauma homeless women face

For women to get to the streets we know that the journey is one that is very complex and almost always full of unspeakable trauma — sexual, physical and emotional trauma — and, so, by the time women are on the streets, they are really suffering, and those who become pregnant often feel despair, discouraged, feel they have no place to go, and feel very attached to having the baby safely and in a good way.

So we found that pregnancy often is not only alarming for the women, but it’s a place where they can actually take stock of their lives and try to come in, so we always try to provide as much service … gentle service as we can to anyone who is pregnant on the street, so they can deliver a good baby and hopefully hang on to that baby.

Unfortunately, many of the women, if you speak to them on the street, have had many children, all of whom they’ve lost to social services, because they were unable to stop using or they had no place to bring the baby once the baby was born. There’s an awful lot of trauma among the women on the streets about the children they have lost and mourn.

Palliative care nurse Theresa Brown is healthy, and so are her loved ones, and yet, she feels keenly connected to death. “I have a deep awareness after working in oncology that fortunes can change on a dime,” she tells Fresh Air’s Terry Gross. “Enjoy the good when you have it, because that really is a blessing.”

Brown is the author of The Shift, which follows four patients during the course of a 12-hour shift in a hospital cancer ward. A former oncology nurse, Brown now provides patients with in-home, end-of-life care.

Talking — and listening — are both important parts of her job as a palliative care nurse. This is especially true on the night shift. “Night and waking up in the night can bring a clarity,” she says. “It can be a clarity of being able to face your fears, it can be a clarity of being overwhelmed by your fears, and either way, I feel like it’s really a privilege to be there for people.”

Sometimes Brown finds herself bridging the gap between patients who know they are dying and family members who are still expecting a cure. “There can be a lot of secrets kept and silences. … One thing that palliative care can be really good at is trying to sit with families and have those conversations,” she says.

While some might see her job as depressing, Brown says that being with people who are dying is a profound experience. “When you’re with people who die … and being in their homes and seeing their families, it’s incredible the love that people evoke. And it makes me realize this is why we’re here; this is what we do; this is what we give to each other.”

Interview Highlights

On cutting costs and stretching nurses too thin

There’s a sense that you can stretch a nurse just like an elastic band and sort of, “Well, someone called off today.” That means a nurse calls in and says that she’s sick or her car broke down or he won’t be there, and sometimes we’re able to get someone onto the floor to take that person’s place, but often we’re not. Or an aide might not be able to show up for whatever reason, and then the assumption is just, “Well, the nurses will just do all the work that the aide would’ve done,” and the problem is that people do not stretch like rubber bands, and even rubber bands will break if you stretch them too far.

On loved ones wanting to feed their dying family members

Theresa Brown is a critical care nurse in Pittsburgh. Her previous book is Critical Care: A New Nurse Faces Death, Life, and Everything in Between. C. Ken Weingart/Algonquin Books hide caption

itoggle caption C. Ken Weingart/Algonquin Books

Food is so fundamental, and their feeling is “I’m letting my husband starve to death and that’s wrong.” So I have to talk them through the process of the body slowly going in reverse. All the processes we think of as normal and that are integral to life, they’re all slowing down. And so the body just doesn’t need food when someone gets very close to the end of their life and, in fact, they found that forcing someone to eat can mean that they just have this food sitting in their stomach, they’re not able to digest it, can actually make them more uncomfortable. So I talked to [one family member] about that, but tried to do it as gently as possible, while also acknowledging the incredible love that was motivating her and trying to honor that, but make it clear that she needed to show her love by being close with her husband, by holding his hand, by talking to him, but not by feeding him.

On whether patients ask if they’re dying

No, they don’t. … I think it’s because they’re afraid. They want to just take things day by day. I did have a wife once ask me. She said, “You know, I’m not new to this, and I want you to just tell me. Is he dying?” And at that point I was a pretty new nurse and I didn’t have the experience to know to say, “Yes.” Now I would know to say that. … I got a sense that she really wanted to know and no one else was telling her. …

Physicians can have a mindset of “we’re thinking positively, we’re focusing on the good that can come, and we’re not going to talk about ‘what if it doesn’t work out.’ ” And they will sometimes pull the nurse aside and say, “What’s going on?”

On leaving the hospital setting for palliative care

I love the hospital. I never thought I would leave the hospital, but I left to see patients outside the hospital because in the hospital I feel like we never see people at their best. They feel lousy. We wake them up at night. We give them no privacy. We give them, really, almost no dignity. We tell them what they’re going to do when, what they’re going to eat when, what pill they’re going to take when and no one likes living like that. … So I wanted to see people in their homes because I thought there’s got to be a way we could make the hospital better. Seeing what it’s like for patients in their homes I thought would show me that. And I would say overwhelmingly what I’ve seen is control: People have so much more control when they’re in their homes and it should not be that hard to give them back a little bit more control in the hospital.

On traveling to a patient’s home

When I started, I thought, “I can’t believe I’m doing this. I can’t believe I just drive up to these houses and go inside them.” I live in Pittsburgh, but it can get very rural feeling actually pretty quickly, and I remember … going to [a house] that was already through back-country roads and then down a gravel driveway, and I thought: “What am I doing? Am I insane?” And then I went into this house, and this family was so loving and amazing and wonderful, so it was a great education for me not to judge. And I know that my workplace checks out and makes sure that the places we’re going are real, so that’s comforting, but it’s definitely a giant leap of faith, and you just have to make that leap.

On home care versus hospital care

Often in the hospital they can be more comfortable in terms of we’re relieving their pain, we’re getting them anti-nausea medications very quickly, but … they’re not as comfortable with themselves, and in their homes they seem much more comfortable with themselves and with the people around them, and I had never thought about those two things as being so distinct, but they are. So the question then is how do we give people care that marries those two things, because they’re both so important.

On how patients express appreciation to nurses

A very popular gift in my hospital was Starbucks [gift] cards. … Often people bring in cookies and chocolate and that’s wonderful, but I remember one nurse saying, “You know, I wish someone would just bring in a lasagna.” … Because we never have time to eat and then you go into the break room and you’re hypoglycemic and you see all this chocolate, and so you eat all this chocolate, which doesn’t really help you feel that much better in the long run. So to actually drop off a meal is wonderful.

Republican presidential candidate Carly Fiorina campaigned at a Christian pregnancy care center in South Carolina Thursday. Opposition to abortion has become a prominent message in her campaign recently.

Transcript

KELLY MCEVERS, HOST:

When a pregnant woman is getting an ultrasound, a partner might be in the room along with a medical technician. In an exam room in South Carolina today, there were also reporters and former Hewlett-Packard CEO Carly Fiorina. The Republican presidential candidate has doubled down on her opposition to abortion and went to a place that’s becoming a popular campaign stop. NPR’s Sarah McCammon takes us there.

SARAH MCCAMMON, BYLINE: The Carolina Pregnancy Center is a Christian-run organization in Spartanburg, S.C., whose leaders oppose abortion. Thirty-one-year-old Lacey Thomas is expecting a baby boy next February. She was there today for an ultrasound, and Carly Fiorina stood by her side.

CARLY FIORINA: Look at that. Is this your first one?

LACEY THOMAS: This is my second. I had the girl the first time. This is the boy.

MCCAMMON: Thomas has agreed to let Dr. Mary Haddad demonstrate the procedure for Fiorina.

MARY HADDAD: So her baby looks great. Would anyone like to hear the heartbeat?

FIORINA: I would love to hear the heartbeat.

(HEART BEATING)

MCCAMMON: Around the corner, Fiorina praises the center’s work and tells a crowd it’s hypocritical for liberals to support environmental protections for wildlife while also supporting abortion rights.

FIORINA: They are perfectly prepared to destroy other people’s jobs and livelihoods and communities in order to protect fish and frogs and flies, but they do not think a 17-week-old, a 20-week-old, a 24-week-old is worth saving.

MCCAMMON: For Lacey Thomas, the expectant mom who let Fiorina watch her ultrasound, the campaign is mostly a lot of noise right now.

THOMAS: I don’t know much about her except that she’s a Republican candidate, and I looked that up yesterday.

MCCAMMON: Thomas meets monthly with her mentor here, volunteer Linda Earnhardt. The stay-at-home mother of five is following the campaign. Earnhardt was impressed by Fiorina’s recent debate performance where she had harsh words for Planned Parenthood, but Earnhardt has one misgiving.

LINDA EARNHARDT: I do think a man should be a leader – that’s me – but I see the men not standing up. And if she’s going to be the one that’s going to stand up and stand up and stick to her morals then by far I will give her my vote.

MCCAMMON: Gender is also a consideration for Carlotta Jackson, who came to see Fiorina today.

CARLOTTA JACKSON: As long as it’s not someone who’s trying to emasculate men and that it’s not just a power trip for them.

MCCAMMON: But others, like Pam Dean, are eager to see a woman front and center in the Republican Party.

PAM DEAN: I like it that she’s a strong woman, and that she held her own with all of those men and that women can lead.

MCCAMMON: And Fiorina has been working hard to earn the support of women. She’s at least the fifth GOP candidate to visit the Carolina Pregnancy Center this year. It’s a place to showcase a message that could play well in the Republican primaries, though in a general election, that message would be a harder sell with female voters. Sarah McCammon, NPR News, Spartanburg, S.C.

Copyright © 2015 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR’s programming is the audio.

Turing Pharmaceutical CEO Martin Shkreli has backed down on his plan for an astronomical price increase on a drug used to treat a deadly parasitic infection. The company did not say what the new price would be, but presumably less than the $750 a pill it had planned to charge. The move illustrates how Shkreli is more Wall Street speculator than pharmaceutical entrepreneur.

Transcript

KELLY MCEVERS, HOST:

We’re going to learn more now about the CEO of Turing Pharmaceutical. The company came into focus after a New York Times story this week detailed how it raised the price of a drug that’s been on the market for more than 60 years – and not a small increase, a 5,000 percent increase. The company has now backed down, but as NPR’s Jim Zarroli reports, the controversy hasn’t.

JIM ZARROLI, BYLINE: Turing didn’t develop Daraprim. It simple bought the drug and then raised its price from $13 a pill to $750. Since then, the backlash against the company has been fierce. Its 32-year-old Martin Shkreli has been mocked and criticized by doctors, other biotech companies and even Hillary Clinton.

(SOUNDBITE OF ARCHIVED RECORDING)

HILLARY CLINTON: That’s price gouging, pure and simple. And pharmaceutical companies that acquire an existing affordable drug that people rely on it and then turn around and charge a fortune for it just bet on the fact that desperate people will find some way to pay for it.

ZARROLI: This isn’t the first time that Shkreli has been on the hot seat. A few years ago, he started his own biotech company, but he was kicked out after a financial dispute with the board. Shkreli also sold some biotech stocks short. That is, he bet the stocks would lose value, then he would try to persuade federal regulators not to approve the drugs they had in development. Noah Bookbinder is with Citizens for Responsibility and Ethics in Washington.

NOAH BOOKBINDER: Then he would go publicly and put out these statements saying these companies are going to lose value because the FDA is going to take an adverse action. And that actually did have the effect of knocking down the stock value, which made a whole lot of money for Shkreli.

ZARROLI: Regulators have never taken any action against Shkreli, and he has stopped giving interviews. So he wasn’t available for comment. But earlier this week, as the controversy over Daraprim mushroomed, he defended his decision to raise the price on CBS News.

(SOUNDBITE OF ARCHIVED RECORDING)

MARTIN SHKRELI: The drug was unprofitable at the former price. So any company selling it would be losing money, and at this price, it’s a reasonable profit – not excessive at all.

ZARROLI: Shkreli said raising the price would allow his company to research new drugs. It’s an argument that doesn’t sit well with Steve Schondelmeyer of the University of Minnesota. He says drug companies typically recoup their research costs after a drug is released. They don’t raise their prices to pay for research they might do down the road. Because Turing has a lock on Daraprim, customers have to pay whatever it charges. Daraprim is a generic, and other companies can try to compete by bringing out their own version of it. But Schondelmeyer says doing so isn’t easy.

STEVE SCHONDELMEYER: You can’t just start marketing a new genetic tomorrow. You have to get it approved by FDA and have them inspect your plan and your processes.

ZARROLI: Schondelmeyer says the FDA is so backed up it could take six years to bring another drug to market. He says something is broken in the drug industry that needs to be fixed.

SCHONDELMEYER: And I think companies certainly need their reward for innovation, but this isn’t innovation in a clinical sense. It might be in a financial market sense, but it’s not in a clinical, therapeutic sense.

ZARROLI: Meanwhile, the controversy over Daraprim has thrust the issue of drug prices into the spotlight, just as the presidential campaign is heating up. Senator Bernie Sanders has called for an investigation into Turing’s actions, and Hillary Clinton yesterday unveiled a new plan she says will hold down the cost of prescription drugs. Jim Zarroli, NPR News, New York.

Copyright © 2015 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR’s programming is the audio.

After their third son was born, Tisha Scott and her husband decided they were done having kids. So Scott, 34, of Drakesville, Iowa, decided to get her tubes tied.

“As old married people, neither of us was really interested in using condoms for the rest of our life,” Scott says. “So that was the decision that we made because we knew that our family was complete.”

But instead of undergoing surgical sterilization, Scott’s doctor urged her to try something called Essure — the only available, nonsurgical permanent birth control option approved by the Food and Drug Administration.

Essure is a device comprising two tiny coils made of nickel-titanium alloy. Scott’s doctor inserted one into each of her fallopian tubes to permanently block them. Since Essure doesn’t require surgery, he said it would be a lot easier, quicker and safer.

“He felt if there was no reason to do surgery then we shouldn’t,” Scott says.

But almost immediately after the procedure Scott started getting an excruciating burning pain in her back and pelvis. “All of a sudden it hurt to have to move my body to get out of bed, to do anything,” she says.

The pain got worse and spread all over her body. Despite two operations and many tests and exams, Scott says she still lives in constant pain.

“It feels like you’ve been hit by a truck every day of your life,” she says. “For me, it’s been a nightmare. I mean, this device literally ruined my life.”

Scott is among thousands of women who blame Essure for a variety of complications, including pain, heavy bleeding, fatigue, hair loss and depression.

Because of complaints, the FDA has asked a panel of outside experts to take another look at Essure during a public hearing on Thursday.

“This device has been sold to tens of thousands — probably hundreds of thousands — of women as a very safe and easy way to permanently end any concerns about pregnancy,” says Diana Zuckerman, who heads the National Center for Health Research, a Washington-based watchdog group that has been studying Essure. “We know that’s not accurate,” she says.

Zuckerman says that Bayer, the company that makes Essure, didn’t fully inform the FDA about the problems the device can cause when it got the device approved in 2002. And while Essure is supposed to be 99 percent effective, Zuckerman says recent research suggests it may actually fail about 10 percent of the time.

“What we’d like to see is new research that’s carefully monitored that can actually tell us how often women have these serious complications from Essure and how often the product does not work to prevent pregnancy. That’s what we really need,” Zuckerman says.

Officials at Bayer defend the device.

“There’s a significant amount of data out there regarding the safety and efficacy of Essure,” says Edio Zampaglione, the company’s vice president for women’s health care.

Zampaglione acknowledges that the device can cause complications, but says they only occur rarely.

“What we believe and feel is that these women represent the small percentage of women who have had a bad experience with it,” Zampaglione says. “There’s nothing that we do or take in the medical world that is 100 percent adverse-event free,” he says.

For most women, Zampaglione says, getting sterilized with Essure is quick, easy, safe and totally reliable. That was the case for Jennifer Jenkins, 33, of Dallas. She got Essure about two years ago during a quick stop at her doctor’s office on her way to work.

“I had no problems,” Jenkins says. “My husband likes to say the only side effect I’ve experienced is that I haven’t been able to get pregnant, which has been a good thing.”

An earlier story on the questions surrounding Essure ran in Shots in July.

The House passed two controversial measures Friday aimed at satisfying conservative Republicans in an uproar over videos alleging Planned Parenthood profits from fetal tissue.

Transcript

AUDIE CORNISH, HOST:

The House fired the opening salvo in what’s expected to be an intense showdown to avert a government shutdown. The Chamber passed two abortion-related measures today so conservative Republicans could vent their anger over videos accusing Planned Parenthood of selling fetal tissue. And NPR’s Ailsa Chang reports, many House Republicans want their leader to go further or face consequences.

AILSA CHANG, BYLINE: With only a few working days left in Congress before the government’s funding expires, both chambers are still in warm-up mode. The House spent its last day in session this week voting on two measures that will never become law. One freezes federal funding for Planned Parenthood for a year, the other toughens penalties for doctors if they don’t provide care to infants who survive abortions.

(SOUNDBITE OF ARCHIVED RECORDING)

REP ROBERT GOODLATTE: If a baby born alive is left to die, the penalty can be up to five years in jail.

CHANG: Republican Bob Goodlatte of Virginia is leading one of the investigations into Planned Parenthood.

(SOUNDBITE OF ARCHIVED RECORDING)

GOODLATTE: If the child is cut open for its body parts or some other overt act is taken, the punishment is that for first-degree murder.

CHANG: Abortion-rights advocates and physicians say it is exceedingly rare for any fetus to survive an abortion and that the bill is simply a way to criminalize doctors. That measure would fail in the Senate, where Democrats are needed to pass legislation. So would any bill that defunds Planned Parenthood. So Majority Leader Mitch McConnell is asking his House colleagues to cool off.

(SOUNDBITE OF ARCHIVED RECORDING)

SEN, MAJORITY LEADER MITCH MCCONNELL: We need to deal with the world that we have. We have a president who deeply supports Planned Parenthood and will not sign a bill that defunds it.

CHANG: Fine for McConnell to say – he’s not facing quite the same climate that House Speaker John Boehner is. House conservatives, like Mick Mulvaney of South Carolina, want Boehner to stand with them, not only on Planned Parenthood, but on budget caps and on a debt ceiling fight that’s just around the corner.

(SOUNDBITE OF ARCHIVED RECORDING)

REP MICK MULVANEY: It is a murderer’s row of issues from a conservative’s standpoint, so I think it’s going to be a tremendous test of his leadership.

CHANG: There’s already resolution floating around the House seeking to oust the speaker, but no vote on it yet. Meanwhile, Boehner allies are stepping up to back him, like Republican Tom Cole of Oklahoma.

(SOUNDBITE OF ARCHIVED RECORDING)

REP TOM COLE: Every time we’ve had any kind of tests of strength, he’s been the one that’s walked away as the big winner. So I just – I think this is, you know, kind of a Washington parlor game right now, but I just don’t see much evidence that he’s anything other than a strong speaker.

CHANG: Boehner has said he doesn’t want to see a government shutdown over Planned Parenthood. And sure, conservatives are saying they don’t want one either, but as Kansas Republican Tim Huelskamp told reporters, if there was a shutdown, it wouldn’t be their fault.

(SOUNDBITE OF ARCHIVED RECORDING)

REP TIM HUELSKAMP: Would the president shut the government down? I don’t know what he would do. Would he shut down the whole government over one line item? You’ll have to ask him.

CHANG: Maybe no one will have to. If Republican and Democratic leaders in the Senate get their way, they’ll pass a short-term bill to fund the government through December that will fund Planned Parenthood. Ailsa Chang, NPR News, the Capitol.

Copyright © 2015 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR’s programming is the audio.