More on how the Dallas hospital may have dropped the ball on the Ebola patient
Here’s some new information which, if true, would further implicate the Dallas hospital that sent Thomas Eric Duncan home the first time he came to the ER there. The story comes from Duncan’s nephew Joe Weeks, who seems to be acting as some sort of family spokesman (and who also is saying that Duncan is now too weak to talk to the family on the phone) [emphasis mine]:
Weeks also had concerns that the hospital wasn’t aware that Duncan may have been infected with Ebola. Weeks said that he called the hospital to report his concerns about Duncan’s condition ”“ and when he didn’t get the reaction he wanted, he called officials at the Centers for Disease Control and Prevention and the Department of Health, at which point Duncan was put in isolation.
“They had him in the ER, like any other patient, and I didn’t think that was the right procedure,” Weeks said.
“I don’t know how long it was going to take, but I wasn’t trying to wait to see how long it was going to take, so I pre-empted and called CDC and reported that there might be a possible Ebola case in Texas. But the hospital was not doing what it needed to do at that time,” he said.
Weeks sounds more on the ball than the hospital, unfortunately. Or rather, fortunately—if not for him, Duncan may have been delayed in being identified as having Ebola, and his contacts would not have been traced and isolated until more time had passed. The disease would almost certainly have gotten even more out of control than it otherwise has, and faster.
Of course, Weeks may be making some self-serving statements that are not true. But if I had to place money on it, I’d say his story is probably relatively accurate. It would be good if the CDC could weigh in on it and either deny or affirm it, but my guess is that lawyers are heavily involved at this point and are telling all the agencies to keep mum as much as possible.
[NOTE: For a review of what we already knew about the behavior of the Dallas hospital regarding Duncan, see the transcript of the news conference in this post, as well as much discussion of the issue in the comments thread there.]
Report that the new medical software (required by the ACA) didn’t work right.
Nurse typed in info and docs didn’t get it.
Software company liable.
Makes the most sense to me.
Hospitals have to kick out ANY ebola suspects.
They need to be triaged into a palliative care regimen ASAP.
You don’t want them even coming into the facility or using ordinary ambulances.
&&&&
ISOLATION is our only solution at this time.
&&&&
BTW, suspected victims are infectious no later than the first day they picked up ebola.
This capacity merely increases with time. It never starts out as a zero-value.
The CDC is lying.
BTW, the more connected you are, the more vulnerable you are.
That’s why Europe’s cities died during the Black Plague.
It reached a point such that entire towns were put to the torch!
Burning down structures was performed at the drop of a hat.
THAT’S what a pandemic triggers.
If permitted, ebola could make all of our real estate assets wholly contaminated — along with the biota.
When that happens, everyone left must have immunity. The rest of the population is dead.
hard drive crash
Humans, especially administrative humans, have a great ability to ignore things they dont want to accept.
the reason i said aministrative humans especially is to note who are the people that take up the points of power and administration, and what are the kinds of facts and thigns they ignore at whim for all kinds of reasons that range from personal reward to promoting the current political goals or conditions.
the horrid deaths of the 20th century and i suspect the 21st century, are all due to the administrative state. this is mostly what the non left complains about and what is going on here in the US. a conversion to an administrative state, which is not new. we have had them before, from the egyptions through romans etc, except that the modern versions have science behind them, not just the whims of a ruling elite that bestows things and expects administration to their tune to be the rewards.
the soviet union, or union of committees, was a fully administrative state, where the organs of the state down to the clerks had administrative powers delegated to them.
this is the conversion your watching when you look at colleges coming up with law or rules to apply to those that attend and try to have legal weight or more weight than current federal/state law has. and how that gets the federal state organs to adopt similar rules or laws. or how a law is vague, allowing the administratio of a group like the FDA or EPA to make rules, that by extenstion, are laws.
however, constitutional scholars when honest tend to inform that such things are not constitutionally legal given that only the owners of power can delegate it, and that without amending or changing the constittion the politicians given power by the people really are not able to delegate powers the way they do, as only the people can give power away the same way as only the owner of a car can loan it out with terms.
the old monarchies and such wer e administratice states where the office granted also came with power perks where the person in charge was free to rule his tiny pond the way they saw fit (up to a point).
this is how the conversion of the US is going apace, as non congressional and non state entities, like councies, or even housing councils, make up rules and things that residents have to follow as if they are law and have the weight of law. but technically the constitution does not grant the ability of these extra political groups to make law, which is reserved to congress… or its equivalent in the states.
and thats about it, as i get in enough trouble for typing too much…
Software company liable.
Maybe, but it’s far more likely to be the office and MD’s unfamiliarity with the software. ACA required everyone to switch over, and whenever you switch systems (whether software or from paper to computers) people are prone to mistakes. This was obviously a very big one, but everybody should know that no medical personnel are perfect. There will be mistakes, that’s why you build in redundancies, that’s why you check and double and triple check everything when you are doing a surgery or giving drugs or what have you. Because accidents are really easy to make.
There was probably not an ‘alert doctor that pt may have ebola’ button in the software. I think the patient should have told the doctor, as well as the nurse, that he was from liberia and had been exposed to ebola. If he wasn’t well enough to think that way, one of his family members should have.
This right here is a damn good example of why it’s better to just keep the disease away by stopping flights rather than letting it in and hoping for the best. If we go on as we have been it will happen again, and again and again.
Lea:
The patient had already informed a nurse. So why would he think he had to say it again? See this for more.
Sophisticated, highly educated consumers of medical care may tend to assume they need to state things over and over, and that their charts may not even be read. But that’s a lot to ask of Duncan, newly arrived from Liberia and also feeling ill enough to go to the hospital, and probably frightened as well. What’s more, it’s not at all clear he knew he’d been directly exposed to Ebola, since he might not have known the pregnant woman he helped died, or what she died from.
And yes, electronic records are probably part of the problem here. Reliance on computers can wipe out due diligence.
Thanks, Obamacare.
Thomas Eric Duncan–aka Typhoid Mary–came here knowing that he’d been exposed to someone suffering from Ebola. He’d laid awake nights thinking about it. He’d dwelled on it and agonized on it, and then he got on a plane and flew here to America. It was a conscious premeditated decision and any deaths that result as a consequence can be laid at the feet of Thomas Eric Duncan. We can pray that he’s the only one. But if this outbreak keeps spreading he won’t be.
One last thing: I’m not convinced. I’m not convinced this disease isn’t airborne. The Reston outbreak is a case in point.
http://www.infowars.com/flashback-ebola-goes-airborne-causes-outbreak-in-medical-lab/
jack:
I’m glad you can read Duncan’s mind, and know what he knew and what he didn’t know.
Saves us the trouble of actually researching it.
There’s a discussion on the topic of what Duncan knew (and what we know and don’t know about it), between me and commenter “Lea,” on this comment thread.
jack:
And on the topic of whether it’s airborne, see this.
I can’t read his mind. However who do you know, that goes to the emergency room because they have a low-grade fever, and a stomach ache? You can give him all the benefit of the doubt you want, but while I can’t read minds, I know people.
The patient had already informed a nurse. So why would he think he had to say it again?
If self interest is not enough, why not in the interest of not contaminating your entire family and community?
I mean, obviously the hospital dropped the ball too, but I’m not willing to let this guy off the hook. He was in liberia, he knew about the epidemic and he had contact with a sick person. And he came here anyway.
But then, I work for a hopsital. I know how often balls can get dropped and I think people need to know that they have to speak up if they think the doctor is missing something.
neo-neocon, i have been in the BSL lab here at work… where we work with ebola when patients are not around.. among other things…
after your post i put up information as to the rhesus monkeys being infected by air… and others who were in the same room, but not in contact…
the docs in africa were also infected despite precautions… so the thing CAN move in air, but not the waythe flu does… but the way small particles of water can move around a room when you cough…
Transmission of Ebola virus (Zaire strain) to uninfected control monkeys in a biocontainment laboratory
http://www.ncbi.nlm.nih.gov/pubmed/8551825
The exact mode of transmission to the control monkeys cannot be absolutely determined, although the pattern of pulmonary antigen staining in one of the control monkeys was virtually identical to that reported in experimental Ebola virus aerosol infection in rhesus monkeys, suggesting airborne transmission of the disease via infectious droplets…
this is how they think the docs got it when they were so careful not to touch things with their bare skin
Lethal experimental infections of rhesus monkeys by aerosolized Ebola virus.
http://www.ncbi.nlm.nih.gov/pubmed/7547435
The potential of aerogenic infection by Ebola virus was established by using a head-only exposure aerosol system. Virus-containing droplets of 0.8-1.2 microns were generated and administered into the respiratory tract of rhesus monkeys via inhalation. Inhalation of viral doses as low as 400 plaque-forming units of virus caused a rapidly fatal disease in 4-5 days. The illness was clinically identical to that reported for parenteral virus inoculation, except for the occurrence of subcutaneous and venipuncture site bleeding and serosanguineous nasal discharge. Immunocytochemistry revealed cell-associated Ebola virus antigens present in airway epithelium, alveolar pneumocytes, and macrophages in the lung and pulmonary lymph nodes; extracellular antigen was present on mucosal surfaces of the nose, oropharynx and airways.
Top Doctors: Ebola May Become Airborne … And May Already Be Transmissible Via Aerosols
In 2012, a team of Canadian researchers proved that Ebola Zaire, the same virus that is causing the West Africa outbreak, could be transmitted by the respiratory route from pigs to monkeys, both of whose lungs are very similar to those of humans. Richard Preston’s 1994 best seller “The Hot Zone” chronicled a 1989 outbreak of a different strain, Ebola Reston virus, among monkeys at a quarantine station near Washington. The virus was transmitted through breathing, and the outbreak ended only when all the monkeys were euthanized.
and
School of Public Health, Division of Environmental and Occupational Health Sciences, at the University of Illinois at Chicago (footnotes omitted):
We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks. [Aerosols are liquids or small particles suspended in air. An example is sea spray: seawater suspended in air bubbles, created by the force of the surf mixing water with air.]
The important points are that virus-laden bodily fluids may be aerosolized and inhaled while a person is in proximity to an infectious person and that a wide range of particle sizes can be inhaled and deposited throughout the respiratory tract.
-=-=-=-=-=-=-=-=-
and i have qualified it that aerosolized particles are not the same as air transmission of virus like the flu, which can survive without water for a time.
its for this reason that you can only work with the virus in a BSL lab with negative pressure, heppa filters, and body suits…
Artfldgr:
My impression is that some of the disagreement has to do with the size of the particles. No one is disputing that larger particles can transmit it in the air, but that’s not technically considered airborne or aerosolized. And the other disagreement has to do with animal vs. human transmission.
I must admit this is not at all my area of expertise.
neo… aerosolized particles can be smaller than 1.2 nanometers… which is large by virus standards like the flu… but small by our standards.. particles smaller than about 3-5 nm can get into the aveoli of the lungs… which is a good place for transmission… also, the desease is nasty in all primates tested… there is no reason to think at all that humans would be different in this case…
anyway… the point is moot given this
We are in big trouble neo
Shock Image Shows Unprotected Workers Cleaning up ‘Ebola Vomit’ in Dallas
http://www.teaparty.org/shock-image-shows-unprotected-workers-cleaning-ebola-vomit-dallas-58783/?utm_source=facebook&utm_medium=cpc&utm_campaign=social
the people doing the washing up are using pressure washers… this will make particles airborne. not only that, but they are black, and are not wearing any protective gear
also… this leads to my point that the stuff was left over night where rats and mice will eat it… and it can exist in mice without killing the mouse if its an adult..
the ONLY saving grace here is that the stuff has been out in the sun, and that the wash MAY have cleanser in it. however, its not a warm fuzzy kind of saving grace…
Jack, if you know people, then you know that many, many, many people go to the ER for conditions that aren’t “emergencies.” People without insurance go there because ERs have to take them. People without primary care doctors go there because they don’t have primary care doctors. People on Medicaid go there because they can’t find doctors who take patients on Medicaid. People go there just because it’s there. As for a person from Liberia, where else would he go? Do you suppose he had a family doctor in Dallas?
As for electronic medical records: I’ve recently been working on a legal case involving a persistent error in a patient’s electronic medical record indicating that he didn’t have a condition that everyone agrees he did have. His medical practice insists that they knew about the problem, tried and tried to fix the error, couldn’t do it, had the same problem with many other patients and are shifting to new software. Meanwhile, I acquired access to my OWN electronic medical record and — while I do like having that access for informing myself and facilitating communication with my doctors — guess what? I’ve discovered that my record is full of errors.
We really do not know precisely and completely what was said by whom to whom at Duncan’s first ER visit. At this point, it really is insignificant, subject to much conjecture, and not part of the big picture.
The big picture is what we have seen with our own eyes: The lies, distortions and evasions of the CDC’s chief, Dr. Frieden, over the past weeks. The slow, adjudicated process of mobilizing the local and state public health “authorities”…a Judge was the chief spokesman for the Dallas “team”. A Judge! The State and Dallas public health people are grotesquely incompetent, “requesting” the immediate family to stay confined to quarters without food (so they left the apt to get some) and with the diarrhea-soiled sheets still on Duncan’s bed the next day; slowly finding a commercial hazmat team that would decontaminate the apartment but not having a place for the displaced family to go; having unprotected workers spray away the vomit outside the apartment (see Art’s note). Not quarantining the family. “Monitoring” contacts by “checking” them once daily and having them take their own temperatures twice daily.
And all the while “ensuring” we are safe.
Disgusting, repellent stuff.
RE EMR: I get a copy gratis every time I leave the office; has a list of my current meds, and the list is never correct. It cannot be made right; the software does not have choices that cover my FDA-approved meds. So they give it to me and I take it home to the shredder. The software cost this small practice $25K, mind you, and reduces productivity, per the mandate of our beloved gummint.
From The Hill, today:
“(Dr Anthony Fauci, head of NIAID) acknowledged that Dallas health workers had made mistakes but said he remained confident that the federal government was managing the response.
“There are things that did not go the way they should have in Dallas,” he said. “Although there were missteps there, there were good things that happened also.”
Keeping score?
The **Confidence** of our leaders is so reassuring. Dr Fauci is 74 years old. He’s been in government approximately since Baraq was born.
Don Carlos, I fully agree. The contrast between the comedy of errors unfolding in Dallas and the simultaneous assurances of our public health experts that we’re fully prepared, we know what we’re doing, we’re on top of this, don’t worry one bit, be happy, everything’s great — well. I’m having quite a lot of trouble believing that these people, straightfaced, are saying these things and expecting us to believe them.
Here’s an article taking a larger perspective on the same phenomenon:
http://freebeacon.com/columns/the-case-for-panic/
“Over the last few years the divergence between what the government promises and what it delivers, between what it says is happening or will happen and what actually is happening and does happen, between what it determines to be important and what the public wishes to be important–this gap has become abysmal, unavoidable, inescapable. We hear of “lone-wolf” terrorism, of “workplace violence,” that if you like your plan you can keep your plan. We are told that Benghazi was a spontaneous demonstration, that al Qaeda is on the run, that the border is secure as it has ever been, that Assad must go, that I didn’t draw a red line, the world drew a red line, that the IRS targeting of Tea Party groups involved not a smidgen of corruption, that the Islamic State is not Islamic. We see the government spend billions on websites that do not function, and the VA consign patients to death by waiting list and then cover it up. We are assured that Putin won’t invade; that the Islamic State is the jayvee team of terrorism; that Bowe Bergdahl served with honor and distinction; that there is a ceasefire between Ukraine and Russia.”
Mrs Whatsit:
He could have gone to a walk-in or urgent care clinic. That’s easier, and they’re very readily available these days.
I think many or most are affiliated with hospitals, but they are separate facilities, and less intimidating.
Of course, by the time he was deathly ill and the ambulance came for him (second visit rather than the first), they probably decided he had to go to the hospital.
http://www.liberianobserver.com/news/man-who-took-ebola-us-will-be-%E2%80%98prosecuted%E2%80%99
-Former Boss Says ‘Thomas Knew He Had Ebola’
blert:
I just read the piece you linked, the one that said his boss said Duncan knew he had Ebola.
But the text of the article gives no evidence of that. Just that the taxi driver suspected it. And the guy speaking hadn’t seen or spoken to Duncan since 9/4, which was way before the incident.
What’s more, the neighbor describes Duncan as having held the ill woman’s hands as her father and brother and Duncan carried her from the cab to the apartment. The woman was not his wife or sister or lover or even a relative of his. If he knew she had Ebola, why on earth would he take a risk like that? I think his behavior argues against his knowing.
Others have said they thought her convulsions and illness were due to her pregnancy (seventh month) and not to Ebola.
I’m not trying to excuse or absolve this guy. But I just don’t see any evidence that indicates he knew. He may or may not have; we just don’t know.
Neo: while traveling far from home, my family recently had occasion to use a walk-in, urgent care clinic. After an hour of signing in, waiting to be seen, being seen — they told us to go to the ER, the situation was too emergent for them. We were trying to conserve medical resources, but we’d have saved some time and spared one of us quite a lot of significant pain had we just gone to the ER in the first place.
There is no question that the hospital goofed up. Humans make mistakes especially when they are interacting with unfamiliar software. That is why we should have massive redundancy in our protection from importing Ebola. So lets admit that the hospital made a mistake, it was a genuine mistake which was perhaps inevitable sine medical personnel hadn’t ever seen Ebola in the USA.
It is much easier to blame the hospital for a mistake than to blame the CDC and Obama administration who removed all the common sense barriers designed to quarantine the outbreak in Africa and to protect us from Ebola. It was their deliberate criminal negligence which placed the responsibility for the lives of numerous people on the shoulders of a single lowly nurse.
Incidentally, the treatment for small pox was discovered by Edward Jenner. It was a variation of small pox which grew in cows called cow pox. In this light, the Reston version of the Ebola virus is very interesting.
“Some of the people at the colony in Texas and several of the workers at the facility in the Philippines also produced antibodies to the virus but did not become ill.”
http://www.infowars.com/flashback-ebola-goes-airborne-causes-outbreak-in-medical-lab/
The Reston virus might be the needed vaccine which could be produced in large quantities.
Neo, FYI, the Federal law requiring ERs must see (and stabilize) all comers applies only to ERs. It does not cover Urgent Care or Walk-In Clinics. All who enter those must have $ or insurance.
The “Stabilize” requirement is to keep hospitals from dumping the financial undesirables too soon. Once stable, they can be shipped elsewhere, e.g. municipal or “charity” hospitals.
Don Carlos, Mrs Whatsit:
The site I linked to says, “Walk-in health care clinics were initially intended to serve the uninsured and underinsured, providing a more affordable option for basic medical services than a visit to a hospital emergency room or urgent care clinic.”
That was my memory of it, as well, but perhaps things have changed in recent years?
Illuminati:
Let me be quite clear: I certainly have no interest in absolving the CDC and Obama, and blaming the hospital instead. I think all deserve plenty of blame.
If it weren’t for Obama failing to put in place the proper travel restrictions, for example, the very unfortunate Mr. Duncan would never have come here.
Nevertheless I continue to find it quite astounding that the very first Ebola patient in the US was known to have come from Liberia and that the info was so easily lost in the shuffle.
neo…
I’ll hazard a guess that the poor woman was hacking and coughing something fierce. For, she died the next morning.
By September, 2014, the symptoms of ebola must be universal knowledge in Liberia.
I also find it hard to believe that three hospitals that turned her away provided no commentary. I suspect triage right on the spot: she was a goner. It was that obvious.
What must strike us as strange: how in the world did a (massively?) pregnant, young woman pick up ebola?
By the seventh month, IIRC, it’s socially taboo for gals to be out roaming the streets, shopping.
In other tragic news: most of those helping this woman are also now dead. T.E.D. is still hanging on.
If word gets back to Liberia, ebola tourism will take off like a rocket. Naturally, it will be stealthy, what else?
$$$
I see at the PJM that others realize that ebola ‘candidates’ must NOT enter regular hospitals.
Given the current state of play, it’s imperative that fever quarters be provisioned IMMEDIATELY. These need to be provided with both isolation and all the needs for living under quarantine… gratis 0-care.
Right now the FEMA centers figure to be the best candidates.
We may need people who are immune to drive ‘candidates’ off to quarantine. Liberian survivors may be just the talent needed. We should put some under contract — IMMEDIATELY.
They’re the only ones who can logically survive incidental contact. Their immune systems are already keyed way, way, up. I’m not suggesting that they wouldn’t use ebola protection. It’s just logical that they can withstand trivial infections that would kill most.
During the 14th Century those who had immunity ended up being the ONLY source of hospice.
[Nostradamus was famously among that crowd. While he missed out on the 14th Century scourge, the Plague was still around and kicking when he was active.]
Beyond that, they’d be ideal samples of surviving genes/ immune systems. They could point the way to better cures.
&&&
One must hope that anti-viral agents are discovered quickly.
But it’s not necessary for Barry Soetoro to infect America to stimulate them.
(It’s like he’s channeling the homosexual who massively inflamed the HIV victim count back in the early 1980s in San Francisco. He’s now considered one of the greatest mass murderers of history… way beyond normal infamy. Something like 40% of all HIV victims trace their disease back to his deliberate bedroom ‘antics.’ He literally screwed his lovers to death.)
off-topic; but, they sent in workers to “clean up” the apartment where he and his family were living in Dallas.
So, my question is this – who wants to rent it now?
blert:
You need to read more of the links, and more descriptions from witnesses of her situation, rather than speculating.
I have provided links for this before and have no time to provide them at the moment, so I’ll just summarize: she was not hacking and coughing. She had stomach pain and convulsions, and she was seven months pregnant. The people helping her thought the problem was her pregnancy, not Ebola. If you’re familiar with pregnancy, stomach problems are very common, and convulsions are typical symptoms of eclampsia, which sometimes occurs in late pregnancy. It was logical for them to think her problem was related to pregnancy and not Ebola. Plus, I read that she had had no contact with a known Ebola patient, so they had even less reason to suspect it.
So far there have been about 3800 reported Ebola cases in Liberia and about 2000 reported deaths (there had been fewer, of course, in mid-September, when this woman died). Liberia has a population of a little over 4 million people. That makes the incidence (if the statistics are correct) so far of the illness to be about 1 in 1000. We tend to think practically everyone in Liberia has Ebola, but that’s not even remotely true. So that’s another reason they wouldn’t necessarily have suspected it for this particular woman.
What’s more, coughing is not generally a symptom of Ebola (Liberians may or may not be familiar with the symptoms of Ebola, but you definitely are not, if you think coughing is generally one of them). Unfortunately, until there are symptoms such as red eyes or bleeding (which tend to be later symptoms of the disease), Ebola symptoms resemble many other problems.
As for the hospitals, they probably turned her away because they are full.
Yeah the pregger Liberian was not Duncan’s squeeze or ex-squeeze, but he got her bodily fluids all over himself because why? Because he was close to Jesus? Ya think? Or because the pup was his? I know how I’d call it. Especially when he showed such care to not infect the Liberians in Dallas, one of whom was an ex-squeeze. They’ll be in isolation hospital beds themselves next week. Thanks, Duncie.
Are people just plain stupid today? You’re a doctor examining a black man with a distinctive foreign accent displaying symptoms consistent with ebola, and what? Your brain stops functions despite months of non-stop news about ebola in Africa growing at exponential rates?
Ditto for the nurse.
They both should have immediately alerted the head of the hospital and local health authorities and spread the word that they might have an ebola case on their hands.
Neo said:
“Let me be quite clear: I certainly have no interest in absolving the CDC and Obama, and blaming the hospital instead. I think all deserve plenty of blame.”
Your intention is clear. The hospital’s failure is indeed astonishing. Medical schools choose highly intelligent people as doctors and they fail like this? Yes, I do blame the doctor not just the nurse. The doctor is the one who bears ultimate responsibility to ask the appropriate questions. It is very possible that the doctor is not a native born American but is actually a foreign medical graduate who was imported to do jobs Americans won’t do. The quality of the foreign medical graduates is very uneven. Regardless, doctors all make mistakes and this one was a doozy.
My point should be equally clear, the overworked hospital ER and its medical staff made a completely human mistake which undoubtedly upsets them even more than it upsets Neo herself. Every doctor makes mistakes and when they occur the psychological pain a good doctor suffers is devastating.
On the other hand Obama and the left deliberately eliminated the redundancy which would have prevented this accident. The difference between them and the doctors mistake is that their behavior is intentional and that they show no remorse for their behavior.
Are people just plain stupid today? You’re a doctor examining a black man with a distinctive foreign accent displaying symptoms consistent with ebola, and what? Your brain stops functions despite months of non-stop news about ebola in Africa growing at exponential rates?
—–
Thank you!!! This is what I have been saying at work. None of this people were using sense.
As to neo finding it amazing that they didn’t make the connection, I don’t. Hospitals are going to make errors with things that have never shown up stateside. They didn’t diagnose the Marburg woman until way after she had recovered. Not everyone is paying attention. At work, we basically got one email with Ebola protocols and that was it. They just resent it this week.
i just love how everyone here knows exactly what was said, by whom to whom and when. Which leads to absolute conviction as to where the fault lies. Verdict first, then the trial.
The incidence of Ebola in Liberia is about 1 in 1000, not 1 in 100000.
@ Don Carlos
I didn’t assume anything particular was said. I assumed Duncan opened his mouth and spoke. Period.
What? When you speak to people you don’t register a non-American, non-Latino accent? All this multi-culturalism, with over 40+ million foreign-born people living in the USA now, and the doctor and nurse have no experience with who is foreign-born and who isn’t? That’s just plain stupid.
I’m not surprised, however. The rate of stupidity I’ve witnessed at top hospitals, government agencies and businesses in general is growing and is readily apparent to anyone with a functioning brain.
As my mother’s oncologist – head of oncology at a top hospital – pointedly said to me when he came to see her a few hours after major surgery, “You’re not going to leave your mother alone for even one minute.” It’s not like he could have publicly dissed the hospital he works for, but he was certainly giving us a warning that we had to be very vigilant – and he was right. What he was warning us about was the stupidity and incompetence of staff. As just one very minor example, the nighttime nurse came and woke my mother up at 3am to take her blood pressure and told me it was 60/30. I told her my mother had normal BP and this was extremely low for her, to which she responded, “Maybe I should use the machine that isn’t broken?” I smiled and said, ‘Yes, maybe you should.” You can’t make this stuff up.
fmt:
Serves me right for doing math too quickly. I seem to have added some zeros along the way. Thanks very much, will fix.
Lea:
I don’t think I ever said I found it amazing that they didn’t make the connection. Unfortunately, errors are all too common, as I am aware.
I find it negligent that they didn’t make the connection, having asked the question and obtained the answer that should have red-flagged the case, given his country of origin and his symptoms. Not amazing, however.
Isn’t anybody also bothered by the fact that neither the original nurse and doctor didn’t put 2 and 2 together afterwards? You go home, hear the news, Liberia is mentioned in every ebola report, and you don’t think to yourself, “Funny, I had a patient from Liberia recently…” Or, mention to your co-workers that you had a patient from Liberia? I mean, just how many patients from Liberia does a Dallas hospital typically see on average in a given week, month or year?
Irene:
Many, I’d guess.
There is a large Liberian community in Dallas, up to 10K individuals. See this and this.
This just in from the Dallas News:
“The hospital at first blamed a flaw in its electronic records system for miscommunication, but late Friday said that wasn’t the case after all. It also pointed out the patient, Thomas Eric Duncan, did not disclose important information.”
Goes back to my earlier point. Better cool off on your blame game, and let the facts emerge.
Don Carlos:
My posts have qualified what I’ve said about the hospital with words such as “if true” (see this, for example). I have always made it clear that subsequent information might change things.
However, I have seen nothing so far that changes my opinion. Did you actually read that article with the quote you cite? I did. Here’s what it actually says:
The article indicates that the electronic records were not at fault, and that Duncan did disclose his travel history:
So, let’s review:
First the hospital spokesperson says that the full team didn’t have access to the information that he’d been in Africa, although Duncan had told them.
Now they are saying that not only had Duncan told them, but the full team DID have access to the information.
They said the electronic records were screwed up, but now they are saying there was nothing wrong with the electronic records.
It doesn’t increase a person’s faith in their competence, does it?
It appears that the quote you offered, that “the patient, Thomas Eric Duncan, did not disclose important information,” is referring to the fact that he did not say that he’d been exposed to the disease, or “around anyone who had been ill” (it’s not clear whether they specifically asked about Ebola, or about illness in general). At the time he answered the question, it is most likely (as I wrote here) that he thought Williams had been ill either with complications of pregnancy or something like malaria, and would not have considered that as having been around a person who was ill with Ebola, or any other disease he could catch (you don’t catch malaria from a person suffering from it, except by blood transfusion or needle-sharing or that sort of thing).
That’s quite a case of blaming the victim. Now the hospital thinks that his symptoms plus the travel history they are now saying they were aware of was not enough? Now he also had to have told them he’d touched an Ebola victim in order for them to pay attention? If anything, this makes them seem more guilty of negligence, not less, if the whole team knew about his travel history and ignored it.
As health professionals, they should have known he could have been exposed to Ebola and not known it, especially if a person he was near who had the disease had mild symptoms and yet was contagious. His travel history and his symptoms should have been enough to red flag him, big time. If he had known he’d carried a woman with Ebola, and told them so, it would have been an even stronger case that he had Ebola, but they had more than enough information already to strongly suspect it. Does the patient need to hand them the diagnosis before they pay attention? Talk about buck-passing!
Neo-
Course I read the whole thing. Just quoted a salient. I try to avoid long comments.
My point remains, as it has thruout, that we should not assign blame before having all the facts. All. The facts just keep on dribbling out, and sometimes they are wrongly stated. The WSJ today, for example, has Anthony Fauci as CDC director, several times. So much for fact-checkers.
I really do not have any interest in what happened to Duncan in Liberia. I also do not care what Liberian hovel-dwellers think about anything. That’s like asking cockroaches to do calculus. Look at what they and Duncan did with the sick female. Isn’t it said they tried to get her to an Ebola hospital? They live in Ebola-land, for Pete’s sake.
PS- On his 1st ER visit, Duncan did not have a temp of 38 degrees Celsius, and hospital says he denied contact with anyone ill. So as the story now goes they had an afebrile patient with nonspecific compaints, in an ER probably chronically swamped with non-emergent people from marginal circumstances. The Ivy Apartments, a large nearby complex where he stayed, are occupied by people with 37 first, non-English, languages, from most of the wretched places on the planet thanks to our Federal policies.
And “Africa” ain’t “Liberia.”
I’m not throwing rocks at anyone except the CDC and TX and Dallas authorities. Yet.
Don Carlos:
His temp of 100.1 was certainly not normal, but although a significant fever is considered anything over 100.4, 100.1 is awfully close. It definitely would be a fever if the person had been taking Tylenol to reduce it, or if his/her temperature generally tended to run slightly low. And his other symptoms were “abdominal pain for two days, a sharp headache, and decreased urination.”
Here are the symptoms of Ebola in its earlier stages (before the major bleeding, which tends to be a later symptom):
He certainly had some of them.
Plus, the article you linked said “Africa,” but all the other articles said he said “Liberia.” Which is true? The preponderance of the articles say he said “Liberia.” But even if he said “Africa,” do you really think that, with those symptoms and a history of coming from Africa, they shouldn’t have asked where in Africa?
I’m not sure why you’re so eager to absolve the hospital of responsibility. The evidence is that they messed up, big time. As I said before, though, there are many culprits so far in this snafu.
Don Carlos:
Well, I happen to have regard for human beings—even humans who live in Liberia. Your mileage may differ.
The report that they tried to get her to an Ebola hospital is not substantiated. Many other reports that they were just trying to get her to a hospital.
Neo: I do not understand the problem you have with my position. I have tried to make it clear I am not taking sides. Yet. You are taking sides, against the hospital. Of course I come to this from the POV of a (ahem) provider, perhaps even an expert. But I am fussed at for so doing.
I say he did not have a fever, as customarily defined by my profession: at least 38C. You even quibble about that…”It’s awfully close.” Then you cite the Ebola criterion: Fever (greater than 38.6°C or 101.5°F). So it’s not close.
If I seem to be defending the hospital (and I’m just being objective, avoiding the conjecture indulged in by others) it is because you are attacking it.
You say “He certainly had some of them (Ebola symptoms).” He had headache, abd. pain, weakness. How wonderfully non-specific. Coulda been migraine, something he ate, malingering, coulda been lots of things, and you want him admitted?
The photo of the hovel in which Duncan and a cloud of others lived was in the WSJ. My error. I was thinking of that when I made my Liberia remark. I too have a “regard for human beings” but I do not imbue them with regard if they are not qualified to be so regarded. But hey, let’s ship them all over here, out of regard.
Now he also had to have told them he’d touched an Ebola victim in order for them to pay attention?
——
Well it sure would have helped.
I think you are inclined to blame the hospital over mr Duncan but mr Duncan had far more information. You are a disease that has similar symptoms to many other diseases and has never before been seen stateside. If all the parts had moved correctly maybe they would have caught it but I put more if the impetus on Duncan.
Don Carlos:
I misread the Ebola fever dividing line (and, as you can see, I misstated it in my comment as 100.5 rather than 101.5). That was an error on my part.
So while he was borderline for fever in general, his temperature did not yet meet the criteria for Ebola fever. He did have a borderline fever, however, and his other symptoms were extremely consistent with Ebola, and he told them he’d come from Liberia (or Africa, if you believe that one report that characterized it that way).
As I’ve said before, the situation warranted much more attention (and monitoring) than it got. Your opinion is different. Fine, we disagree.
But I don’t know why you don’t understand my problem with your position. You say you are not taking sides, yet you seem to be quite angry and critical, despite the fact that I have qualified my statements about the hospital in my posts with “if it’s true,” etc. etc.. I have an opinion on this matter; I am not generally anti-hospital or anti-doctor or looking for a fight. This is a case in which I happen to think it’s clear, from the evidence so far, that the hospital erred in not at least flagging this patient for further monitoring, or informing the CDC of the possible need for further monitoring. And I think they may have been negligent in not doing so, back when they said they lost the info about his being from Liberia (which turns out not to have been true—at least, at this particular telling).
Their story has changed so many times it is also evidence of incompetence and disorganization.
You write that you have “regard for human beings” but do not imbue them with regard if they don’t qualify for regard. I don’t think the following remarks of yours show any regard whatsoever for human beings who happen to be Liberians who live in what you regard as hovels—the lot of them. How big do their homes have to be for you to regard them as human beings worthy of some regard, I wonder? Here is what you wrote:
And by the way, what’s like “asking cockroaches to do calculus”? Asking you to care what Liberian hovel-dwellers think? Or asking those Liberian hovel-dwellers to think? The reference isn’t clear.
And the final sentence of your most recent comment, “But hey, let’s ship them all over here, out of regard” is rather odd, because no one on this blog has suggested such a thing. No one. Having respect for human beings does not suggest that it’s necessary to “ship them all over here.” I am pretty certain that everything I’ve written on the topic of immigration and/or travel from West Africa during this epidemic is quite opposed to that notion.
Neo-
I give up. I have tried to explain why, medically, and from the standpoint of the likely ER environment at the hospital, it was not practically possible to expect them to have made a diagnosis of “probable or possible Ebola” on his first ER visit, and tie up a valuable asset (an isolation room, used for other diagnoses too). You tossed in a few hedges in your brief against the hospital, the ER and the ER docs, but so far have resisted my efforts to show the other side. So I have gotten frustrated, and my keyboard so showed that in my comments.
“Ship them over here” was not a reference to anyone here so advocating. But it is clear from the White House and CDC we should have no entry barriers, not for Ebola “tourists” or anyone else. I was reacting to that.
Don Carlos:
If the fact that he’d just come from Liberia, a country where Ebola is epidemic, and that he had a somewhat elevated temperature, stomach pains, and a “sharp” headache wasn’t enough to flag him as possibly worthy of following (not necessarily admitting at that point, but perhaps just reporting to the CDC or public health), then why even bother to have the question about travel? Surely it is meant to flag people who might have been exposed to Ebola? Do they have to be in full-fledged Ebola collapse, exhibiting absolutely unequivocal symptoms, to pay attention?
For example [emphasis mine]:
By the way, relevant to the fever discussion we had earlier, by accident I came across something that indicates that Duncan may indeed have been one of those people whose normal temperature is somewhat low; when he got on the airplane, his temperature was measured several times as being 97.3. That’s not necessarily something the hospital would have known, but I think it’s interesting nevertheless, and could have explained why his temperature was only 100.1 on his first visit to the hospital.
This is why I am no longer an ER nurse. I knew that someday I would make a big mistake, and that in addition to my own dismay and horror at what I’d done, I’d also have to listen to all those who had THE BENEFIT OF HINDSIGHT excoriate me for my error.
We all know this man had Ebola. The hospital didn’t have the benefit of that knowledge. Furthermore, there had never been a case in this country! The staff heard hoofbeats and thought “horses”, not “zebras”. They’d never seen a zebra before. They’ve seen one now.
There is no question the hospital and staff “dropped the ball.” They know they did, and they will do everything it is HUMANLY possible to do to see that it doesn’t happen again. I hope that the staff has the courage and fortitude to stick with it. I’m just glad it wasn’t me.
fmt:
The problem is that I believe that even a layperson might have suspected Ebola with that fact situation, especially his recent arrival from Liberia. The diagnosis was not esoteric—or at least the suspicion of the diagnosis. I don’t think I’m saying this just because of ex post facto knowledge. That’s my point. It’s as though he practically had to walk into the ER wearing a sign saying “I HAVE EBOLA!!” for them to pay attention.
The other thing is that, since the error happened, they’ve continued to make error after error, misrepresentation after misrepresentation, correction after correction, in the reporting of what had happened. They can’t seem to get their facts straight, with the result that now it makes no sense to trust whatever they are reporting about the incident. They have been incompetent not only about the diagnosis, but about tracking what happened.
This is below the standard of what people want or expect in a hospital. And if it is the normal standard, we are in a heap of trouble.
I understand about human error in hospitals. But egregious error (which I believe this was), compounded by error after error after error, is not normal human error.
At least, let’s hope it’s not.
Just will not see the other side, will you? You quote as if it means something:
“If there is any suspicion the patient may have Ebola, doctors are supposed to contact their local public-health department so that the patient can be placed into isolation for testing, she said.”
Duncan was there in the middle of the night, when all public health people are asleep. Do try to see it in context. I hope some here are able to understand what fmt and I have said.
“This is below the standard of what people want or expect in a hospital. ”
Yeah, we all want unicorns too. Hospitals are people and people make mistakes, even lawyers do. A black guy talking funny comes in at midnight and says his tummy hurts, he doesn’t feel good, he doesn’t have a fever, his exam is negative, and the ER is supposed to do what? Draw a blood alcohol level? admit him for ebola? Get a belly surgeon’s consult? Ignore economic realities?
The errors after errors after errors have all been by the Authorities, the esteemed public health folks in TX and Atlanta. There have been no medical errors alleged in Duncan’s care since Duncan was admitted.
Don Carlos:
I was referring to the errors in the reports of how this patient was dealt with during his first visit–first they said there had been an error in the electronic records software, than not, first they said his travel history wasn’t communicated to the full team, then that it was. These errors about the errors were committed by people such as this guy, a doctor/administrator at the hospital, who has the title of chief quality officer, and who works “closely with hospital and physician staff leadership to promote clinical excellence and safety in patient care.”
Now, I don’t know whether you consider that a medical person, medical administrator, or one of the “public health folks” you say made all the errors. I’d say he’s a doctor/administrator, for want of a better term (there may be a specific term for what he is, but I don’t know it). He certainly made errors, as have others in similar capacities with the hospital, acting as spokespeople for the hospital.
I find it astounding that you consider that expecting the hospital to consider Ebola as a possible diagnosis for Duncan, and at least report him to public health authorities or flag him in some way (as many other patients around the country have had happen, even before the Duncan case) is asking for “unicorns.” I fail to see why you have such obvious contempt for that point of view, rather than merely disagreeing with it.
I’ve said several times what they should have done, and other hospitals have managed to do it for other suspected Ebola patients (none of whom have turned out to have Ebola, fortunately).
And by the way, how would you, or I, or anyone not on the staff of the Dallas hospital, know whether any subsequent medical errors have been made in his health care since his admission? He may be receiving absolutely perfect treatment, or not—but how would you know?
Re medical errors,I said “alleged”.
Re public health authorities, I mean public health authorities.
Re the difficulty of dealing with vague symptoms in a busy ER in the middle of the night, I tried to explain that, as fmt has also.
Re errors on top of errors, these errors are useless in addressing the crux of the matter. Theses errors are useful only to litigants. I don’t care about them. They are distractions from the medical issues: What are we going to do? When? How?
I will admit to some scorn of able people who are unwilling to consider all the facts. I agree they are entitled to their own opinions, however medically and practically ill-founded those may be. My persuasive abilities seem limited. So it goes.
Don Carlos:
We’ve exchanged many back-and-forths in this and other comment threads, and you haven’t responded to many points I’ve raised. Such as: was Lester a “public health authority”? Or is he an MD/administrator with the hospital? As were the other spokespeople who made errors in reporting what happened, such as the one about the electronic records being at fault, and then not at fault?
My point in bringing up the later, non-medical errors—and I have no idea why you don’t see this—is that the hospital reporting on what happened has been very flawed, which further undermines belief in the efficiency and competence of the hospital—that was my point. I am well aware that the ER doctor and other staff who saw Duncan on his first visit are not the same as the hospital administrators (who, however, are also MDs), but the latter set the tone and policies and govern the overall atmosphere and accountability of the hospital. They either can’t figure out what happened, are getting poor information, or are jumping the gun on giving out information to the public. There’s a big breakdown in communication, and this does not speak well of the hospital’s efficiency and general functioning as a whole, in addition to whatever poor medical decisions may have happened during Duncan’s initial visit. That is not about litigation, it’s about how a person evaluates an institution and what goes on within its walls.
My suggestions about what should have happened are not so very unicornish, either, according to this:
By the way, that same article from which the above quote comes mentions that his initial ER visit was at 10 PM. Is that “the middle of the night,” according to you? I’m actually curious what you’re talking about. To me, 10 PM is not the middle of the night, nor is it a time when an ER’s efficiency should go down. For example, that’s not a time when most people would ordinarily be asleep—such as, for example, 3 AM, when people might be feeling sleep-deprived. If ERs can’t be expected to function properly at 10 PM, we are in bigger trouble than I think.
No one deserves your scorn here, although you seem to be rather free with it. I have considered the facts that have been presented. We disagree on how they should be interpreted and judged.
Oh, by the way, here’s another error—although this one would probably (if I understand the procedure correctly) come under the heading of an error by public health workers.