nope. no computer glitch. Dallas Hospital Alters Account, Raising Questions on Ebola Case

[cali]

Health officials’ handling of the first Ebola patient diagnosed in the United States continued to raise questions Friday, after the hospital that is treating the patient and that mistakenly sent him home when he first came to its emergency room acknowledged that both the nurses and the doctors in that initial visit had access to the fact that he had arrived from Liberia.

For reasons that remain unclear, nurses and doctors failed to act on that information, and released the patient under the erroneous belief that he had a low-grade fever from a viral infection, allowing him to put others at risk of contracting Ebola. Those exposed included several schoolchildren, and the exposure has the potential to spread a disease in Dallas that has already killed more than 3,000 people in Africa.

On Thursday, the hospital, Texas Health Presbyterian Hospital in Dallas, released a statement essentially blaming a flaw in its electronic health records system for its decision to send the patient — Thomas E. Duncan, a Liberian national visiting his girlfriend and relatives in the United States — home the first time he visited its emergency room, Sept. 25. It said there were separate “workflows” for doctors and nurses in the records so the doctors did not receive the information that he had come from Africa.

But on Friday evening, the hospital effectively retracted that portion of its statement, saying that “there was no flaw” in its electronic health records system. The hospital said “the patient’s travel history was documented and available to the full care team in the electronic health record (E.H.R.), including within the physician’s workflow.”

The hospital had said previously that the patient’s condition during his first visit did not warrant admission and that he was not exhibiting symptoms specific to Ebola.

<snip>

The confusion was indicative of the various local, state and federal protocols and levels of preparedness that have raised questions about the ability of the nation’s health care infrastructure to handle a potential epidemic.

<snip>

http://www.nytimes.com/2014/10/04/us/containing-ebola-cdc-troops-west-africa.html?_r=0

[Iris]

1. "But on Friday evening"

Way to news dump.

[cali]

2. the hospital flat out lied- which I thought the minute I heard the

"computer error" line. Lying in such a circumstance is totally beyond the pale.

[Iris]

3. this is really disgusting

And could have disastrous results.

[TBF]

30. Not surprising at all -

they are going to let an individual doctor or nurse take the fall before the whole hospital reputation suffers. This has always been the case. I worked in a psych hospital years ago in which I saw medical records falsified by a nurse (in order to make the administrators happy). Anyone who thinks administration of a large entity would not do this is extremely naive.

[cali]

34. oh, I know they do it. that doesn't- particularly in this circumstance- make it any more

acceptable.

[Mojorabbit]

41. Early reports put the blame on the nurse

not informing everyone and I though then she was going to be used as a scapegoat cause the doc missed it in the records. She must have fought back.

[rainbow4321]

43. Most likely she was able to show she entered the info correctly into the computer

So the hospital had to back off saying she screwed up. Because within days of blaming the nurse, they then said that she had entered the info but the computer system didn't "share" the info with the doctor and THEN they came back and said, yes, the system did have the info in the doctor section.

With each new press release the hospital has given a new excuse. I can tell you the newest local article has them now blaming the patient again...saying that when he was asked if he had been in contact with a sick person he told them no. Except the problem is Ebola guidelines say if the person is FROM the affected countries and not "have they been around a sick person in those countries"

They are basically refusing to say "yes, our doctor screwed up and we are at fault for sending him home".

[vanlassie]

4. Therefore, some DOCTOR failed to utilize the records.

Can anyone come to a different conclusion?

[HereSince1628]

22. Logical. It's the 'dog ate my homework' syndrome

I would say, ER's operate in a manner where the SOP is for MDs to address the symptoms they face first, and complicating factors later (and many Dr's outside the ER practice the same way).

Patients pile up waiting for attention, MDs move from patient to patient as quickly as they can, circumstance demands it of them. Day to day there is reinforcement that travel histories don't matter very much. So travel histories drop off the radar.

One could say it's an inherent weakness in the operation. IMO, we've merely discovered what is common knowledge in urban ERs. There are weaknesses in delivery of service in ERs , in this case very likely placed on it by a combination of demands to deal with the patient pool and administrators pushing productivity.

At the same time, MDs and the hospital are in a position of authority and great responsibility. They live in a world where everyone assumes they are always right. When shit happens for which they are responsible, cognitive dissonance and denial emerge. Excuses are sought, administrators don't want a finger pointed at them, "they see lawsuits".

So, they invent something else and they fall on an excuse common among paper-pushers... the computer ate the data.

That's just the old 'dog ate my homework' ruse applied to healthcare.

[vanlassie]

26. Not Enough Staffing. Surprise, Surprise.

[HereSince1628]

28. Yes, but it's also how a specific adjustment to understaffing

is manifested by persons at the top of the hierarchy.

Persons whose authority and esteem are much protected by the system.

[TBF]

31. More likely the hospital is lying -

I saw this in a psych hospital many years ago. The administrators asked the nursing staff to "fix" the documentation when there was a suicide. I have no doubt that the hospital in this case (it's administrators) are far more likely to blame an individual doctor/nurse than blame their own procedures.

[hedgehog]

5. I think one of the earlier accounts stated that they diagnosed him with

flu (influenza) and sent him home with a script for an antibiotic

The actual diagnosis: "you're black, you're poor, so you're probably not that sick, get out of my ER!"

[hobbit709]

11. And what good does an antibiotic do against a virus?

The hospital is in full blown CYA mode.

[hedgehog]

12. Exactly! Prescribing an antibiotic for a viral infection is both ineffective

and contributes to the development of antibiotic resistant bacteria.

[Princess Turandot]

6. When they used the word 'work-flow'...

to explain what happened, it sounded like legal department weasel wording. 'Work-flow' to me is who has the ability to enter or change data on a particular info screen, not read access to that information. You don't really want other departments being able to enter or alter information outside of their scope of responsibility. You probably wouldn't want the patient registration clerks being able to access the entire record.

But the suggestion that the MD could not call up that info to read it makes no sense at all. The triage nurse's notes are the patient's entire record at the point when the doctor sees a patient for the first time on that visit. And if the docs couldn't access that info for this now 'notorious' patient, they couldn't access it for anyone else. Sure.

Given HIPAA privacy issues, it wouldn't surprise me if the system logs who accesses a specific information set.

[Warren DeMontague]

7. It's that top notch crack first world health care system they've been telling us for months

"Is totally ready for ebola"



Makes you comfortable about that "just a handful" of potentially exposed people, according to Freiden on Oct. 1, in Dallas - that turned into over 100, according to Freiden on Oct. 2- doesn't it?

"A handful"!

Sure, if you have real big fuckin' hands.

No, nothing to worry about, certainly no reason to start with all that crazy talk about limiting travel from Ebola countries. Couldn't do that, no, no.

[hedgehog]

13. A few years back, all the talk was about possible emerging

diseases from tropical rainforests. i thought that had nothing to do with my very small town in rural Upstate New York. Then I went downtown and noticed the Mayan migrant workers doing their shopping. I also new a woman from Papua New Guinea who had ended up living here. It's all one world now.

[ColesCountyDem]

8. I wonder if the decision was made by some overworked resident?

The decision to discharge the patient always belongs to the physician, and I wonder if that decision was made by some resident physician who was dead on his/her feet, from lack of sleep.

[Ilsa]

16. And hadn't seen much news lately,

even health news about the continuing spread of Ebola in Africa.

[ColesCountyDem]

29. It's certainly enough to make one wonder. n/t

[dixiegrrrrl]

23. Plus....the overcrowding in most ERs these days.

Esp. in big city hospitals.

There was a recent ...Frontline???...documentary showing a 24 hour look at a big city ER, where the docs were understaffed, over-worked, and the available beds constantly full.
The pressure to see so many patients was quite obvious.
And there was only 1 triage nurse.

Even our little county ER is constantly full of waiting patients now.

Maybe Obamacare will lessen that pressure.

[ColesCountyDem]

27. Yes. Our small E.R. is always busy, too.

It has 6 rooms, so it's not teeny tiny, but it's also the only hospital within a 20-mile radius.

[TorchTheWitch]

9. my guess is that neither the nurse nor the doctor

had a clue that when he said he came from Liberia that this meant he might have Ebola. I think if the nurse knew that Liberia meant a possible Ebola patient she wouldn't just have entered that into the computer and gone on her merry way but flipped her lid and immediately made it known verbally throughout the ER... at volume 12.

[cali]

17. I think you're right. and that kind of ignorance is frightening

[TorchTheWitch]

32. and we were assured that our hospitals were all prepared

and were told which countries Ebola was having outbreaks in. Well, I now have not one grain of faith that any of them do.

[PuraVidaDreamin]

24. I had this discussion in the OR the other day...

And I gotta tell ya'- the overwhelming ignorance astounds me even from so-called
Smart people. A surgeon said he would have discharged the patient too because he
Didn't know where Liberia is!

[eShirl]

40. holy crap

this is info that should be getting drummed into medical staff's heads on a constant basis, considering the circumstances

[Silver Gaia]

25. I've been thinking that is a possibility, too.

The average American's knowledge of geography is abysmal. There's a damn good chance that she had no idea where Liberia is, and just did not make the connection.

[Whiskeytide]

33. Having seen those stats on...

... how few Americans can find the US on a map, you could be right.

[TwilightGardener]

36. Maybe that nurse thought Liberia was somewhere down near Houston. Most Americans

probably don't realize there is such a country, and are only now learning about it. This is what ignorance brings.

[kestrel91316]

38. Or they don't know that Liberia is a country in West Africa.

[Demeter]

10. Why does anyone in these benighted days expect to be told the truth?

We haven't been told the truth since Kennedy was assassinated...

[sendero]

20. Since....

.... just before Kennedy was assassinated.

[Sancho]

14. I don't think they ever diagnosed this patient....

hospitals are just interested in dealing with patients with INSURANCE. When a foreign black man without American insurance is standing there the protocol is simple: unless it's an obvious heart attack then hand them a prescription and send them home.

Any staff doctor who admitted that patient would cost the hospital $$'s, so their beds are for paying customers only! That doctor is likely under orders to only admit insured patients. Emergencies without insurance, etc. are stabilized and moved somewhere else asap. If they can move they are sent home.

Walk-in immigrants which happen every day are to be handed antibiotics or pain killers, advised to go to a public clinic or medicaid doctor, and sent packing! Texas doesn't have the ACA to cover most uninsured poor.


Those ER docs didn't even take the time to read the record, interview the patient, or diagnosis anything. Otherwise, the would not have prescribed an antibiotic or missed the patient history. The only line on the intake that mattered was "insurance"?

[Ilsa]

18. And the infectious disease doctors like to blame patients

for requesting antibiotics too often and for irrelevant conditions.

[sendero]

21. This...

....... is the most likely explanation.

[Dustlawyer]

15. Many doctors want as little interaction with the common people as possible. They don't really

listen, and shoot out a guess, "antibiotics" and spit you out.

[kestrel91316]

39. Many of them don't want their veterinarians working to arrive at a rational diagnosis either.

I cringe when i find out a new client is a physician because I know that it's highly likely that they will try to second guess me, pooh pooh all standard protocols that I work to follow as part of responsible practice, and demand a simple pill or shot to make the symptoms go away.

And then they disregard all advice regarding followup, and are often anti-vaxers or vaccine neglecters when it comes to their pets.

[1dogleft]

19. between the hospital

the family at the apt complex refusing to be quarantined and how sick this guy was it will be a miracle if it does not spread. There will be others bringing it into the country it's just a matter of time

[PCIntern]

35. HEY! Where's that poster who was touting the wonderful

Hospital System, who blasted me for my post questioning their competence a few days ago?

[kestrel91316]

37. SMH

[LisaL]

42. Well, if they had a believe that the patient had low grade fever froma viral infection, this belief

was not erroneous. He did have a low grade fever from a viral infection. Infection being Ebola.