Ebola patient's temperature spiked to 103 degrees

[Omaha Steve]

Source: AP-EXCITE

By EMILY SCHMALL, HOLBROOK MOHR and NOMAAN MERCHANT

DALLAS (AP) — Thomas Eric Duncan's temperature spiked to 103 degrees during the hours of his initial visit to an emergency room — a fever that was flagged with an exclamation point in the hospital's record-keeping system, his medical records show.

Despite telling a nurse that he had recently been in Africa and displaying other symptoms that could indicate Ebola, the man who would become the only person to die from the disease in the U.S. underwent a battery of tests and was eventually sent home.

Duncan's family provided his medical records to The Associated Press — more than 1,400 pages in all. They encompass his time in the ER, his urgent return to the hospital two days later and chronicle his steep decline as his organs began to fail.

Duncan carried the deadly virus with him from his home in Liberia, though he showed no symptoms when he left for the United States. He arrived in Dallas on Sept. 20 and fell ill several days later.

FULL story at link.



This Friday, Oct. 10, 2014 photo shows a copy of Thomas Eric Duncan's medical records from Texas Health Presbyterian Hospital, provided by Duncan{2019}s family to The Associated Press. The records encompass his time in the emergency room, his urgent return to the hospital two days later and a chronicle of his steep decline as his organs began to fail. Duncan carried the deadly Ebola virus with him from his home in Liberia, though he showed no symptoms when he left for the United States. He arrived in Dallas on Sept. 20 and fell ill several days later. (AP Photo/Kiichiro Sato)


Read more: http://apnews.excite.com/article/20141010/us-ebola-medical-records-f268d6fdd1.html

[femmocrat]

1. Sounds like they are preparing a lawsuit?

I'll bet their phone has been ringing off the hook with calls from personal injury lawyers.

[herding cats]

14. I've read it's unlikely they would win a malpractice lawsuit under Texas laws.

Case would likely fail

Dallas lawyer Michael Sawicki, who takes medical malpractice cases, said a lawsuit against the hospital or the doctor in the Duncan case is likely to fail because Texas law makes specific exemptions for emergency care.

He quoted a 2003 Texas legal rule that essentially says someone has to intentionally cause harm to be liable for civil damages. There has been no case in Texas where a plaintiff has proved a case under that rule, Sawicki said. “The law is written so in emergency care you’re not responsible for anything,” he said.

Read more here: http://www.star-telegram.com/2014/10/09/6188006/deputy-showing-no-signs-of-ebola.html#storylink=cpy

There's some speculation as to if the hospital may be guilty of patient dumping by Dallas County Commissioner John Wiley Price.

Price was among those who questioned the quality of Duncan's care. He urged the U.S. Centers for Medicare & Medicaid Services to investigate the hospital's response, alleging that it may have violated federal laws that prohibit patient dumping.

"The fact that they turned him away the first time should be the basis for a CMS review," Price said. "It's tantamount to patient dumping — they changed their story at least three times. I stand by my position that the reason they basically dumped him was because he was black and didn't have insurance."

Even if that wasn't the case, Price said, "the bottom line is they missed the protocol" for dealing with potential Ebola patients.

http://www.freep.com/story/news/nation/2014/10/10/dallas-hospital-defends-care-ebola-victim-thomas-eric-duncan/17024985/

[Dustlawyer]

20. They passed tort reform a few years ago duping people into thinking that we file all sorts of

frivolous lawsuits all of the time. Think about it, we only get paid if we win a recovery and we have to front all expenses and only get those back out of a recovery if there is one. Now you pretty much have to prove your med mal case up front, post a bond, have expert reports and damages are capped. With the cost of litigation and the experts, few cases are worth taking. If you are a minor, unemployed, or retired you probably cannot find a lawyer in Texas to take your case.
When RW potential clients come to me with a med mal and I turn them down I usually hear, "But my case is legit, not like the others you get!" I almost enjoy telling them they shouldn't have voted for the tort reform, they were lied to.

[Sunlei]

23. That emergency room Quack, probably didn't read much of any patients information.

Or 'listen' to what 'they' had to say. "the bottom line is they missed the protocol", yes, probably the biggest fail in that Doctors lifetime.

[rainbow4321]

28. Local papers addressed this possibility

Adding that there are multiple obstacles for the family.

1) State law limits awards to $250,000
2) Another law gives protection to ER workers
3) 3rd law says it would have to be proven that had a person been given a different treatment, would they have had more then a 50% chance of survival...given how high the death rate is for Ebola this probably would work against the family.

[MADem]

41. I can't see that lawsuit prevailing.

The patient lied at every step of the process to get into the country. He misstated his associations with people who were infected, and by doing that he interfered with the ability of medical personnel to diagnose him. The medical personnel may have screwed up but when the patient lies to the doctor it can be a challenge. If he'd said "I was recently in the part of Africa where Ebola is rampant and I hauled a woman with Ebola to and from a hospital and then she died," people may have taken him more seriously.

Africa is a big continent, the disease is not everywhere, and he was one of the earlier Ebola cases in USA. This guy was an early victim who didn't help himself with an incomplete medical history, but he did do a great service to those who might come after him in that his case has sensitized ERs across the country to the nuances of the disease in earlier stages.

[hedgehog]

43. Given how sick he was, who knows if he knew what he was saying.

Why would anyone go to an ER and then deny any connection to Ebola?

[Wellstone ruled]

2. This is going to leave a mark.

You just knew someone or circumstances got out of control. When we see the Judge from Dallas County do a press conference at this Hospital,pretty much sunk this man's fate. Only in Texass.

[bullwinkle428]

3. Sent home after reading a temp. of 103°? That is the very definition of malpractice.

[Chemisse]

31. I was sent home from the doctor's office - twice - with a fever of more than 104.

And that is with no diagnosis and certainly no antibiotics (a few years ago).

After a few more days I went to the local ER and found out I had pneumonia. That time I was sent home - again with a very high fever - but this time with antibiotics. I improved slowly after that.

So to say that someone with a high fever is or should be automatically admitted to the hospital is not right.

[RobinA]

35. I Doubt It

It's not that easy to get admitted to a hospital these days. I'd be willing to bet that hospitals turn away 103 fevers every day. They sure as heck don't admit them all. In fact, they discharge way worse than this. If this guy hadn't turned out to have Ebola he would be just another feeling-crappy schmoo who got hustled out of the ER with an antibiotic prescription. One of hundreds who received the same treatment that day.

I wish the take home from this episode would be less about Ebola and scapegoating this particular hospital and more about the slap dash way medicine has to be practiced these days.

[magical thyme]

44. ^^^^exactly

thousands of people/year get sent home w/a prescription jic.

Short-staffed, overworked "quacks" do this all the time. This Dr. just drew the short straw on the first Ebola patient.

[TwilightGardener]

4. Decreased urination should have been a red flag, also--it's an unusual thing to complain

about. I've never had a patient complain about not producing enough urine. The staff probably assumed it was dehydration related to his general illness, although he didn't complain about recurrent vomiting or severe diarrhea--and even then, your kidneys still produce urine, even if concentrated. I wonder if he was given IV fluids and had his output monitored?

[TwilightGardener]

8. People are latching on to the fever, but I don't know that an ER automatically admits

people with fevers. 103 is high and indicative of acute illness/infection, but it isn't crazy-high, and that in itself wouldn't be grounds for hospital admission or a diagnosis of something like ebola. It's just another piece of the puzzle they missed--the low urine production, the abdominal pain, and the travel history and the fever COMBINED is what should have gotten him immediately isolated and admitted.

[Iliyah]

17. Here in California if you have a temp of 103

ER will keep you until the temp breaks. Texas may be different, especially if patient has no health insurance.

California regardless of no insurance will keep the patient to monitor and until the fever breaks.

[Yo_Mama]

29. They don't - I was sent home from the ER at the age of 20 with a 104 degree fever and abx

It depends on how stable the patient is. I had insurance, btw. And it was a good hospital, and the right thing to do. I was much better off at home. That doesn't mean Duncan was, or should reasonably have been discharged.

But if his fever rose to 103 in the ER, given the recent African connection you would think they would have been more cautious - unless, of course, they thought they had it connected to typhoid fever or malaria.
http://en.wikipedia.org/wiki/Typhoid_fever

Well, now that the family has released the records, everyone can take a look at them and make up their own minds.

I don't think the family members are looking for money - I think they are honestly trying to prevent this from happening to someone else.

Does anyone know what abx they prescribed?

[Judi Lynn]

5. Thank you. Unbearably sad. n/t

[maynard]

6. Did he have health insurance?

Haven't been following threads, but since Texas does not believe in people having health insurance, was he sent home for insurance reasons?

[Omaha Steve]

13. He didn't have any

Isn't that Governor getting ready to run for POTUS. He did say Texas was the best state for this to happen in, before the patient died.

[freshwest]

15. What makes you think he'll change his tune after he died? I think not...

[redruddyred]

27. he may have had a point

had he meant that ironically.

[Yo_Mama]

30. People with insurance and high fevers are commonly sent home from ERs

The ins cos can make it very hard to hospitalize a patient.

My husband was discharged from the ER with a diagnosis of pneumonia, diarrhea, and a fever of 104 with nothing but two prescriptions - one for penicillin and one for something to treat the diarrhea. I was states away with my mother who had been in intensive care. I spoke to him, took her home, got on the first plane and made it back in time to take him into the hospital to save his life (a day and a half later!, but insurance companies aren't necessarily going to authorize decent care either. I called for an ambulance and they wouldn't send it. I had to carry him to the car myself. His fever was over 105 and he was grey.

My husband was in intensive care for a week, so that particular episode of "managed" care didn't save the ins co any money, but don't assume that this man's fate would have been different if he had insurance.

The US health care system is not what it was, and insurance companies are one of the main reasons for it. Remember "drive by" births?

[Erose999]

10. I had the flu and had a 105deg. fever. They gave me tylenol and sent me home. Granted,

that was 5 years ago.

[jeff47]

11. Fever alone isn't enough to keep him.

Fever + other symptoms + recently from Africa is.

Previously, the story was that he only had a low fever on his first visit, as an excuse for why they missed it on the first visit.

[cstanleytech]

12. Ya but if they knew he had just got back from africa recently that should have sent up a major red

flag you would think for the hospital.

[colorado_ufo]

16. I feel your pain, Erose999!

I was in the doc's office with 104 degrees and he said, "You're the sickest patient I've seen in years!" And then sent me home, without even a question about whether or not there would be someone there to help take care of me. Doesn't matter if I had a huge infiltrate in my lung with pneumonia, severe anemia, blistered burns over half my body, wrecked knee swollen like small cantaloupe, or anything else - they ALWAYS send me home! It's like I have a tattoo that says, "inhospitable." And it wasn't the same doctors. And I had excellent insurance, so why?

At 105 degrees, they most definitely should have hospitalized you; your life was in danger.

[pnwmom]

21. Did they test you for flu? Did they give you an anti-viral?

Did you have health insurance?

[Erose999]

42. No insurance, was offered Tamiflu if I paid full price. It was the university health center, more of

a clinic and not really a hospital. I rode the bus there and rode the bus home, delirious all the way.

[Sunlei]

18. What a fail by that Texas emergency room! So sad, the man died a suffering death.

His family couldn't even bare to view him, he was in such bad shape at the end. He never got a serum transfusion from a survivor because the hospital said, no blood match. Why couldn't they ship some serum from a survivor in Africa? That may have helped him survive.

We still have more than a week to go before all the other contacts are clear.

The family can not sue if the man went into emergency room as a uninsured or non-paying patient. I don't think Medicaid patients or medicare patients can sue any hospital or Doctor either. Maybe he had insurance or was a cash payer. Sue the heck out of that Doctor!

It was the family who called our Federal CDC and they/ CDC contacts the Texas hospital and sent the ambulance ASAP.

[Iliyah]

19. There is a high % of Texans who are uninsured re: health insurance

by your truly the GOP party.

[azurnoir]

22. well the fever was one indication however I'm curious what was his blood pressure?

was it low?

[Sunlei]

24. wonder how long the uninsured man waited in the Texas emergency room. Can be several hours in Tx.

We have to wait another week or so longer to see if this Texas hospitals incompetence, caused a spread of ebola to any others.

[TwilightGardener]

25. They sent him for a CT and other tests. He was all over the place in that hospital.

How well did they clean the equipment? The stretchers, the exam tables, the floors?

[LisaL]

26. Considering they didn't suspect he had Ebola at the time, my guess is not that well.

[Chemisse]

32. I continue to think this hospital's only mistake was not acting upon his African connection

His symptoms, including a high fever, were not sufficient to hospitalize him.

In addition, I think hospital ER doctors miss things in the patient's background all the time. They are incredibly busy and they have to work fast.

While I agree the hospital is covering up in the aftermath, I don't think they acted in a way that is shockingly negligent, especially since there had never been an Ebola case diagnosed in this country before. Really, what were the chances somebody would walk in with Ebola? It had never happened before and it has not happened since.

[George II]

33. Over the years my temperature "spiked" to 103, and even higher - I never had Ebola

[RobinA]

36. Mine Hit 103

when I had Lyme. Before I knew it was Lyme and thought it was the flu. Actually, I started to feel better before I knew it was Lyme.

[George II]

37. Exactly.....just because one's temperature rises to 103 doesn't mean it's Ebola.....

....and it's not like they see Ebola cases every day. In fact, this was the very first one diagnosed EVER in the United States. In hindsight everyone is implying "they should have known"!

[Aerows]

40. Mine got high enough to have hallucinations

when I got chicken pox.

[AngryAmish]

34. Question: isn't 103 where you have to consider cooling baths?

Or is that 105? Either way that is really sick.

[Aerows]

39. 105 is where brain damage occurs

So, yes, 103 or 104 should be where they start cooling. He didn't have insurance, though.

[Aerows]

38. Have good insurance

get admitted. Don't have insurance, get sent home unless you are on the threshold of dying.