Dallas hospital retracts explanation for missed Ebola diagnosis

Jason Sickles

Texas Health Presbyterian has not addressed how it overlooked Thomas Eric Duncan as likely having Ebola. (REUTERS/Mike Stone) Click photo to view slideshow.

DALLAS – The Texas hospital that failed initially to identify and isolate the country’s first Ebola patient in its emergency room is now backtracking on its explanation for the error.

Authorities at Texas Health Presbyterian Hospital in Dallas first said they had “thoroughly reviewed the chain of events” and blamed a flawed computer system for hospital staff's failure to recognize that Liberian native Thomas Eric Duncan was at high risk for the deadly disease.

Late Friday – 24 hours after releasing the details in “in the interest of transparency” – the hospital modified its original explanation of what had happened. Revising the earlier account, officials said that Duncan’s travel history was visible to all in the hospital’s electronic health record (EHR) system.

“There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event,” the hospital said in a written statement.

But as of Saturday afternoon, no other explanation for the oversight had been given. Emails to the hospital with specific questions from Yahoo News have not been returned for days.

The orginal statement detailed how the hospital had been proactive in fixing the alleged flaw.

Texas Health Dallas has relocated the travel history documentation to a portion of the EHR that is part of both workflows,” the hospital stated on Thursday. “It also has been modified to specifically reference Ebola-endemic regions in Africa. We have made this change to increase the visibility and documentation of the travel question in order to alert all providers. We feel that this change will improve the early identification of patients who may be at risk for communicable diseases, including Ebola.”

Hospital's original statement faulted its computer system. Click to read entire document.

Duncan's condition was downgraded on Saturday afternoon from serious to critical.

Officials in charge of the Dallas investigation and public health response also had no answers when asked about the hospital’s retraction during a Saturday news conference.

“There are a lot of issues that have come forward with the first case in the U.S.,” said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention. “It’s definitely possible to take care of patients with Ebola safely, but it’s not easy, and there are lots of issues.”

Federal guidelines published in August advise that patients in Duncan’s condition and known to have been in diseased-ravaged West Africa be placed in isolation and tested. Instead, Duncan was prescribed antibiotics and sent home. The decision may have put others at risk for exposure to Ebola before an ambulance rushed Duncan back to the ER two days later, when his condition worsened.

Dr. David Lakey, commissioner of the Texas Department of State Health Service, counseled the country’s medical professionals to learn from Texas Health Presbyterian’s lapse.

“The travel history is very, very important to take right now, and it has to be communicated,” Lakey said on Saturday. “If you have a patient with a fever or symptoms that could possibly be related to Ebola, you've got to ask that travel history and take it seriously.”

U.S. Ebola patient Thomas Eric Duncan. (AP Photo/Wilmot Chayee)

Duncan, 42, showed up at the hospital with what officials described as a fever of 100.1 degrees, abdominal pain for the previous two days, a sharp headache and decreased urination. The hospital said Duncan told them he had not experienced nausea, vomiting or diarrhea — strong indicators of Ebola.

Texas Health Presbyterian acknowledged that Duncan, who had just moved to Dallas from Liberia on Sept. 20, said that he had been in Africa for the previous four weeks.

“The nurse entered that information in the nursing portion of the electronic medical record,” the hospital said in the original statement.

However, it added that “when Mr. Duncan was asked if he had been around anyone who had been ill, he said that he had not.”

The retraction late Friday did not address how Duncan answered the questions or revise the hospital’s position that it had followed the necessary protocols.

[Related: U.S. officials acknowledge ‘missteps’ in Ebola case]

Officials said public health investigators are monitoring 46 people for Ebola symptoms, including nine who are considered to be at higher risk because they had definitely been in direct physical contact with Duncan. None have shown any symptoms, but they will be tested through late October.

Dallas resident Don Petty said he has grown weary of the “mixed signals” and lack of answers.

“The computers at Presbyterian do not prevent or preclude intake personnel, nurses and doctors from talking to each other about the cases they observe,” Petty told Yahoo News. “I don’t know if we know what we have going on here in Dallas. We’re kind of like the dog that caught the car – what are we going to do with it now?”

____

Jason Sickles is a reporter for Yahoo. Have a story tip? Email him at jsickles@yahoo-inc.com. Follow him on Twitter (@jasonsickles).