DALLAS – A flawed computer system and untruthfulness by the patient led medical workers to mistakenly send a sick man home instead of isolating him for Ebola, a Texas hospital announced Thursday night.
Officials with Texas Health Presbyterian Hospital in Dallas said its emergency room staff followed protocol by obtaining the required information from Thomas Eric Duncan, including the fact that he had recently been in Ebola-ravaged West Africa.
But the hospital’s electronic health-records system has two workflows: one for nurses and another for doctors.
“As designed, the travel history would not automatically appear in the physician’s standard workflow,” Wendell Watson, the hospital’s public relations director, said in a written statement.
Watson said the problem has been corrected.
“It also has been modified to specifically reference Ebola-endemic regions in Africa,” Watson said. “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.”
The change comes a week after Duncan, 42, showed up at the hospital with what officials described as fever of 100.1 degrees, abdominal pain for two days, a sharp headache, and decreased urination. The hospital said Duncan told them he hadn't experienced nausea, vomiting, or diarrhea — strong indicators of Ebola.
Texas Health Presbyterian admits that Duncan, who had just moved to Dallas from Liberia on Sept. 20, acknowledged that he had been in Africa in the past four weeks.
“The nurse entered that information in the nursing portion of the electronic medical record,” Watson said.
However, “when Mr. Duncan was asked if he had been around anyone who had been ill, he said that he had not.”
That contradicts what people in Liberia told the New York Times this week. Duncan’s former neighbors in Monrovia said he helped a pregnant woman on Sept. 15 get to the hospital in a taxi. She was convulsing and vomiting. The woman died at home hours later after being turned away from a crowded Ebola treatment ward.
Earlier Thursday, Liberian authorities said they planned to prosecute Duncan for lying on health-assessment forms he completed at the airport on Sept. 19. On the form, obtained by the Associated Press and confirmed by a government official, Duncan answered “no” to questions about whether he had cared for an Ebola patient or touched the body of someone who had died in an area affected by Ebola.
The Centers for Disease Control said Duncan had no fever when he boarded the flight, and apparently didn’t start feeling ill until Sept. 24, four days after arriving in Dallas. Texas Health Presbyterian said the symptoms Duncan presented in the ER late on Sept. 25 “could be associated with many communicable diseases, as well as many other types of illness.” A doctor ultimately wrote him a prescription for an antibiotic and sent him home, where he is believed to have been in contact with several family members and others.
By Sunday his condition had worsened, and an ambulance was called to make the mile-long trip back to hospital. He was immediately placed in strict isolation. Late Tuesday the CDC confirmed the dreaded diagnosis, making him the first person to develop symptoms outside Africa during the current epidemic.
Hospital officials reported that he remained in serious condition Thursday night.
Texas Health Presbyterian, which had come under great scrutiny this week, said they divulged the chain of events with Duncan’s approval because "we want other U.S. hospitals and providers to learn from our experience.”