There are plenty of questions surrounding the misdiagnosis of the Ebola patient who died last week in isolation at Texas Health Presbyterian Dallas. On Thursday, the health system’s executive in charge of monitoring clinical performance at its 13 North Texas hospitals will tell the nation “we are deeply sorry.”
In a transcript posted to the website of the House Energy and Commerce Committee’s Subcommittee on Oversight and Investigations, Dr. Daniel Varga, Texas Health’s chief clinical officer, expresses remorse for the way Presbyterian treated Liberian national Thomas Eric Duncan when he initially sought care at the emergency department on Sept. 25.
It was 10:30 p.m. when he arrived at the ER with a fever of 100.1º, abdominal pain, dizziness, nausea, and headache. They were nonspecific symptoms, but Duncan, 42, told nurses that he had recently traveled to Liberia. For the next four hours, he “was examined and underwent numerous tests.” His fever spiked to 103º, Varga says, but dropped to 101.2º. And on Sept. 26, he was sent home with antibiotics.
From here, the story has been repeatedly told: His symptoms became more severe, developing into pain that he described as being at a rate of 8 of 10. He was vomiting and had diarrhea. He was taken via ambulance to Presbyterian on September 28, at which point, Varga says, “he met several criteria of the Ebola algorithm.”
“At that time, the CDC was notified,” the transcript reads.
Duncan was immediately isolated. He was diagnosed with Ebola on Sept. 30. He died on Oct. 8.
“It’s hard for me to put into words how we felt when our patient Thomas Eric Duncan lost his struggle with Ebola on October 8. It was devastating to the nurses, doctors, and team who tried so hard to save his life,” Varga says. “We keep his family in our thoughts and prayers. Unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team, we made mistakes. We did not correctly diagnose his symptoms as those of Ebola. We are deeply sorry.”
Seventy-six healthcare professionals provided care. Two of these, both nurses, have since become infected with the virus. Nina Pham, 26, is in good condition in isolation at Presbyterian. Amber Vinson, 29, was transported to Emory University Hospital in Atlanta, which has treated numerous American aid workers who were infected with the virus. They are all being monitored twice daily for any symptoms of Ebola.
The initial 48 who came into contact with Duncan are also being monitored, but none have shown symptoms. The incubation period for that group will end on Oct. 19.
The hospital has given disparate explanations for the misdiagnosis: It has blamed the electronic health record system for not displaying the travel history the nurse recorded to the physician. It later negated that statement, saying each knew where Duncan had visited.
“In our effort to communicate to the public quickly and transparently, we inadvertently provided some information that was inaccurate and had to be corrected. No doubt that was unsettling to a community that was already concerned and confused, and we have learned from that experience as well,” Varga says.
The transcript describes Pham as “an extremely skilled nurse” who “was using full protective measures under the CDC protocols.” Dr. Tom Frieden, the director of the Centers for Disease Control and Prevention, says she has been cooperative and helpful in the investigation of how she was exposed. He has blamed it on a “breach of protocol,” but says it may have been inadvertent.
Varga says THR has changed its screening process to capture travel history and ensure it is dictated through throughout all caregivers. The electronic health record has also been modified to highlight “high risk activities” that indicate whether a person has come into contact with a person or animal from a country stricken with Ebola. It’s believed that Duncan contracted the virus while carrying a pregnant woman to a clinic who later died of Ebola.
The emergency department has also undergone emergency preparedness training that includes verifying the screening methodology.