Hospital Failed to Isolate Ebola Patient at First

By Brenda Goodman, MA
WebMD Health News

Reviewed by Arefa Cassoobhoy, MD, MPH

Oct. 1, 2014 -- Hospital officials in Dallas admitted Tuesday they missed an opportunity to isolate a man who'd recently arrived in the United States from Liberia and was showing the first signs of Ebola.

While the man was sick, he had contact with five school-aged children at a relative's home, says Mike Miles, superintendent of the Dallas Independent School District, talking to reporters. The children are being watched at their homes. So far, none of them are ill.

As a precaution, their schools are adding more health care workers to check for symptoms of illness in their classmates. The schools are also beefing up their custodial staff to disinfect the classrooms and common areas, Miles says.

The man initially came to Texas Health Presbyterian Hospital in Dallas in the late evening on Sept. 25. He complained of fever and abdominal pain, says Edward Goodman, MD, an infectious disease specialist at the hospital.

He was given antibiotics and allowed to go home, even though he'd told a nurse who was using the hospital's Ebola checklist that he'd recently traveled to Texas from West Africa.

"Regretfully, that information was not fully communicated through the whole team. So the import of that information was not fully appreciated," says Mark Lester, MD, an executive vice president for Texas Health Resources.

The man returned to a relative's home for 2 days before being taken by ambulance back to Texas Health's emergency department on Sept. 28.

The hospital declined to name the man, but the Associated Press identified him as Thomas Eric Duncan, a Liberian citizen.

The New York Times reported that he may have become infected with the virus in Monrovia, after he helped carry his landlord's daughter to a local hospital. She died of Ebola the next day.

State laws, including Texas's, give public health departments the ability to "implement control measures" if they believe someone might spread a disease to others. Usually, that's a verbal order that allows doctors to detain a potentially infectious person for at least 72 hours, says Jeffrey S. Duchin, MD, chair of the public health committee for the Infectious Disease Society of America.

"It takes minutes," Duchin says. "All health care facilities should know how to communicate directly with their local public health authorities 24-7. This is something we've been working on [in] the U.S. for many years."

Public health authorities need to know about potential Ebola patients so they can start appropriate testing, track people the person might have come into contact with, and provide technical support to hospitals that are suddenly called on to give complex care in challenging cases.

But the delay in making the diagnosis pushed back those activities -- which are critical to containing the spread of the disease -- for at least 2 days.

'All Hands on Deck'

In a Dallas press conference on Tuesday, Texas Gov. Rick Perry reassured the city that appropriate measures were in place to stop the spread of the infection.

"This is all hands on deck. We understand that," Perry said. "We're working very closely with both the city and county health officials on this very serious case."

Doctors at the news conference said the hospital had cleared an entire ward to treat the patient, who they described as being in serious but stable condition.

The man's family members are being voluntarily isolated in their homes, says David Lakey, MD, commissioner of the Texas Department of State Health Services. If they don't heed the advice of public health authorities to stay home, he says other measures will be taken to keep them away from other people.

Hospital officials say they're still trying to determine how many health workers or other patients might have been exposed to the man when he first came to the hospital.

But because his initial symptoms were mild, they think the risk to others was low.

"He was not vomiting or having diarrhea, so there were no exposures. So we really feel like no health care workers were exposed on Friday," infectious disease specialist Goodman says.

"There was no further exposure from Sunday morning on. People were wearing appropriate protective equipment," he says.

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Sources: Mike Miles, superintendent, Dallas Independent School District, Dallas, TX. Edward Goodman, MD, Hospital Epidemiologist, Texas Health Presbyterian Hospital Dallas, Dallas, TX. Mark Lester, MD, executive vice president, Texas Health Resources, Arlington, TX. Jeffrey S. Duchin, MD, chair, public health committee, Infectious Disease Society of America; Chief, Communicable Disease Epidemiology, King County, Seattle, Wash. Rick Perry, Texas governor, Austin, TX. Press Briefing, Texas Health Presbyterian Hospital.

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