Sister: Ebola patient told hospital he'd been in Liberia -- they sent him home anyway.

[pnwmom]

http://www.usatoday.com/story/news/nation/2014/10/01/texas-ebola-patient/16525649/

On Sept. 26, he sought treatment at the hospital after becoming ill but was sent home with a prescription for antibiotics. Duncan's sister, Mai Wureh, said he notified officials that he was visiting from Liberia when they asked for his Social Security number and he told them he didn't have one.

Two days later, he was admitted with more critical symptoms, after requiring an ambulance ride to the hospital.

The patient, whose condition was upgraded to serious Wednesday, was in contact with several children before he was hospitalized and had been staying at a northeast Dallas apartment complex, health officials here said.

Each of those children have been kept home from school and are under precautionary monitoring,

SNIP

http://www.theepochtimes.com/n3/992702-thomas-eric-duncan-identified-as-first-us-ebola-patient-breaking-news/

Dr. Mark Lester confirmed Wednesday that a nurse asked Duncan on his first visit whether he had been in an area affected by the Ebola outbreak that has killed thousands in West Africa, but that “information was not fully communicated throughout the whole team.”

[notadmblnd]

1. I wonder how much this person's

brown skin and no insurance had to do with being given a prescription and sent home instead of being admitted?

[magical thyme]

2. it was a communication problem

The triage nurse asked him his travel history and he told her.

The communication path was broken somewhere between triage nurse and his healthcare team.

Nobody sent him away because of his brown skin. It was a stupid mistake somewhere. Nothing more; nothing less.

[WinkyDink]

3. Complete lack of current-events awareness, at least. Scary.

[magical thyme]

4. no. the triage nurse knew to ask the question about travel.

it depends on how their communications work between triage and health care delivery team.

This is a very large hospital with presumably very busy ED, and therefore the communications are not necessarily direct.

[WinkyDink]

13. Is that supposed to be reassuring, 'cause it ain't.

[magical thyme]

19. no, it's not supposed to be reassuring. it's about not assigning blame without facts.

people here are already stating the triage nurse should be fired, etc. the fact is we don't know the facts, other than that she collected the required information and somehow the all the recipients didn't receive it.

[kestrel91316]

37. It's actually terrifying. "Whoops, just missed that part. My bad."

[notadmblnd]

5. ok, I'm certain that he just didn't fit the "criteria" for being admitted

Just like my sister didn't fit the "criteria" for being admitted to the psych ward after attempting suicide.

[magical thyme]

8. I can understand your feelings, but I think they are misplaced here

Nobody wants Ebola loose in America.

The triage nurse did not deliberately withold information from the healthcare delivery team, nor did anybody else deliberately withhold it. In all likelihood, the triage nurse is one of the people in being monitored now, along with the rest of the healthcare providers involved.

They could be the most bigoted people out there, and they wouldn't withhold it if only out of self-preservation.

That mistake allowed a contagious Ebola patient to roam around potentially infecting others -- including the healthcare workers caring for him on the 26th as well as the EMTs on the 28th.

It's not always about race. I didn't 'fit the criteria' to have any blood tests run when I showed up to a doctor's appointment having dropped 20%+ of my body weight with serious, serious symptoms. I was septic and they sent me packing without running a single test. My dentist literally saved my life.

[PCIntern]

12. Yeah, we do save lives...many...

despite people denigrating us as sadistic, money-hungry, self-serving Philadelphians.

[WinkyDink]

14. Bwah! Did you get auto-corrected from "Philistines"?

[PCIntern]

34. LOL. No, the poster was disparaging

My city on another thread.

[get the red out]

27. They probably need to revamp the line of communication

Whatever process of communication they used probably needs to be re-examined. With even that strange virus attacking kids throughout the country right now, perhaps hospitals should make sure their flow of communication is efficient.

Maybe a wake-up call. Things goof-up sometimes.

[magical thyme]

29. agreed. I've since read in several places that not all of the health delivery people

got the message. It sounds like it was the health care delivery team that failed to communicate among themselves. Every one of the people on that team should have understood the implications of travel from Liberia and someone should have spoken up when whoever made the decision to release him instead of isolating and testing for Ebola.

[muriel_volestrangler]

10. Early stage symptoms of Ebola are not always serious

If the doctor doesn't make the link with a disease that becomes deadly, like Ebola, then "antibiotics and rest" will seem the normal treatment for anyone.

[WinkyDink]

15. His sister says that he told them he was JUST IN FROM LIBERIA. To me, "LIBERIA" IS a symptom!

[muriel_volestrangler]

17. Yeah, the loss of "from Liberia" was the problem (nt)

[LiberalArkie]

32. The problem is that no one listens in admitting.

They are too busy asking a question and filling out forms. I had told more than 5 nurses that I was taking Plavix before a kidney stone procedure. Never rang a bell. I was about to be knocked out when the doctor asked me when was the last time I took the Plavix. I told told him it was right on the form, This morning. He freaked.

I have had them almost start operating on the wrong hand. The hand they were supposed to operate on was all bandaged and bloody.

I just think that like so many busy over worked people, they only hear what they want to hear and shut out the rest.

[misterhighwasted]

6. whaa? Local news saying he did not inform the ER until the second visit.

They also said there may have been a language barrier. maybe he should have said EBOLA..LIBERIA. Ya think?

As to your post I do agree. No insurance indeed may have contributed to this f-up.
Pretty much how it works anymore. Sadly.

[magical thyme]

9. no, a triage nurse got the travel information from him

communications broke down and it didn't make it to the delivery team.

[WinkyDink]

16. "Language barrier," my arse. ENGLISH is Liberia's official language! See, it's THIS kind of obfusca-

tion that drives people to buy tin-foil!

[FrodosPet]

31. Forget the tin foil

[misterhighwasted]

33. oh boy. This is what it'll all come down to..

Body condoms. With protective eye goggles. Does it come in pretty colors?

[taught_me_patience]

7. Given antibiotics?

Antibiotics don't do crap against viruses. Why didn't they even test for a bacterial infection?

[magical thyme]

11. you don't know what tests they did or didn't run

I don't know their specific protocol, but at my ED we automatically do a CBC, CMP and urinalysis on just about anybody who walks in the door, certainly with fever. Maybe he had an elevated white count with increased polys. Maybe a urinalysis showed positive for leukocyte esterase. We don't know because they don't publish that info due to privacy laws.

You can have a bacterial infection -- or show symptoms of it -- concurrent with viral. CBCs aren't always totally clear on whether something is bacterial, viral, or parasitic. They just point you one way or another.

[WinkyDink]

18. Privacy laws only apply to the identification of the patient. The hospital can certainly state what

tests were run.

Maybe this, maybe that, yeah, and maybe THE STAFF SCREWED WAY UP, which is LIKELY the case here.

[magical thyme]

20. the only screw up I see is that the triage nurse collected the travel information

and somehow it wasn't received by all of the health care delivery team members.

Again, we do not know what tests they did or did not run.

Even though the general public doesn't know the name of the patient, there is a community in Texas that very likely does know the name.

The way HIPAA works is that you cannot release patient health information in a way that could lead to the public to connect the health information with the identity of the patient.

Any test results released would enable people in the local Liberian community to connect test results with the patient's identity. Therefore they are highly unlikely to release them. They have nothing to gain by it, and HIPAA violation penalties to incur.

I have read in a couple places now that they initially diagnosed him with a low grade viral infection. *If* that is the case, then that is a 2nd mistake because you don't treat viruses with antibiotics.

[seabeyond]

21. but really, if you are a nurse, aware enough to ask the questions, wouldnt you be concerned about

your own health, wanting to folow along. at the minimum at least an immediate isolation until they have further noticed. i would think the flag would be raised by her immediately, and she would be starting "protetion" seeing how she is interacting with a whole lot of others.

that just seems odd to me. surey suspected ebola is not consider in such a laissez-faire manner.

[magical thyme]

22. again, we don't know the details of the situation

She is described in articles as a "triage nurse." That tells me that she is seeing patients when they first come in to ID cardiacs, traumas, whatever to see who can wait a few minutes and who's life is hanging in the balance at the moment.

It's a very large looking hospital. If it's a very busy day, she probably doesn't have time to personally follow every or even any case down it's full path.

EDs can have quiet days or they can have days that look like the teevee show ER, with everybody running every which way and patients literally stacked up in the aisles.

We don't know what was going on in that ED on that day. Without facts, I'm not assigning blame to anybody. From the articles I've read, the travel information was passed on to the patients care team, but not every member of the team got all the information. It seems to me that the breakdown of communications was within the care team, not with the triage nurse.

[seabeyond]

23. true. and again. have tons of people, you are personally involved with a person that possibly

has ebola. she asked the question. she is aware.

isnt the first thought and only concern, isolate... and be concerned about her health.

instead of sending on his way, and interacting with others whom are sick?

that does not make sense to me.

i am not blaming. i am thinking.

i hear sympotoms. i hear liberia. and i start putting on protective gear and isolating the man.

i would rather be protected and wrong, than waiting for a diagnosis and picking up ebola

[magical thyme]

24. she didn't send him away. his health care delivery team did.

She would already be wearing PPEs. Patients are already in their own rooms in my ED, unless they are out of space and stacking them in the halls.

It's been made clear that she transmitted the travel information to some on the delivery team. She may well have had to wash up, re-glove up, and move onto the next incoming patient.

I'm more surprised that health care delivery team didn't communicate that amongst themselves. The ones with the travel information should have balked at sending him home and made sure the doctor who made that decision understood that he was from an Ebola country.

You focus on your job, especially when it is very busy. Part of your job is protecting yourself by ensuring you clean your hands before and after every patient, re-glove, change your lab coat if it's visibly soiled, etc.

[seabeyond]

25. it doesnt make sense to me. i would think the urse would be talking about it, spreading the word,

ect... first possibe ebola case in u.s. huge concern.

these people are not working in vaccuum.

i do not know what happened. this is ALL specualtion. i am just thinking how i would process info.

ebola symptoms and just back from liberia.

i would be wanting to know where he sat, who he sat next to. ect...

[uppityperson]

26. Wrong. Privacy laws apply to all treatment and testing. Unless told by law to, or in case of public

health emergency, and even then with limitations, no. The hospital can not state what tests or treatment have been done.

Starting at wiki hipaa

Privacy Rule
The effective compliance date of the Privacy Rule was April 14, 2003 with a one-year extension for certain "small plans". The HIPAA Privacy Rule regulates the use and disclosure of Protected Health Information (PHI) held by "covered entities" (generally, health care clearinghouses, employer sponsored health plans, health insurers, and medical service providers that engage in certain transactions.)[15] By regulation, the Department of Health and Human Services extended the HIPAA privacy rule to independent contractors of covered entities who fit within the definition of "business associates".[16] PHI is any information held by a covered entity which concerns health status, provision of health care, or payment for health care that can be linked to an individual.[17] This is interpreted rather broadly and includes any part of an individual's medical record or payment history.

http://privacyruleandresearch.nih.gov/pr_07.asp

To understand the possible impact of the Privacy Rule on their work, researchers will need to understand what individually identifiable health information is and is not protected under the Rule. With certain exceptions, the Privacy Rule protects a certain type of individually identifiable health information, created or maintained by covered entities and their business associates acting for the covered entity. This information is known as “protected health information” or PHI.

The Privacy Rule defines PHI as individually identifiable health information, held or maintained by a covered entity or its business associates acting for the covered entity, that is transmitted or maintained in any form or medium (including the individually identifiable health information of non-U.S. citizens). This includes identifiable demographic and other information relating to the past, present, or future physical or mental health or condition of an individual, or the provision or payment of health care to an individual that is created or received by a health care provider, health plan, employer, or health care clearinghouse. For purposes of the Privacy Rule, genetic information is considered to be health information.

There are, however, instances when individually identifiable health information held by a covered entity is not protected by the Privacy Rule. The Rule excludes from the definition of PHI individually identifiable health information that is maintained in education records covered by the Family Educational Right and Privacy Act (as amended, 20 U.S.C. 1232g) and records described at 20 U.S.C. 1232g(a)(4)(B)(iv), and employment records containing individually identifiable health information that are held by a covered entity in its role as an employer.

A critical point of the Privacy Rule is that it applies only to individually identifiable health information held or maintained by a covered entity or its business associate acting for the covered entity. Individually identifiable health information that is held by anyone other than a covered entity, including an independent researcher who is not a covered entity, is not protected by the Privacy Rule and may be used or disclosed without regard to the Privacy Rule. There may, however, be other Federal and State protections covering the information held by these entities that limit its use or disclosure.

When health information is individually identifiable and is held by a covered entity, it is likely to be PHI. In contrast, the HHS Protection of Human Subjects Regulations describe “private information” as including information about behavior that occurs in a context in which an individual can reasonably expect that no observation or recording is taking place, and information which has been provided for specific purposes by an individual and which the individual can reasonably expect will not be made public (for example, a medical record). Under the HHS Protection of Human Subjects Regulations, private information must be individually identifiable (i.e., the identity of the subject is or may readily be ascertained by the investigator or associated with the information) in order for obtaining the information to constitute research involving human subjects unless data are obtained through intervention or interaction with the individual.

http://www.hhs.gov/ocr/privacy/hipaa/understanding/training/udmn.pdf

[WinkyDink]

38. Operative words: "in case of public health emergency."

[uppityperson]

42. This is not a public health emergency that necessitates releasing his tests and similar info.

Privacy laws apply.

[kestrel91316]

50. Ebola in the US sure is a public health emergency. They don't send in the cavalry from CDC

for the common cold.

Stupid victim (lied to Liberian airport screeners, puked all over the lawn), stupid hospital staff (ignored his travel history and ignored federal guidelines), stupid family (exited isolation the minute the health department's backs were turned, necessitating a court order and cop guarding their door to prevent running off).

If it's not an emergency, with all these screw ups it sure will be one soon.

[uppityperson]

54. This is not a public health emergency that necessitates releasing his tests and similar info.

It isn't yet, may be but not yet.

[nashville_brook]

28. correct me if i'm wrong, but a bacterial culture would take a few days, no?

better to start abx empirically b/c no improvement would likely provide a quicker answer.

[davidn3600]

30. Could have had a secondary infection...

You can have the flu which then triggers a sinus infection, bronchitis, etc..

The Ebola could have caused a bacterial infection and the doctors thought the fever was from that.

The problem with Ebola is it mimics the flu, especially in the early stages of symptoms. So it's incredibly easy to be misdiagnosed. The bigger concern was that he told the medical staff that he had visited an Ebola hot-spot. So infection of the virus should have been considered.

[PCIntern]

35. Yup. That is exactly correct. nt

[WinkyDink]

39. Not "visited"; is FROM. He helped CARRY an Ebola victim.

[LisaL]

41. Patient who died just a few hours later.

[WinkyDink]

45. I'll say it again: He behaved unconscionably by boarding, not just a flight, but one with multiple

lay-overs.

He associated with (presumably related) children, who now are quarantined.

[seabeyond]

55. absolutely. then, walk into hospital with sympotms, clearly spel out for all... ebola

that would be the least he could do. instead of answering a questionaire and taking anti biotics with fingers crossed.

denial at best.

[kestrel91316]

36. Gross negligence by the screening nurse who failed to pass this boring little factoid on.

Liberia? Yawn. Where's that? North of Virginia?

[pnwmom]

43. And it's even worse.

I read somewhere that the didn't take the ambulance and medics out of circulation till 2 days after his second trip to the hospital -- so nobody knows who else might have been contaminated in those two days.

[LisaL]

44. And he was puking all over the place before being loaded into that ambulance.

I presumed he continued on puking in the ambulance as well.

[kestrel91316]

49. They are power washing the entire outside of the apartment building. Awesome. Aerosolizing ebola!

Unless they use disinfectant to do it, they could endanger more people. But as he was puking all over the outside common areas from what I hear, they need to do SOMETHING.

[valerief]

52. And they don't keep records of who uses each ambulance? Amazing. nt

[pnwmom]

53. Maybe those people are among the 100 people Texas is checking on right now,

looking for people with significant exposures.

[WinkyDink]

46. Liberia? Well, we're mostly Conservatives here! Go home!

[AverageJoe90]

40. Unbelieveable mistake these folks made.

They should have kept him under VERY close watch.....although hopefully this gets contained soon.

[WinkyDink]

47. Bobby Burns had a poem for this. Its best-known stanza:

But Mousie, thou art no thy lane,
In proving foresight may be vain:
The best-laid schemes o' mice an' men
Gang aft agley,
An' lea'e us nought but grief an' pain,
For promis'd joy!

[SidDithers]

48. That hospital fucked up in a big way...

Someone's going to have to answer for that screw-up.

Sid

[kestrel91316]

51. That hospital's owners are going to see their investment sued into bankruptcy if anybody dies, and

perhaps even if nobody dies.