When Texas Health Presbyterian was still in the middle of its Ebola public relations fallout, hospital officials had an ever-shifting series of explanations for why Thomas Eric Duncan was initially misdiagnosed and sent home.
The hospital had at first made a subtle suggestion that the misdiagnosis was a nurse's fault. Though a nurse who saw Duncan in his first visit to Presby was aware that he had traveled to Africa, "regretfully that information was not fully communicated" to the rest of the medical team, Presby said at the time. Shortly after releasing that nurse diss however, the hospital clarified that it was actually the computer's fault. The electronic record system apparently had a "flaw" that caused the doctor to miss a nurse's note that did in fact indicate Duncan had traveled from Africa.
The next day, Presby took that statement back too, and denied that its record system had any flaws or that the nurse or the doctor did anything wrong. "As a standard part of the nursing process, the patient's travel history was documented and available to the full care team in the electronic health record (EHR), including within the physician's workflow," Presby's updated statement said. "There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event." The amended statement did not offer an alternative explanation for why the misdiagnosis happened.
Now The Dallas Morning News has interviewed the ER doctor who treated Duncan, and he has more unclear things to add about what may or not have gone wrong during Duncan's treatment.
The paper says that it had first contacted the doctor, Dr. Joseph Howard Meier, in October. After hiring an attorney, Meier recently agreed to answer the paper's questions in the written form, as a series of carefully worded statements. In the statements, Meier appears to admit making some mistakes, but he doesn't say too much about why or how. "I was unaware of a 103-degree fever," Meier wrote to the paper. "It appears in the chart, but I did not see it."
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In his own notes, Meier mistakenly identified Duncan as a local resident, missing nurse's notes that he came from Africa. In his statement to the News, Meier suggests that it was the maybe nurse's responsibility to tell him that Duncan had been in Africa, but also adds that the nurse had no reason to tell him about Duncan being in Africa. "Nurses typically bring doctors important or medically significant information verbally," Meier wrote to the News, adding this caveat: "It's rare that travel history is medically significant."
And the reason that Meier says he did not see the information about Duncan's travels just by looking at the medical records himself is that "travel information was not easily visible in my standard workflow...this has now been modified very effectively." So maybe the electronic record system did have a flaw, after all.
Of course, at this point it's probably in the hospital's and Dr. Meier's best interest not to point fingers or offer anything too concrete about how it could have done things differently, as the hospital not too long ago reached an amicable settlement with Duncan's family. Presby officials, for their part, are definitely ready to move on and no longer want anyone to talk about the time that the Ebola crisis came to Dallas. "We didn't particularly see a lot of value in rehashing this story," the hospital's public relations director told the New York Times on Monday.
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