Texas Health Presbyterian Hospital of Dallas
Federal and state health regulators have yet to determine whether they will investigate why Texas Health Presbyterian Hospital of Dallas didn’t hospitalize a Liberian man when he first entered its ER last week.
Instead, Thomas Eric Duncan, whose home country is a hot spot for Ebola outbreaks, was released with antibiotics. It was only when he returned to the hospital two days later that he was diagnosed with the often fatal disease – the first such case identified in the U.S.
The Centers for Disease Control and Prevention characterizes Liberia as “active” for Ebola transmission, and it’s among the West African countries hardest hit. Texas Health Presbyterian officials said Tuesday that they were prepared for an Ebola patient. In a news conference, a hospital epidemiologist said the hospital has “had a plan in place for some time now in the event of a patient presenting with possible Ebola.”
But questions now abound about how meticulously caregivers screened Duncan for symptoms and assessed his risk as a Liberian.
“The immediate focus at this time is on managing the situation with this specific patient,” said David Wright, deputy regional administrator for the Centers for Medicare & Medicaid Services, the primary regulator of federally funded hospitals. “We need to let things settle down before determining what, if any, actions we may take.”
A spokeswoman for the Texas Department of State Health Services, which usually collaborates with CMS on hospital care investigations, said that agency also had yet to begin an inquiry.
Family members said Duncan told a Texas Health Presbyterian staffer on that first visit that he had recently come from Liberia. And a hospital physician acknowledged today “regretfully that information was not fully communicated to the whole team.”
Duncan “had direct contact with a woman stricken by Ebola on Sept. 15” and left his native Liberia for Dallas four days later, The New York Times reported today. It attributed the information to the woman’s parents and Duncan’s neighbors. The 19-year-old woman, who was pregnant, and her 21-year-old brother have since died, the newspaper said.
Neither CMS nor the Texas State Department of Health Services set specific medical screening standards for potential Ebola patients. The CDC has posted on its website Ebola preparedness guidelines for hospitals since August 1, but they are not federal mandates. The guidelines recommend, among other practices, asking patients “relevant questions” about travel from “affected West African country, exposure, etc.”
Hospital regulatory agencies can investigate whether a hospital performed improper screenings for infections and other conditions in patients under the federal Emergency Medical Treatment and Active Labor Act.
“We’d have to look at information that was available to the physician at the time of (Duncan’s) screening,” Wright said Wednesday afternoon. But he stressed that he does not have enough information yet to even know whether EMTALA could come into play.
Hospital officials said Duncan remains in serious but stable condition.
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