A Dallas County sheriff’s deputy who unwittingly set off a brief Ebola scare was cleared Thursday of having the disease. The hospital where Thomas Eric Duncan died, meanwhile, released new details about the first U.S. case of the virus.
Michael Monnig was one of four deputies who briefly entered the apartment last week where Duncan had been staying. Monnig developed a stomachache Wednesday, and his visit to a Frisco urgent care clinic brought out a fleet of Frisco fire-rescue vehicles, briefly isolated the staff and other patients at the clinic and ended with an anxiety-raising, televised ambulance trip to Texas Health Presbyterian Hospital Dallas, where he was put in isolation.
Monnig’s wife said Thursday that the Dallas County’s medical director, Dr. Christopher Perkins, told her husband to go to his own doctor or an urgent care clinic rather than a hospital. By Thursday afternoon, blood tests confirmed Monnig had no Ebola and he was sent home. Dallas County health department director Zachary Thompson said the instruction to go to the clinic was in keeping with federal guidelines.
The result of Monnig’s blood test were released by health authorities in less than 24 hours, and he was discharged from the hospital on Thursday. It took almost three days for authorities to confirm that Duncan had Ebola after he was hospitalized.
State officials said that 48 people who had contact with Duncan before he died, including 10 considered at highest risk, had shown no symptoms as of late Thursday. The disease can only be transmitted through contact with bodily fluids from someone both infected and ill. Neither Monnig nor the other deputies are on the list of those being monitored.
It can take as long as 21 days for symptoms to appear, but most cases show up around 10 days after exposure. The last contact any of the people under observation had with Duncan was Sept. 28.
Victim’s treatment
Duncan, 42, died Wednesday morning at Presbyterian, where he’d spent 10 days in isolation. He developed symptoms of Ebola four days after arriving in Dallas from his native Liberia. He was admitted to the hospital on Sept. 28, three days after he had first visited the emergency room there and been sent home.
A statement from the hospital Thursday did not address why he was not admitted on his first visit, but it explained some of his course of treatment:
•He had not received an experimental blood serum transfusion given to a few other Ebola patients because his blood type was not compatible with the available serum.
•An experimental drug, ZMapp, given to other Ebola patients was not available. The experimental drug Duncan did get, Brincidofovir, “was administered as soon as his physicians determined that his condition warranted it, and as soon as it could be obtained.” He got the first dose of the twice-weekly pill on Saturday.
•Duncan’s heart stopped Wednesday morning. Early in his hospital stay, he told his doctors that he wanted no “chest compressions, defibrillation or cardioversion to prolong his life.”
Presbyterian defended its initial treatment of Duncan, saying he’d been given “a four-hour evaluation and numerous tests.” The hospital did not address earlier statements that Duncan had told an emergency room nurse he had recently been to Africa. Nor did it explain why that information from the patient did not trigger the response recommended by federal guidelines.
Dallas Mayor Mike Rawlings joined a chorus of critics of the early days of Duncan’s care. Speaking after a luncheon talk to executives about the state of downtown Dallas, Rawlings said: “On that issue in particular, I would have liked everything, early in this process, to go a little quicker.”
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, made the same point on national news shows Thursday.
“Everyone knows that when he first went to the emergency room, it was not recognized that he had Ebola,” he told CNN. “I mean, that was a misstep that’s very clear, unfortunate. Certainly was not deliberate.”
And Duncan’s nephew, Josepheus Weeks, released a statement critical of the hospital:
“It is suspicious to us that all the white patients survived and this one black patient passed away. It took 8 days to get him medicine. He didn’t begin treatment in Africa, he began treatment here, but he wasn’t given a chance.”
The charge of racial discrimination was emphatically denied by the hospital. “Our care team provided Mr. Duncan with the same high level of attention and care that would be given any patient, regardless of nationality or ability to pay for care,” it said.
Court limitations
If Duncan’s family wished to take its unhappiness into a courtroom — and there has been no public discussion of a lawsuit — Texas law severely limits the results.
The state has one of the nation’s strictest malpractice liability laws, with a $250,000 cap on damages as well as special protections for emergency room physicians, nurses and other workers.
The cap can apply to each facility involved in a case, with a total limit of $750,000 if multiple defendants are sued. The cap applies only to non-economic damages; there is no limit on damages such as lost wages and medical bills.
An additional standard set by case law would require the family to show that Duncan would have had a 50 percent or better chance of surviving Ebola if he had received different treatment — a near-impossible requirement, given the deadly nature of the virus, legal experts said Thursday.
Some are using Duncan’s death to call for changes in the state’s medical malpractice laws.
“Unfortunately for patients, the big corporations that make a lot of money off health care in Texas control the politicians down in Austin,” said trial lawyer Mike Sawicki of Dallas.
Defenders of the 2003 law, however, say it has provided protection for health care workers and hospitals that has brought new doctors — particularly emergency room physicians — to areas of the state that had none.
“Often doctors taking emergency cases have had no prior contact with the patient. They’re making snap decisions in a complex case, and they must take all comers, regardless of whether that person is conscious or speaks the same language,” said Jon Opelt, executive director of Texas Alliance for Patient Access, an organization that works to maintain Texas’ lawsuit statutes.
Staff writers Wendy Hundley, Karen Robinson-Jacobs and Matthew Watkins contributed to this report.
Head of House panel to hold Ebola hearing Friday
The U.S. House Homeland Security Committee chairman has scheduled a hearing to review the federal, state and local response to the nation’s first Ebola case.
U.S. Rep. Michael McCaul has scheduled the hearing for Friday at Dallas-Fort Worth International Airport. Among those scheduled to testify before the Central Texas Republican are Dr. David Lakey, the Texas health commissioner, and Dallas County Judge Clay Jenkins.
The hearing comes two days after the death of Thomas Eric Duncan at a Dallas hospital. Duncan was the first person to develop symptoms of the deadly Ebola virus and died after a weeklong hospitalization.
The Associated Press