My Dallas Ebola Hospital Theory - ENJOY!

[IdaBriggs]

I don't think the medical staff thought about "Liberia=Ebola" because they are probably too busy working 12-14 hour shifts dealing with their day-to-day normal stuff.

Car accidents. Gun shot wounds. Heart attacks. Strokes. Diabetics in crisis. Broken bones. Appendicitis. Scrapes, cuts, bruises, sprains --

I think (and I am probably just a conspiracy theorist so take this with an appropriate grain of salt) they also probably get a lot of Non-Emergencies in the ER: young mom with baby's first fever, the elderly gentleman with constipation that isn't a heart attack, the nice lady who threw her back out moving furniture, the scared people who don't have insurance and whose cold/flu is making it hard to breathe, but it isn't pneumonia yet, anybody with kidney stones (who might wish they were dying, or so I have heard!), and dozens of others I don't even think about.

Oh, and we can't forget about the crime victims who come through their door - the rape victims and the assault victims. I have been told that even children come through their doors as crime victims (which I know some will find hard to believe - sarcasm!).

So, I would be surprised if people who spend their entire day being calm in the face of other people's crisis, who deal with blood, guts and tears as part of their job, who are at the highest risk of being exposed to deadly infectious illness ALL THE TIME, who are mainly motivated by a commitment to helping others, with the bonus of a decent wage, but are expected to work twelve or more hours at a time, have TIME to more than glance at the news. I work a desk job 40 hours a week, listen to the radio less regularly than I used to, get most of my "news" from the Internet, and keep pretty busy with issues on THIS continent, and I don't have "Liberia is Super Scary" burned into my brain because I live in Michigan.

For a medical professional to put "low grade fever + likes to travel = Ebola" together on a busy day at work on this continent would probably have sounded like a paranoid over reaction.

So, here is my crazy theory: systems were not in place to "flag" Ebola possibilities because there were previous ZERO occurrences on this continent. Unfortunately, someone had to be the first, and it was this hospital and their staff. (Sucks to be them!) Now the media has done its job by publicizing the "disastrous failure of medical personnel" (is that trademarked yet?) and everybody else will put the "do you like to travel to places where pandemics are currently starting?" into their procedures.

And soon, this will become just another part of the job for the over worked, understaffed, ongoing life of the medical folk in the ER.

My best wishes to all involved with this difficult situation - it isn't a job I would want to do.

[appleannie1]

1. You left out the druggies that routinely arrive having extreme pain that over

the counter meds won't touch asking for pain meds by name and dosage.

Yes, the ER is usually understaffed and overworked. The problem though is that hospitals are supposed to be notified of things like the possibility of an epidemic and what to look for and what to ask. They don't have to rely on the news or media.

[IdaBriggs]

46. I debated including them, but decided against it due to space issues.

Plus controversial post already, and that topic (addiction) can be a hot button.

At a certain point, I think people have to balance their "denial - it can't/won't happen here" versus "eh, it is just a normal day at the office, and this is how we handle it."

It is now a big deal HERE, at least in Texas. Not sure how it would be handled in Michigan yet.

Maybe we need some "practice people" testing the system? Who DON'T have Ebola, but could "fake" the symptoms/risks as part of a disaster preparedness plan?

[JaneyVee]

2. This guy might actually save people's live's...

Now fevers and flu-like symptoms will be a top priority.

[DrDan]

3. I think you hit it on the head

my thoughts as well

[magical thyme]

4. +1,000,000,000

This. Exactly.

[NYC_SKP]

5. Recommended. (nt)

[brewens]

6. Yeah. They need to look at how many other hospitals had protocols in place that would have flagged

that guy for sure. Was it realistic for someone to have thought that they could be seeing an ebola case at any time and brief the staff on how to handle it? It would have been nice if they had but did anyone else anywhere do it?

[Kablooie]

7. Sound reasonable but because of the news I'll bet they will find a fall guy.

The hospital execs are probably mulling over which of their staff to throw under the bus to save the hospital reputation.

[csziggy]

50. Their fall guy will be the nurse

There have been posts here on DU that wonder why she didn't just pick up a phone or stop by to tell the doctor about the guy's recent travel from Africa.

Sorry, but ER triage nurses have NO time to take that extra step, especially when the information is already in the patient's file and is supposed to show up for the doctors. She probably had dozens of other patients to screen with no time to do beyond the basic steps of her job.

I feel bad for that nurse - she was relying on the software and it really is not her fault that the system did not work as planned. I hope I am wrong, but I will not be surprised if she is fired over this.

[LawDeeDah]

55. Yes. Overworked nurses can easily take the blame. As always.

[csziggy]

56. Nurses have always taken the blame for doctors

And these days nurses are always overworked and understaffed.

[ProdigalJunkMail]

8. sort of related story

preface the story with the fact that i am a pretty fat guy...

i am prone to kidney stones... they run in my family somehow. i awoke one sunday morning with a twinge of pain in my lower abdomen... not the place where my previous stones had caused pain. after a couple of hours it had become unbearable and i was not sure what it was so i (stupidly) drove myself to a hospital... normally would have gone to a doc-in-a-box but we don't have any 24hr ones around here.

so... into the emergency room lumbers this big overweight guy doubled over in pain and all red from the last couple of hours of being in pain. the triage nurse, seeing me come in this way, assumed i was having a heart attack and immediately calls for a gurney and something else that i missed and the whole place went into a whirlwind.

when i was finally able to talk (yes, it hurt that much) i was able to briefly describe the pain and at that they called off the dogs!

looking back now... pretty funny. at the time, i just wanted something to cut the pain.

sP

[BrotherIvan]

48. Watermelon juice

If you get them a lot, drink it regularly. This was prescribed by a doctor to a friend who had a stone and was in so much pain for a week, he was asking me to kill him. He was uninsured and the doctor at Kaiser said basically, (off the record) we can operate and you pay or you can drink as much watermelon juice as possible and see what happens. Supposedly the acid breaks up the stone. Over the next week, he guzzled fresh juice and the pain went down. Not miraculously or all at once, but it did. He kept doing it another week and then stopped. Pain gone and never passed a stone.

I know this is anecdotal and complete woo, but it saved him upwards of $25k which he didn't have, fixed the pain that no painkiller could touch, and he didn't have to pass the stone. If I ever had one, you bet I would be all over that.

[librechik]

9. It was a software glitch. The travel info was not transferred from admissions to doctors.

and only doctors make the discharge decisions.

So the hospital says. And they fixed it for future patients.

So no problem!

Oops, they retracted--

http://www.democraticunderground.com/10025619704

[cali]

13. the hospital has retracted the computer glitch dogshit lie.

[librechik]

14. Yes, I just saw THAT BS --shameless

will correct my post.

[cali]

10. that's a poor excuse. This has been a blaring top story for fucking weeks and weeks

and you are wrong about systems not being in place being an excuse. Protocols supposedly were in place.

The fucked up in a completely and totally non-acceptable way. period.

[MH1]

32. 12 hour workdays are not a "poor excuse" for mistakes on the job.

That is why truck drivers are required to take breaks.

Hell, I can be fairly fried by hour 8 of day 4 of my job in any given week, and I work (nominally) 8 hour days at a far less stressful and hectic job than nursing.

And let's not even mention the way the DOCTORS are pressured to "process" patients in the least possible time. I'm sure the ER is much worse than scheduled appointments.

I refuse to blame the nurses or doctors. I blame the failure of the US populace to insist on the implementation of a high quality, standardized electronic health record system that could easily be updated to flag patients based on certain information. As a programmer I know what is possible, and I also know something about what is and isn't happening in the EHR world. It's disgraceful. Like almost everything else in this country, it is being driven by capitalist theory and profit motive, rather than what is best for society. Thus we have a multitude of disjointed, difficult to use EHR systems that probably make it impossible for the CDC to rapidly apply a new protocol for an emerging epidemic. (Let's imagine for the moment that we aren't discussing ebola, but something far more contagious by being airborne or having more prevalent animal hosts.)

It would be fairly simple to program the EHR to flag the record based on the content (or missing content) in certain responses, and popup a bright red warning message when someone tries to mark the record to be discharged. Probably this hospital has already attempted to do that, now, after this incident. But what about every other hospital in the country? We are relying on every hospital or hospital system with a discrete EHR software instance, to ask their IT staff to apply a change like this. Which will get done when the IT staff gets to it. Which may only be after the first ebola patient comes through that hospital's ER. And that's only the hospitals ... what about doctor's offices? Other clinics?

Anyway, in short, the blame belongs to the demands of capitalism and profit motive being applied to a supposed "health care" system.

(I do want to be clear that I don't think everyone involved in health care and EHR development are "evil profiteers". I think most are well-meaning people trying to do good, but trapped in an evil profiteering and counterproductive system that has unfortunate consequences for patients and society in general.)

[treestar]

36. Why is that a bad excuse?

People make mistakes when they get tired. They shouldn't be working that long.

[MH1]

37. Exactly, that is what I am saying to the poster I replied to.

I'll go add quote marks to my subject line so it's more clear.

[Hari Seldon]

11. A coordinted National Health System

might have been able to avert this scenario, which is quite reasonable to assume without further information.

Sadly it will take a pandemic in order for that to become political reality.

Rec'd.

[Ilsa]

12. Quite reasonable!

Add in the underfunded CDC maybe not getting alerts out. And residents who are pulling multi-day shifts with only a few hours break for something that might resemble sleep. Hell, maybe a resident was awakened from a brief nap to look at Duncan's chart. He or she looked at vitals for hard facts, but little written narrative, and missed the recent foreign travel.

[SmittynMo]

15. What gets me is the media

Should we be concerned? Hell yes. But, as usual the media just blows everything out of proportion. And it now seems that everything on the news is surrounded by fear. Now we need to spend hours bringing in all kinds of "so called" experts to tell us we're all gonna die. Why can't they just state the facts, and move on to the next story. The excessive drama and fear conveyed by the media is totally unacceptable.

[KoKo]

16. Reasonable theory.

It's possible that without a Staff Meeting Slert that relying on electronic transfer wasn't effective, also. Maybe going back to posting information for staff in crucial places patient check in, nursing stations(like the old days) hospital break rooms, cafeteria might get more attention than electronic transfer.

Even putting a notice at the check in window of the EMR for patients to disclose if they'd traveled recently and where might be helpful.

Not everyone in hospital staff watches CNN to get hysterical over EBOLA in America. So, maybe the CDC should have put out immediate alerts to every hospital to be aware of patients who have traveled recently. Wasn't this kind of alert the job of the U.S. Surgeon General (who hasn't been appointed because of obstruction) in the past? Maybe that's where the real blame lies.

[Fred Sanders]

17. You are correct. Just that correctness does not generate the desired fear the media desire.

[Sienna86]

18. Did he have insurance and did that affect decision?

Just wondering if that was a factor.

[BrotherIvan]

49. Good question

[riverbendviewgal]

19. I agree

In my recent travels, I found many staff at motel front desks do not even know what their local channels are. The have no time to watch TV or keep informed of the events happening, locally and in the world.

[BlancheSplanchnik]

20. rec for reality.

That's how it is.

[Gidney N Cloyd]

21. I absolutely agree on the hospital staff's actions but...

...but, and let me say first that I haven't been following all this closely and I'm relying a lot on the scene you paint here, but if I had walked into the emergency room with a fever and feeling like shit, and it's not flu season, and I had just come from a country where there's an Ebola crisis in progress, I as the patient might say something to somebody treating me like "I hope this isn't Ebola. There's a lot of that in Liberia, where as I mentioned, I just came from." It sounds like the patient didn't do that.

[seabeyond]

28. that is my problem. 10 days ago i was with a woman that died from ebola. nt

[B2G]

40. What? How did you manage that??

ETA:

Lol. Nevermind, I didn't read the post you were responding too.

[treestar]

35. good point

I wonder if he was in denial. Or possibly not a particularly bright guy.

[MrsBrady]

51. The patient and family

Told them he had come from Liberia...on his FIRST visit.

And Duncan's nephew also had to call the CDC.

The hospital screwed this up.

[Gidney N Cloyd]

58. Right-- he told them he had come from Liberia. And I don't mean to defend the hospital, but...

...but if it were me in the ER feeling like hell I think I would have brought up the word "Ebola," not just stopping with "I've come from Liberia" and leaving it to the staff and their system to gather all the dots they might need to connect.

[DhhD]

22. Knowing to protect themselves from Hepatitis from any number of persons coming in to the ER,

staff is gloved and knowledgeable to prevent exposure to a virus. They know that Ebola is passed by body fluids; where as, Hep A and B, might be on the fingernails or fingertips; Hep C, a virus, on urinated pants or on places bleeding.

I believe that they knew if they turned away this West African traveler, with viral symptoms, he would go to another hospital, the county hospital, Parkland, who is ready to work with patients that need care under Medicaid. In other words, Parkland is the Texas Health and Human Services provider in Dallas County. It is a long process for the doctors at the other area hospitals, to contact TX Health and Human Services to get Medicaid set up. There was no federal grant set up at this hospital either. University of Texas works with Parkland through Medicare and Medicaid. The university hospitals with pay for care services already set up, are another alternative that the patient and his family were probably directed to, in my opinion.

There is no Medicaid Expansion in Texas. This patient would require a very long and expensive stay.

I blame this on Tea Party Governor Rick Perry and the Tea Party Extremist in the Texas Legislature who give a crap less about the numerous minimum wage and below earners in this state with no health care options.

[DhhD]

25. Hope the family sues and the case goes back to the Supreme Court over refusal of

Medicaid Expansion when the Patient Protection and ACA wa in place before the Robert's court decision: Texas Hospitals vs. the 5 Justices on the Supreme court.

[MH1]

38. That's another good point, that brings it back to the perniciousness of capitalism

when applied to health care.

(for the record, I am fine with appropriately regulated capitalism - but I think some goals are not addressed best by the capitalist approach, and basic health care is one I would include very high on that list.)

[nashville_brook]

23. thank you for the dose of reality

[Whiskeytide]

24. Part of the problem is that DUers...

Are generally more informed about this stuff than the average American. We surf not only DU, but other websites, and have a better grip on world events. Accordingly, we find it hard to understand that not everyone has the same perspective. Ill give you that.

But is was still a monumental screw-up, and people will suffer because of it. Having a reason, even a good one, doesn't relieve you of responsibility for your errors.

[DhhD]

26. Governor Rick Perry needs to be held responsible for the screw-up.

[CrispyQ]

27. There was a good post the past day or two about the understaffing of America

in general. Everywhere you go, places are understaffed while corporations have piles & piles of cash they are holding on to. But what the hell, they are people too.

[otohara]

29. In 1954 I Had Low Grade Fever & Leg Pain - Hospital Said Flu

wanted to send me home.

My mother insisted they check me for polio - and sure as shit my mom's intuition was correct.

This was during the years of polio - so IMO not much has changed.

[yardwork]

30. Yes.

[treestar]

31. A good point, I agree people are way too willing to judge others'

job performance harshly - one wonders what types of job they have. And just how perfect they are.

[blackspade]

33. *1000

And now that are talking about charging this patient.
But of course he is black and had every reason to believe that he would end up dead in Liberia, whereas his infected white counterparts get the full red carpet medical treatment.

[VA_Jill]

34. Couple things wrong with this

1. This is not, apparently, a public type hospital, or at least that's what I'm hearing. Whether or not it gets the usual stuff that someplace like Parkland gets is open to question. However, it's big, so, granted, the ED is busy.

2.It's located in a neighborhood that has a large immigrant population, and many of those immigrants are from countries in--you guessed it, WEST AFRICA. That should raise a few flags right there!

3. "Likes to travel" wasn't the question--the man CAME FROM Liberia! Hellooooo......!

4. Protocols WERE in place. Unfortunately, it seems the computer charting system may have been inherently screwed up, which is not outside the realm of possibility. In my career as a travel nurse, I learned at least 8 different systems of computer charting, and all but one of them sucked big time. However, hospital IT people are among the poorest paid in the business, and hospitals are notoriously cheap when it comes to paying for IT, so you get what you pay for.

So, sorry, from this nurse's viewpoint, your theory has many holes.

[justabob]

44. ..

I live in Dallas and can tell you a little more about Presbyterian.... It is the hospital closest to the neighborhood with lots of immigrants this man was visiting, and some housing projects and other lower rent housing, but I have always associated it with rich folks. We have two or three other large hospital complexes within 5-10 miles of Presby and in my experience (no proof) the wealthier folks go to Presby rather than Baylor, Medical City, or UTSW/Parkland complexes. I am sure their ER is busy, but I am curious what their volume is relative to Baylor and Parkland. Parkland is our county hospital and it is a zoo (facilities for major trauma and burns). You can grow old waiting to be seen there. Baylor is also busy inner-city facility.

[Horse with no Name]

54. Presby is a not-for-profit hospital.

Parkland is the county hospital but Baylor and Parkland share the trauma, with Methodist at 3rd divert and Presbyterian at 4th, so, depending on how busy the city is, any and all ER's can be crazy at any given time. Presby does get a lot of high risk OB patients from outlying hospitals which rarely, but sometimes, will go through the ER. Presby and Baylor do not see an extremely high percentage of young children in the ER since they don't have huge inpatient peds units, but they generally see the ones that are in the vicinities of the hospitals and will generally ship the sickest of them.

The wealthiest patients actually gravitate more to Zale Lipshy and Baylor, although Presby does get their fair share.

Medical City probably gets the highest majority of insured patients as they are the only for profit hospital with an ER in that vicinity. They do not take trauma divert, however, they do take transfers from other facilities.

Parkland has the busiest of the ER's since they do get the majority of the indigent population, which is why Baylor took a heavier share of the trauma.

Just a fun fact. Presbyterian Plano was intentionally built off the beaten path so far because there were no bus stops in the vicinity. They did not want the inner city ER patients coming to the burbs for treatment.

[mountain grammy]

39. The insurance companies broke our health care system out of sheer greed.

[Iliyah]

41. Also, was it the lack of or limited health insurance coverage

a part of the decision to release him? I'm assuming the hospital did get notice of potential Elobla warnings.

[jwirr]

42. Sounds reasonable and like most of our lives.

[kestrel91316]

43. CDC has been providing hospitals and expecially ERs with detailed guidance on this whole ebola thing

for MONTHS, so hospital admins had a duty to do staff training in the threat.

I'm sick of lame excuses.

When I was 5 years out of vet school and working relief, I saw a cat with neurological abnormalities that had just come form Mexico and had been bitten by a dog previously there. All sorts of red flags came up for me, because it's MY JOB to be alert to that sort of thing among the sneezing cats and HBC dogs.

Yes, the cat WAS rabid.

[Barack_America]

45. Or, the triage nurse could've received a memo about patients from "West Africa"...

But had no clue that Liberia is in West Africa.

Sad possibility, eh?

[XemaSab]

47. If he was an American, maybe

But a black African who is obviously from Africa?

Especially since there are all kinds of tropical diseases there like malaria, typhoid, lassa fever, yellow fever... hell, according to the CDC, rabies is a big thing there.

It's one of the few instances I can think of where racist assumptions could be beneficial.

[Horse with no Name]

53. There are actually quite a few Black Africans from Africa in Dallas

it isn't anything that would stand out.

[Horse with no Name]

52. Presby is a good hospital. They don't turf out uninsured patients.

I think they do a good job overall.

I don't think this guy necessarily lied to them but I honestly don't think he told them the complete truth, probably because he was fearful of being deported (as he had already lied on the other side).

There are viruses going around right now that have the same early symptoms. I can't fault the medical staff for not keying in on the situation immediately, especially with vague information.

He probably thought that just saying that he had been to Africa would have been enough for someone to draw the conclusion that he MIGHT have Ebola. Had he said that he had been exposed it would have been an entirely different story AND he would probably be clinically in a better situation right now. He was probably initially relieved when they sent him home--until he got sicker.

At that point, he knew he had it. And then, everybody else did too.

[Quixote1818]

57. Well put. nt

[KoKo]

59. K&R