Dallas Hospital Deals With Aftermath Of Ebola Missteps

Authorities in Texas are working to limit travel by health workers who may have been exposed to Ebola. Meanwhile, the hospital at the center of the first cases in the U.S. is trying to move forward.

SCOTT SIMON, HOST:

This is WEEKEND EDITION from NPR News. I'm Scott Simon. Three cases of Ebola have been diagnosed so far in the United States. And now a lab supervisor from Presbyterian Hospital in Dallas, where three people with Ebola were treated, has been quarantined aboard a Carnival Cruise ship. Other medical workers from the hospital who had contact with Thomas Eric Duncan, who died from Ebola, have agreed to avoid public transportation until their monitoring period is over. NPR's Wade Goodwyn spoke to the hospital system's chief clinical officer about how the Hospital came to make some very serious mistakes.

WADE GOODWYN, BYLINE: In the lobby of Presbyterian Hospital in Dallas, a lady with white hair and oversized glasses clings her hands over the keys of a Baby Grand.

UNIDENTIFIED NURSE: Nurses station, may I help you?

UNIDENTIFIED WOMAN: Can I please have my nurse?

UNIDENTIFIED NURSE: Sure, one moment. I'll send her right in.

GOODWYN: The Presbyterian campus is huge; nine large, glass building covering blocks of one of the most diverse and robust sections of Dallas. So it was nothing out of the ordinary when Liberian Thomas Eric Duncan showed up in the emergency room with a fever and stomach pains. Dr. Daniel Varga is the chief clinical officer for the hospital system.

DR. DANIEL VARGA: Mr. Duncan arrived in the emergency department around 10:30. And it wasn't until shortly after midnight that Mr. Duncan actually was evaluated by the ED nurse back in the treatment area. And that was the first place that the travel history with picked up.

GOODWYN: Duncan told the Emergency Department nurse he'd come from Africa. And that was duly written in his medical chart. But the ER doctor instead asked his own question about where Duncan lived. Duncan replied this time with his Dallas address. So the doctor didn't think possible Ebola here. Varga says it was a small but critical error.

VARGA: This isn't the patient's fault. This is a scenario of people who are sick, when asked the same question by a couple different people, a couple different ways, not infrequently give an answer that isn't identical.

GOODWYN: The consequences were dreadful. Duncan was on the verge of becoming exceedingly infectious with Ebola, but out the ER doors he went. Two days, later he was back.

VARGA: So Mr. Duncan, on his return visit, has a high fever, nausea, vomiting and lots of diarrhea; classic symptoms of Ebola.

GOODWYN: According to nurses at the hospital, managers at first seemed unsure what sort of protection should be worn. Eventually, it settled on caps, particulate masks, face shields and goggles. That left parts of the head and neck exposed.

It wasn't until two days later when Duncan was finally confirmed by the CDC as positive for Ebola that the Hospital issued fully hooded Hazmat suits. This failure of judgment put the lives of its medical staff and especially its nurses at risk. It's also much harder to understand than the hospital's first mistake with Duncan's diagnosis. Here was a recently traveled patient from West Africa exhibiting effusive and classic symptoms of Ebola. It was senseless not to provide the medical staff with the best protection the hospital had on hand. Varga admits Presbyterian wasn't ready. They hadn't trained for Ebola and were not wise enough about the threat the virus posed.

VARGA: In retrospect, what we would do is say if you have a high suspicion of Ebola on first contract in the Emergency Department, you would immediately move to a full Hazmat Personal Protective Equipment.

GOODWYN: The news that critical care nurse Nina Pham had contracted the disease from Duncan was a shattering blow to everyone at Presbyterian. A careful review of the hospital's protocols left the CDC with the unhappy conclusion that it would be no surprise if another caretaker got Ebola too. Sure enough, Nurse Amber Vinson, who also cared for Duncan during those first two days, tested positive. And this was the straw that broke the camel's back. First Amber Vinson, and then soon after Nina Pham were whisked away from Presbyterian to two of the nation's best infectious disease hospitals in Georgia and Maryland. Presby was done treating Ebola.

VARGA: There's no one more devastated about these three cases, you know, for this crew, they felt devastated enough with Mr. Duncan's loss. But to have two of our own also become infected, become ill, be put at risk was just crushing for us.

GOODWYN: In its effort to serve its community, Presbyterian Dallas paid a high price. Its hereto for good name was dragged through the mud, and doctors who practice at Presbyterian's buildings blocks away report their medical practice is off by as much as half. The CDC in the County of Dallas didn't emerge looking all that rosy either. When Ebola came to Texas, it sickened almost everything it touched. Wade Goodwyn, NPR News, Dallas.

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