North Texas was relieved after a Dallas County sheriff’s deputy tested negative for Ebola on Thursday, but questions lingered over the care of the Liberian man who died of the virus a day earlier.
The deputy, Sgt. Michael Monnig, went to a CareNow clinic in Frisco on Wednesday and was taken by ambulance to Texas Health Presbyterian Hospital Dallas, where he was isolated.
Monnig had been inside the Dallas apartment where victim Thomas Eric Duncan had stayed. A date was being set Thursday evening for Monnig’s release.
Duncan’s family began pressing for an investigation within hours of his death at 7:51 a.m. Wednesday. Relatives have been concerned about his initial release from an emergency room, which put him on the streets of Dallas for two days until he returned in an ambulance. They also questioned why Duncan didn’t get an experimental drug earlier, noting that drugs have been given quickly to other Ebola patients treated in the U.S.
“We begged and pleaded several times” for doctors to do more, Josephus Weeks, Duncan’s nephew, said in a text-message interview. “They said it’s too late in his treatment. They didn’t try any other options but saline, oxygen and water.”
Hospital representatives first said a flaw in the electronic records system meant that Duncan’s physician didn’t see a nurse’s note that he had recently been in Africa. Later, the hospital said that electronic records weren’t at fault and that the information was available to everyone.
In a statement released Thursday afternoon, hospital spokesman Wendell Watson said: “We’d like to correct some misconceptions that have been reported about Mr. Duncan’s first visit. 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. In this case, that included a four-hour evaluation and numerous tests. We have a long history of treating a multicultural community in this area.”
Faster treatment can make a difference
Doctors elsewhere say that if Duncan’s hospital treatment had started sooner, he might have survived. He was sick Sept. 24 but didn’t seek treatment until Sept. 25.
Then he wasn’t treated until he returned Sept. 28. He had been ill for 10 days when he was given brincidofovir, the experimental drug, on Saturday. Duncan’s condition was downgraded from serious to critical that day.
Duncan’s heart stopped Wednesday, according to the hospital’s statement, which said he had requested early in his stay that physicians not perform chest compressions, defibrillation or other measures to try to revive him.
Other patients who were treated in the U.S. and survived “were all diagnosed very, very quickly,” allowing them to get supportive care to keep their organs functioning while their bodies fought off the virus, said William Schaffner, an infectious-disease specialist at Vanderbilt University Medical Center in Nashville.
“If you start all those things earlier, you are much more likely to have the body respond appropriately,” Schaffner said by phone.
Jana Shaw, an infectious-disease physician at Upstate Golisano Children’s Hospital in Syracuse, N.Y., said the experimental drug may have been administered too late.
“If you start treatment when the virus is integrated, they may not help at all,” she said by phone. “It’s very likely his body was already overwhelmed by this virus and this drug had very little chances of working.”
The Dallas hospital’s statement says, in part, “After consulting with experts across the country, the CDC, and the FDA, the investigative drug was administered as soon as his physicians determined that his condition warranted it, and as soon as it could be obtained.”
Physicians have emphasized that Ebola medications are experimental and unproven. Among patients who were given other experimental drugs and recovered, it is unclear what role the medicines played.
“We have no idea whether any of them work. That is a great question mark,” Schaffner said.
The one that missionary Dr. Kent Brantly took, ZMapp, takes a long time to make and hasn’t been available since Aug. 12, according to the hospital statement.
The family also wonders why Duncan wasn’t given blood serum from surviving patients.
An NBC cameraman who contracted Ebola got a transfusion from Brantly, whose case was followed closely in Texas because he did his residency at John Peter Smith Hospital in Fort Worth.
The statement from the Dallas hospital says Duncan’s blood type was not compatible with available donors.
Case would likely fail
Dallas lawyer Michael Sawicki, who takes medical malpractice cases, said a lawsuit against the hospital or the doctor in the Duncan case is likely to fail because Texas law makes specific exemptions for emergency care.
He quoted a 2003 Texas legal rule that essentially says someone has to intentionally cause harm to be liable for civil damages. There has been no case in Texas where a plaintiff has proved a case under that rule, Sawicki said. “The law is written so in emergency care you’re not responsible for anything,” he said.
The Texas Department of State Health Services said it is considering investigating the hospital, though its priority is tracking people who were exposed to Duncan.
“It’s under consideration, but our top focus right now is the contact investigation and monitoring,” said Christine Mann, a spokeswoman for the agency.
Duncan’s death and his direct contact with 10 people now being monitored for Ebola symptoms have prompted more screening at five U.S. airports.
Travelers from Guinea, Liberia and Sierra Leone — the countries at the center of the outbreak — will have their temperatures taken and be asked about possible exposure to Ebola.
Thomas Frieden, director of the Centers for Disease Control and Prevention, said in a call with reporters that Ebola now has a face in the U.S. and that Duncan’s death should serve as a reminder of the patients whom health workers are trying to save in West Africa.
“We remember what a deadly enemy Ebola is,” Frieden said, “and how important it is that we take every step possible to both protect Americans and stop it at its source.”