Medical records reveal deceased Texas Ebola patient sent home with high fever

Thomas Duncan, the first person to die of Ebola in the US, was released from hospital with a 103F fever on his first visit, despite telling a nurse he had recently travelled from Africa and exhibiting key symptoms of the deadly virus, it was revealed on Friday.

Duncan, a Liberian national, was sent home from Texas Health Presbyterian Hospital even though his fever spiked on his first visit to the emergency room on 26 September, according to his medical records obtained by the Associated Press. A “physician’s note” from the visit says Duncan was “negative for fever and chills” despite having a 103F (39.4C) temperature.

The family provided the AP with more than 1,400 pages of Duncan’s medical records, which apparently chronicle the events that ultimately culminated in his death at 7.51am on Wednesday.

Duncan arrived in Dallas from Liberia on 20 September to be reunited with Louise Troh, the mother of his child, whom he intended to marry. A few days later, Duncan fell ill. He went to the hospital complaining of abdominal pain, dizziness, a headache and decreased urination, according to the AP. The records show that Duncan reported his level of pain was eight on a scale of 10. Doctors ran a series of tests, ruling out appendicitis and a stroke, among other ailments.

When the examination was over, the doctors prescribed him antibiotics and told him to take Tylenol, an over-the-counter drug designed to relieve pain and fever. Duncan returned home to the apartment he was sharing with Troh and her relatives.

Four days after he first began feeling sick, his condition worsened and he was rushed to the hospital by ambulance, where he was admitted and quickly placed in isolation. The Centers for Disease Control and Prevention (CDC) confirmed last Tuesday that Duncan had tested positive for Ebola.

Over the weekend, Duncan’s kidney function declined, he was placed on dialysis and was breathing through a respirator. The hospital began treating Duncan with the experimental antiviral drug brincidofovir. On Wednesday, Duncan died.

It is still not clear why the hospital did not test Duncan for Ebola on his first visit, based on his travel history and symptoms. The hospital initially said Duncan had not told them of his travel history, and then later said he had, but the nurse had not shared that information with the entire medical team. The following day, the hospital changed its story again, attributing the error to a “flaw” in its online health records system, but then corrected its statement and said their was “no flaw” and Duncan’s travel history had been available to the entire medical team.

Many in the community are raising questions about the standard of care Duncan received, and some believe his race and lack of insurance played a role in the hospital’s decision to send Duncan home, feverishly ill with a course of antibiotics.

Duncan’s nephew, Josephus Weeks, issued a statement on Thursday in which he alleged that his uncle may have been given inadequate treatment because of his skin colour: “Eric Duncan was treated unfairly. Eric walked into the hospital, the other patients were carried in after an 18-hour flight. It is suspicious to us that all the white patients survived and this one black patient passed away. It took eight days to get him medicine. He didn’t begin treatment in Africa, he began treatment here, but he wasn’t given a chance.”

The hospital responded to similar claims in a statement it released on Thursday, saying that it has “a long history of treating a multicultural community” and provided Duncan with “the same level of attention and care that would be given any patient, regardless of nationality or ability to pay for care.”

Mark Wingfield, associate pastor at the church attended by Louise Troh, Duncan’s partner, said that Troh, her teenaged son and two nephews are still in quarantine and not showing any symptoms. They are expected to remain isolated until 19 October when the maximum 21-day incubation period is over.

Wingfield said that the family has not yet decided whether to sue the hospital. “That’s still an underlying current. I don’t know that Louise has come to any resolution on that,” he said.

As well as the obstacle to any potentially successful legal action posed by the virus’s high mortality rate, Texas governor Rick Perry in 2003 signed into law one of the nation’s toughest statutes to limit liability for medical malpractice. The law caps “non-economic” damages payable by individuals and hospitals – such as payouts for suffering and mental trauma – to $250,000 per claimant.

None of the 48 people under observation in the Dallas area who may have had contact with Duncan are showing symptoms of the virus, David Lakey, the Texas health commissioner, told a congressional homeland security committee hearing on Ebola response coordination held at Dallas-Fort Worth international airport on Friday afternoon.

It is the 12th day of monitoring via daily contact with an epidemiologist and twice-daily temperature checks; the most common period for Ebola symptoms to reveal themselves, according to the CDC, is eight to 10 days after exposure.

“We remain confident that Ebola is not a significant public health threat to the United States,” Toby Merlin, director of the CDC’s division of preparedness and emerging infection, told the hearing. He reiterated the agency’s stance that restricting air travel between the US and the affected region in Africa would be a harmful step because it would hamper efforts to combat Ebola and worsen the economic situation there.

Dallas County judge Clay Jenkins, who has been criticised for driving the quarantined family from their north Dallas apartment to a temporary home in an undisclosed location without wearing protective clothes, defended his decision at the hearing.

Jenkins said it was “important that I not move that family wearing a Hazmat suit. It’s important for them to see me as a fellow human being, face to face, and for me to converse with them as equals. That is a basic tenet of leadership and it is in keeping with modern medicine. Louise Troh and those three young men have been handling an extraordinary scary, sad and difficult situation with grace.”

Still, a professional hazardous materials cleaning company decontaminated and stripped out the apartment last Saturday, removing the contents in 140 55-gallon drums and disposing of them.

Asked by the Guardian if he expected the family to take legal action, Jenkins said: “The family is grieving, they’re hurting like any family would be in any death and those sort of things will be determined at some time later but it’s only normal in the grieving process for people to ask, ‘what if?’ and ‘why?’ and that doesn’t make them any less deserving of our prayers and sympathies and they have every right to ask ‘what if?’ and ‘why?”

Jenkins said he spoke to Duncan’s son, Kasiah, on Thursdayight. “He’s a 19-year-old young man who can’t go back to college right now, who can’t hug his mother and his father died, so he’s in a tough place but he’s doing as well as can be expected,” he said.

The New York Times reported thaton Thursdaynearly 100 children were absent from the elementary school in Dallas’ affluent Highland Park district where Jenkins’ eight-year-old daughter is a pupil and his wife volunteers at lunchtimes, ompared with the usual number of about a dozen.

“I tend to focus on the several hundred who follow science and stay calm and carry on as opposed to the people who understandably love their children and have this concern, but we’ve gone to extraordinary lengths to reassure people – the top Ebola response doctors, the CDC, Dr Lakey and the entire Dallas County medical society leadership have signed letters saying there is zero risk of me having contracted Ebola and therefore zero risk of that eight-year-old girl having Ebola,” said Jenkins.

Dallas education officials said last week that five children who may have come into contact with Duncan are being kept out of their schools during the 21-day incubation period. Jenkins said that he and Dallas school district superintendent Mike Miles would be talking to principals and forming a plan to make sure the affected children are not bullied, teased or otherwise shunned when they return to classes. “We’ll see to it that those children are treated with the dignity that every child deserves,” he said.

The game between the universities of Texas and Oklahoma, which will take place on the State Fair grounds, is a 92,500 sell-out. Karissa Schuler, spokeswoman for the fair, said that organisers have not noticed a decline in attendance since the Ebola scare started. “Since the news broke we have definitely made hand sanitiser even more available,” she said, adding that more signage promoting handwashing and cleanliness has been put up.

Schuler said that several times an hour, Big Tex, a 55-foot-tall talking mechanical cowboy who is the centrepiece of the fairground, is broadcasting messages to attendees advising them to “wash your hands before you eat”.

Merlin, of the CDC, said that dramatic images such as footage of a Dallas-area sheriff’s deputy being taken to hospital by officials wearing full protecting clothing were helping inflame public fears that were unwarranted, he said, given the limited ways in which the virus can be transmitted.

“I wince every time I see the TV images with people in space suits because it gives an impression about the infectivity of the virus that is not realistic, it is an overreaction,” he said.

This weekend is set to see an unusually large influx of visitors to Dallas, as there is a high-profile college American football game at the Cotton Bowl on Saturday and the annual state fair is ongoing.

Frank Librio, spokesman for the Dallas convention and visitors bureau, said that since the news broke they had only received two requests for information from organisations scheduled to visit Dallas. “The groups were not concerned or cancelling their meetings, an indication that people are paying attention to the medical facts. We have not received any calls from tourists to my knowledge,” he said.

As questions linger over Duncan’s death in the US, the World Health Organization (WHO) announced a grim milestone in the current Ebola outbreak – the disease has claimed more than 4,000 lives since the outbreak began in March 2014.

The WHO report noted that the exposure of health care workers to the virus is an “alarming feature of this outbreak”. More than 400 health care workers have developed Ebola since the outbreak began, including three American medical missionaries who contracted the virus while working at a hospital in Liberia and an American doctor with the WHO who contracted it in Sierra Leone and is still being treated in an Atlanta hospital.