After the tragic death of Thomas Eric Duncan, the victim of Ebola in Texas, people are wondering if things were handled badly. With reports that Duncan was turned away from the hospital when he first started showing symptoms, the question of medical malpractice is in the air. The New York Post reports that Duncan’s family is calling for an investigation into the hospital’s practices and behaviors in this case.
Thomas Duncan’s story
Duncan arrived in the United States on September 19. He had come into contact with infected people while living in Liberia, but answered “no” when asked about if he had cared for somebody with the virus. Four to five days after he landed in the United States, he started having symptoms.
Duncan went to Texas Health Presbyterian Hospital in the evening of September 25, where he was treated for vomiting, fever, and abdominal pain. Though he told hospital staff he had recently come from Liberia, he was sent home with antibiotics and a pain receiver and was not screened for the Ebola virus. Three days later he returned and was finally tested for and diagnosed with Ebola.
The questions asked repeatedly by family members and concerned citizens are these: Would Duncan have survived had he been admitted earlier, when he first showed up with the symptoms of Ebola and reporting he had been in Liberia? Was Duncan’s treatment sub-par because he was uninsured? Was he turned away because of his race, or because the doctors don’t want to treat the uninsured?
While we may never know the answer to Duncan’s survival odds if he had been treated earlier, it seems there is no doubt that the Hospital dropped the ball in providing the standard of care that this person required. He gave them the information they needed to diagnose and begin treating him. Why didn’t they?
Tejal Gandhi, president of the National Patient Safety Foundation said “Almost all errors are related to communication. This was true before electronic health records and it’s true now.”
Politico.com reports that old-school ideas about doctors vs. nurses have influenced how a modern hospital functions, including Texas Health Presbyterian, where medical records have different sections for nurses’ notes, and another section for doctors notes. At one point Prebyterian blamed that segregation of notes for the missed diagnosis. However, perhaps fearing this was an admission of a mistake, the hospital reversed its story. (source)
This doctors vs nurses mentality have made it hard for nurses to feel comfortable speaking to doctors, second guessing them, or otherwise taking a more proactive role in patient care. Perhaps it was the intake nurse who failed to raise the alarm, but it may have been a doctor who dismissed or ignored the nurse. We simply wont ever know the facts.
Brent James, director of Intermountain Healthcare’s Institute for Health Care Delivery Research, believes that what happened is that the physician didn’t read the nurse’s notes and missed the patient’s travel history. (source) Because there was no person-to-person hand off, the nurse had no way of knowing if the information she provided was heard. Most likely the nurse’s notes and the travel information were tucked away inside of multiple pages of electronic forms. When notes get that long, some doctors simply don’t read them.
When does it cross the line into malpractice?
For malpractice to have occured, the following must have happened:
1. A failure to meet a standard level of care. For malpractice to exist, the medical professional must have been negligent. In court, that means showing that the doctors failed to be “reasonably careful.” In the case of Thomas Duncan, it seems likely that if the doctor failed to read the notes made by intake nurses, and those notes contained anything about exposure to Ebola, there has been a failure to provide a reasonable level of care.
2. The doctor’s negligence led to injury. This is where the Duncan case may fall apart. With such a deadly infection, it will be incredibly difficult to prove that Duncan would have fared better had treatment started earlier, or been done differently. Certainly the defense would argue that his fate was sealed as soon as he became infected and there was nothing that any doctor could do to change it, or improve his condition. Were this case to go to trial, experts-a-plenty would be hired to present both sides of the argument.
3. The injury led to specific damages. In the Duncan case, if the plaintiff can prove that the doctor was negligent and that negligence led to real injury, the specific damages may be physical pain, mental anguish, medical bills, and, so on.
How could it be avoided?
Our medical culture is in a state of denial. With over 400,000 deaths estimated every year due to medical mistakes, there must be changes to how our broken system operates. The first step needs to be in how we communicate. While doctors are trained for years and years, the corporate communication methods most of them embrace is simply too rooted in outdated standards.
Training can help. Doctors and nurses can learn to communicate in ways that make their patients safer. But it first will require a recognition that there is a problem, which this case of Ebola only serves to highlight.