Patterico's Pontifications

11/13/2014

Hospital That Treated First U.S. Ebola Patient Settles with His Family

Filed under: General — Patterico @ 7:36 am



What a country:

The family of Thomas Eric Duncan, the only Ebola patient to have died in the U.S., has reached a settlement with the Dallas hospital that treated him, according to the family’s attorney.

Attorney Les Weisbrod said Wednesday that Texas Health Presbyterian Hospital Dallas will pay an undisclosed sum to his relatives and create a charitable foundation in Duncan’s name. The hospital has also apologized to family members and says it will foot the cost of Duncan’s treatment.

Wait, what?

Didn’t he lie to get into the country? And then infect two nurses who tried to help save his life?

Why, yes. Yes, he did.

80 Responses to “Hospital That Treated First U.S. Ebola Patient Settles with His Family”

  1. The nurses at the hospital say he lied to the hospital as well.

    But this is PR and PC. And we don’t know how much money the family got. Not a whole bunch I would guess.

    Patricia (5fc097)

  2. But he admitted to having recently returned from West Africa and the ER person DID NOT get that information to the doctor. I’m sorry but that sort of incompetence is unacceptable and I’m glad they had to pay out. I hope it was a lot. Enough to convince them to make a serious attempt to get it right the next time!

    Georganne (e37667)

  3. I bet you this is because Jesse Jackson got involved. Its a shake down.

    Dejectedhead (393701)

  4. The line between tort law and extortion is…well, it’s gone.

    Art Deco (ee8de5)

  5. Want to bet he didn’t have to show an insurance card?

    DN (395a7b)

  6. This is why everybody hates lawyers.

    Hoagie (4dfb34)

  7. Actually, he lied to get out of the other country. A quibble, perhaps.

    The hospital screwed up when he showed up the first time. There are sillier malpractice cases that win. Even in Texas.

    Kevin M (d91a9f)

  8. the charitable foundation is the stupidest part i think

    but that’s just me

    happyfeet (a037ad)

  9. The line between tort law and extortion is…well, it’s gone.

    It’s been gone for some decades now.

    Kevin M (d91a9f)

  10. Duncan didn’t disclose he’d been exposed to Ebola, that’s the reason he didn’t receive appropriate medical care. It’s entirely his own fault. If he’d been truthful he might be alive today.

    ropelight (1eaaf6)

  11. I’m sorry but that sort of incompetence is unacceptable and I’m glad they had to pay out. I hope it was a lot. Enough to convince them to make a serious attempt to get it right the next time!

    It would be interesting to see what role the Electronic Medical Record system played in this story. The ones I’ve seen are clumsy and counterintuitive. They were written by programmers who know nothing about healthcare but the Obama administration is forcing them on physicians and ERs. The hospital probably won’t talk about it but it would be interesting to hear from someone who knows.

    Mike K (90dfdc)

  12. Papertiger’s solution is looking better all the time.

    nk (dbc370)

  13. At that stage, or even today, what is the standard of care for treating potential Ebola patients? I think it would be hard to articulate any accepted standard of care. Without which, I can’t see them maintaining a cause of action. The hospital may well have erred but they shouldn’t have settled.

    Lorem Ipsum (cee048)

  14. Didn’t he lie to get into the country? …

    Why, yes. Yes, he did.

    Really? How do you know he did? All we know is that there was a newspaper report that a Liberian was going to charge him: we don’t even have an accusation. Furthermore, if the facts are as the newspaper reported, I would have answered “no” to this question as well, as would any other honest person.

    Jeff Hall (4e23a4)

  15. NObola!

    Colonel Haiku (2601c0)

  16. Resist we much!

    Colonel Haiku (2601c0)

  17. This was not a settlement — it was graft and payola, stolen from the taxpayers’ pockets, disguised as settlement, in my opinion. I’m from Chicago. I really would like to see how much of the money will go to the family and how much to the lawyer. And what his “connections” are to the politicos who authorized the “settlement”.

    nk (dbc370)

  18. Mike K-
    There had been things reported back and forth about the role of the EMR, some claims it had a role because of a division between MD and Nurse work flow, and other claims that it was not an issue.
    It does go back to the fundamental issue that technology never solves anything, it is just a tool, insuring there is communication is the goal.

    But, I have read that on his first ER visit his temp was below what the CDC protocol gave for suspecting Ebola, so that if they went by the CDC recs at the time the result would have been the same as far as sending him home, though there might have been more aggressive follow up when his temp later became higher [though that it is 20/20 hindsight as well, as one expert (so claimed, anyway) said people with Ebola get NO fever about 12% of the time].

    I can understand the hospital wanting to settle and just get rid of it, perhaps for a relatively low fee compared to what this has cost the hospital overall;
    but in another way, a hospital gives the best care possible, far above what he would have gotten had he become sick in Liberia, even at the cost of 2 of their own workers getting ill,
    and they should be thanked,
    not treated punitively.

    MD in Philly (f9371b)

  19. oops, that was supposed to be shut up…

    Rorschach (61bf43)

  20. 18.It is not likely to be all that much money. Under Texas law, the “pain and suffering” is capped at $250K if memory serves. Actual damages are not capped but that doesn’t get awarded to survivors. Therefore likely they wrote off the costs of his care and gave a token amount to the family to make them shut up and go away. bt since it is an undisclosed out of court settlement, we will never know.

    Rorschach (61bf43)

  21. MD, they’d need a doctor, in that specialty, to testify that the treatment Duncan received was below the standard of care existing in the community and it was the proximate cause of his pain, suffering, and death. At a minimum. Texas’s med mal protection laws may impose a tougher standard. This is the kind of story that screams “Seriously?”

    nk (dbc370)

  22. Simple: it was cheaper to settle than fight, even if they fought and won.

    The Dana who isn't an attorney (f6a568)

  23. I think we all essentially agree.

    MD in Philly (f9371b)

  24. nk, I’m not seeing the taxpayer connection.

    My impression is that Texas Health Presbyterian is a private hospital, not a government-owned one; their website’s a bit vague on the details (or I can’t find the right page in it), and I don’t know if it’s nonprofit or not.

    But normally a private hospital would have its own liability insurance, whose carrier may have the right to make settlement decisions within policy limits (which I’d expect to be a eight-figure number). It might be self-insured in whole or part. If this family’s claim was not an insured claim, it would still typically be the hospital management’s call whether to fight or settle; and even if it is insured, insurers sometimes make into consideration the wishes of major insureds to end controversy with an early settlement.

    I’m reluctant to condemn or even comment in detail about settlements without knowing a lot more details, including the whole cast of players, their respective contractual and civil relationships to one another, and dollar figures. It might be a craven decision by people who ought to have fought instead of settled, but I don’t think the public knows — or is ever likely to know — enough to make informed judgments about that.

    Beldar (fa637a)

  25. I defer to Beldar. And saving the scenario for my next novel. Now, who is the real cynic around these parts, DRJ? 😉

    nk (dbc370)

  26. I agree, Beldar, with the comment that it is not necessarily the taxpayer per se on the hook,
    but I can not imagine what facts would substantiate malpractice.
    There is no known proven treatment for Ebola that works best when started early, there is no known benefit of early supportive care as long as the person gets to medical care before in extremis, there is no reason to suspect an error was made in treatment that resulted in his death.

    Perhaps the biggest problem was that he didn’t have the correct blood type to get a plasma transfusion from Brantley or the woman survivor, and that was not the hospital’s fault.

    MD in Philly (f9371b)

  27. “they should be thanked,
    not treated punitively.”

    Would you like to hear some of my med-mal stories ?

    The only dollar ever paid on my behalf was to a Medicaid kid who I took care of for 10 years, finally saving his life when he was bleeding from esophageal varices. He developed AIDS five years later and they alleged he got it from the Red Cross blood (8 units) he got the month before the first report of HIV (It wasn’t yet named) possibly being in bank blood. January 1984.

    My insurance carrier paid them $1500, and they lost the entire support network I had set up for them in the community. They cried as they told me their lawyer said they had to include me in their suit against the Red Cross. There was, of course, no test for another several years.

    Mike K (90dfdc)

  28. Honestly I’m shocked that any lawyer would have wasted their time and energy on representing them since pain and suffering is what pays the lawyer generally speaking.

    Rorschach (61bf43)

  29. There is a problem with that hospital. The New York Times made a report a month ago.

    They settled for a good reason. Even if they won that case on some kind of technical ground – the patient lied (particularly about the fact he had no insurance coverage) and bears some responsibility or something like that, there’d be all sorts of material, and leads, for lawyers in other cases from all the material that would made public, not to mention loss of business and other consequences.

    http://www.nytimes.com/2014/10/16/us/infamy-for-dallas-hospital-where-virus-spread.html

    Sammy Finkelman (ae0b12)

  30. MD in Philly (f9371b) — 11/13/2014 @ 11:20 am

    There is no known proven treatment for Ebola that works best when started early, there is no known benefit of early supportive care as long as the person gets to medical care before in extremis, there is no reason to suspect an error was made in treatment that resulted in his death.

    Nothing except that every other patient who was treated for ebola in the United States lived, and the hospital refused to try to get a transfer to Emory.

    Maybe there were some bureaucratic obstacles but a transfer to a better equipped and trained hospital is something which somehow managed to happen later for the two nurses.

    Sammy Finkelman (ae0b12)

  31. MD in Philly, I certainly don’t mean to imply that I think a claim against the hospital has merit. You’ve pointed out some huge and obvious hurdles that any such claim would face, and there are others. They’ve been under a public magnifying glass already; a lot of things that in hindsight could have been handled better probably weren’t their fault; certainly many there performed heroically.

    I could hypothesize scenarios where some act or omission by the hospital that’s buried in the medical records, but that hasn’t yet gotten any public view, might have arguably have had some impact on the patient and his prognosis. One reason some defendants settle is to bury their skeletons beneath a confidentiality agreement. No one who’s outside the hospital’s and its lawyers’ (and likely its insurers’) decision loop can rule that kind of thing out. But certainly nothing about this makes me think this would be anything other than pure fantasy.

    But we don’t know the settlement amounts. Could be huge; could be trivially small; likely somewhere in between, but I’d guess closer to the latter.

    And what’s a “reasonable settlement” depends on who the evaluator is, and how that evaluator ranks and weighs various factors. We’re in the grandstands, neither writing checks for settlement nor checks for defense lawyers. My guess is that neither the insurer(s) nor the hospital management saw any upside to fighting this tooth and nail, even if the claim was ridiculously weak, and that both considerations of closure/PR and of litigation economics prompted them to offer enough money that the family and its lawyers took the offer.

    Beldar (fa637a)

  32. “Nothing except that every other patient who was treated for ebola in the United States lived”

    Sammy – Now you’re falling for the “Lump of Ebola” fallacy.

    daleyrocks (bf33e9)

  33. I have no issue with this from a business perspective if the hospital and their lawyers jointly decided that this was the best way to handle the Duncan situation. They surely have more information than we do out here in internet land about what went on, about what signs may have been missed, and what internal protocols may not have been followed. If there are such things they prefer not to have put in open court this is a solution to avoid that. If they want to save their employees, (nurses, staff, doctors) from even further stress of having a lawsuit hanging over them, such as being deposed and having to testify, then this may have been a very wise and humane decision by the hospital. The hospital’s name was dragged through the mud for several weeks and if they need to reassure future patients and future employees that the hospital is patient-centric and that they learn from mistakes then the statement this settlement makes to the community may have been necessary PR.

    Having worked in conjunction with the Law Department of a major corporation I can personally attest that this type of cost/benefit analysis goes on each day with respect to legal decisions involving potential liability or crisis management situations.

    elissa (6da717)

  34. 26.I agree, Beldar, with the comment that it is not necessarily the taxpayer per se on the hook,

    Well, you’re both wrong MD in Philly. It’s always the taxpayer who is on the hook per se or otherwise. Especially with a public facility who has to accept Medicaid, Medicare, Obamacare and treat emergency victims regardless of their ability to pay (which this guy was BTW). If either of you don’t realize who actually ends up paying the bottom line in these situations I suggest you begin posting at HuffPo.

    Hoagie (4dfb34)

  35. Again, I think I essentially agree with everybody (except Sammy), depending on how one looks at it.

    Mike K- You and I both know there must have been a reason why your patient had esophageal varices, perhaps from Hep B or C which reflected risk factors for HIV other than transfusion. Your patient would not have been the first nor last to have sued over a blood transfusion when that is not probably how they picked up HIV.

    MD in Philly (f9371b)

  36. Hoagie,
    Hold on just a second. It wasn’t just the taxpayer on the hook, unless you want to claim since taxpayers are the ones who make money and pay for everything one way or another. We’re just sayin’ that since it was also the rich patient who pays cash and the people with private insurance and companies that pay insurance premiums for their workers, etc.

    I suggest you begin posting at HuffPo.
    Hoagie (4dfb34) — 11/13/2014 @ 12:39 pm

    You are a cruel, cruel man to suggest such a fate. 😉

    MD in Philly (f9371b)

  37. Hoagie, you’re talking about indirect costs, and to that extent you make a good point. I share your distress at the degree to which the federal government and its financial tentacles are woven through our healthcare system. The government, its tax code, its regulations, its benefit programs, its carrots and sticks, its toxic interactions with special interest groups and insurers — it’s a very long list.

    But this isn’t mostly about that. Medicaid isn’t going to be writing a settlement check to directly reimburse this hospital or its insurer for this case. And I don’t think a public official made this decision.

    Beldar (fa637a)

  38. “Nothing except that every other patient who was treated for ebola in the United States lived”

    daleyrocks (bf33e9) — 11/13/2014 @ 12:29 pm

    Sammy – Now you’re falling for the “Lump of Ebola” fallacy.

    That is circumstantial evidence, all by itself, that his treatment wasn’t up to par. That two nurses got sick indicates also that some other aspect of his care, maybe not related to his survival was not up to the quality that CDC was assuming for no good reason. They didn’t do a few things the family suggested, and their communications apparently was with members of his family not closest to Mr. Duncan (because he and the mother of his child were not married)

    The family suggested he be transferred to Emory and the hospital more or less said it was impossible, although that turned out not to be impossible later with the nurses. Their transfer of the nurses kind of proves they were not up to the standard of care, because the standard of care was Emory. If a doctor or a hospital doesn’t know how to handle a case, shouldn’t it NOT resist a transfer, and in fact shouldn’t it in fact, do whatever it can to arrange a transfer even if it means making 20 or 30 phone calls and costs a tremendous amount of money?

    And remember, by that stage, money was no object. Duncan was famous then and whatever amount of money was needed, or insisted upon, by them, or others, would have been raised. They had no business objecting or not bringing up something on grounds of expense.

    Sammy Finkelman (ae0b12)

  39. 26. MD in Philly (f9371b) — 11/13/2014 @ 11:20 am

    Perhaps the biggest problem was that he didn’t have the correct blood type to get a plasma transfusion from Brantley or the woman survivor, and that was not the hospital’s fault.

    We don’t know if that’s true. We don’t know if they inquired.

    More to the point – are there not people in Africa, or maybe in other countries, with the correct blood type? So couldn’t have blood been taken and stored and shipped to Dallas?

    Beyond a certain point in time in this case, money was no object – and it’s not the job of the doctor or the hospital to decide that something is not affordable.

    You know maybe an ebola survivor could have been given an emergency visa to the United States, or if not, maybe could have been gotten into Mexico or an island in the Carribean. They could have asked.

    And the real point is they resisted a transfer to Emory where the best heroic measures would have been attempted, and they wouldn’t have been stifled by the fact all ideas were experimental treatment.

    And then when it was one of their nurses, things were different. Maybe they were different because they learned something, but maybe it was something they already knew – that they weren’t really equipped to treat an ebola case the best possible way, and somebody else was.

    The one thing they tried was probably futile, and maybe even made things worse.

    I didn’t mention statins because so far nobody seems to have tried that (not as a cure but as a means of avoiding system collapse)

    Sammy Finkelman (ae0b12)

  40. This is from the New York Times article about that hospital:

    http://www.nytimes.com/2014/10/16/us/infamy-for-dallas-hospital-where-virus-spread.html?_r=0

    Presbyterian Hospital of Dallas opened as a faith-based nonprofit in 1966 in what were then sparsely populated northern suburbs. In 1997, Texas Health Resources was formed by merging the hospital with others in Fort Worth and Arlington. The hospital’s most recent tax filings, from 2012, show that it had $613 million in revenue and $1.1 billion in net assets. The hospital’s president at the time was paid $1.1 million.

    In Medicare’s most recent ratings, the hospital scored well on surgery, obstetrics, and cardiac and stroke care. But it did less well, below state and national averages, on assessments of its emergency department. For instance, it took an average of 52 minutes for an emergency patient to be seen by a doctor or nurse, twice the state and national averages.

    Court records also reveal several recent cases of bad outcomes in the emergency room. In 2012, for instance, one of the hospital’s own doctors, Rachel Dunagin, showed up at the emergency room with breathing problems. The lawsuit she later filed, which was dismissed after an out-of-court resolution, charged that a nurse had caused nerve damage and a permanent disability while inserting an IV line.

    Another patient, Dwain Williams, said in a telephone interview that he had gone to the emergency room in July 2013 after coughing up blood. Records provided by Mr. Williams and evaluated by doctors consulted by The New York Times show that the hospital failed to determine that he had tuberculosis and sent him home with antibiotics, as was the case on Mr. Duncan’s first visit. Mr. Williams, who was insured by Medicare, received a correct diagnosis two weeks later in Los Angeles, but only after exposing family members and airplane passengers.

    Sammy Finkelman (ae0b12)

  41. Sammy-
    First, I refuse to concede that the standard of care as far as the patient was concerned was Emory. The transfer of the nurses to other hospitals, IMO, had more to do with giving the hospital in Dallas a chance to “recover” more than it has to do with the care the nurses themselves received.

    Is it not very possible that what was impossible at point A in time with one very sick patient was possible at point B in time with patients that were not yet critically ill? Often/usually there is a question as to whether a person is “stable enough” to be transferred, there was the question as to the availability at the moment in time of the very specific transportation services needed, and whether or not Emory would have received the patient in transfer at the time.

    I have no reason to think cost was an issue. If cost was the issue, the faster they got him out of the hospital and somewhere else would have been the right thing to do, as no one wanted to go to that hospital as long as “the Ebola patient” was there.

    All of this is speculation form a distance. I maintain, as I said before, that unless there was some specific event that could be pointed at that we have no idea of, there was no obvious malpractice simply because he didn’t survive. Like I also said before, perhaps the fact that he did not have the correct blood type to get a transfusion from Brantley was the most important factor in his care, but we don’t and will likely never know.

    MD in Philly (f9371b)

  42. If Dallas Presbyterian is liable, then so is the CDC, and the NIH which had ‘unsatisfactory’ protocols to say the least

    narciso (ee1f88)

  43. Les Weisbrod? Yes, the epitome of the unethical, ambulance-chasing scumbags with
    a law license. When you read Shakespeare’s line about “First kill all the lawyers”, know
    that he was thinking precisely about despicable filth like this Weisbrod slimeball. Well
    known in Texas as a malpractice parasite in the same low class as Al Gore’s VP running
    mate who made millions off the misery of cerebral palsy patients by falsely blaming OBs
    for not performing cesaerian section deliveries quickly enough.

    Truth doesn’t matter to scum like this. All that matters is how to twist truth to
    squeeze the highest possible contingency fee out of the deepest pocket. If truth mattered, the family would not be given a single penny since Duncan lied about his exposure to Ebola to get into the country, and at his first trip to the ER.

    The next time some leftwing apparatachik spews their stupidity about “the high cost of medical care”, you can point to egregiously wasteful, wrongful and despicably immoral legal
    cases like this. Texas Presbetyrian Hospital paid this off as quickly as possible to end
    the negative media attention they got from being unlucky enough for the deceitful Duncan
    to have chosen them for his initial ER visit.

    I wonder how much more it will take before all physicians refuse to treat ANY malpractice
    scumbag, and anyone who works for them, to put a stop to this contemptible greed.

    Pete (435606)

  44. Sammy- there are lots of hospitals where one would be ecstatic to be seen within 52 minutes after getting into the ER. There are lots of ER’s hither and yon in areas where the staff are waiting for a patient to show up.
    So they can point to one missed case of TB in an ER visit over a several year period? So what??? The most common cause of hemoptysis in an ER is probably a simply bronchitis.
    A bad outcome and permanent disability from an IV insertion???

    This is an article from the NYT, Murray Gell-Mann Amnesia is in play.

    MD in Philly (f9371b)

  45. Pete, I think you’ve confused Joseph Lieberman with John Edwards. Edwards made a boatload of money practicing personal injury law, IIRC in his own solo practice. Joseph Lieberman has not worked in a firm since 1982. The firm he worked for is I think about 3x the size it was when he left it. Can’t say what their book was when he worked there ca. 1975, but as we speak their advertised practice areas do not include personal injury and they only defend against medical malpractice suits.

    Art Deco (ee8de5)

  46. Williams, who was seven months pregnant, was turned away at the hospital because of lack of space in the Ebola ward, the Times reports.

    She returned home that evening, hours before she died.It is not clear whether Duncan knew of the woman’s diagnosis, which initially appeared to be pregnancy related, at the time he left the country. Officials in Liberia said Duncan showed no symptoms when he boarded the plane and he was therefore not contagious.

    Mr. Duncan went to the hospital with freaking Ebola symptoms, and they turned him away. If that’s not malpractice, what is?

    carlitos (c24ed5)

  47. Sammy, responding to MD in Philly:

    Perhaps the biggest problem was that he didn’t have the correct blood type to get a plasma transfusion from Brantley or the woman survivor, and that was not the hospital’s fault.

    We don’t know if that’s true. We don’t know if they inquired.

    Apparently you don’t know but the rest of us do: Why Dr. Keith Brantly couldn’t donate blood to Thomas Eric Duncan:

    Thomas Eric Duncan, the first person in the United States to be diagnosed with Ebola and who later died, didn’t receive a blood transfusion from a physician who survived the virus because their blood types didn’t match.

    Dr. Kent Brantly told ABC News today that his blood type is A+, while Duncan’s family has said his blood type was B+, making them incompatible for a transfusion of whole blood or plasma. Blood transfusions from someone who successfully battled the virus are believed to possibly be beneficial to Ebola patients.

    Had Duncan received a blood transfusion from Brantly, it would have caused hemolysis – the breakdown of red blood cells – according to Dr. Christopher Stowell, director of Transfusion Medicine at Massachusetts General Hospital.

    I was given the wrong blood twice during my cancer treatment because of a blood bank error, so I have personal knowledge about hemolysis. It’s not helpful if you are sick. It’s especially problematic if you are as sick as Duncan was.

    DRJ (a83b8b)

  48. PS to Sammy:

    Brantly offered his blood to Duncan:

    Brantly said in a recent speech that he also offered his blood for Duncan, but that their blood types didn’t match.

    That’s why he knew he was the wrong blood type.

    DRJ (a83b8b)

  49. DRJ – I’m sorry to hear of your troubles, and I hope that you are OK now.

    I can hardly donate blood anymore, because I travel to “malarial” zones too much.

    carlitos (c24ed5)

  50. 48. I didn’t know where this was from. (This isn’t where it from but refers to something else)

    This explanation was never communicated to the family, apparently.

    Sammy Finkelman (ae0b12)

  51. 47. This is a better source, and gives details.

    Sammy Finkelman (ae0b12)

  52. This link reports important facts which, if true, hurt the hospital and would lead me to consider settlement:

    Duncan, who arrived in North Texas from Liberia on Sept. 20, was initially sent away from the hospital’s emergency room with antibiotics, something Presbyterian administrators have acknowledged was a mistake. He returned to the hospital in an ambulance two days after his release and was quickly diagnosed with possible signs of Ebola, which has killed more than 5,000 people in West Africa.
    ***
    The hospital has apologized for releasing Duncan the first time, and after initially denying he had told them he was from West Africa, they acknowledged key caregivers missed his travel history in their record system.

    What I’ve heard, and it’s admittedly rumor, is that the ER doctor missed the travel history. It’s one thing to admit a triage problem. It’s another to admit liability by an ER doctor. But the main point is that the hospital acknowledged it was a mistake to send Duncan away. That’s negligence. It may not be enough to satisfy the malpractice standard in Texas for ER doctors, but it’s close enough that I wouldn’t want to take a chance.

    In addition, the family isn’t just getting money:

    Duncan’s nephew, Josephus Weeks, has previously been critical of the care Duncan received, saying his death was partly due to his race, nationality and lack of insurance. But on Wednesday, he credited Presbyterian’s officials for moving quickly to settle the case and acknowledge mistakes.

    Weeks said he will be “the face of the foundation,” which he hopes will lead to a new hospital or the dedication of a hospital wing in Liberia.

    “The main focus is that Eric’s name is on something and everybody knows that he didn’t die in vain,” Weeks told The Associated Press.

    Win-win for the family — except for Duncan (obviously) and his fiance — but her son, Duncan’s parents, and his 3 other children are reportedly getting the settlement funds. It must be a substantial settlement if it’s enough to provide for all of them, although it is the plaintiffs’ attorney who made that claim.

    DRJ (a83b8b)

  53. It’s likely the hospital’s parent company decided to settle to avoid negative publicity if this report is correct that the legal standard that plaintiffs would have to meet is higher than negligence:

    Duncan’s family would have faced a very high bar had they filed a lawsuit against Presbyterian hospital. Texas medical malpractice law places a $250,000 limit on noneconomic damages related to pain and suffering in almost all cases.

    It also gives extra protection to emergency room doctors and nurses. Instead of just proving that Duncan’s doctors were negligent in his care, Duncan’s family would have to prove that any negligence was “willful and wanton” – essentially, that doctors knew they were causing harm.

    A quick resolution to Duncan’s case also benefits parent company Texas Health Resources, which faced weeks of negative publicity over its handling of the case and saw patient visits plummet immediately afterward.

    It doesn’t help the hospital that at least one ER doctor implied the hospital’s ER doctors were (at a minimum) negligent:

    A local emergency room doctor explained that letting the patient in Dallas go home after presenting with Ebola symptoms and noting he was from Liberia is concerning.

    Doctors told Thomas Duncan, the Ebola patient in Dallas, on Friday to go home and take antibiotics. He spent two more days out of the hospital suffering from the deadly virus before returning on Sunday. His diagnosis was confirmed on Tuesday.

    “I did think that, yes, it is definitely a serious problem,” Dr. Paul Roberts, with UT Health Northeast, said.

    Dr. Roberts said asking for travel history is common practice in most emergency rooms, so hearing that the Dallas Ebola patient was sent home is surprising.

    “We have to be, as clinicians, suspicious of what could possibly be serious and we have to ask the right questions,” he explained.

    Though, he said, there are no defining symptoms of Ebola in the beginning.

    “It’s like any infectious virus, illness. When it first starts maybe a mild fever, a headache, feeling bad, not appearing to be so serious,” he explained.

    That’s why asking for travel history, and making note, is vital.

    “The most important thing is asking the right questions. The physical exam is not so important. It’s asking for history.

    I’ve seen similar statements by other doctors. Texas law requires expert medical testimony to prove medical malpractice. That’s sometimes hard to find in a believable expert witness. I don’t think it would have been in this case, so I see why they settled.

    DRJ (a83b8b)

  54. 41. MD in Philly (f9371b) — 11/13/2014 @ 1:56 pm

    whether or not Emory would have received the patient in transfer at the time.

    I think that was a big question.

    I have no reason to think cost was an issue. If cost was the issue, the faster they got him out of the hospital and somewhere else would have been the right thing to do, as no one wanted to go to that hospital as long as “the Ebola patient” was there.

    The cost of transfer. And I agree it was more to save the hospital, or to prevent further transmission that they transferred the nurses – yet there are obvious differences in palliative care and the thing that they said that learned was that maintaining body electrolytes etc = palliative care that is – was extremely important in survival.

    All of this is speculation form a distance. I maintain, as I said before, that unless there was some specific event that could be pointed at that we have no idea of, there was no obvious malpractice simply because he didn’t survive. Like I also said before, perhaps the fact that he did not have the correct blood type to get a transfusion from Brantley was the most important factor in his care, but we don’t and will likely never know.

    We don’t know how the care was different at Emory. Even for blood transfusions, well there was more than one or two ebola survivors in the world. Maybe not in the Unoted States, but in the world.

    Sammy Finkelman (ae0b12)

  55. I agree with earlier comments that this will be paid by insured patients and cash patients. My experience is that Dallas hospitals, especially, charge paying customers more to compensate for non-paying and Medicare/Medicaid patients. The insurance companies help lower the payments but they still cost more than the government pays.

    Let me give you this example from my family (I think I’ve told this here before so I apologize to anyone who’s already heard it):

    Our son was very sick. He was treated for 1 week in our small-town hospital at a cost of $15,000. He was transferred to a larger town’s hospital for 1 week and received the same care and tests at a cost of $20,000. He was then transferred to a Dallas hospital where (again) they did the same tests and care for 1 week at a cost of $35,000. We finally went to Mayo Rochester where he had the same care and tests for 1 week at just under $6,000. I don’t know what was more surprising — that the hospitals never trusted the tests done by other hospitals, or that the prices were so different.

    DRJ (a83b8b)

  56. “Liberia says” is right up there with “Glenn Beck says” in my book.

    carlitos (c24ed5)

  57. Sammy,

    This report says the Dallas hospital and the CDC, along with Duncan, agreed he would stay in Dallas for treatment. At the time, the CDC’s official position was that any hospital could treat ebola. If true, the lesson is never believe the CDC.

    DRJ (a83b8b)

  58. ” there must have been a reason why your patient had esophageal varicose,”

    He had a thrombosed portal vein from a case of neonatal oomphalitis and had had bleeding varices since he was a baby. He had had a failed shunt at age 4 and I got him at age 8. I took care of him avoiding surgery, since he had no patent portal system vein we could find and I hoped that, as he grew, he would develop better collateral veins. Finally at 18 he came in bleeding into shock. I operated on him and found an unnamed vein along the bottom of his pancreas. I hooked it to his left renal vein and he never bled again.

    He had become an alcoholic and I prescribed Antabuse for him and sent him around to other specialists who would see him because I referred him. Most docs in my area don’t accept Medicaid, which they were. I helped him get jobs and the like. He was a little dull mentally. Finally at age 24 he was having frequent pulmonary problems and I sent him to a Pulmonary doc who made the diagnosis. That was right before I retired in 1993.

    I didn’t want to get into the long story but it was quite an adventure. Too bad it ended that way. I never learned what became of him after.

    Mike K (90dfdc)

  59. I am not sure which is more frustrating about Sammah – the things that he claims to be true that simply aren’t so, or the things he claims to be unknown that are absolutely known.

    JD (fb69bb)

  60. “…oomphalitis…”

    This should be a fun medical condition. But it doesn’t seem like it.

    Birdbath (3be0e2)

  61. You’re funny, narciso. Klain, not so much.

    DRJ (a83b8b)

  62. Thanks for that info Mike K. It sounds like he had quite a doctor for awhile, and his reason for varices was not at all among the more likely reasons.

    Now,
    never let the facts get in the way of rampant speculation.

    Since we do not know some specifics after many different reports, let me give three scenarios:
    1) Duncan comes to ER, says he was exposed to someone with Ebola 2 weeks previous, has temp of 101, is prescribed antibiotics and sent home.
    => that would be malpractice, except if the standard is “willful and wanton” disregard, and even then probably so
    2) Duncan comes to ER, has temp of 100.1 which is (was?) lower than the CDC recommended cut-off, and denies any exposure to Ebola, even though he admits being from West Africa.
    HINT- he has no more risk factors than anyone else allowed to come into our country from Liberia
    IMO- sending him home with this scenario I do not think would be malpractice as it would be according to the recommended standard of care.
    But I would have wanted to go beyond standard of care with a high index of suspicion with any fever, and my suggestion of admission would have been denied by utilization review if he had insurance as having insufficient reason for admission.
    3) Something in between.

    After all of the reports I have read, having little idea which were most accurate, it seems to me that scenario #2 was closest. Even if the Doc had received communication directly or through the nurse that he had been in West Africa, if he denied contact with anyone with Ebola, and his fever was so freaking low as to be below the CDC recommendation to consider Ebola, how could he have been held liable for malpractice when he had practiced according to acceptable standards?

    And “palliative care” and “supportive care” refer to completely different things, Sammy. People with Ebola (at first, anyway) get supportive care.

    And you can get anyone to be a 20/20 hindsight back-seat driver among doctors as anyone else.

    The idea that a person sick with a fever having been exposed to someone with Ebola being turned away does sound like malpractice on the face of it, but when you find the fever was minimal and the history of exposure to Ebola was denied, then it becomes much more questionable.

    But even then, I would contend that there is no documented medical proof that delaying care for 2 days necessarily lead to his death, and I would also contend that the bigger concern would have been further unnecessary exposure of family and others.

    MD in Philly (f9371b)

  63. The records released by the family reportedly say Duncan had a 103 degree fever on his first ER visit, the one where they sent him home with antibiotics:

    The man, Thomas Eric Duncan, 42, had a high fever — his temperature was 103 degrees — during his four-hour visit to the emergency room of Texas Health Presbyterian Hospital on Sept. 25, according to 1,400 pages of medical records that Mr. Duncan’s family provided to The Associated Press. Mr. Duncan reported severe pain, rating it an eight on a scale of one to 10. His fever was marked with an exclamation point in the hospital’s record-keeping system, The A.P. reported.

    DRJ (a83b8b)

  64. Of course, initially the hospital said his temperature was much lower — 100.1 degrees. But the hospital’s conflicting statements don’t help its case and, to me, only make it look worse.

    DRJ (a83b8b)

  65. Thanks for the additional info, DRJ.
    All I can say is what I said, and that I will not make a final decisions based on what the NYT says (this time).

    If indeed he had a fever of 103, and still denied contact with anyone with Ebola, then we are in scenario #3.
    And yes, not having one’s story straight never looks good.

    MD in Philly (f9371b)

  66. probably, MD, the hospital did not cover itself in glory, yet following the available protocols was less than helpful, remember the talking point was he was just visiting relatives

    narciso (ee1f88)

  67. Why did the hospital settle? It’s true we don’t know all the facts but there’s one important fact we do know: The hospital published a full page letter in the Dallas Morning News apologizing for its mistakes in caring for Duncan and for its failures in Ebola preparedness. That is admissible in court, and it would be important to a jury. I think most jurors would consider that letter an admission of liability and the only remaining issue would be measuring damages. The hospital would probably be safer agreeing with the family on damages, instead of leaving it up to a jury.

    DRJ (a83b8b)

  68. I don’t feel sorry for the hospital, anymore. Even its apology letter starts with a lie “… the fact that Mr. Duncan had traveled to Africa was not effectively communicated to our team.” No, Mr. Duncan had not traveled to Africa — he had come to the United States from Africa. I stopped reading right there because I don’t expect the rest of the letter to be any less mental pollution. Let Texas Presbyterian suffer whatever it deserves, and everybody do their best not to have to go through its doors.

    nk (dbc370)

  69. yes, DRJ the letter was part and parcel of Dallas Presbyterian’s flawed strategy, they were hamstrung by a whole host of obstacles, the failure to effectively diagnose the disease, any effective containment strategy, et al

    narciso (ee1f88)

  70. So Guido gets arrested. He calls his lawyer, and his lawyer tells him, “I’m on my way. Until I get there, keep your mouth shut and don’t make any statements to the police”. When he gets there, he finds Guido in the interrogation room, with his hands cuffed behind his back. He asks the detective, “Do we need the handcuffs?” and the detective uncuffs Guido. He then asks Guido, “Did you talk?” And Guido says, “How could I? They had my hands cuffed behind my back”.

    nk (dbc370)

  71. The apologizing thing is interesting. I think in general, it is the advice of risk management people to tell docs not to apologize because it seems to be an admission of wrongdoing as you suggest, DRJ.
    But often the anger of a patient is more at what they perceive as an uncaring attitude by a doctor or his/her staff, and a heart-felt apology may be a communication that prevents a lawsuit, even though it may seem to sink the defense in legal proceedings.
    And then there is the thought that one’s interpersonal behavior should not be driven primarily by legal advice.

    In any event, I think what the hospital did in public statements and in settling was more the result of their calculated cost-benefit analysis than any admission of malpractice by the docs, and IMO a clear determination of that is difficult after multiple conflicting reports of specific details.

    MD in Philly (f9371b)

  72. “risk management people”

    They call the hospital lawyers “quality control” up here. 😉 In a Chinese factory, “quality control” is what determines whether the product gets packaged and sold, or recycled. Nice system we have, right, where the lawyers are “quality control” in a hospital? Or even “risk management”?

    nk (dbc370)

  73. We got snow last night, nk, and some of it was still on the ground this am.
    I did some painting outside yesterday as the weather man said it wasn’t supposed to precipitate until later than it did, and stay above 35 until this am. we’ll see if it holds.
    How cold, windy, and snowy is the windy city today?

    MD in Philly (f9371b)

  74. A little bit colder, around 30, light wind, light flurries, cloudy with breaks, temperatures slowly climbing to mid-30s tomorrow, to mid-40s by Wednesday. I’ll have a better idea of overall conditions if the girls going to the tavern are still wearing micro-minis this evening.

    nk (dbc370)

  75. The much more interesting legal claims, to me, would be those which might potentially be brought by Nina Pham or Amber Vinson. Their direct claims against their own employer (the hospital) will be complicated and in some ways probably preempted by their workers compensation rights; and their potential claims against the CDC or other governmental agencies which misled or underprepared the hospital will be complicated by the Federal Tort Claims Act.

    But any claim by someone like Duncan (or his survivors & family) who contracted the disease in the field is going to be fundamentally different than a claim brought by or through an infected healthcare worker. The most obvious difference, but far from the only important difference, has to do with proximate causation: Even on the very first day he presented at (and was turned away from) the ER, his chances of survival were already terribly compromised, and a tort defendant can argue with considerable force that nothing they did or could have done would have saved him. There are ways to sidestep that argument at least in part, but it’s still a huge part of the legal landscape in a claim by a patient like Duncan.

    Beldar (fa637a)

  76. DRJ: I hadn’t seen that public letter from the hospital. I’m sure to your eyes, as mine, it shows signs of being carefully vetted by the hospital’s lawyers beforehand, probably in a tug-of-war between them and the hospital’s PR consultants. But there’s no doubt that it would have been admissible in a later court case, so it’s reasonable to assume that the concessions contained in it represent the hospital’s (and its lawyers’) careful evaluation of what they’d have to concede early on in litigation, so they might as well concede it up front to get whatever PR benefit they could from that, and take their lumps in the resulting settlement negotiations. In those negotiations, their lawyers would still have put on a good game face, and acted as though they were sure they could win any lawsuit regardless of such PR statements. But overall I’m quite sure that Mr. Duncan’s family’s lawyers were glad to have that letter in-hand while they argued.

    Beldar (fa637a)

  77. Claims Department –> Litigation Department –> Risk Management Department –> Quality Control Department –> Quality Control/Quality Assurance Department. These actually may be, and should be, more than cosmetic changes, but often that’s all they are.

    Beldar (fa637a)

  78. The ebola patient (a surgeon from Sierre Leone) taken to the Unoted states has died. It took too long for his wife to arrange his transportation.

    Sammy Finkelman (a248bd)

  79. General ebola update: The World Health Association is torn between saying things are still bad in Liberia – maybe it moeved to the countryside – and takeing credit for the decline. Preswident Obama says he still wants the $6.2 billion.

    The number of new cases in Liberia in the week of November 3-9 was 97 – probably less the following week. The Presddient of Liberia said last week that she hoped to have it eliminated by Christmas.

    In Sierre Leone meanwhile while the situation is imporiving in eastern Sierre Leone it is very bad in and around the capital of Freetown. 5,000 cases but I am not sure what tjat nunmber refers to.

    It’s also not getting better in Guinea, and twp cases (one contained) have come to Mali. The border is open, with people only being chewcked for temperature.

    One early problem that caused the outbreak was this malicious libel that someone wanted dead people for their organs.

    Sammy Finkelman (a248bd)


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