Dallas hospital caught in spotlight in Ebola case

DALLAS (AP) — Five things to know about Texas Health Presbyterian Hospital Dallas, where the first U.S.-diagnosed Ebola patient died:

EMERGENCY ROOM WEAKNESSES

Presbyterian's emergency department failed to meet five national benchmarks of patient care, according to the hospital's most recent report to the federal government. The benchmarks cover how long it takes for patients to be seen and treated in ERs, and many experts say failure to meet them could indicate larger problems. On its website, the hospital itself says long waits could indicate understaffing or overcrowding. The hospital's ER patients waited 44 minutes on average before their first contact with a health care professional, 50 percent longer than state and national averages. They spent more than five hours in the ER, on average, before being admitted, more than an hour longer than average. Hospital spokesman Wendell Watson said: "Wait time is only one component of patient care and patient experience."

EBOLA PATIENT'S SITUATION

Thomas Eric Duncan first arrived at the hospital Sept. 25 complaining of abdominal pain, a severe headache, dizziness and nausea. He was discharged after a few hours and told to take antibiotics for a sinus infection. Two days later, he was rushed back to the hospital, where he later died of Ebola. Though an ER nurse recorded that Duncan had recently come from Africa, it's unclear if that information made it to the treating physician. Two doctors who reviewed Duncan's medical files for The Associated Press noted several potential warnings that apparently went unnoticed, including somewhat abnormal blood and urine test results that could have raised questions, particularly about kidney function. Those results, along with a fever that spiked at 103, might have indicated an infection, mild dehydration, the onset of diabetes, or nothing at all, they said. But that information combined with his travel history would have prompted them to consider the possibility of Ebola, they said.

PRESIDENT'S CHOICE

Overall, in the most recent metrics Presbyterian provided the government, the hospital met or exceeded 75 percent of 138 specific measures of care. It exceeded seven national benchmarks for strokes, earned perfect scores on a number of surgical measures and met six of 10 criteria on heart attacks, according to its data. It had nearly no infections from IV insertions, about 75 percent fewer than national benchmarks. The hospital was the choice of former President George W. Bush, who underwent a heart procedure there last year.

A TEAM WITH NO REPORTED PROBLEMS

Duncan was treated by a battery of doctors and nurses during his two Presbyterian visits. State records show that none of Duncan's 20 doctors have ever been disciplined, investigated by the Texas Medical Board for malpractice, had restrictions placed on their licenses or been linked to any criminal history. Dallas County court records show relatively few malpractice cases filed against the doctors. Some earned medical degrees from top schools, including Harvard and New York University. On average, they have about 14 years of experience. Among 32 nurses involved in Duncan's care, none whose records could be located had a disciplinary record. They averaged about six years of experience in Texas.

MOVING FORWARD

Presbyterian has conceded its Ebola training was not fully deployed and apologized for Duncan's initial misdiagnosis. As part of a public-relations push, it has hired a New York-based communications firm, recorded YouTube videos of nurses praising the facility and participated in a "PresbyProud" Twitter campaign. Watson says Presbyterian is "determined to be an agent for change across the U.S. health care system by helping our peers benefit from our experience."

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