Josephus Weeks; National Nurses United
October 15, 2014
The Dallas Morning News
On Friday, Sept. 25, 2014, my uncle Thomas Eric Duncan went to Texas Health Presbyterian Hospital Dallas. He had a high fever and stomach pains. He told the nurse he had recently been in Liberia. But he was a man of color with no health insurance and no means to pay for treatment, so within hours he was released with some antibiotics and Tylenol.
Two days later, he returned to the hospital in an ambulance. Two days after that, he was finally diagnosed with Ebola. Eight days later, he died alone in a hospital room.
Now, Dallas suffers. Our country is concerned. Greatly. About the lack of answers and transparency coming from a hospital whose ignorance, incompetence and indecency has yet to be explained. I write this on behalf of my family because we want to set the record straight about what happened and ensure that Thomas Eric did not die in vain. So, here’s the truth about my uncle and his battle with Ebola.
Thomas Eric Duncan was cautious. Among the most offensive errors in the media during my uncle’s illness are the accusations that he knew he was exposed to Ebola – that is just not true. Eric lived in a careful manner, as he understood the dangers of living in Liberia amid this outbreak. He limited guests in his home, he did not share drinking cups or eating utensils.
And while the stories of my uncle helping a pregnant woman with Ebola are courageous, Thomas Eric personally told me that never happened. Like hundreds of thousands of West Africans, carefully avoiding Ebola was part of my uncle’s daily life.
And I can tell you with 100 percent certainty: Thomas Eric would have never knowingly exposed anyone to this illness.
Thomas Eric Duncan was a victim of a broken system. The biggest unanswered question about my uncle’s death is why the hospital would send home a patient with a 103-degree fever and stomach pains who had recently been in Liberia – and he told them he had just returned from Liberia explicitly due to the Ebola threat.
Some speculate that this was a failure of the internal communications systems. Others have speculated that antibiotics and Tylenol are the standard protocol for a patient without insurance.
The hospital is not talking. Until then, we are all left to wonder. What we do know is that their error affects all of society. Their bad judgment or misjudgment sent my uncle back into the community for days with a highly contagious case of Ebola. And now, officials suspect that a breach of protocol by the hospital is responsible for a new Ebola case, and that all health care workers who care for my uncle could potentially be exposed.
Their error set the wheels in motion for my uncle’s death and additional Ebola cases, and their ignorance, incompetence or indecency has created a national security threat for our country.
Thomas Eric Duncan could have been saved. Finally, what is most difficult for us – Thomas Eric’s mother, children and those closest to him – to accept is the fact that our loved one could have been saved. From his botched release from the emergency room to his delayed testing and delayed treatment and the denial of experimental drugs that have been available to every other case of Ebola treated in the U.S., the hospital invited death every step of the way.
When my uncle was first admitted, the hospital told us that an Ebola test would take three to seven days. Miraculously, the deputy who was feared to have Ebola just last week was tested and had results within 24 hours.
The fact is, nine days passed between my uncle’s first ER visit and the day the hospital asked our consent to give him an experimental drug – but despite the hospital’s request they were never able to access these drugs for my uncle. (Editor’s note: Hospital officials have said they started giving Duncan the drug Brincidofovir on October 4.) He died alone. His only medication was a saline drip.
For our family, the most humiliating part of this ordeal was the treatment we received from the hospital. For the 10 days he was in the hospital, they not only refused to help us communicate with Thomas Eric, but they also acted as an impediment. The day Thomas Eric died, we learned about it from the news media, not his doctors.
Our nation will never mourn the loss of my uncle, who was in this country for the first time to visit his son, as my family has. But our nation and our family can agree that what happened at Texas Health Presbyterian Hospital Dallas must never happen to another family.
In time, we may learn why my uncle’s initial visit to the hospital was met with such incompetence and insensitivity. Until that day comes, our family will fight for transparency, accountability and answers, for my uncle and for the safety of the country we love.
[Josephus Weeks, a U.S. Army and Iraq War veteran who lives in North Carolina, wrote this piece exclusively for The Dallas Morning News. Reach him at email@example.com. ]
Photo credit: National Nurses United
Statement by RN’s at Texas Health Presbyterian Hospital as provided to National Nurses United
October 15, 2014
National Nurses United
This is an inside story from some registered nurses at Texas Health Presbyterian Hospital in Dallas who have familiarity with what occurred at the hospital following the positive Ebola infection of first the late Thomas Eric Duncan and then a registered nurse who cared for him Nina Pham.
The RNs contacted National Nurses United out of frustration with a lack of training and preparation. They are choosing to remain anonymous out of fear of retaliation.
The RNs who have spoken to us from Texas Health Presbyterian are listening in on this call and this is their report based on their experiences and what other nurses are sharing with them. When we have finished with our statement, we will have time for several questions. The nurses will have the opportunity to respond to your questions via email that they will send to us, that we will read to you.
We are not identifying the nurses for their protection, but they work at Texas Health Presbyterian and have knowledge of what occurred at the hospital.
They feel a duty to speak out about the concerns that they say are shared by many in the hospital who are concerned about the protocols that were followed and what they view were confusion and frequently changing policies and protocols that are of concern to them, and to our organization as well.
When Thomas Eric Duncan first came into the hospital, he arrived with an elevated temperature, but was sent home.
On his return visit to the hospital, he was brought in by ambulance under the suspicion from him and family members that he may have Ebola.
Mr. Duncan was left for several hours, not in isolation, in an area where other patients were present.
No one knew what the protocols were or were able to verify what kind of personal protective equipment should be worn and there was no training.
Subsequently a nurse supervisor arrived and demanded that he be moved to an isolation unit- yet faced resistance from other hospital authorities.
Lab specimens from Mr. Duncan were sent through the hospital tube system without being specially sealed and hand delivered. The result is that the entire tube system by which all lab specimens are sent was potentially contaminated.
There was no advance preparedness on what to do with the patient, there was no protocol, there was no system. The nurses were asked to call the Infectious Disease Department. The Infectious Disease Department did not have clear policies to provide either.
Initial nurses who interacted with Mr. Duncan nurses wore a non-impermeable gown front and back, three pairs of gloves, with no taping around wrists, surgical masks, with the option of N-95s, and face shields. Some supervisors said that even the N-95 masks were not necessary.
The suits they were given still exposed their necks, the part closest to their face and mouth. They had suits with booties and hoods, three pairs of gloves, no tape.
For their necks, nurses had to use medical tape, that is not impermeable and has permeable seams, to wrap around their necks in order to protect themselves, and had to put on the tape and take it off on their own.
Nurses had to interact with Mr. Duncan with whatever protective equipment was available, at a time when he had copious amounts of diarrhea and vomiting which produces a lot of contagious fluids.
Hospital officials allowed nurses who had interacted with Mr. Duncan to then continue normal patient care duties, taking care of other patients, even though they had not had the proper personal protective equipment while caring for Mr. Duncan.
Patients who may have been exposed were one day kept in strict isolation units. On the next day were ordered to be transferred out of strict isolation into areas where there were other patients, even those with low-grade fevers who could potentially be contagious.
Were protocols breached? The nurses say there were no protocols.
Some hospital personnel were coming in and out of those isolation areas in the Emergency Department without having worn the proper protective equipment.
CDC officials who are in the hospital and Infectious Disease personnel have not kept hallways clean; they were going back and forth between the Isolation Pod and back into the hallways that were not properly cleaned, even after CDC, infectious control personnel, and doctors who exited into those hallways after being in the isolation pods.
Advance preparation that had been done by the hospital primarily consisted of emailing us about one optional lecture/seminar on Ebola. There was no mandate for nurses to attend trainings, or what nurses had to do in the event of the arrival of a patient with Ebola-like symptoms.
This is a very large hospital. To be effective, any classes would have to offered repeatedly, covering all times when nurses work; instead this was treated like the hundreds of other seminars that are routinely offered to staff.
There was no advance hands-on training on the use of personal protective equipment for Ebola. No training on what symptoms to look for. No training on what questions to ask.
Even when some trainings did occur, after Mr. Duncan had tested positive for Ebola, they were limited, and they did not include having every nurse in the training practicing the proper way to don and doff, put on and take off, the appropriate personal protective equipment to assure that they would not be infected or spread an infection to anyone else.
Guidelines have now been changed, but it is not clear what version Nina Pham had available.
The hospital later said that their guidelines had changed and that the nurses needed to adhere to them. What has caused confusion is that the guidelines were constantly changing. It was later asked which guidelines should we follow? The message to the nurses was it’s up to you.
It is not up to the nurses to be setting the policy, nurses say, in the face of such a virulent disease. They needed to be trained optimally and correctly in how to deal with Ebola and the proper PPE doffing, as well as how to dispose of the waste.
In summary, the nurses state there have been no policies in cleaning or bleaching the premises without housekeeping services. There was no one to pick up hazardous waste as it piled to the ceiling. They did not have access to proper supplies and observed the Infectious Disease Department and CDC themselves violate basic principles of infection control, including cross contaminating between patients. In the end, the nurses strongly feel unsupported, unprepared, lied to, and deserted to handle the situation on their own.
We want our facility to be recognized as a leader in responding to this crisis. We also want to recognize the other nurses as heroes who put their lives on the line for their patients every day when they walk in the door.
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