DALLAS — Thomas Eric Duncan’s temperature spiked to 103 degrees during the hours of his initial visit to an emergency room — a fever that was flagged with an exclamation point in the hospital’s record-keeping system, his medical records show.
Despite telling a nurse that he had recently been in Africa and displaying other symptoms that could indicate Ebola — fever, sharp headache and abdominal pain — the Liberian man who would become the only person to die from the disease in the U.S. underwent a battery of tests and was eventually sent home.
Duncan’s family provided his medical records to The Associated Press — more than 1,400 pages in all. They chronicle his time in the ER, his urgent return to the hospital two days later and his steep decline as his organs began to fail.
In a statement issued Friday, Texas Health Presbyterian Hospital said it had made procedural changes and continues to “review and evaluate” the decisions surrounding Duncan’s care.
Duncan carried the deadly virus with him from his home in Liberia, though he showed no symptoms when he left for the United States. He arrived in Dallas on Sept. 20 and fell ill several days later.
When he first showed up at the hospital, the man reported severe pain — rating it an eight on a scale of 10. Doctors gave him CT scans to rule out appendicitis, stroke and numerous other serious ailments. Ultimately, he was prescribed antibiotics and told to take Tylenol, then returned to the apartment where he was staying with a Dallas woman and three other people.
“I have given patient instructions regarding their diagnosis, expectations for the next couple of days, and specific return precautions,” an emergency room physician wrote. “The condition of the patient at this time is stable.”
After Duncan’s condition worsened, someone in the apartment called 911, and paramedics took him back to the hospital on Sept. 28. That’s when he was admitted and swiftly put in isolation.
Duncan died Wednesday, almost two weeks after he first sought help. He was 45, according to the records. Relatives said he was 42. The discrepancy could not be immediately resolved.
Josephus Weeks, Duncan’s nephew, said his uncle’s care was “either incompetence or negligence.”
Either way “there is a problem, and we need to find the answer to it,” he said, adding that it was “conspicuous” that all the white Ebola patients in the U.S. survived “and the one black man died.”
Only a fraction of the documents are related to the first visit. Most are related to Duncan’s care after he was admitted to the hospital.
Dr. Amesh Adalja, an infectious-disease specialist at the University of Pittsburgh Medical Center who reviewed some of the records, said the care after Duncan’s second ER visit was “impeccable.” Physicians immediately signaled concern about Ebola and “spared no measure to try to keep him alive.”
The documents also show that a nurse recorded early in Duncan’s first hospital visit that he recently came to the U.S. from Africa, though he denied having been in contact with anyone sick. There was no indication in the paperwork that he was asked any follow-up questions about his travels.