Oct 10, 2014 5 min read

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 he was recently in Africa and displaying other symptoms that could indicate Ebola, the Liberian man who would become the only person to die from the disease in the United States 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 encompass 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 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 Sept. 20 and fell ill several days later.

When he first showed up at the hospital, the man complained of abdominal pain, dizziness, a headache and decreased urination. He 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 Sept. 28. That’s when he was admitted and swiftly put in isolation.

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 it was “conspicuous” all the white Ebola patients in the U.S. survived “and the one black man died.”

The documents also show a nurse recorded early in Duncan’s first hospital visit that he recently came to the United States from Africa, though he denied being in contact with anyone sick.

The Centers for Disease Control and Prevention alerted hospitals nationwide to take a travel history for patients with Ebola-like symptoms.

According to the records, Duncan was 45 when he died Wednesday. Relatives said he was 42. The discrepancy could not be immediately resolved.

The hospital said it made changes to its intake process and other practices “to better screen for all critical indicators” of Ebola.

Doctors who evaluated Duncan did not respond to messages left at their offices by the AP.

A spokeswoman for the Texas Department of State Health Services said the agency was considering investigating the hospital for compliance with state health and safety laws.

Dr. Amesh Adalja, an infectious-disease specialist at the University of Pittsburgh Medical Center who reviewed some of the records, said Duncan’s travel history was listed in a nursing notice but not in the physician’s note.

The patient’s 103-degree fever might warrant “a little more investigation,” Adalja said. A chart showed he did not arrive with a fever but left with one.

By Duncan’s second ER visit, the care was “impeccable,” the doctor said. Dallas physicians immediately signaled concern about Ebola and “spared no measure to try to keep him alive.”

After it became clear Duncan was suffering from Ebola, another option would have been to give him a transfusion from an Ebola survivor in the hopes antibodies in the blood could help him fight the disease.

But Duncan did not receive a transfusion because the blood types did not match, the hospital said.

Dr. Kent Brantly, the first American flown back to the United States for treatment of Ebola, confirmed that account, saying he spoke with a doctor caring for Duncan and was willing to donate blood. But their blood types were incompatible, he said Friday in an interview with Abilene Christian University’s alumni magazine.

The hospital repeatedly changed its account of what the medical team knew when it released Duncan from the emergency room early Sept. 26.

A few days later, on Sept. 30, it initially said Duncan did not tell the staff he was in Africa. On Oct. 1, it said Duncan’s nurse was aware of the Africa connection but did not share information with the rest of the medical team.

The next day, the hospital blamed a flaw in its electronic health-records systems for not making Duncan’s travel history directly accessible to his doctor.

A day later, on Oct. 3, the hospital issued a statement saying Duncan’s travel history was available to all hospital workers, including doctors, who treated him during his initial visit.