https://www.ajmc.com/focus-of-the-week/in-texas-ebola-case-was-patients-insurance-status-an-issue
In Texas Ebola Case, Was Patient's Insurance Status an Issue?

Mary K. Caffrey

As Texas health officials monitor 80 people for symptoms of the Ebola virus, the question arises: could this public health threat have avoided if the ER at Texas Presbyterian admitted the patient with the disease when it first had the chance?

Health officials are working to contain the spread of Ebola after learning that Thomas Eric Duncan, who traveled from Liberia to visit relatives in Dallas, became ill September 24. According to the Associated Press, Duncan began experiencing symptoms and told a nurse in the ER that he had arrived from West Africa, but he was sent home. The story of how that happened has evolved in the days since Duncan's diagnosis was announced. He returned on September 28 after his condition worsened and was admitted. News reports have since attributed the initial discharge to a problem with hospitals electronic health record system, saying that separate workflows for nurses and physicians kept the information from being shared.

Critics have questioned that decision and asked how Texas Presbyterian could not have had an infectious disease control protocol in place, with the Daily Kos asking in an editorial whether Duncan’s insurance status played a role in the ER staff’s decision. In the era of healthcare reform, with healthcare providers facing penalties for failing to provide quality care, the Texas Presbyterian case will provide an important test.

The Daily Kos editorial points out that a New York hospital in a similar circumstance in February went through an Ebola checklist and in 7 minutes had an infectious disease protocol in motion. The patient in that case turned out to not have the disease, but a crisis was averted. In Texas, a patient who admitted to being from Monrovia, Liberia, and having odd symptoms, was sent back to a neighborhood known for its high immigrant population.

Those now being monitored include the 12 to 18 people who first came into contact with Duncan — which federal health officials have said include 3 members of the ambulance crew that took him to the hospital, plus a handful of schoolchildren — as well as others with whom those persons were in contact, according to the AP.

Texas’ ongoing refusal to expand Medicaid under the Affordable Care Act means the state is among those with the highest shares of uninsured, according to the Kaiser Family Foundation.

The issue has come up in the current race for governor, with Republican Greg Abbott saying he would ask the federal government for Medicaid to give Texas additional money in the form of a block grant, with Democrat Wendy Davis chastising Republicans over the fact that Texans are paying tax dollars for Medicaid but low-income residents are getting nothing in return.

David Wright, regional director of the U.S. Centers for Medicare & Medicaid Services, wouldn't say if the hospital was under investigation. Wright said that in cases they do handle, federal investigators examine if a hospital complied with a "reasonable physician standard" in deciding whether to admit a patient with a potential medical emergency.

But the hospital's actions highlighted the threat of Ebola far from Africa.

"The scrutiny just needs to be higher now," said Dr Rade Vukmir, a spokesman for the American College of Emergency Physicians. Meanwhile, Duncan has been kept in isolation at the hospital since Sunday. He was listed in serious but stable condition.

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