<p>I don’t know who WILL pay, but I think that the federal government should budget for the costs of containing the outbreak (versus treating the patients).
I think it should also budget for some of the costs of treating, separately.
The last thing we want is Ebola infected people delaying treatment out of fear it might bankrupt their families.</p>
<p>His relatives are likely not responsible. This is another uninsured case. Under federal law, the ER doesn’t have to do everything under the sun for a patient. The rules are about stabilizing their condition. Obviously with a communicable disease there are other public health requirements, but they wouldn’t have to obtain experimental drugs for a person who just walks into the er. </p>
<p>I doubt that ordinary US citizens would have gotten the experimental drugs, insured or not. The aid workers who received the experimental drugs were not treated as ordinary citizens would have been. I saw on the news that they have no more doses of these drugs available, so how could the hospital give him what they did not have. Additionally, it is not so easy to just start dispensing experimental drugs to patients - even if they are likely to die. Yes perhaps there is some ambulance chaser willing to take this case, but I doubt that they could prove that if he was admitted a couple of days sooner it would have helped him. </p>
<p>
</p>
<p>Anyone who was exposed to him in the days after he was sent home from the ER and subsequently becomes infected will likely sue. </p>
<p>There are many differences between the patients that were treated at Emory and Duncan, from the beginning. Emory was prepared for them. They were transported on a plane alone with a crew that had taken precautions via a military air force base to an isolation unit with trained staff. They were given an experimental vaccine, which at the moment I believe is not available. The treatment worked, but it could have gone the other way.</p>
<p>Duncan, on the other hand, arrived in this country on a commercial plane, did not disclose his exposure, and so potentially exposed many people to a serious disease. He went to the ER completely unknown to the hospital staff, who did not treat him as a special patient because they had no idea at the time. A busy ER sees a lot of people with non specific virus symptoms. There is no room ( or reason) in the hospital to admit all of them. Perhaps this is the biggest mistake- not relaying the info that he arrived from an area where Ebola is rampant, but that is not the mindset of health care workers in the US to assume someone has Ebola. The majority of patients with his symptoms in the US do not have Ebola ( thankfully) and they are not going to think of this first.</p>
<p>Duncan faced a certain death if he stayed in his home country. I think it was wrong to lie and expose others, but it is understandable that he wanted a chance to live and resorted to desperate actions. The hospital made an error by sending him home, but in context, it wasn’t out of line for the usual illnesses that they see in their ER. Once admitted, the hospital did what they could. However, Ebola has a high fatality, and unfortunately the odds were not in Duncan’s side. </p>
<p>Duncan did not KNOW that he “faced certain death if he stayed in his home country”. He was symptom -free when he traveled to the US. Therefore he was not contagious while traveling on the air plane. And according to news reports, the ER staff was aware that he had been in West Africa. And sent him home.</p>
<p>That’s a little unclear at this point and will probably stay unclear since there are people telling several versions of the backstory and have been since the very first day. But who cares? What he knew or didn’t know has nothing to do with how the hospital did or didn’t treat him. </p>
<p>“That’s a little unclear at this point and will probably stay unclear since there are people telling several versions of the backstory and have been since the very first day. But who cares? What he knew or didn’t know has nothing to do with how the hospital did or didn’t treat him.”</p>
<p>I was responding to pennylane’s comment that It was wrong of Duncan to lie and expose others, and to “resort to desperate actions”. It doesn’t appear that he did - and why would he knowingly expose his family and friends?</p>
<p>Well, none of those people were his family or friends except the girlfriend. Everyone else was a complete stranger. I have no idea what he knew or didn’t know and don’t really think anyone else does, either. Including Louise. </p>
<p>“His relatives are likely not responsible.”</p>
<p>Assuming his relatives aren’t responsible for the bill then why should they be able to sue the hospital? After listening to Jesse Jackson talking I’m pretty sure some sort of suit is going to be filed.</p>
<p>This seems like a clear cut case of “What does it matte? This is ebola.”</p>
<p>Duncan got hundreds of thousands of dollars in free treatment, which none of the ‘relatives’ will ever pay for. Moreover, many health professionals and hospital staff put themselves at risk to care for him. To sue the hospital shows real ingratitude for all that. </p>
<p>
</p>
<p>If they survive…</p>
<p>
</p>
<p>You cannot know any of this. There is, in fact, significant evidence to the contrary.</p>
<p>My sister-in-law is a former hospital nurse who evaluates cases for malpractice lawyers.</p>
<p>Question 1: Did the doctor follow standards of care? In this case, yes, though they could have diagnosed him two days earlier. Anything experimental or not FDA approved is outside of the standards.</p>
<p>Question 2: Did the mistakes lead directly and provably to the death or disability? In this case, no, as he already had Ebola and was going to most likely die no matter what they did.</p>
<p>Even for clear cases of malpractice the trial outcome is 75% in favor of the doctors. The only reason a lawyer would take on this case would be grandstanding, a chance to get his name associated with a high profile situation. If one does, I hope the hospital goes to the mat on it as it would be a terrible precedent for treating infectious disease.</p>
<p>A lot of people are uninsured, and I really hope nothing will be done by the hospital that will inhibit uninsured people from going to an ER if they think they might have a serious communicable disease like Ebola. If they avoid the ER out of fear of getting a big bill, the disease will only spread faster.</p>
<p>Maybe there needs to be some sort of financial immunity for victims of Ebola. Public health has to trump the cost of their care.</p>
<p>I wonder if the people who were more or less incarcerated at the Carville leprosarium were charged for what care they received. (I read an autobiography of someone who was there years ago: very interesting.) Similarly, what about patients during the great influenza epidemic?</p>
<p>Answer to OP question is simple. All of us.</p>
<p>
</p>
<p>As a general rule, no one is required to stay at a hospital, so people who don’t want a big bill can go home any time they want. This case is different, however, due to the nature of the disease. The hospital could not allow him to leave for public health reasons, so I’m going to guess that there is a special fund for these kinds of cases.</p>
<p>Texas trauma centers have access to a fund that reimburses them for care which they give to patients who don’t pay. Treating patients who don’t and/or can’t pay is nothing new, and most states have a fund like this. It’s called the Uncompensated Care Fund. The theory is that since the EMTALA law requires hospitals to accept ER patients without regard to whether they can pay or not, then the state has an obligation to defray the cost. I know of one hospital that had to care for a visitor from Greece who was in the hospital on a ventilator for 6 months, and the patient couldn’t pay a dime. I suspect that, even given the extraordinary expense of this case, the bottom line cost to the hospital and to the state fund won’t be material. </p>
<p>I apologize if I made assumptions about Mr. Duncan that are not fact. I have not read every detail about the case, but I thought that before he left, he had helped a very sick woman get to the hospital and that woman died of Ebola. I assumed that he would consider that this was an exposure when he boarded and airplane to the US. </p>
<p>Assuming that Mr. Duncan contracted Ebola before he came to America, his chances of survival were slimmer had he not come here. I also thought there was some screening being done in Liberia before getting on a plane that included questions about exposure, but I could be wrong about this. </p>
<p>In any case, whether he knew it or not, he did receive medical care here, at no cost to him. I think his best chance at survival was in the US. However, even with good care, the mortality of Ebola is so high, that it is astonishing to me that his family is trying to find blame for it. </p>