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Responses of Dr.

Joseph Meier
Q: We saw in a deposition you gave in 2004 that you said you taught in Los Angeles before you
went to med school? Can you tell us more about your time teaching?
A: I spent much of my time working in the alternative schools with kids that had been
expelled from high school for gang activities, drugs, etc. The structure was nontraditional,
and I had a lot of personal interaction with the kids. It was a great experience.
Q: We also saw you wrote scripts, poems and short stories? Can you share more details about
that writing (the genres you wrote about, who you worked for and whether your material ever
published)?
A: Nothing published. I did write a script for a Latin Christmas special for a friend. We
had a very talented musician to do the arrangement. Unfortunately, it was never done.
Q: What led you to leave teaching and writing, and get into emergency medicine?
A: I had always intended to go to medical school and had been set on Emergency Medicine
since high school. It was just a matter of timing. Going to the Mayo Clinic for school was a
great opportunity.
Q: What drew you to Texas and work at Texas Health in 2001?
A: I had a friend in medical school that was from this area.
Q: There was one civil lawsuit involving you and other physicians in the Dallas area. It stemmed
a 2001 tooth extraction. A woman said you were among those who did not diagnose her mouth
infection following the extraction. You denied the allegations in court records. You elaborated in
a deposition, saying that you couldnt examine her mouth because she was unable to open it; you
phoned an oral surgical specialist for advice before releasing the woman. The case eventually
settled in 2005. Is there anything more about that case that you want us to know or understand?
A: I was dismissed from the case and was not part of the settlement.
Q: You testified as an expert witness on behalf of doctors defending against malpractice cases,
you said in the deposition. Do you continue to testify as an expert witness? If so, how often do
you testify?
A: I did testify in a few cases years ago but have not done so since that time.
Q: Can you share with us more about your experience with Maxx Graphics LLC (ie, why you
launched it in 2002, its successes, its setbacks)? Why did you dissolve it in 2009?
A: Maxx Graphics was a venture I started with my wife. Initially, we designed software to
edit digital images and then parlayed into oil painting reproductions and portraits.

Overall, the company did not do well financially, but I do have a beautiful portrait of my
daughter as a result of the venture. So it was worthwhile.
Q: Was Sept. 25-26 (Thursday-Friday) your regular shift? How long was your shift? When did it
begin?
A: That is one of several shifts we all work. That particular shifted started at 10 p.m. and
ended at 5 a.m.
Q: How many patients were you treating at the same time you were treating Mr. Duncan? Was
that number typical?
A: There were several other patients. It was busy for a Thursday night, but not unusually
so.
Q: What training did Presbyterian and/or Texas Medical Resources give you for a potential Ebola
patient?
A: I was not aware of any specific training for Ebola.
Q: Did you receive the materials on Ebola (including CDC alerts from this summer) that
Presbyterian officials say they shared prior to Mr. Duncans care?
A: I do remember receiving the CDC email at the beginning of August.
Q: Prior to Sept. 25, was it typical for you as a physician to ask about a patients travel history?
Why or why not?
A: That would depend on the nature of the chief complaint.
Q: Was it typical for other physicians in the emergency department to do so? If not, can you tell
us which type of conditions would then warrant a physician in the ED to ask about a patients
travel history?
A: I really cant speak for other Emergency Physicians. Many have told me that their
approach would be similar to mine. In other words, it would likely depend on the nature of
the chief complaint.
Q: Is there a written policy at Presbyterian or Texas Medical Resources instructing ER
physicians to ask about travel history?
A: There is now. I am not aware of the existence of any policy prior to this case.
Q: Presbyterian officials, in materials to Congress, as well as Mr. Duncans medical records,
gave no indication you asked Mr. Duncan about his travel history. Did you ask Mr. Duncan about
Mr. Duncans travel history? If yes, what did Mr. Duncan say? If no, why did you not ask?

A: I have a general recollection of Mr. Duncan, but I don't recall the specifics of our
discussions. However, I routinely pair the recent travel question with the sick contact
question so it is likely that I did so in this instance. According to the medical records, Mr.
Duncan at least said no to the sick contact part.
Q: How did Mr. Duncan or his companion come to tell you that he was a local resident?
A: I don't recall the specifics of the discussion so I can only assume from a review of the
medical records that he made the comments to me or during triage.
Q: Presbyterian officials said the ER nurse knew Mr. Duncan had come from Africa, but that
information had not been verbally communicated to you as prompted by Presbyterians
electronic health record system. Do you now know why the nurse did not do so in this case?
A: It would be unfair to speculate after the fact, but our nurses are very good, and they
provide excellent care to our patients.
Q: Have nurses typically told you verbally about a patients travel history? Or are you, as an ER
physician, expected to review the EHR to find that information for yourself?
A: In the ER, it can occur both ways. Nurses typically bring doctors important or
medically significant information verbally. It's rare that travel history is medically
significant.
Q: Presbyterian officials said you had accessed portions of the EHR where the nurse had
recorded Mr. Duncans arrival from Africa, but it wasnt clear which information you had read.
Did you see the nurses documentation of Mr. Duncans Africa travel? If so, how did that
information factor into your diagnosis and evaluation? If not, why not?
A: No, I did not see it. Despite the way it may appear on the printed record, the travel
information was not easily visible in my standard workflow. This has now been modified
very effectively.
Q: How easy or difficult is it to use Presbyterians EHR system?
A: The system is very good, but it contains a lot of information. Like patients, medical
information must also be triaged.
Q: Did you enter the notes and information contained in the ED Physician Note section of Mr.
Duncans medical records?
A: I am responsible for the physician part.
Q: A CT scan of Mr. Duncans head was unremarkable. What was the intent of that scan? Did
that factor into your diagnosis of him having sinusitis? How so?

A: The CT scan was ordered because of his headache. Sinusitis is mostly a clinical
diagnosis, so the nasal congestion on physical exam along with his headache raised the
possibility of sinusitis.
Q: At one point in the ED Physician Note section of the medical records, it says Mr. Duncan was
negative for fever and chills. Why would it state that, given his temperature readings of 100.1
degree upon arrival and then elevated temperatures of 103.0 and 101.2 degrees?
A: That information comes directly from what the patient tells us.
Q: Mr. Duncans fever had elevated to 103.0 degrees some 35 minutes prior to discharge. Did
you know that prior to discharge? If so, what did you do with that information? If not, why not
(ie, is someone else required to tell you)?
A: I was unaware of a 103 degree temperature. It appears in the chart, but I did not see it.
At the time of discharge his temperature was 101.2.
Q: Would the temperature reading of 103.0 degrees have been valuable for you to know?
A: Given what little information I had, a 103 temperature would most likely not have
helped with the diagnosis of Ebola. Although, if it did not quickly improve, he could have
possibly been admitted to the hospital.
Q: Sixteen minutes after the fever hit 103.0, Presbyterian officials say you left a note that read,
Patient is feeling better and comfortable with going home. How did you come to conclude
that?
A: Most likely from asking the patient directly when I checked on him. I typically do an
exit interview which involves reviewing labs, scans, asking if they have any additional
questions, giving warnings, etc.
Q: In hindsight, would knowing Mr. Duncans travel history have changed your evaluation of
him in any way? If so, how? If not, why not?
A: If he told me he came from Liberia, this would have prompted me to contact the CDC
and begin an evaluation for Ebola, but the likelihood would have still been low since Mr.
Duncan denied any sick contacts.
Q: Texas Healths top clinical officer, Dr. Daniel Varga, testified to Congress that we did not
correctly diagnose Mr. Duncan. He added: Unfortunately, in our initial treatment of Mr.
Duncan, despite our best intentions and a highly skilled medical team, we made mistakes. He
also added: Where we fell short initially was in our ability to detect and diagnose EVD [Ebola
virus disease], as evidenced by Mr. Duncans first visit. Being the ER physician responsible for
Mr. Duncan and his initial diagnosis, how do you respond to Dr. Vargas remarks?

A: The ER functions as a unit with many moving parts. The hospital has a right to
acknowledge that mistakes were made. I certainly didnt take that personally. As a medical
team, we certainly would have liked to have made the diagnosis that night.
Q: Texas Healths CEO, Barclay Berdan, wrote in a letter to our community: On that visit to
the emergency department, we did not correctly diagnose his symptoms as those of Ebola. For
this, we are deeply sorry. He also wrote: Despite our best intentions and skilled medical team,
we did not live up to the high standards that are at the heart of our hospitals history, mission and
commitment. Being the ER physician responsible for Mr. Duncan and his initial diagnosis, how
do you respond to Mr. Berdans remarks?
A: Essentially the same as the previous question. As medical professionals we aspire to
perfection in the diagnosis and treatment of all our patients and have regrets when an
incorrect diagnosis occurs.
Q: Were sure youve seen the quotes or heard the TV statements from medical experts who
criticized your diagnosis and discharge of Mr. Duncan. Since you were in the unprecedented
position of being the first American ER doctor to see an Ebola case unannounced in an ER, how
would you respond to those experts?
A: It's very easy to make a diagnosis of any condition after the patients medical
evaluation confirms the final diagnosis. Unfortunately, such 20/20 hindsight is not available
to medical professionals caring for patients in real time.
Q: One expert in emergency care told us picking out the nations first Ebola case here was like a
needle in a hayfield. How would you describe the challenge of handling the first unannounced
case to come through an American ER?
A: It can be a challenge to diagnose disease and illness. As doctors, we are trained to work
from a set of differential diagnoses and seek to rule out until we hopefully reach the correct
diagnosis. The more rare a disease or condition, the more likely it is that it will not be on an
initial differential list. Since this first case, we have better protocols in place, but, even then,
it can still be very difficult to diagnose something so rare. We do the best we can to get it
right based on our training and experience.
Q: In hindsight, would you do anything differently?
A: Hindsight is always 20/20 so it's virtually impossible to answer this question. Based on
the information I had at the time, I believe that the care and treatment were appropriate.
Q: How has dealing with this experience as the first U.S. ER doctor to see an Ebola case
unannounced been for you personally and professionally?
A: A little bit like getting struck by lightning, but mild in comparison to what Mr.
Duncans family has gone through in losing a loved one to Ebola.

Q: What can other ER physicians in the U.S. learn from your experience treating the nations
first person to arrive at an ER here?
A: That certain infectious diseases pose a very real threat, not only to the patient, but also
to the caregivers and the community at large.
Q: What can the public learn from your experience from this historic case?
A: There are many lessons for many people; however, one that stands out is that simple
habits such as good hand washing can go a long way toward preventing infections.
Q: What do you think the public should know, that we dont already know, about that initial visit
of Mr. Duncan or this case in general?
A: That the enemies are Ebola and infectious diseases in general not the caregivers who
are on the front line of diagnosis and treatment of patients.
Q: Is there anyone you think we should try to interview, such as one of your colleagues or a
mentor?
A: Although I've had many colleagues offer to back me up and support my care and
treatment, I prefer not to publicly involve others in this matter.
Q: Is there any question you think we should ask Texas Health or Texas Medical Resources?
A: No.
Q: Are you still working at Presbyterian in Dallas? For any Texas Health hospital? For Texas
Medical Resources?
A: Yes.