Did You Hear the One About the Corporate Spy who Infiltrated the Nursing Home?

It’s always good to know who the bad guys are.

Imagine, for example, that you work at a nursing home. You see things that are wrong. Filthy conditions, neglect of residents, or worse, outright abuse of the elderly leading to injury. You decide to do something about it – take photos or a video perhaps – and turn them over to authorities. But before you can do that, management catches you and calls the cops, and you end up being the one arrested.

No way, right?

Amy Meyer: The Accused

Amy Meyer: The Accused

Well consider the case of Amy Meyer, a 25-year-old animal rescue worker in Salt Lake City, Utah. Concerned about deplorable conditions at the local meat packing plant, she stood outside their fenced property and took a cell phone video capturing what she believed to be a “downer” cow, i.e., sick or too weak to stand but still processed, for example, for school lunch programs.

Spotted by plant management, they called police. Seven – seven — squad cars showed up within minutes wanting to know what she was up to. They were investigating Amy pursuant to state “Ag Gag” laws. These laws make it a crime – in Utah you face 6 months jail — for employees to document abuse or to lie about their association with animal advocacy groups on job applications for farm or meat packing employment.

Though Amy was released at the scene – she was neither a plant employee nor on their property – the prosecutor’s office nonetheless later filed Ag Gag charges against her. So she had to hire a lawyer and attend several court hearings. Even though the charges were eventually dismissed, the life of an Accused is fraught with anxiety. Take a look, for example, at Amy’s encounter with police which she captured on her cell phone camera.

Why does Amy’s case matter? Because the conditions of factory farms and meat packing plants are notorious the world over for contaminating the meat with pathogens and making us sick. For example, a recent report in the Guardian of London documented a new form of MRSA present in 9 of 100 samples of pork randomly selected from 4 major grocery chains in the UK. This is consistent with research in the US that found significantly increased rates of MRSA in people who live near to or work on these factory pig farms in rural Pennsylvania.

So industry is fighting back with legislation – these Ag Gag laws – aimed at keeping prying noses out of their businesses, and locking you up in the process if necessary. And they mean it. Take a look at the “model legislation,” drafted by the business advocacy group, American Legislative Exchange Counsel, that’s being distributed to lobbyists and lawmakers across the country. It’s called The Animal and Ecological Terrorism Act, which criminalizes, among other things, “entering an animal or research facility to take pictures by photograph, video camera, or other means with the intent to commit criminal activities or defame the facility or its owner.” It also proposes the creation of a “terrorist registry” that would contain the names, addresses and photographs of those convicted under the proposed law.

Rep. Szoka: Spy Games

Rep. Szoka: Spy Games

Just last month, North Carolina – the second largest pork producer in the country – passed its version of an Ag Gag law, called “The Property Protection Act.” It establishes an employer’s civil right of action against any employee caught recording wrongdoing. The law calls this a – wait for it – breach of the person’s “loyalty to the employer,” and allows the employer to seek $5,000 per day in damages for every day that “violations” continue. In other words, the law is meant to bankrupt you.

So back to the nursing home story: The NC law isn’t restricted to factory farms or slaughterhouses. For example, according to the AARP, the law “applies to any business’s employees who may seek to reveal illegal and unethical practices … including nursing homes … group homes … daycare centers, and so forth.”

So let’s give the final word to the people who passed the NC law and hear how they justify it. Representative John Szoka, who sponsored the legislation, said it’s wrong to call it an Ag-Gag bill. “There are Ag-Gag bills out there, but this is not one of them,” he told VICE News. “It certainly does cover food processing,” he said, but “the aim of the bill is to stop corporate espionage — like someone stealing information from a rival business.”

Cheap Meat

An endangered species?

What’s the hidden cost?

The true cost of cheap meat – beef, chicken, and pork – is slowly making its way into the public consciousness. A recent example comes from the Guardian of London, published last Thursday.

The issue arose because newborn babies in a British hospital were found to have a deadly form of bacteria called Livestock Associated – MRSA (LA-MRSA) in their umbilical cords. This sparked an 18-month investigation by the Guardian to find out why. Their report revealed the following:

(1) This is not hospital-MRSA but a cousin of you will, animal-MRSA. This particular type of MRSA is now well established in UK farms. But how, exactly, it found its way to these babies remains a mystery.

(2) LA-MRSA has contaminated the British food supply. The Guardian tested 100 samples of pork from 4 major supermarkets and found 9 of them contained the MRSA, a result they say is “significant” and “shocking.”

(3) The root problem is our “insatiable demand for cheap meat.”

(4) To meet this demand – which grows with world population – we’ve turned to a different kind of farming altogether: the large-scale industrial farm. Such “farms”: (a) Pack their animals together (b) In unsanitary conditions – in filth (c) Wean piglets early so sows can be quickly impregnated again. The stress of early weaning increases the risk of disease (d) In an effort to prevent disease the use of antibiotics is rampant (e) The use of antibiotics has backfired: we are breeding “superbugs” resistant to the antibiotics – often the same ones we use  – which is fueling a “crisis” that’s part of the global problem of antibiotic resistance.

(5) The solution lies in more natural farming. Better conditions for the animals means less disease and less drugs. Inevitably, consumers will have to pay a higher price for their bacon and eggs and so on because the price of cheap meat is too dear.

The Guardian video report is well worth looking at because it contains undercover footage of the conditions the pigs are raised in. Think cows, chickens, and turkeys as well. You don’t have to be a scientists to understand why this is a hotbed for disease.

So, about that pork chop …

Earlier this month the Obama family changed its diet. It was announced that the Presidential Food Service will serve meats only from sources that follow responsible antibiotic use. (Presumably, though, there’s still this loophole.)

The White House concern is that the overuse of antibiotics in food animals is making us sick. While that’s true, there’s also a deeper story in play here, which the President has so far shied away from.

Others, however, not so much. As F. Scott Fitgerald once observed: “Let me tell you about the very rich. They are different from you and me … They have more money.”

The gutsy filmmaker and RFK Jr.

The gutsy filmmaker with RFK Jr.

And he could add, if he were around today, they make fearless films. A case in point is actress turned aristocrat turned activist Tracy Worcester (nee Ward, and sister of actress Rachel Ward).

Ms. Worcester (pronounced ‘Wuster’) spent 4 years exploring the global pig business, learning where and how pork is produced, and asking who wins and who loses. The result is a gem of a film, Pig Business, which makes its case this way:

(1) On Profit: Worcester uses Smithfield Foods of America as her case study. It’s the world’s largest pork producer (i.e., “farmer”) and processor. With annual sales of almost $12 billion dollars, it processes over 27 million pigs a year, and employs over 52,000 people in 15 countries.

And it slaughters more than hogs. Robert F. Kennedy Jr., who is featured in the film, explains: “Twenty years ago there were 27,500 independent hog farms in North Carolina. Today they’ve been completely replaced by 2,200 hog factories, 1,600 of them owned or operated by Smithfield Foods.”

(2) On Cruelty: On such a vast industrial scale, pigs are no longer seen as animals but as industrial raw material. “We’ve taken the lessons of industrial systems designed to build cars and machines and applied them to living creatures. It’s infinitely cruel and no civilized society ought to countenance it,” says Tom Garrett of the Animal Welfare Institute. As he speaks, the film shows acts of cruelty – briefly, but long enough – least among them, sows in narrow cages during gestation, too narrow to turn around in.

(3) On Health: We are paying the ultimate hidden price: we are getting sick. Because hogs produce 10 times the fecal waste that humans do, the gases coming out of a swine operation are a “toxic brew” of dust, bacteria, and antibiotics, all mixed together with the upshot that:

“One of the big weaknesses of the system is the heavy dependence on antibiotics, and the fact that causes infections that can spread from animals to humans such as … MRSA. [I]n the Netherlands for example, where the most research has been undertaken, 40% of their pigs are carrying a strain of MRSA that can be passed to humans,” says Richard Young, policy adviser to the highly regarded Soil Association in Britain.

Worcester’s film may be 6 years old but she gets it just right. For example, scientists reported last year that people living closer to industrial pig farms – which includes the workers – were 38 percent more likely to have a MRSA infection than people living farther away. And the people getting MRSA are not like the ones who used to get it; they’re not old and sick, they’re young and healthy.

This map of rural Pennsylvania, where the research was done, tells the story. Each red dot is the home of a person with a MRSA infection. The blue bits are the pig farms.

mrsamap

So the pigs lose. We, the consumer, lose. The small farmer and his family who are run out of business lose. The low wage worker the farmer is replaced with loses. And people living downwind or downstream of the industrial farm lose.

So who wins?

Worcester gets to the heart of this business model in her interview with Professor of Economics and former Central Banker, Bernard Lietaer, who says the driving force is return on investment: “The financial institutions are running the show. The governments are all indebted to them. In the U.S. a third of all contributions to political campaigns are done by the financial institutions. So there’s no chance that they would change the rules of the game.” (My emphasis.)

Tracy Worcerster’s film is important enough in its own right. But its central message also serves as a powerful explanation for how the deep structures of capital determine not just wealth and debt, but, in this case, disease as well. Simply put: International corporations too often produce an inferior product at a cheaper price and, in doing so, kick small business – i.e. families – to the curb, trampling over local communities, wreaking environmental havoc and consequent illness. What Mr. Kennedy describes in the film as the “Walmartization of America.”

As Ms. Worcester frames it in an interview with The Guardian of London: “The story of the pig industry was the epitome of what’s going on in every [industrial] sector.”

Compare, for example, the energy sector, where these scholars, among others, argue that “What is needed for climate stability is a systemic transformation based on … changed … corporate and financial power structures.” In other words, on this view, both MRSA and climate change are themselves symptomatic of a common and structural underlying “disease.”

This smart, elegant film, has met with legal opposition from industry players. Many copies, therefore, are truncated or watered-down. Here’s one, though, that seems to be the complete version.

A Tale of Two Studies

Two studies presented at a national medical conference in Orlando, Florida last month reported findings that suggest its authors might want to talk to one another.

A research team from the Ronald Regan UCLA Medical Center, led by Elise Martin, MD, wanted to know what would happen to hospital infection rates if they stopped using routine contact precautions.

Is the hospital gear doing its job?

Does wearing this gear really prevent the spread of infection?

Precautions are used for patients infected with bad bugs such as MRSA (methicillin-resistant staphylococcus aureus), and VRE (vancomycin-resistant enterococcus). They are placed in isolation and healthcare workers (HCW) wear personal protective equipment (PPE); such things as gowns, gloves, masks, and goggles, for each and every patient contact.

There are, however, downsides to the procedure: It’s time consuming for staff to don and doff the gear; patients report feeling that staff avoid them because of the inconvenience of having to put it on; the gear is expensive, for example, it costs the UCLA hospital over $650,000 every year; and besides, say the researchers, there isn’t a lot of data saying this approach works to begin with.

Dr. Elise Martin: The gear makes no difference

Dr. Elise Martin: The gear makes no difference.

So to find out if the effort is worth it, Dr. Martin and her colleagues simply suspended the contact precautions from July through to December last year, and checked the data to see whether there was any effect on hospital infection rates. The result: No difference; i.e., whether you use the contact precautions or not, the infections rates for MRSA and VRE remained the same!

Oh boy. That’s quite a finding because these precautions are SOP across the country, if not the world. And so her work has become a hot topic in the medical community; for instance, it remains the most read article on Medscape Infectious Disease a week after it was first posted.

But there’s a problem.

At that very same conference in Orlando, a research team from the Cleveland Veterans Affairs Medical Center in Ohio, led by Myreen Tomas, MD, presented their study on PPE, which looked at it from a different angle; namely, whether or not HCW are using the gear properly, and if not, do they become contaminated as a result, thereby increasing the risk of contaminating their patients.

Dr. Myreen Tomas: We're not using the gear properly

Dr. Myreen Tomas: We’re not using the gear properly.

The Tomas team say their results were “very surprising”: The skin and clothing of HCW became very contaminated during the removal of the gear; for example, when the PPE gloves were contaminated the workers themselves became contaminated 80% of the time, especially their hands, thus increasing the risk of spreading disease throughout the hospital.

Overall, gown and glove contamination resulted in HCW contamination 46% of the time. The problem, Dr. Thomas says, is improper use of the gear, especially when taking it off. For example, the gown should be removed away from the body, not over the head.

When the researchers made sure that the correct procedures were followed the contamination rate dropped dramatically – all the way down to 5%.

In other words, according to this study, contact precautions do work – if they’re done right.

And there’s the rub. Because outside of the controlled environment of a study, where researchers are there to tell the HCW if they’re donning and doffing the equipment properly, the real word is very demanding of their time and those pressures lead to mistakes.

Ironically, it’s those very demands on HCW time that makes the UCLA study so appealing. Because it offers the service provider the promise of more time to do their job which translates into happy employees and satisfied patients.

So imagine:

You’re the CEO of the Ronald Reagan UCLA Medical Center. Your budget’s tight, your staff say they’re overworked and underpaid, your patients say they want more attention from their HCW – and remember there’s a lot more patients without drug-resistant infections than there are with.

Dr. Elise Martin walks into your office and says she has a sure-fire way of taking care of these concerns – be a pioneer, she tells you, and dump the traditional practice of contact precautions.

What do you say to her?

Guess Where All the MRSA Is?

We have assumed all along that it was the hospital. But a study released just this week says it’s the nursing home. The absolutely stunning bit is just how prevalent MRSA (Methicillin-resistant Staphylococcus aureus) was found to be in the homes: a little more than 1 in every 4 residents were colonized with it.

The research was conducted in 13 community-based nursing homes in Maryland and Michigan. The study found 28 percent of residents (113 out of 403) harbored MRSA.

Hospital MRSA rates are much lower. We don’t have an exact count for MRSA alone, but a 2013 study found that 1 in every 12 patients in hospitals across Canada were colonized or infected with one of three bugs: MRSA, which led the pack with 67% of the cases, followed by CD (Clostridium difficile), and VRE (Vancomycin-resistant Enterococci). Thus the MRSA number would be in the vicinity of 1 in 20 patients.

A close reading of the Canadian study reveals that the average age of the MRSA-afflicted patients was 70, thus lending support to the high nursing home numbers that were found.

MRSA is easily transmitted by touching: from person to person, or from person to some surface, say a bed rail or table or chair, to a second person. Thus the study raises real concerns for not just the nursing home residents, but for staff and visitors as well.

Down at the Courthouse: A Judge Wants to Know Why a Two-Month-Old Infant with MRSA Died

The Judicial Inquest into the MRSA-caused death of two-month-old Drianna Ross is taking place in courtroom 114 of the Law Courts Building in downtown Winnipeg. Presiding Judge Don Slough is nearing the end of his two-year investigation into Drianna’s death in November, 2011, in the northern Manitoba city of Thompson.

The Inquest was struck because Drianna’s mother and father, backed by community leaders, say that northern medical services are substandard and that’s why their child died.

Drianna Ross

Drianna Ross

The case began when they took Drianna, crying, coughing, and with difficulty breathing, to a local nursing station four times over two days. She was never referred to a doctor; instead, she was sent home with Tylenol. Finally, on her fourth visit to see the community nurse, Drianna was medevaced to Thompson General Hospital. The following day she died from a MRSA-induced septic shock.

The purpose of the Inquest is to examine the adequacy of healthcare in remote northern communities and, if that care is found wanting, to recommend changes in government healthcare practices so cases like Drianna’s don’t happen again. (Judicial Inquests, unlike trials, do not assign blame and do not have the authority to hold anyone legally responsible.)

On the stand yesterday afternoon was Dr. Stasa Veroukis, Pediatric Intensive Care Specialist at the Health Sciences Centre in Winnipeg. She wasn’t directly involved in the case but had reviewed the relevant medical documents in order to offer her expert opinion about the quality of Drianna’s medical care.

A half dozen lawyers from various health authorities questioned Dr. Verooukis, trying to pinpoint where it all went wrong after Drianna got to the hospital.

In Dr. Veroukis’s view the moment of truth was Drianna’s first night in the hospital. By 3:00 a.m. her heart rate had risen to 203 beats per minute, her temperature was a “very high” 39.3 degrees C and, most tellingly, when nursing staff poked Drianna to insert an IV she did not respond – which meant she was unconscious. Stunningly, that’s where it was left — no doctor was consulted to see what they should do next.

Those downward-spiraling vital signs meant that septic shock was setting in, said Veroukis, and as brain and heart cells begin to die off the process quickly becomes irreversible and death inevitable.

Dr. Veroukis was clear: “All the symptoms should have been put together by the nurse and [she should] have called the doctor.” Veroukis could only guess why that wasn’t done: a busy night perhaps, poor communication between nurse and doctor, inexperienced staff, and/or a lack of awareness about what the vital signs meant.

When asked how a two-month-old infant could possibly contract MRSA in the first place, Veroukis told the court there’s “More MRSA in the northern communities. The best option I can offer is the people around her have it.”

The research agrees with her, but with one important qualification: It’s not that MRSA frequents the north more than, say, the south, it’s that remote northern areas are home to First Nation communities and it is First Nation people who are disproportionately affected by MRSA.

For example, in a 7-year study ending in 2002, First Nation patients in Canada were found to be 6-fold more likely to have a Community Associated-MRSA infection than non-FN patients. (Community Associated means the patient picked up the MRSA before going to the hospital.)

And it might be getting worse: A U.S. study of Indigineous populations found that MRSA-associated hospitalizations increased from 4.6 per 100,000 American Indians/Alaska Natives in 1996 to 1998 to 50.6 per 100,000 in 2003 to 2005 – more than a 10-fold increase.

In other words, professional red flags have been waving about the increased prevalence of MRSA in First Nation communities for at least a decade.

Drianna’s death reminds us what happens when those warnings are ignored.

Nurses — Educate, Advocate and Treat: SSI’s by: Nicole Gould, Nursing Student, Ontario

surgical nurseAs a nursing student over the last couple years I have gained a lot of knowledge in the field of infections and what to look for in a patient who may be at risk for one. Recently, I was reading an article written by Carolyn Cross about SSI’s and it got me thinking about the problems that are occurring at the hands of the professionals. Some of the major problems that I am seeing when it comes to infections are that the healthcare team is not very knowledgeable about the infections, they are not documented properly and not treated immediately…with the right treatment.

When a patient comes out of surgery they look to the nurses and doctors to take care of them and help get them on their feet again. They trust that we know what we are doing and trust that if something were to go wrong we would notice right away. Throughout my schooling I have come across many articles talking about how there is a lack of knowledge within the healthcare team when it comes to monitoring for infections, specifically surgical site infections. It is our duty and responsibility to be highly educated on infections, how they start and the time period in which they start to develop. I also believe that it is equally important to teach our patients about the signs and symptoms to look out for so they are aware when something does not feel right.  We need to remember that our patients know their body and they know when something is not right. Far too often we ignore what our patients complain about for whatever reason and by the time it is taken seriously, they are dead. No matter how silly or how often our patients voice problems we need to listen immediately and be proactive before it is too late.

There are patients dying every day from what was supposed to be a minor surgery that turned into a horrible infection. We, as nurses need to take responsibility and educate ourselves on infections because they happen more than we think. We need to document properly and efficiently so this problem around the world can be stopped. No improvements, no new technology or new skills can help fight this problem without proper documenting and proper accountability. If we don’t document about how often infections happen in the hospitals, how will we ever find the proper solution? How will the healthcare system know what they need to focus their attention on? How will we stop innocent patients from dying from these infections? Are we just going to keep throwing antibiotics at them that no longer work?

These infections require immediate treatment and the RIGHT treatment. We are running out of treatment options. The antibiotics that use to combat these infections no longer have the same effect due to overuse, improper timing and misuse of the drug. “An estimated 40–60 percent of Surgical Site Infections (SSIs) are preventable with appropriate use of prophylactic antibiotics.” Imagine the amount of money, time and most importantly lives we could save if we just used the proper treatment. It is so easy to fall back and use the same antibiotics hospitals have always used but when it no longer works…who are you helping? We need to be more cautious and treat infections the proper way because our patients are dealing with those consequences.

We need to educate, advocate and treat.

 

 

It’s Not the Crime it’s the Cover-Up: A MRSA lawsuit against the Tampa Bay Buccaneers illustrates the principle

In the Circuit Court of Broward County, Florida, this past Monday, former National Football League kicker Lawrence Tynes filed suit against his former team, the Tampa Bay Buccaneers.

TynesHe says he contracted a methicillin-resistant staphylococcus aureus (MRSA) infection from the Tampa Bay Buccaneers’ Training Facility, One Buccaneer Place, during the summer of 2013, which, among other things, caused him to: (1) have 3 surgeries to remove infected tissue (2) live under the threat that doctors were going to have to amputate his toe as the infection worsened (3) endure six weeks of intravenous antibiotic therapy which involved a central line catheter inserted into his arm and placed above his heart (photo) (4) live with persistent pain which he is reminded of every time he gets out of bed and his feet hit the ground, and (5) sustain permanent damage to his kicking foot thus ending his career which cost him over $20 million in expected future earnings.

A crucial component of Mr. Tynes’s complaint against the Bucs is found in paragraph 23 of his 57 paragraph Statement of Claim which reads, in part: “… Defendants failed to disclose, and actively concealed, ongoing separate incidents of infection amongst individuals who used and visited One Buccaneer Place.” (My emphasis)

What, exactly, did they cover-up? It was the fact that 6 other members of the Bucs – 4 players, an assistant coach, and the head trainer – were also battling bacterial infections that summer. That these people “used the same hot and cold tubs, soak buckets, and other therapy devices, equipment, and surfaces used by Mr.Tynes.” And that as a result Lawrence Tynes contracted his life-threatening career-ending infection.

But why the cover-up? What reason would the Bucs have for keeping this critical information from him? The answer, according to Mr. Tynes, is the Bucs’ effort to gain advantage in the very competitive NFL marketplace in order to attract the best available players and coaches.

Lawrence Tynes, an integral part of the New York Giants 2007 and 2011 Super Bowl Championships, was a sought after free agent when he signed with the Bucs in the summer of 2013. What induced him to sign was the Bucs’ highly-touted superior medical and rehab facility, as laid out in para 9 of his Claim:

“Defendants represented to Bucs players, prospective Bucs players, including Mr.Tynes … that the Bucs Training Facility is a world-class facility at which ‘state-of-the-art’ physical training, medical care and treatment, and other rehabilitative services are provided … that the ‘gleaming new team headquarters,’ which it calls ‘One Buccaneer Palace,’ ‘is the largest facility in the NFL. Equipped with every modern tool to help produce a successful team on the field, the facility is also a major draw for potential free agents.’”

This had particular appeal to Tynes because as a kicker he has “a podiatrist perform a toe-nail procedure on his great kicking toe” in the summer before the start of each season. This requires a strict rehabilitation regimen; the use of “hot tubs, cold tubs, and a soak bucket for his toe, and included dressing changes to the open wound on his toe” – the functional equivalent of a quarterback’s arm.

Knowing this, the Bucs told Tynes’ agent that they had “the best of everything” and “procedures designed to prevent the spread of infection were in place … at the Bucs Training facility.” And that’s what Tynes relied on.

Now, Lawrence Tynes only feels betrayed: it’s not so much that he contracted MRSA; rather, it’s the cover-up that led to the infection that bothers him most. In a recent interview he told ESPN: “You expect this billion-dollar enterprise to protect you at all costs, and obviously, they didn’t do a lot of right things. I’m standing up for what I think is right, or what I know is right. I’m in this thing ’til the very end. I’m not going away.”

 

 

Greater Global Co-ordination is Needed to Address SSI Prevention and Antibiotic Resistance

SSISurgical Site Infections (SSI) are a significant risk factor for patients undergoing surgeries. In fact, 77% of deaths among patients with SSI are directly attributable to SSI. Patients with an SSI have a 2-11 times higher risk of death, compared with operative patients without an SSI. Each SSI is associated with approximately 7-10 additional postoperative hospital days, resulting in significant financial burdens to the healthcare system.  SSIs are classified as superficial incisional (involving only skin or subcutaneous tissue of the incision), deep incisional (involving fascia and/or muscular layers) and organ/space. 1 The cost of each SSIs ranges from $1,000 to $100,000. SSIs are believed to account for up to $10 billion annually in healthcare expenditures in the US, and up to $1billion in Canada…before including the cost impact on families and the economy.

Significant reductions in SSI rates have been realized due to adoption of protocols involving prophylactic use of potent systemic antibiotics like Vancomycin. Long term Vancomycin resistance generation resulting from more widespread use is the trade-off for these significant reductions in short term SSI rates. Vancomycin, long considered one of the potent “last resort” class of antibiotics, has become a prophylactic medical tool to keep surgical site infections in check. The challenge is that there are too few new classes of last resort antibiotics being developed to replace Vancomycin should significant resistance evolve, due to the $1-1.5 billion cost and over a decade required for new drug development.

In light of this challenge, there should be a global coordinated effort to develop new classes of powerful replacement antibiotics as well as a global coordination of antibiotic rotation to preserves the ones that we do have. More emphasis should be taken on screening for at-risk individuals as well as health care workers, at times, the vectors of the spread of infection. Non-antibiotic antimicrobial therapies, such as Photodisinfection, Ultra-Violet Robotic Sterilization, etc. should be quickly advanced and integrated into healthcare associated infection prevention protocols. The superior patient outcomes would be well received around the world and the economics easily justified.

Reference: Infection Control Hospital Epidemiology/Volume 29/Supplement S1/ October 2008, pp S51-S61 http://journals.cambridge.org/action/displayJournal?jid=ICE

The CRE Infections: No One Warned the Patients

“I want to know what the hell is going on and I want to know right now,” Sheila Adamczyk said. “They had two deaths. They knew this had taken place.”

Sheila is talking about the endoscope-caused CRE, or carbapenem-resistant Enterobacteriaceae, superbug outbreak at the Ronald Reagan UCLA Medical Center this winter that killed 2 people, seriously infected 5 more, and put 179 other people on notice that they, too, might become infected.

informed consent 4Her worry is that her 16-year-old daughter, Bailee, whose recent cancer screening involved a scope similar to the ones involved in the outbreak at UCLA, is now at risk. The problem is, no one told her this could happen. Sheila learned about in news coverage and has been trying to reach her doctor ever since.

And this is the position approximately 500,000 people across the country find themselves in, the number of people who annually undergo the procedure.

But there’s an even deeper story. According to specialists like Dr. Andrew Ross, head of gastroenterology at Virginia Mason Medical Center in Seattle “You have to understand that this issue dates back to 2011 – 2012.”

For example, we saw the emergence of the CRE deadly pattern of illnesses in 2012 – 2013 at hospitals in Seattle (11 deaths, 32 infected), Chicago (38 infected) and Philadelphia (8 infected). In each case investigators identified the same source of transmission: a specialized endoscope, threaded down the throat of patients to treat GI tract illnesses.

The agency responsible for oversight of these outbreaks, the U.S. Food and Drug Administration, also knew about them. In a March 4 letter from Congress to the head of the agency, demanding answers, they write: “It appears that the FDA has known for at least two years that the design of [endoscopes] could result in CRE outbreaks.”

Remarkably, the knowledge trail is actually decades long. “We have known about this even as early as 1983 or 1984,” says John Allen, of the Yale School of Medicine. In 1987, Allen wrote in an academic journal about 10 of his patients in Minnesota mysteriously becoming infected with a bacteria that they traced to a single endoscope.

And in this case, knowledge is power. Because in hospitals where outbreaks occurred they immediately fixed the problem, preventing any further infections.

For example, at Seattle’s Virginia Mason Hospital they put used scopes in quarantine for 48 hours after disinfecting and then retested them to make sure no bacteria had regrown before reuse.

So what we have here is everybody knew – the hospitals, the Feds, and the scientists – everybody, that is, except the patients.

The National Law Review, commenting on the pending CRE lawsuits in California and Pennsylvania, issued a clear warning: “Health care personnel should … thoroughly explain associated risks to patients when using reprocessed endoscopic devices.” (My emphasis.)

This is not only how you avoid lawsuits, it’s also how you keep innocent people like Sheila, young Bailee, and others across the country from feeling they were sucker-punched by a “nightmare bacteria.”

So now – and only now – are we seeing places like Cedars-Sinai Medical Center in Los Angeles, also the scene of a recent outbreak, issuing directives that physicians will discuss with the patient “the current unresolved national questions regarding [endoscopes] and CRE.”

While that may be a start, Lisa McGiffert, consumer advocate and director of the Safe Patient Project at Consumers Union in Austin, Texas, says this comes too late for some patients: “It’s really horrific to know so many people underwent these procedures when they could have known the danger beforehand,” she said. “They went in trusting the system, and the system broke down.”

It came too late for Lori (a nurse) and Glenn Smith, the adoptive parents of 18-year-old high school student Aaron Young. Aaron has been in the UCLA hospital since January, bedridden, trying to overcome his CRE infection. We know how Sheila Adamczyk feels because she told us. Here’s a picture of Lori and Glenn taken at their home last month.

How do they feel?

aaron 7

 

 

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