The Crime Boss, Part 4: Mr. Parnell Goes to Prison

This past Monday, Stewart Parnell, former head of the Peanut Corporation of America, was sentenced by a federal court judge in Georgia to 28 years in prison. At age 61, Parnell will spend the rest of his life behind bars. (Two others at PCA were also sent to prison, one for 20 years, the other for 5 years.)

This case directly implicates how we treat people colonized with infectious pathogens such as MRSA. It suggests that the law could play a greater role in policing the problem, not just in the traditional sense of using the civil law to sue, but there’s now more than a hint that the criminal law could be used as well. But first, some background.

Stewart Parnell

Stewart Parnell

Parnell’s company caused a U.S.-wide salmonella outbreak in 2008 – 09 that killed 9 people, including children, and infected over 700 more. Parnell was more than just the guy in charge; internal company documents show that he knew they were shipping peanut butter laced with a bacterial poison – salmonella — to retailers across the country. What’s more, when he found out, he didn’t care: “… just ship it,” he said, “… these lab tests are breaking me/us.”

U.S. District Judge W. Louis Sands wanted to hear from the victims and their families before he pronounced sentence on Monday. Gabriel Meunier, on behalf of her son Christopher told Judge Sands, “My 7-year-old son told me that he was in so much pain that he wanted to die.” Jeff Almer, who attended most of the trial hearings last summer, stared at and talked directly to Parnell. In a haunting tone, he said, “Stewart Parnell, you killed my mom [Shirley Mae Almer].” Peter Hurley, whose son, Jacob, was sickened by PCA peanuts, flew in from Portland, Oregon, to say, “Stewart Parnell, you gave some people deathsentences. Luckily, you are not being sentenced to death.”

The idea that a corporate executive, in the context of causing infectious illness, could be thought of as a murderer and thus eligible for the death penalty is gaining currency with more people than just the victims and their families. For example, award-winning science journalist Julia Belluz, the 2013-14 Knight Science Journalism Fellow at MIT, asked attorney Bill Marler, who represented some of the victim families:

If someone took a gun and killed seven people, he would get the death penalty. Why did Stewart Parnell get away with 28 years?

Get away with 28 years?”

U.S. Attorney Michael Moore of Georgia’s Middle District, whose office prosecuted the case, called it “a landmark [case] with implications that will resonate not just in the food industry but in corporate boardrooms across the country.” (My emphasis.)

Which brings us to the question: Which boardrooms?

Take a look at this study of people colonized with MRSA and what happens to them. It says that 1 in 7 people who acquire the bug at the hospital become infected by it: i.e., they get sick, require surgery, multiple readmissions to the hospital, stays in the ICU, and many die. This happens fast, usually within a month. Here’s a similar study, but it says the infection rate is actually much greater, that 1 in every 4 people who are MRSA-colonized get sick.

So when a hospital discovers that a patient is colonized with MRSA they do the prudent thing and “decolonize” them, right?

Surprisingly, most don’t even though they could; moreover, the patient is neither warned of the risks nor involved in the decision making. Various reasons are given including the fact that “it taxes hospital resources.” And there’s the rub.

Shirley Mae Almer (in the chair)

Shirley Mae Almer (in the chair)

So here’s what we’ve got: An inherently dangerous situation; that puts completely unaware and innocent people at grave risk of life and limb; the ability to do something about it; and the refusal to do so. Are we talking about Parnell, poisoned peanuts, and the public; or hospitals, pathogens, and patients? The answer is both, but there is one crucial difference: foodborne illnesses hospitalize 100,000 people a year and kill 3,000; but infectious illnesses resistant to antibiotic treatment exact a far greater toll. They hospitalize 3 million people a year and kill over 23,000. MRSA alone is responsible for almost half of those deaths.

So let’s rephrase Julia Belluz’s question. Let’s say you’re a doctor or you’re in hospital management. You know or should know that between 1 in 4 and 1 in 7 people who are colonized with MRSA become infected; i.e., they get sick, some seriously, some will die. Nevertheless you don’t decolonize. Instead, you discharge them knowing the risk they face. So here’s the question – the kind of question that lawyer’s ask at trial:

What’s the difference between that and giving a patient a gun with a bullet in 1 of the 6 chambers and telling them to go home and play with it? If they shoot themselves, shouldn’t you go to prison? More to the point, suppose you did this year in and year out, and as the body count mounted you still didn’t change your polcy. Shouldn’t you go to prison now?

No, the analogy to Parnell’s case isn’t exact. But the relationship between law and medicine is shifting. Doctors and hospitals aren’t as immune to the law as they once were. So before another forward-thinking prosecutor considers whether or not to reach into your office, you may want to look at any policy affecting people’s lives that’s driven by anything that resembles “it taxes hospital resources.”

It’s not an argument that sits well with jury’s, not when it’s balanced against the life of a child.

We have followed the Parnell case and its implications for the practice of medicine since its inception. Earlier columns are The Crime, The Victims, and Rethinking Crime.

 

 

 

 

 

 

 

What’s the Greatest Threat That We Face?

The New York Times ran an interesting piece yesterday asking who, or what, threatens the U.S. the most. It offered up the usual suspects: the Joint Chiefs of Staff say it’s Russia, the FBI says it’s the Islamic State, and President Obama says it’s nuclear terrorism.

However, the president of the Council on Foreign Relations, Richard Haas, weighed in with an unusual suspect, saying that it might be, among other things, “an Ebola-like pandemic.” He didn’t elaborate and the implication was that whatever this pandemic might be we haven’t yet seen it.

Dr. Davies: The risk of antibiotic resistance is "just as important and deadly as international terrorism."

Dr. Davies: The risk of antibiotic resistance is “just as important and deadly as international terrorism.”

But the health community say otherwise. For example, the UK’s chief medical officer, Dr. Sally Davies, said in an interview with the CBC this year that antibiotic resistance (ABR) – the idea that bacteria are so adaptable they have developed immunity to drugs (antibiotics) devised to kill them – is at least on par with our top threats.

CBC host Michael Enright: “You’ve compared the threat of ABR to the threat of terrorism … and nation-states are activating their resources to counter that. Why are governments so slow to seriously tackle this problem?”

“Let’s be clear,” said Dr. Davies, “In the West and actually across the world far more people are dying of ABR than of terrorism. But somehow it doesn’t seem so shocking. Already, about 50,000 people in Europe and the United States are killed each year by bacteria and other microbes that have developed resistance to the drugs we throw at them.”

And these numbers are expected to climb Davies says: by the year 2050 drug-resistant bacteria could cause as many as 10 million extra deaths globally, surpassing cancer deaths.

Commenting on these numbers, Mr. Enright offered an astute perspective: “If the headlines were about Ebola and not ABR that was going to kill 10m people a year, surely to God there’d be global governmental action.”

“Absolutely,” said Davies. “And if you look at the number dying every year of ABR – how have we let the public become complacent about it? We need to do something.”

But Davies cautioned that solutions won’t come easy.

“What we have to do – it’s a complex, wicked problem – is work on every level: public awareness, government awareness, with the professionals so they don’t overprescribe, the public education about not demanding them when they don’t need them, and see how we can resolve that market failure in the R&D pipeline. This is a really difficult problem.”

“I sometimes lie in bed at night,” Davies continued, “and wonder whether the families of these people who died knew that these were needless deaths, that we should have done something about it.”

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