Tuesday, April 29, 2014

A Matter of Trust

When you are poor expect the worst but when you are rich, insured, or informed you assume that those entrusted to care for you will regardless. Well regardless is the caveat.

When you enter a hospital it is akin to entering a casino and you may come out ahead, even or in the worst possible case scenario - down and out. The latter is for 60% of Americans the fact when it comes to debt and bankruptcy. Then there are the 100K or so of admissions that end up fatal.

The story below is about families who hoped for the best and found out the worst. The hospital entrusted, yes the word trust is present there, with the care for their children failed to meet that trust.

If you believe that there is a need for transparency, regulation and in turn investigation into our medical system then you will find that if any one thing that has come out of this Obamacare is the sudden microscope now being turned on the providers.

We are finding out about the absurd medicare billings that many are charging for their services. Just yesterday there was another article about a Physical Therapist who bills the Government over 4 Million for his work. Laughable as we come to the pinata that Medicare has become in the last few years. It appears that the theft and fraud are actually the reasons the costs are out of control and putting this legacy program at risk. Old people, not so much.

And then we had another article about how those in poorer communities receive less care. Wow SHOCKING, I know!

There is no oversight with regards to the medical profession and its related industries. There are licensing requirements and internal demands that are of course "self regulating." Funny but being a Teacher requires constant licensing and accreditation requirements than the Medical or in fact legal profession. Clearly the AMA and the ABA manage to let their Practitioners remain stagnant when it comes to continuing education. Really? Law and medicine never changes over time? Really? Better unions clearly.

So no, the answer to the question: Will this article, will a lawsuit change the practices and policies of the hospital in question. No it won't. But what will change is the affect that this hospital has on these families for their lives. I am also sure they received a bill for their loss as the hospital is the house and the house never loses.

Children's Hospital in New Orleans is accused of breaking faith with the community. Credit Edmund D. Fountain for The New York Times

A Deadly Fungus and Questions at a Hospital

April 28, 2014

NEW ORLEANS — The first victim was a premature boy in the intensive care unit whose mother noticed a mysterious irritation in his groin; it grew into an open wound burrowing into the baby’s abdomen. The last patient to die was a 10-year-old girl, whose face was ravaged.

Three other patients at Children’s Hospital here were also stricken, including a 13-year-old boy who his parents said endured over 20 surgical procedures in 54 days in a futile effort to save him.

Like the others, Zachary Malik Tyler, the 13-year-old, arrived at Children’s Hospital battling a serious illness before being overwhelmed by an infection. “What haunts me more than anything is thinking about what he suffered,” said Stephen Tyler, his father.

The children died of various causes between August 2008 and July 2009 during an outbreak of a flesh-eating fungal infection, mucormycosis, most likely spread by bed linens, towels or gowns, according to a medical journal. The disclosure this month caused new pain for the families of the children and raised troubling questions about how the infections came about, why doctors did not connect the cases until more than 10 months after the first death, and what obligation the hospital had to inform parents — and the community — of the outbreak.

Cassandra Gee's son, Tyrel, was another of the children who contracted the deadly fungal infection.

Those questions take on greater urgency, experts say, because deadly fungal infections, while still rare, appear to be on the rise nationwide.

That may be because of changes in the environment and a larger pool of vulnerable people with suppressed immune systems because patients are living longer with serious illnesses.

An estimated 75,000 patients with infections picked up in health care facilities die in hospitals each year, according to figures released last month by the Centers for Disease Control and Prevention.

The outbreak may have spread unchecked, at least in part, because of lapses in the hospital’s infection controls and sloppy handling of contaminated linens, according to a review of emails, patient records, legal testimony from hospital and laundry staff, and interviews with doctors, lawyers, federal health officials, hospital administrators and patients’ families.

Workers unloaded clean linens on the same dock where medical waste was removed, moved clean and soiled linens on the same carts, and stored linens in hospital hallways covered in dust from a nearby construction site, court records indicated.

C.D.C. investigators did not fault the hospital for failing to move more quickly to detect the outbreak, noting that the infections occurred weeks or months apart in different areas of the hospital. Still, there were problems, records and interviews showed. With one of the five children, a doctor allegedly agreed to biopsy an infected spot only after a nurse and the parents insisted. And the hospital’s infection investigators did not become involved for months because their threshold for reviewing cases excluded some of the five deaths.

In a city where so many institutions had failed its citizens — a former mayor convicted of bribery, a police department tainted by charges of brutality, schools where student performance was historically abysmal — Children’s Hospital was well respected. It cared for New Orleans’s sickest young patients, from those living in the poorest precincts like the Lower Ninth Ward to those from the hospital’s genteel neighborhood uptown

But now, Children’s Hospital is accused of breaking faith with the community. Much of the anger has focused on what a local newspaper, The Times-Picayune, charged in an editorial was an “appalling” failure to alert the public and a “lack of urgency” that slowed the discovery of the outbreak.

Hospital officials first suspected they had a problem in late June 2009, and in the weeks after alerted state and federal health officials, but few others. They contacted the children’s families only after the journal article “Mucormycosis Outbreak Associated With Hospital Linens” appeared in The Pediatric Infectious Disease Journal. (The article did not identify the hospital, but a local television station, WVUE, disclosed it based on a tip from a local doctor, Brobson Lutz.)

“We failed to do what we should have done, pure and simple,” Dr. John F. Heaton, the hospital’s associate medical director, said during a news conference this month, in which he acknowledged that the infections most likely contributed to the children’s deaths.="Children's Hospital in New Orleans is accused of breaking faith with the community."

Children's Hospital in New Orleans is accused of breaking faith with the community.

In response to several unrelated outbreaks in recent years, the C.D.C. started an initiative to help hospitals and health departments communicate with the public about medical errors and infections acquired in health care facilities. Abbigail Tumpey, who leads the effort, said that while it is important to avoid scaring away patients, hospitals that are open about problems and the steps taken to remedy them have built public trust.

Children’s Hospital is trying to be more transparent, but for some, it is too late. Dolly Malik, Zachary’s mother said, “We clearly felt silence back then.

Tyrel Cayden Gee, born prematurely at 26 weeks, would eventually be identified by investigators as Case No. 1. But because the infant had been critically ill before contracting mucormycosis — in its severe form the fatality rate tops 90 percent, and it primarily afflicts patients with compromised immune systems — it was not considered a primary cause in his August 2008 death. Even though Children’s Hospital had not had a single incident of hospital-acquired mucormycosis for at least 15 years, Tyrel’s case did not raise alarms or become labeled a sentinel event, which would have set off an inquiry.

Dr. Rodolfo Esteban Bégué, who headed the hospital’s infection control committee, said later in a deposition that he was not aware of the case. Even though mucormycosis had caused rare hospital outbreaks elsewhere, his committee had not included it in its quarterly reviews of hospital infections, and it was not among the diseases hospitals must report to the government.

When Zachary Malik Tyler came to the emergency room six months later, with a recurrence of a cancerlike condition that causes widespread tissue damage, his parents still expected he would return home to his siblings, his book collection and his chess sets. By March 2009, though, his immune system was suppressed by chemotherapy, his health precarious. Zachary’s empathy had still shown through during his hospitalization. When he saw his brother Crawford’s plans for an underwater car, Zachary said, “It just might work.”

That month, Zachary’s mother noticed a small black spot in his armpit. In operations, sometimes just a day apart, doctors chased the infection — cutting underneath Zachary’s arm and into a second site in his lower back. To repair the defects, they moved skin and muscle from his chest and thigh and operated on his belly, performing a colostomy. “After his skin graft, his pain was quite intensified,” doctors noted. He died of multiple causes on May 17, 2009.
Dr. Bégué helped treat Zachary and asked for a review of infection control procedures regarding his treatment, but did not consider opening a wider inquiry, he said later.

While Zachary had been struggling, another premature baby received a diagnosis of mucormycosis and died in a different part of the hospital, but Dr. Bégué did not learn of the case. In late June, Tierica Jackson, 10, admitted for heart surgery, also fell victim to the infection. Hospital personnel began swabbing various surfaces to determine the source, which struck one more patient, an 11-year-old girl, who died the day after her diagnosis. One of the doctors decided to test the linens.

The parents of Zachary Tyler said they hoped their son’s death would inspire hospitals and health care facilities to be more vigilant about controlling the spread of deadly infections.< Fungi thrive in moist environments, and the 40,000-square-foot washing warehouse owned by the hospital’s off-site launderer, TLC Linen Services, was just that. The laundry sits several blocks from Lake Pontchartrain on a dirt road in the city’s Ninth Ward. The owners, who declined interview requests, replaced drywall and flooring after the levee failures caused by Hurricane Katrina brought in water. But he never tested to verify that the plant was free of mold, records showed.

The company, which was not accredited by the main voluntary group that inspects health care laundries, also lacked proper filters on ventilation fans to block spores and dust from the street, records showed. There was also reason to suspect that the outbreak was due to myriad problems with the way hospital workers handled linens, court documents showed. (Three patients’ families have filed lawsuits; one was settled.)

In the rare instances when linens have been associated with transmitting illnesses, the problem is usually caused by improper transportation or storage, said Lisa Waldowski, an infection control specialist with the Joint Commission, the organization that accredits most American hospitals. Hospitals typically do not sterilize linens, except those used in operating rooms. Hospital bedsheets and towels typically are washed and bleached to reach the same standard of cleanliness as hotel laundry. One key difference is that medical linens are supposed to be wrapped in bags or cellophane for transport.

Starting in 2007, TLC managers complained in meetings and emails about how Children’s Hospital housekeepers were handling the linens. Washcloths were being used as “cleaning rags” to wipe down bathrooms, TLC said. Laundry workers had to fish bags of dirty towels and sheets out of hospital trash bins. Trash was being put in linen carts and linens in trash carts.

Especially frustrating, TLC managers said in a deposition, was that, in violation of industry and federal guidelines, the head of housekeeping, Glenn Cobb, told them in 2007 to stop delivering the clean linens in sealed bags.

“I didn’t agree with it,” Charles LeBourgeois, a co-owner of TLC, said in the deposition. The plastic bags were cumbersome for the housekeeping staff and getting caught in cart wheels, he recalled being told by Mr. Cobb, who did not respond to interview requests. It was only after dust from nearby construction sullied linens that the hospital agreed to allow TLC to cover the carts

Mr. LeBourgeois testified that he had discovered workers at the hospital washing bed linens in a machine there after the outbreak — using a method intended for cleaning floor mops. He said he had explained that the chemicals were too weak and the water temperatures too low to be hygienic. “Oh, my god,” he recalled Mr. Cobb saying. “So, we are not getting them clean?”

In recent weeks, hospital officials have emphasized the protective measures that they have taken, like resterilizing key areas of the hospital, including where linens were stored, and changing the site where they were delivered. The hospital now uses sterile linens for sick infants, cancer patients and other highly vulnerable patients. It also now wraps linens for transport.

Dr. Heaton also pledged that the hospital would fully disclose any adverse event or hospital-acquired condition that affects any of its patients.

Mr. Tyler, Zachary’s father, said such measures might have saved his son and other patients. “Perhaps it will inspire other institutions to be more vigilant.

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