State conceals which had potentially lethal infectious outbreaks
Sunday, May
13, 2007
BY CAROL
ANN CAMPBELL
Star-Ledger
Staff
Eleven outbreaks of
dangerous infections took place in
State health officials
will tell you the names of the pathogens, even the counties where outbreaks
occurred. But they won't disclose what consumers most want to know: the names
of the hospitals.
While the 11 outbreaks
represent a small number of overall hospital infections, the secrecy is typical
of how state government and
More than a dozen states,
including
"Why is
Most of the limited data
State health officials
said the surveillance system is not designed for consumers and would not help
them select the best hospitals. But the effort to shield names shows just how
sensitive the topic of hospital infections remains.
Consumer groups are
calling for more openness.
"Secrecy has allowed
this problem to fester for far too long. You can call your local health
department and get more information on a restaurant," said Betsy
McCaughey, a former
Intensive efforts by
hospitals can dramatically lower infection rates. About three years ago, 18 of
Collectively, the 18
hospitals reported that over two years they cut ventilator-related pneumonia by
more than half -- from 5.14 cases per 1,000 ventilator days to 2.3 -- and
central blood line infections by an even a greater percentage. Both infections
can be deadly.
The effort showed that
low-tech interventions, such as strict hand washing policies and measures to
get patients off ventilators and intravenous lines more quickly, can make a
difference. Yet even hospitals boasting about lowered rates of infection
declined to make their rates public.
"There was a
presumption that these (infections) were an inevitable risk of surgery and
hospitalization," McCaughey said. "But there's compelling evidence now
that nearly all are preventable."
FEELING LUCK TO BE
ALIVE
Gerald
Isaacson underwent a cardiac catheterization at
In October 2005, doctors
inserted a thin plastic tube through a leg artery and into his heart. It turned
out his heart was fine. A few days later, however, his leg began hurting during
a ballroom dancing lesson. During a checkup, he showed the nurse a lump where
the tube entered his leg.
"They sent me right
to the ER," the 63-year-old Isaacson recalled. The
"I'm not vindictive,
and I consider myself lucky," Isaacson said. "But nobody offered to
take care of anything for me. Nobody ever said, 'I'm sorry,' or took
responsibility. If they did an investigation they did not tell me about
it."
A spokesman for the
hospital, Mark Broadhurst, said he could not comment.
However, he said the type of infection described is extremely rare and would
trigger an investigation. He said the hospital works aggressively to combat
infections, and that employees follow a comprehensive checklist and stringent
protocols.
HOSPITALS DEFEND SELVES
Many hospital
officials insisted their organizations were working harder than ever to reduce
infections. They said no clear guidelines existed to create a fair and useful
reporting system, and that even the definition of a hospital-acquired infection
was not clear-cut. Some patients may already have an infection when they enter
a hospital, for instance.
"The more transparent
we are, the better," said John Brennan, senior vice president for clinical
services for the Saint Barnabas Health Care System. "But there is no good
report card."
He said the hospitals in
the Saint Barnabas system voluntarily submit infection data to the Institute
for Health Care Improvement, a private, nonprofit health care improvement
organization based in
Hospitals also said they
collect infection data for their internal use, and many work with national
health quality programs to compare their rates with other hospitals.
"We don't generally
disclose the rates, but we participate in a national health safety
network," said Joan Lebow, a spokeswoman for
Atlantic Health, which operates
Others questioned whether
a reporting system could be fair.
"There are nuances.
How do you compare a hospital like ours that takes care of transplant patients
and patients with multiple illnesses and unusual diseases?" said Melvin P.
Weinstein, chief of infectious disease at
Eddy Bresnitz,
the state's epidemiologist, said the state health department supports
transparency, as long as a fair system can be devised.
"You have to understand
what you are comparing," he said.
Consumer advocates
acknowledge that infections are not as easily rated as, say, mortality. But
they said definable data can be collected, such as post-surgical infections,
central blood line infections or ventilator-associated pneumonia.
Nash, of
"The typical myth is,
'Look, we take care of really sick people. You can expect someone to get an
infection,'" Nash said. "But you cannot predict the chance of a
hospital-acquired infection based on the patient's severity of illness upon
admission. A high infection rate is a result of failed hospital processes."
Lisa McGiffert,
manager of Stop Hospital Infections, a campaign by Consumers Union, said states
have created fair systems by adjusting for risk, a common practice. Several
states follow definitions and guidelines developed by the federal Centers for
Disease Control and Prevention. She said public reporting is crucial to
reducing infections and saving lives.
"If hospitals know
this information will be made public, things will be different," she said.
The cost for a densely
populated state to create an infection reporting system can be as high as $1
million, McGiffert said. The CDC estimates the cost
of treating 2 million or so patients who acquire infections in hospitals is at
least $7 billion a year.
'SHE SUFFERED'
Mary LaStatione, who lived alone in Bernardsville, was 93 and in
remarkably good health when a doctor incorrectly diagnosed pneumonia and
admitted her to
"I know she was older
and might have gone one day in her sleep," said daughter-in-law Theresa Symonds of Basking Ridge. "But to see her go this way
was horrendous. She was skin and bones. She suffered. ... And the day before
she went into the hospital she was outside her house with a cane in one hand
and a leaf blower in the other."
The hospital could not
comment on specific cases, a spokesperson said.
CREATING A NEW SYSTEM
The state's
Epidemiology Surveillance System uses hospital laboratory results to track
several antibiotic-resistant organisms. That system, however, is severely
backlogged. The most recent report -- issued in 2003 -- uses data from 2001.
Bresnitz said staffing limitations have led
to the backlog. In addition, he said the hospital laboratory reports are now on
paper and the state is working toward creating an electronic system to get
information back to hospitals more quickly.
"Then we can get back
to hospitals in real time," Bresnitz said.
"Right now, they (the reports) are basically sitting there."
A Star-Ledger request
filed under the state Open Public Records Act for data collected by the
surveillance system for 2005 and 2006 -- but not yet compiled in a report --
was denied by the state Department of Health and Senior Services. The
department's denial letter said the information, by law, is available only to
health agencies, and that additionally "records concerning morbidity,
mortality and reportable diseases of named persons" are exempt under an
executive order.
Bresnitz said the system was not designed for
consumer use.
"This is basically a
resource for practitioners in hospital settings to know the prevalence of
various infections in hospitals and to get guidance on what antibiotics might
be appropriate," he said.
But health care advocates
said better surveillance of antibiotic-resistant infections is critical at a
time of heightened concerns over bioterrorism.
"The lack of
information is shocking," said David Knowlton, president of the New Jersey
Health Care Quality Institute, a nonprofit organization. "There are
security issues here."
Some state legislators are
getting involved. State Sen. Barbara Buono
(D-Middlesex) has sponsored a bill that would require hospitals to check all
intensive care unit patients for MRSA, an especially lethal and
antibiotic-resistant type of staph infection. The
most recent surveillance report identified 3,903 examples of MRSA in
"In
The bill does not require
the state to make hospital MRSA rates public. Buono
wants public reporting, she said, but she said state health officials told her
there was no funding to turn the data into a report suitable for consumers.
A spokesman for the AARP
of New Jersey called the bill "a good step," but said it didn't go
far enough.
"We still think
information about infection rates should be available to the public," said
spokesman Douglas Johnston. "Our members absolutely care about this
issue."
There are some signs of
openness. Just three weeks ago, the New Jersey Hospital Association began
posting limited data on post-surgical infections on its Web site. It names
specific hospitals and compares rates with "expected" rates.
Aline Holmes, the association's senior
vice president for clinical affairs, said the association expects to provide
additional data in the future.
"Our board thinks
transparency is the right way to go," Holmes said.
A DAUGHTER'S ANGUISH
Minodora Tibrea did not expect to take up the cause of hospital
infections. Not until her mother, Ruxanda Tibrea, had her gallbladder removed at
The daughter believes the
hospital should have known her mother was susceptible to an infection and
worked harder to prevent one -- or should have intervened sooner when she said
clear signs appeared.
Her mother died on April
6, 2005 -- two weeks after her surgery. The death certificate lists the primary
cause as "septic shock," which is physiologic shock caused by
overwhelming infection. Three other causes are listed, too, including
pneumonia.
The hospital said laws
prevent it from commenting on specific cases, but said it has worked with the
hospital association to reduce infection rates. The hospital said it went 14
months without one case of ventilator-associated pneumonia, for instance, and
10 months without any central blood line infections in the ICU.
"We're proud of
that," said Ken Garay, the hospital's director
of medical affairs.
But Tibrea's
anguished daughter believes the hospital did not protect her mother from
infection. The 31-year-old photographer and administrative assistant who lives in
"This should never
have happened," she said.
Carol Ann
Campbell may be reached at ccampbell@starledger.com or (973) 392-4148.
© 2007 The Star Ledger