Hospital, health officials explain handling of three cases

Campbell County Memorial Hospital officials said they kept the public informed of the three cases of Streptococcus A infections as soon as the information became available to them. 
Yet, hospital trustee George Dunlap said he and others in the hospital administration knew about the cluster of infections before the hospital initially denied their existence.
Two of the three patients suffered from necrotizing fasciitis, also known as flesh-eating bacteria. The other patient, the first one to come into the care of the hospital, was treated in mid-August for a severe internal infection caused by Strep A.
One of two patients who was treated for necrotizing fasciitis died after being treated both with antibiotics and surgery, said Dr. Christopher Brown, Campbell County Memorial Hospital infectious disease specialist.
Brown said that HIPPA, the federal law protecting a patient’s right to privacy, prevented him from commenting on the other two patients and their condition. While Brown wouldn’t confirm if those two patients were transferred to another hospital, he did say “I’ve spoken to all the physicians involved in the care of those individuals, be the care here or in outside institutions.”
Coming clean
Hospital officials refused to release the date that each of the people were admitted to the hospital, citing privacy laws.
When asked on Sept. 5 by the News Record about rumors of a Strep A outbreak, hospital spokeswoman Karen Clarke said they were simply that: rumors. But at least two of those people already had been treated.
Dunlap said hospital officials knew about the cases and didn’t release the information.
“I think I have to apologize because I heard about this prior to Karen’s comment that it didn’t happen. I personally allowed it to be told that way. I believe Karen, knowing her personally, would not in any way mislead the press,” said Dunlap, who said he was speaking on his own behalf and not the board. “I believe she was given bad information.”
Dunlap said he didn’t speak up because he was tired of being criticized by hospital board Chairman Brook Bahnson for speaking out about issues at the hospital.
“I find out a lot of what happens from the employees, from people in the community, and we knew about this. And I personally blew it to allow this to happen and not stand up because I didn’t want to be criticized and belittled by Mr. Bahnson again,” Dunlap said.
Bahnson didn’t attend the press conference and declined to comment.
Dunlap was the only hospital trustee at the meeting.
“Somebody knew because I knew. And I was told who in the administration was told about this, and it’s wrong,” Dunlap said. “As a board member, I let the public down and so did, I’m sure, other board members. ... We have to stand up and do what’s right in the community. And to stick our head in the sand is wrong, and I did that. And I apologize to the community.”
When they knew
Brown and other hospital officials would not say when the patients came into their care, citing patient confidentiality.
But State Epidemiologist Dr. Tracy Murphy said Wednesday that his office was notified of the first case in the middle of August. They were told of each subsequent case as it came under the hospital’s care.
When asked why the hospital first denied the cases existed, Brown said, “I don’t feel like there was any attempted cover-up.” They released the information as it became available, he added.
He deferred to administrators for answers about why information about a public health concern was not released.
Andy Fitzgerald, CCMH executive vice president, and Deb Tonn, the vice president of patient services, said the hospital was forthcoming with information as soon as it was available.
“At the time that first press release was made by the hospital and the information was published, we certainly went on the information that we had,” Tonn said.
She said that it was later, when the extent and severity of the cases was known, that the hospital released the information.
“But at the time, the hospital was being as transparent as we could be and we certainly went on what was in the chart and had been confirmed at the time,” Tonn said.
CCMH CEO Bob Morasko was not at the meeting to answer questions and was out of town Thursday morning. He did not return phone messages by press time.
Dunlap said after the meeting that he didn’t want the public to blame the entire staff of the hospital, especially Clarke, for a few people withholding information.
“There’s a lot of great people that work at the hospital,” Dunlap said. “It’s important that they do not associate everybody at the hospital with this incident.”
Precautions taken
After the first case was identified as a Strep A infection, the hospital tested 60 workers who could have had contact with the patient to see if they had the bacteria, said Veronica Taylor, a registered nurse and the director of infection prevention at the hospital.
“They were all negative,” she said. “I have talked to the state, and they assured me we went way above and beyond what was needed for follow up.”
Taylor said the hospital didn’t test workers once the second case was identified, but assured them they would be immediately seen by a doctor if they exhibited any symptoms.
Brown said the hospital followed the normal protocol for making sure the bacteria didn’t spread in the hospital.
“Those were standard precautions you would use with any infection. That didn’t change or alter, because if you look at the official (Centers for Disease Control and Prevention) recommendations, they will describe standard precautions” for dealing with the bacteria, Brown said.
Normal precautions that the hospital takes to prevent contamination and the spread of infections are sufficient to prevent Strep A from spreading within the facility, Brown said.
At no time were the normal operations of the hospital and its surgical facilities disrupted during the treatment of the three patients, Tonn said.
How the cases were treated
Once the cases were identified as invasive Strep A, the hospital reached out to experts in Strep A infections, including Harvard University’s chief of infectious diseases, Dr. Stephen Calderwood. Brown said Calderwood directed him to Dr. Dennis Stevens, a world-renowned expert in Strep A infections from the University of Washington and the Veterans Affairs Medical Center in Boise, Idaho, who helped advise the hospital on how to proceed.
“If you want to pick out one single world’s authority on group A Strep, that’s him,” Brown said. “He volunteered the assets of his laboratory.”
Brown would only discuss the treatment for the one person who died from the infection, which was the second confirmed Strep A infection and the first to present necrotizing fasciitis.
“He was treated with the standard two interventions in these serious infections, which are broad-spectrum antibiotics and surgery. And those are the definitive treatments,” Brown said.
The CDC said amputation often is necessary when trying to fight the disease.
“I looked at it and I thought the care was excellent,” Brown said.
Brown said the hospital sent samples from the two cases of necrotizing fasciitis to Dr. James Musser at the Methodist Hospital Research Institute in Houston.
“Based on recommendations from the gentlemen we’ve spoken to who are the world experts on these organisms, we’ll be doing some organism typing and trying to do some tracking of the organisms,” Brown said. “I think it’s appropriate under the circumstances.”
Typing the strains of bacteria would allow public health officials to track the bacteria in case it appears in another patient.