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“It is unacceptable that so many hospitals are doing so poorly.”

--John Santa, M.D.
Medical Director
Cosumer Reports Health

Patient Beware

New Survey Ranks Tulane Medical Center as One of the Unsafest Hospitals in the Country
The May, 2014 issue of Consumer Reports featured an article on medical errors and hospital safety that included safety ratings of 2,591 hospitals.  The ratings were based on a composite score of five safety categories (mortality, infections, readmission, excess scanning and patient communication), each scored from 1 to 100.  From the magazine's published table, the 13 worst hospitals had an average score of 22, while the 13 best hospitals had an average score of 74.  Tulane Medical Center, with a score of 19, had the second worst safety score.  The data for the Consumer Reports study was reportedly obtained from the Centers for Medicare & Medicaid Services.

In past years, Tulane Medical Center has been cited for its failure to properly sterilize invasive medical devices used to examine and treat patients.  Especially newsworthy was its failure to properly sterilize endoscopes used for colonoscopy (see below) and surgical instruments used for brain surgery.


Tulane Medical Center alerts patients after medical gear improperly sterilized
March 10, 2011

Tulane Medical Center has notified 360 patients that it failed to properly sanitize gastrointestinal scoping equipment used during seven weeks last fall, potentially exposing the group to various infectious diseases. tulane_university_hospital_clinic.

Dr. Robert Lynch, the hospital's CEO, acknowledged the error in a Jan. 3 letter that invited affected patients to obtain free screening for hepatitis B, hepatitis C and HIV. The letter, however, characterized the chances of infection as "minimal to non-existent."

Lynch cited a mistake in one of five steps in its sanitizing protocol and framed the tests as a way "to reassure patients whose procedures were impacted."

State epidemiologist Dr. Raoult Ratard, who has conferred with Tulane officials about the case, said the chances of the equipment transmitting an infection "would be extremely, extremely small. I think Tulane just wants to be careful."

That has not satisfied at least one patient, identified as "John Doe" in the lawsuit he filed Feb. 22 in Orleans Parish Civil District Court. The suit, which seeks class-action status, accuses the hospital of negligence and alleges a long list of harmful effects ranging from "mental anguish" to "loss of enjoyment of life."

According to Lynch's letter and a follow-up written statement released Thursday, a routine maintenance inspection confirmed that part of the disinfecting procedure for endoscopes and bronchoscopes did not occur at a sufficient temperature. The error persisted from Oct. 7 to Dec. 1 on equipment used for colonoscopies, sigmoidoscopies and upper-endoscopies of the stomach. "Once this was discovered, it was remediated immediately," Lynch wrote, explaining that the hospital immediately contacted infection control experts, including the Ratard's unit at the Louisiana Department of Health and Hospitals.

According to the Centers for Disease Control and Prevention, infection associated with the use of endoscopes occurs in about 1 in 1.8 million procedures, low odds but enough to make endoscopes the most likely medical device to yield outbreaks associated with health-care institutions.

Neither the letter nor Tulane's statement detailed its sanitizing procedure.

According to Ratard, the scopes in question cannot be sanitized using steam because of the likelihood of heat damage. Instead, the key step of the cleaning process calls for application of a chemical disinfectant or sterilant for a specified period of time at an elevated temperature. Ratard said the settings on the sanitizer were elevated, but still too low, though he could not recall specifics. He attributed the mistake to human error.

Ratard characterized Tulane's mistake as "fairly common" in American health care and said the hospital "has handled this by the book" by notifying patients and offering them several rounds of testing, along with follow-up counseling.

Harvey attorney Ron Austin, lead counsel on John Doe's class-action petition, said the hospital's admission of error does not mitigate the risk involved for the affected patients.

"This is extremely serious, and it's unfortunate," he said. "They are petrified. They are extremely angry. How do you have that conversation with your partner that you may have HIV, and what of the social fallout for anyone who discovers that?"

The suit also names John Doe's wife, Jane Doe, as a plaintiff, because of her potential exposure through the couple's sexual relations.

Austin said both Does have been tested for infectious diseases and both have been negative, though follow-up testing will be ordered because of the incubation periods of some viruses.

The case has been assigned to Judge Paulette Irons, who will decide whether to certify the matter as a class action.

Tulane Medical Center is jointly owned by the for-profit Health Care Corporation of America and Tulane University.

A decade ago, the hospital suffered a black eye and a subsequent legal tussle when it announced that eight surgery patients had been exposed to a rare, incurable brain disorder because they all underwent operations using some of the same instruments used on a patient with Creutzfeldt-Jakob disease.

Those incidents were not a clear-cut matter of errant sanitizing, however. With a similar pathology to mad-cow disease, Creutzfeldt-Jakob disease is spread through protein agents that, at least at the time, were resistant to standard sterilizing procedures. The condition was diagnosed with certainty in an initial Tulane surgery patient only after death.

The hospital settled a negligence claim by one of the subsequently exposed patients. The financial terms were never disclosed. None of the eight is known to have developed the disease.

Copyright 2011, NOLA.com

From: Bill Barrow, "Tulane Medical Center alerts patients after medical gear improperly sterilized," The Times-Picayune, New Orleans, March 10, 2011, http://www.nola.com/health/index.ssf/2011/03/tulane_medical_center_alerts_p.html, accessed 04/03/2014. Reprinted in accordance with the "fair use" provision of Title 17 U.S.C. § 107 for a non-profit educational purpose.

Video adapted from: Scott Walker, "Lawsuit Claims Hospital Failed to Sterilize Equipment," WDSU 6 News, March 10, 2011, http://www.youtube.com/watch?v=c0kN_MfPkr8, accessed 04/03/2014.  Reprinted in accordance with the "fair use" provision of Title 17 U.S.C. § 107 for a non-profit educational purpose.





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