taken from Canadian article on hepatitis outbreak:
The suit alleges that Scarborough Hospital was negligent because it failed to “disinfect and adequately maintain” machines and surfaces in the hemodialysis unit and failed to test staff and others in the hospital.
It is also alleged that the hospital either hired incompetent or poorly trained staff and failed to adequately train them.
These are situations I have observed every tx in dialysis for years. I have dialyzed in units of most of the major corporations and some privately owned. The units are dirty, staff do not wash hands between patients and observe the rules of infection control, IV medications are given with unwashed/ungloved hands, medications are prepared in non-designated unclean areas, medical emergencies are fumbled, any corner that can be cut usually is.
All of this goes on and God only knows what else occurs behind the scenes and in areas of the facilites that can not be viewed. State surveyors turn a blind eye to these violations. They either don’t write the unit up or give them a slap on the wrist which allows them to get right back to business as usual. It seems the only recourse patients have are lawsuits. Any thoughts on this subject?
Well, it’s a lawsuit, initiated by people who hope to make big bucks out of it. So, it’s not going to state that the hospital does a good job and that this is some kind of freak occurence.
All dialysis centres here acknowledge the possibility of exposure to hepatitis. That’s why they highly recommend and pursue vaccination when you start there.
They clean as best they can, they have strict procedures with respect to infection control, but there are some surfaces which could not reasonably be cleaned after each shift of patients. As you know, dialysis machines in centres are not internally disinfected after every patient, but that’s standard practice throughout the industry.
Why 8 out of 400 patients at that particular hospital would test positive for hep is something I don’t know.
But it depends, I mean weren’t they doing monthly lab work on all patients and keeping track?
On the other hand, HepC is common. Many people have it without knowing it. Even healthy people have it, mostly transmitted from blood to blood…sex and that sort of stuff…or perhaps tongue kissing…
Pierre,
In this particular thread, I am not referring to the recent Canadian situation- I am referring to conditions in U.S. units where blatant disregard of federal/state regulations for cleanliness and patient safety occurs and oversite is weak/corrupt.
I hesitate to think this is a case just so someone can make big bucks. I also
hesitate to think the hospital is in the wrong. So far we have only heard one side of the story. If we are saying they are doing the best they can this could very well be true but if the best we can invites infection than the best we can isn’t good enough and needs to be changed. Although strict procedures are in place we have no proof they were carried out. All we have heard is the
ALLEGATION they were not and the lawsuit should settle the dispute. It is unfortunate but the truth alot of time remains hidden until someone files a lawsuit.
Jane, I’m really sorry that you have had such a negative experience with dialysis facilities. My experience has been different. I have worked in 3 dialysis clinics during my dialysis career – two free-standing (one corporate owned and one physician owned) and one hospital-based. In every one of them all external surfaces of the machine, chair, chair table, dialysate hoses, and jugs that blood could have come into contact with were cleaned with bleach between patients. Machines were disinfected nightly. Dialyzers were reused but checked by two people (we encouraged patients to check too) to be sure that someone didn’t get someone else’s dialyzer. Blood spills were cleaned up with bleach right away. In fact, when OSHA came to our clinic, the inspector was surprised by how blood-free my last clinic was (she expected to see blood everywhere, I believe). Nurses and techs used gloves with every patients and washed their hands and changed gloves between patients. Staff made put-on and take-off packs with all the supplies wrapped together in a chux. If anything fell on the floor it was thrown away…and the last two clinics I worked at were for-profit clinics. Infection control was that important to them. Remember, every day a patient is hospitalized is a day the hospital is making money and the dialysis clinic isn’t.
The key to good infection control is training, observation, and continuous quality improvement to identify problems and efforts to find out why the problem occurred. This includes looking at the system of care and at the individual who didn’t do the procedure correctly.
Surveyors go to clinics when patients or staff make complaints so if clinics are dirty or staff aren’t doing what they should be doing, patients can report this and the surveyor can make a surprise visit. I don’t know if all surveyor visits are surprise everywhere, but they are surprise in my state. Even if there’s a complaint about a clinic not following infection control protocol, surveyors can only observe what they see when they come to the clinic on the days they’re there. Most times they’re there for several days. However, once they walk in the door and the staff know they’re there, I’m sure they try do the right thing as much as they can remember what the right thing is. They still get caught and clinics still are written up and required to develop a plan of action to improve the deficiency. So far as clinics being given a slap on the wrist, there have been clinics that have been shut down when safety concerns are identified. Some of them have never reopened. I recently attended a national training for surveyors and these are some very dedicated and overworked folks who take responsibility for quality of care for dialysis patients seriously.
It will be interesting to follow this story to see what is identified as the reason for the hepatitis outbreak. Even if patients became Hep B positive, they may or may not develop chronic hepatitis and will need to be tested regularly for it. If someone has Hepatitis B, he/she should not have unprotected sex and family members of those with Hepatitis B should get the hepatitis B shots too.
As Gus said, many people have Hepatitis C and don’t even know it. There apparently is treatment for Hepatitis C that results in about 50% of people being able to stop treatment without having a recurrence. However, this article says there’s no cure for Hep C.
Ewwww yuck! You would think if they are catching hepatitis then they arent cleaning the machines properly. We have pretty high standards when it comes to machine maintenance here, and I like that!
I guess the question I have is have they proven without a doubt that these pts. contacted the hep. at the unit, and if so how exactly did that occur. There are units in urban areas that have a high incidence of hep. b and c, but then those units also have a high incidence of iv drug abuse ect… I’m not saying we in units shouldn’t be concerned, just that we need to keep things in context. Right now it’s the Avian bird flu I’d be a lot more concerned about as it has now mutated to a human (in Turkey), perhaps a very good reason why the more on homehemo the better. Lin.
Jane, I’m really sorry that you have had such a negative experience with dialysis facilities. My experience has been different. I have worked in 3 dialysis clinics during my dialysis career – two free-standing (one corporate owned and one physician owned) and one hospital-based. In every one of them all external surfaces of the machine, chair, chair table, dialysate hoses, and jugs that blood could have come into contact with were cleaned with bleach between patients. Machines were disinfected nightly. Dialyzers were reused but checked by two people (we encouraged patients to check too) to be sure that someone didn’t get someone else’s dialyzer. Blood spills were cleaned up with bleach right away. In fact, when OSHA came to our clinic, the inspector was surprised by how blood-free my last clinic was (she expected to see blood everywhere, I believe). Nurses and techs used gloves with every patients and washed their hands and changed gloves between patients. Staff made put-on and take-off packs with all the supplies wrapped together in a chux. If anything fell on the floor it was thrown away…and the last two clinics I worked at were for-profit clinics. Infection control was that important to them. Remember, every day a patient is hospitalized is a day the hospital is making money and the dialysis clinic isn’t.
I would love to dialyze in a unit like that. Every tx in each unit I have been in I have felt like I am under assault as there are so many violations. Thankfully, in my current unit, the staff is as nice as can be. But they are clueless when it comes to infection control and just like all the other units, there are dirty areas everywhere that just makes my skin crawl. There are areas that havn’t been cleaned since the unit opened yrs ago. The unit was inspected not long ago and nothing was cleaned up and the inspectors didn’t ding them…so? what does that say??? And, yes, you would think that keeping patients out of the hospital would be the goal, but apparently not.
Beth:
The key to good infection control is training, observation, and continuous quality improvement to identify problems and efforts to find out why the problem occurred. This includes looking at the system of care and at the individual who didn’t do the procedure correctly.
Even if the violator is the neph or administrator???
Beth:
Surveyors go to clinics when patients or staff make complaints so if clinics are dirty or staff aren’t doing what they should be doing, patients can report this and the surveyor can make a surprise visit. I don’t know if all surveyor visits are surprise everywhere, but they are surprise in my state. Even if there’s a complaint about a clinic not following infection control protocol, surveyors can only observe what they see when they come to the clinic on the days they’re there. Most times they’re there for several days. However, once they walk in the door and the staff know they’re there, I’m sure they try do the right thing as much as they can remember what the right thing is. They still get caught and clinics still are written up and required to develop a plan of action to improve the deficiency. So far as clinics being given a slap on the wrist, there have been clinics that have been shut down when safety concerns are identified. Some of them have never reopened. I recently attended a national training for surveyors and these are some very dedicated and overworked folks who take responsibility for quality of care for dialysis patients seriously.
I was in one unit where the surveyors came. They wrote them up for numerous violations. As soon as they were out the door they were right back at it again. We called the state back and let them know what was going on, at great risk to ourselves. They told us they could come back, but it was hard to catch them in the act. Well they had already caught the unit staff in the act, but it didn’t bother the staff much. They were only bothered by the extra work they had to do putting up with the surveyors for 3 days and complying with some of their deterrants. Yes, it accomplished something, but not enough. The state told us to call corporate and maybe they would do something. We are not the police… that is their job. The unit is still being surveyed for the same violations to this day! Some states enforce…others are soft on unit crime.
Jane, I think you hit the nail on the head! If the state you live in, (their board of health) has the reputation of letting things slide apparently the poorly run units have gotten wind of it, or so it seems because it’s unusual for so many units in one given area to be bad. Are they all run by the same company? Have you contacted any state officials other than those in the board of health? Perhaps they should know that their state board of health needs a shakedown. I’m glad you spread the word, and copy and past informative articles for all to see but am concerned that this isn’t really changing things for you! Are their other pts and family members that are concerned? Perhaps you can all ban together. Has anyone contacted the network and given them a list of grievances? Lin.
Lin,
The thing that has me conerned is the units I have been in are in different regions of the country, but it’s the same problems. The worst unit I was in had a monoply in that city and surrounding areas. They had no real fear of the surveyors- just consdiered it an interruption to their already hectic day. But the situation has bascially been the same in other regions I have lived in. It’s the same dirty units, the same lack of infection control, same dismissive attitudes etc.
After seeing what happens when the state was called in in the first unit and seeing the state come in other subsequent units in different regions and walk right back out with the same obvious, glaring violations overlooked, I haven’t been eager to risk my neck going to the network or state again. Remember, I was harrassed and had it strongly suggested that I “might be happier dialyzing somewhere else”.
I haven’t found that patients in any of the units I’ve been in are willing to ban together to do something. I’ve had numerous patients tell me how they were treated unprofessionally and they will beg me not to tell anyone. They are afraid for good reason.
This is a situation where patients are in a Catch 22, because one can not risk losing their dialysis chair should the network/state not enforce. When one sees that the unit is filthy and staff don’t wash their hands etc, and the state has done an inspection and clearly seen what goes on and didn’t ding them that sends a strong message which is how could they be getting away with this unless the system in that region is corrupt?
To me, suggestions about contacting the networks and states is fruitless as I have seen what goes on with the agencies not doing their job in the areas I have been in. I feel patients need a different approach where they will be promised protections.
Most patients take the attitude that this is too heavy -why bother to fight it. I would like to know what is different about the regions that do take enforcement seriously. I have spoken with officials in some of the top offices and they have acknowledged the problems do exist. They said one must go to their elected officals and form advocacy groups that hold the state, whose job it is to inspect units, accountable. Sounds right, but where are the particpants and where are the protections?
Two hours ago I found out that my father was put on a machine for hemo that had not been cleaned at all. The patient before him had hep b. That is totally unforgiveable. I would say that is a pretty basic thing to do. Patient finished dialysis - clean machine. We wash our dishes before we eat from them. He is being “closely monitored”.
How did you find out; did staff tell you? This pt. should’ve been in isolation if possible, if they have machine or area that is for isolation. Has your father had his Hep. vac. series, and if so has he had a recent titre to make sure it’s still effective? My concern is that if they are letting something this routine (or at least it should be routine!) go, that they are letting other things pass. This is totally unacceptable, and if possible get him out of there! Would it be possible for you or your father to be trained to offer him hd at home? Lin.
OH MY GOD are you serious Joanne?!?!?!
That is just so completely unforgiveable. There is absolutely NO EXCUSE for that!!!
I would of demanded they take him off that machine. I dont know how easy it is to catch Hep B of a machine but that is just so rediculous.
I would be going straight to the health department.
This is a medical error and there should be a written an incident report explaining what happened. The clinic should have a procedure for handling medical errors. I assume that your clinic has a process whereby this medical error will be discussed and some plan should be developed, including retraining any personnel involved, to prevent this error from happening again. I’d want to know from the admininstration and from the doctor what the risks are of catching Hepatitis B for your father, what anyone who is in contact with your father needs to do until he finds out his Hepatitis B status, and I’d want to make sure that the doctor knows about this medical error and how it makes you feel.
Patients who are Hepatitis B are supposed to be dialyzed in a separate room or in away from other patients if dialyzed in a common room. It sounds like the Hepatitis B patient was dialyzed in the same room with other patients. Hopefully, this person was dialyzed far from others so that even though your father was dialyzed on the same machine that was not cleaned between patients and may have been exposed to Hepatitis B, other patients weren’t exposed too. An event like this could explain how the Hepatitis B infection in Canada was spread.
This is the problem that lets this “error” to happen, the esrd and the company where this happen and Beth just want to talk and fix the problem, making it go away.
How many times to do we just make it go away by talking? That is what the esrd and the company wants. If this happened to me the company and doctor and the esrd would know very fast how I feel.
bobeleanor :shock:
First, are we sure that the patient had Hepatitis B or Hepatitis C? Hep C patients do not have to be isolated while Hep B patients do. Neither is something any clinic would want one of their patients to get at the clinic. I would like to know what happened to the staff member who was assigned to clean that machine and how it came to pass that the machine wasn’t cleaned. Cleaning a machine between patients is basic infection control. I am not only concerned about your father but about other patients in the clinic who may have had similar problems.
If he has had the Hep B shots, he might ask the clinic his Hep B antibody status prior to the event and then when he can be expected to be tested again. Hep B can be dormant in the body for 2-12 weeks so I’d want to know when they plan to test/re-test:
When I wrote what I wrote, I wasn’t implying that you just talk about it. I was saying that the first step would be to find out how this was reported and handled within the clinic and whether the doctor knows about it. However, knowing what the clinic policies and procedures are might help you in the next steps.
You can always contact your state department of health to alert them to this error. State health departments contract with Medicare to survey clinics for health and safety issues. To find your state survey agency go to http://www.medicare.gov/Contacts/Include/DataSection/Questions/SearchCriteria.asp and in Step 2, choose from the drop down menus ESRD State Survey Agency and choose your state from the list.
If surveyors come to the clinic for this complaint, they would not only investigate this complaint, but would go through the entire survey process to see if they could find other problems (called deficiencies). There are various levels of deficiencies and some are so severe that a clinic must be shut down immediately. I suspect the surveyor would start by asking about the error and ask to see a report of it and what the clinic policies and procedures are to avoid this type of error, how the breakdown occurred, and what policies and procedures have been put in place to avoid future errors like this.
You can always take legal action. However, if you’ve ever filed a lawsuit or have known anyone who has, you would know how much it can cost and how long it can take to get a lawsuit resolved. Many lawyers won’t accept medical error lawsuits unless there has been actual harm…as opposed to a potential harm. My friend who has experienced 41 medical errors talked with several lawyers about worst ones and no one would take her case because they didn’t feel enough harm had been committed. If the facts are as reported, your father develops Hep B, that would be an obvious harm committed and maybe you’d find a lawyer to take the case. I believe you would be alleging neglegence which is a tort.
Assuming that you do find a lawyer, your case could go to trial which raises the cost or it may be settled out of court. Your father could be awarded monetary damages. Attorneys on contingent fee basis get a percentage of the damages so they want to be sure that cases they take are win-able. Although from what you read and hear in the media you would think that doctors’ medical malpractice insurance costs are increasing because of more lawsuits and excessive awards, data doesn’t support this claim.
My friend who has experienced 41 medical errors talked with several lawyers about worst ones and no one would take her case because they didn’t feel enough harm had been committed.
There is something majorly wrong with the legal system if it is not possible to sue someone unless they harm you so bad they kill you. There is more than one way to harm patients. I have witnessed and experienced many types of abuses in units. If someone on the street punched you it would be considered an assault. I wonder why it is not considered an assault when dialysis staff, let’s say, work on a patient’s access without washing their hands. Not speaking of a momentary lapse, but unit willfully cutting corners. When all the abuses are added up it equals much ongoing emotional and physical duress for patients.
I’d like to say that our system of justice is fair, but I don’t think that you can assume that just because something isn’t right, the judicial system would find fault. Think of lawsuits from the lawyer’s point of view. It can cost tens or hundreds of thousands of dollars to do the legal work to prepare a case to go to trial. If there was no harm – no infection, no hospitalization, no economic damages (doesn’t have to be death) – how could damages be assessed? Therefore, the case could be dismissed for failing to state a cause of action (i.e., not legally entitled to recover damages. If the lawyer took the case on a contingent fee basis (percentage of award), the lawyer would be out the time and money in preparing the case. The lawyer could file the case and state that the patient had mental anguish as a result of the potential harm. However, I believe there would have to be proof of the mental anguish as well – symptoms, cost of visits to a therapist, etc. I’m not a lawyer, but am a social worker and believe strongly that distress leads to negative outcomes, but from what I gather, it’s not always easy to convince a court .
Therefore, if you’re trying to make sure that clinics do the best job of preventing medical errors and respond appropriately if/when medical errors occur, I’d suggest the state health department first.