Mr. and Mrs. Republican: A lawmaker's response to their hospital acquired infection

Leo and Rita Pepino were married for almost 60 years. "She was my life," Leo says.

Rita died from bone cancer in 2005, after battling two other cancers. She was affectionately known in New Hampshire as "Mrs. Republican" for her political activism. Her husband Leo was the former Speaker of the New Hampshire House of Representatives.

Rita had acquired several painful infections while in the hospital, getting sicker from the place that was supposed to make her well, Leo said.

"Every time she went to the hospital, she always got an infection," he said. He got one, too, years ago from a different hospital when he had back surgery.

Also a Republican, he kept his word after Rita died, helping to marshal through a new law requiring New Hampshire hospitals to report to the state for public release their rates for the three most serious hospital-acquired infections.

New Hampshire Gov. John Lynch signed the bill into law in 2006, "in memory of Rita." However, public reporting has lagged: the state still does not publish the rates of individual hospitals' infections.

A year ago, Leo vowed at age 81 to run again for the seat he lost last time around to make sure consumers get information to compare hospital infection rates. It's for Rita, he said.

Advice to political activists: Be vigilant to ensure your new patient safety laws are implemented faithfully after they become law.

Read another story about Massachusetts'new law on reporting hospital acquired infections.

Thanks to Helen Haskell, and Nancy West for the source article in the New Hampshire Sunday News of August 10, 2008.

Back at the same level: Tom Brady's hospital post-surgical infection

A few minutes before Super Bowl LXIII, and Patriots fans know that in a just world, Tom Brady should be guiding the Patriots to another Super Bowl win.

Tom, of course, suffered a season-ending injury early in the season. He had surgery on October 6 to repair his knee, with a patella tendon graft inserted to replace his torn ACL (anterior [front] cruciate ligament). His torn medial (middle) cruciate ligament (MCL) was also repaired.

Afterward, he suffered a postoperative staph infection – the most common kind of post-op infection. He was put on antibiotics, and remained on antibiotics through at least November 11. The infection was caught early, and was treated aggressively with wash-out procedures and intravenous antibiotics.

The infection has delayed the start of physical therapy to restore his range of motion, prevent the build-up of scar tissue, and protect the cartilage.

But Patriots fans can take consolation in the words of Kevin Wilk, the associate clinical director of Champion Sports Medicine in Birmingham, Alabama, who has helped more than 500 NFL players recover from ACL surgery: "He's going to make it back and play at the same level."

Advice: Bet on Tom Brady.

Read another football knee surgery story.

Thanks to Shira Springer for the source article in the Boston Globe of Nov. 11.

Twice he was given last rites: Staph infection from a knee replacement

Robert Besse's painful journey began when he checked into a Cincinnati hospital a year ago to get his right knee replaced. The 60-year-old retired pharmacist had worn down the joint skiing and hiking and working on his feet for years.

Ten days after leaving the hospital, his knee was still oozing bits of fluid. "The pain was off the scale," he said. One of his surgeons took a look and immediately had him admitted to a different hospital, where he declined rapidly. Twice during the first night he was given last rites. But he survived until the morning when the surgeon opened up his knee again and found a raging staph infection that took two rounds of surgery to clean up. He spent the next several months on infused antibiotics and pain medication. He was barely able to celebrate his 60th birthday with his family in Breckenridge, Colorado.

He might have fared better at a specialty hospital – one of 200 centers in the U.S. that focuses on the care of a particular body part like the heart, spine, or joints, or a specific disease such as cancer. A study by the University of Iowa on thousands of Medicare patients found that rates of bleeding, infections, or death ("complications") are 40% lower for hip and knee surgeries at specialty hospitals than at big community hospitals. A study funded by Medicare in 2006 found that mortality rates for orthopedic surgery, e.g., knee replacements, are 75% lower for orthopedic patients in specialty hospitals than for other hospitals.

Advice to patients about to have surgery: Consider having the surgery at a specialty hospital.

Read another knee replacement story.

Thanks to David Whelan for the source article in the March 10 issue of Forbes magazine.

His family was hopeful he would fully recover: Enterobacter Aerogenes infection

On September 2, 2006, 27 year old Josh Nahum was injured in a skydiving accident near Boulder, Colorado. He had broken his femur and fractured his skull and was admitted to the Intensive Care Unit (ICU). His family was hopeful that, even though the doctors believed Josh would have a long road ahead, he would, with rehabilitation, fully recover within a year or two.

During his recovery in ICU he suddenly developed a bacterial infection - Staph. His neurosurgeon prescribed Vancomycin which cleared it up. As the weeks went by, Josh began to get better, even taking brief walks with the help of his walker and his Physical Therapist, Brian.

After 6 weeks or so in ICU, he was transferred to a nearby Rehab facility until he suddenly developed a 103-degree fever and was sent back to ICU. Tests reported that Josh had yet another bacteria named "Enterobacter Aerogenes." 

On Monday, October 9th Josh coded and stopped breathing, becoming comatose with no respiratory effort whatsoever. The Emergency Room was called and he was put on a ventilator. An excessive pressure buildup on his brain due to the bacterial infection caused a portion of his brain to be pushed into his spinal cord, permanently interrupting his ability to breathe on his own as well as his ability to move his head, arms or legs ever again. 

In a matter of moments, Josh had become a ventilator dependent quadriplegic. Less than two weeks later, he died, not from his original injuries, but from complications arising from virulent bacteria he caught in ICU.

Advice: Help strangers protect themselves against medical errors by telling your stories widely, as Josh's mother, Victoria Nahum, has been doing.

Read another young athlete’s hospital infection story.

Thanks to Victoria Nahum for the source story in hospitalacquiredinfections.blogspot.com and to Adam Gee and Elizabeth Cohen.

I’m sure they have some record: A laboratory medical error

The last time she saw her father - a soft-spoken man who "always had a joke for everyone" - was when she visited her parents' home in Florida for Christmas. "He was great," Jeanne Zeller said. "He even carried my luggage for me."

Around a week later, though, Thomas Zeller started to have shoulder pain. After enduring it for a week, the 69-year old man checked into the hospital, on Jan. 8, 2006. His initial vital signs were normal and his chief complaints were left shoulder pain and right hand swelling. X-rays of Zeller's left shoulder showed a slight dislocation of bone. On his first day in the hospital, he was given a Foley catheter to help with urine retention.

Thomas' temperature spiked to 102 degrees during the late evening of Jan. 11, and a blood culture was taken the next day. Meanwhile a cardiac catheterization on Jan. 11 had suggested dysfunction of the heart muscle (cardiomyopathy). Though the condition was serious, it didn't warrant his staying in the hospital any longer, and he was discharged to a nursing home on Jan. 14.

Thomas’ fever continued to spike during the next week, while he was having rehabilitative physical therapy in the nursing home. At the end of that week, he was transferred back to the hospital, on Jan. 20. There, the blood and urine cultures revealed Pseudomonas aeruginosa, a "superbug" resistant to most antibiotics. From there, his condition deteriorated, as the infection spread to his heart valves. On Feb. 15, Zeller's wife signed the "do not resuscitate" order, and he died soon afterward.

The superbug had spread, unknown and untreated, for a week, because the Jan. 12 blood culture result was delayed or missing until after he left the hospital. "By not having important lab results in the chart in a timely manner," Jeanne Zeller wrote to the Florida Agency for Health Care Administration, the hospital "sentenced my father to death."

The most likely explanation: "Persistent Pseudomonas aeruginosa bacteremia blood poisoning probably started off as a urinary tract infection," Dr. Murali Puthisigamani wrote after examining Thomas on Jan. 30.

The hospital had made at least three errors. First, unsanitary conditions were surprisingly prevalent. Three of nine patients sampled by AHCA "were not provided catheter care and/or personal hygiene care," according to AHCA’s report. Second, the initial lab result was delayed. Third, when the critical result was determined, staff told no one. Apparently the hospital had no effective system in place to immediately sound an alarm to doctors when laboratory staff learn of such critical lab results (also called "panic values").

The AHCA inspector had asked the infection control nurse why Thomas Zeller's Jan. 12 blood culture never made it to his chart. Her response: "If a patient left before the final results were in, they may be - I don't know how medical records does their filing. I'm sure they have some record."

Advice: Before you let your father into a hospital, ensure that the hospital participates in the Five Million Lives campaign of the Institute for Healthcare Improvement.

Read a story on misplaced lab results, or read Elena Lesley’s source story, dated April 1, 2007.