He had to be re-admitted: Rep. John Murtha's hospital acquired infection

U.S. Representative John Murtha, Chairman of the House military appropriations committee, is recuperating in the intensive care unit after a surgical infection from his gallbladder surgery. He'd had laparoscopic surgery to remove the gallbladder in late January, and had to be re-admitted to a hospital because of the infection.

He was in grave condition following the hospital infection. Now the infection is responding to antibiotics, and the condition of the 77-year-old congressman has been improving.

Nurses should provide antibiotics before surgery (prophylactic antibiotics) to prevent surgical infections, but don't always do so. A surgical checklist should remind nurses and doctors about the antibiotics, but checklists are not always used.

Advice to patient advocates of patients undergoing surgery: Ask the surgeon beforehand if he or she uses a checklist. If you don't hear Yes, choose another surgeon. If they don't use a checklist, or if they bristle at the question, that might indicate arrogance that can intimidate their clinical teammates into silence when a surgical error is about to occur.

Read other surgical infection stories. Thanks to Carol D. Leonnig and Paul Kane for their background article in the Washington Post of Feb. 3.

The bleeding was mysterious: Re-admission to the hospital

Here's the story of Jocelyn Angel Mommy of Melbourne, Florida, found on Nikki's Project Angel Mommy on MySpace:

I married a man who already had two children (then ages 11 and 9) from his first marriage. It was my only marriage and I had no children and I really wanted to have my own but I had to wait till he was ready which took more than 6 years. We did conceive quickly though and I found out I was pregnant on my 36th birthday in April 2004. My pregnancy was rough on me -- I was extremely nauseated and vomiting a lot for the first couple of months. But I was starting to feel better and get excited around halfway through and I allowed myself to believe I would really be bringing a baby home.

On Aug. 10, 2004, at 22 weeks, I started bleeding at home. I was admitted to Labor & Delivery and the bleeding was mysterious but they found my blood pressure to be extremely high. Although I was released the next day with meds (bleeding had stopped), the BP didn't come down so I was readmitted a few days later. I was in the hospital for another 10 days but nothing they did kept my BP down so I was transferred to a larger hospital in Orlando on Aug. 24th. There I got very sick very quickly and was diagnosed with severe pre-eclampsia and HELLP syndrome...my life was in immediate danger and my only chance was to deliver the baby immediately.

[HELLP syndrome, a variant of pre-eclampsia, stands for: Hemolytic anemia, Elevated Liver enzymes and Low Platelet count, according to Wikipedia.]


Jocelyn was one of the people whose "bounce-back" re-admission to the hospital can indicate that the quality of care during her first hospital admission had been sub-par. This is a disturbingly common occurrence. In a recent study in the New England Journal of Medicine of April 2, Dr. Stephen Jencks and his collaborators found that one-fifth (20%) of Medicare inpatients were re-admitted within a month of their discharge. The results: great suffering, like Jocelyn's, and great costs, many of them unnecessary.

Apparently, many of the re-admitted people in the study had not seen their primary care doctor between the two inpatient stays. Dr. Jencks found that half of the patients with medical (i.e., non-surgical) discharges had not had a doctor's office visit between the two hospitalizations.

Advice to people who are leaving the hospital: Make sure you see your primary care provider right away, and make sure he or she knows you've just left the hospital.

Thanks to Jocelyn and Nikki.