Thursday, July 21, 2011

Why were C. diff deaths kept secret?

"The Niagara Health System has revealed that a patient died after acquiring C. difficile during the last outbreak at Greater Niagara General Hospital in 2008.
"We have confirmed with (Niagara Region) Public Health that there was one death associated with the 2008 outbreak of C. difficile at the GNGH site," said NHS interim CEO Sue Matthews.
Speaking at the NHS' daily C. difficile media briefing at GNGH in the Falls, Matthews said that at that time and even now, hospitals are not required by the Ministry of Health to report C. difficile deaths and because of that non-obligation to report, the hospital did not make the death public at the time.
That previous outbreak in the Portage Rd. hospital's Unit C ward lasted from Dec. 5, 2008 until March 5, 2009, with The Niagara Falls Review reporting at the time that there had been six confirmed cases and one suspected case of C. difficile in the unit. At the time, no mention was made of the death.
It was a reporter's question during a NHS media briefing on the current C. difficile outbreaks that sparked the recent revelation, said Matthews.
Underscoring the NHS' recent pledge to be more transparent with the public, Matthews said the NHS has changed its ways since the 2008-2009 outbreak in the Falls and that now, that death would've been disclosed.
"Hospitals were not reporting deaths at the time of this outbreak and in our new culture, this death would've been reported in a timely fashion," Matthews said.
Because of patient confidentiality legislation, the NHS has not and will not be releasing the patient's name, but on Wednesday Matthews said it was still unclear as to the exact date of the death or even how old the patient was. Officials were still trying to find out more information by checking records, Matthews said.
Manwhile, the current outbreaks have so far been linked to the deaths of 13 patients at the St. Catharines General Hospital, four patients at GNGH, and six patients at the NHS' Welland hospital, according to NHS figures.
Although the total number of deaths reported by the NHS is 24, media have been reporting 25 deaths.
This is because a C. difficile-linked death that happened at the same time of the St. Catharines outbreak is not counted by the NHS because it is not considered to be an outbreak-related case.
As of Wednesday there was still a total of 75 cases confirmed since the first C. difficile outbreak in St. Catharines was declared on May 28.
There were 21 patients confirmed to have C. difficile at the St. Catharines General, which was up two from Tuesday. At GNGH, there were 14 patients in the hospital, down one from the day before. As well, Welland's total number of in-patients with C. difficile rose by one to eight in total.
In the smaller local hospitals, there was still one non-outbreak related death associated with the Niagara-on-the-Lake hospital, where there was still one patient in hospital with C. difficile. As well, there was three cases at Fort Erie's Douglas Memorial Hospital and three cases at the Port Colborne hospital.
Clostridium difficile, a bacteria found in the intestines, can cause severe diarrhea and potentially life-threatening intestinal ailments such as inflammation of the large intestine, extreme inflammation and distention of the colon.
Matthews also said that she anticipates that the NHS will face criticism when NHS documents pertaining to a Hamilton media outlet's freedom-of-information (FOI) request are released in the coming days.
Despite previous attempts to try to block the release of information, Matthews said the NHS will fulfill the FOI request after removing any references that might breach provincial confidentiality legislation.
According to an April 12, 2011 ruling from an adjudicator with the Information and Privacy Commissioner of Ontario, the media outlet had asked for "all documents, reports, correspondence, e-mails, briefing notes and minutes pertaining to Clostridium difficile in the Niagara Health System since 2007."
Asked if the info will essentially make the NHS look bad, Matthews said she expects that it might.
"I expect that there will be some questions about our infection-control practices in the past and I think what we need to do is focus on going forward," Matthews said. "We will learn from the past. I believe we have.""
'Looking bad'?! Are you kidding? This is more than that - this skulduggery should be for a criminal court to judge.
This whole thing about not reporting C. difficile deaths goes back to my July 4, 2008 post here, where the Hamilton Spectator reported that "Dr. Michael Baker, the Ontario patient safety adviser in charge of designing the reporting system, says there will be a standard definition for what constitutes an outbreak. But there is no intention to require hospitals to report deaths."
This effort not to focus on the C. difficile patient deaths has been standard procedure under the Liberals.
We are still being told by the NHS that, on the one hand, "hospitals are not required by the Ministry of Health to report C.difficile deaths", but then, we're also being told that the NHS has a sudden 'new culture', and now C.diff deaths would be reported; so, which is the official policy here?
Is the Health Ministry's original stance (ie - hospitals are not "required" to report C. diff deaths) still in effect (as Sue Matthews says) elsewhere in Ontario, or has this been over-ridden as specific local policy, ie, that hospitals always had the ability to report these deaths, but they didn't, because the Liberals told them they didn't have to.
In other words, being "not required to report" didn't mean that a hospital couldn't report! So the question then is: if  hospitals, province-wide, didn't have to report - but could, nevertheless, report their C. diff deaths - why didn't more hospitals opt to report?? Why the allowed secrecy; why did Smitherman and Caplan allow this lax default-"not required to report"-position, instead of making it law that these outbreak deaths (any outbreak) must be reported??
And this patient-death information is what the Hamilton Spectator was trying to pry out of the Liberal's secretive health monopoly province-wide in 2008.
Maybe Good Ole Secretive MPP Jim Bradley can explain his Liberal government's position ... except that no media outlet in Niagara dares to ask Jimmy about this...

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