Saturday, February 21, 2015

Healthcare Driven By Media Hysterics

Our endoscopy suite right now is in complete turmoil. If you haven't heard the news yet because you've been on a 48 hour call shift, UCLA Medical Center released a bombshell of a press release yesterday. They've had two people die and five other people infected with the highly resistant bacteria CRE or carbapenem resistent enterobacteriaceae. The patients came into contact with the bacteria after undergoing ERCP with contaminated duodenoscopes. Up to 180 other people who had the procedure performed from October 3, 2014 to January 28, 2015 are being asked for follow up at the hospital to determine if they too have been contaminated.

When the news broke late Wednesday afternoon, our own hospital went into crisis mode. The following morning, swarms of epidemiologists and microbiologists invaded the GI department. Every scope was taken down from their storage racks and cultured. Multiple meetings involving the highest levels of the hospital administration were quickly convened to deal with the hundreds of calls from worried patients and the news media, even though our hospital has never had any known transmission of CRE through a GI procedure. Patients are cancelling cases out of doubt and fear. When they do come, they are demanding full accounting of how our facility cleans the scopes, as if they had any clue which scope washing techniques works the best.

Olympus, the maker of the duodenoscopes, is already facing lawsuits from infected, and potentially infected, patients. Funny how there were no suits before this became big news. But as soon as the cameras start rolling, lawyers just suddenly pop out of nowhere, each seeking face time on TV to express their outrage at the manufacturer for making a "defective" product.

The Food and Drug Administration is also circling the wagons. People now accuse the FDA of knowingly approving a medical device that could potentially transmit harmful pathogens between patients. They may be fast tracking new cleaning protocols for duodenoscopes, which will probably involve outsourcing the cleaning using expensive gas sterilization with ethylene-oxide, a known carcinogen.

Though the UCLA deaths and infections are terrible events, I can't help but wonder why this has suddenly become front page, network news material. Gastroenterologists, the FDA, and the scope makers have known about this potential flaw in the design ever since it was approved for use. This is not new news. The only reason the duodenoscope continues to be supported by the government is because there is no real alternative for these patients who need an ERCP performed for acute cholangitis, pancreatic cancer, or a host of other pancreato-biliary diseases. But as soon as the four letters U-C-L-A becomes involved, then the entire weight of the masses comes crashing down on all the affected institutions.

As an example of the persecution being heaped on UCLA just for having those famous initials, there was an even more severe outbreak of CRE last year that nobody outside that local area and GI doctors know about. The highly esteemed Virginia Mason Medical Center in Seattle had eleven patients die after contracting CRE from infected duodenoscopes. That certainly did not make any front page headlines anywhere. Even earlier than that, the University of Pittsburgh Medical Center also suffered a rash of CRE infections that were traced to ERCP's. In that instance nobody died.

But now, just because UCLA is the targeted institution, a whole new way of taking care of a medical device will probably be instituted across the entire nation. This is going to cost the hospitals, and eventually the consumers, millions of dollars to prevent a few infections out of half a million ERCPs performed every year in this country. Healthcare consumers in the U.S. are demanding absolute protections with minimal costs. They are going to realize eventually that you just cannot have it both ways.

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