Posted on 05/31/2003 7:07:17 AM PDT by harpseal
SARS alert ignored: Nurses Doctors deny they failed to heed warnings about family `There was no link to any SARS patients:' North York MD
THERESA BOYLE AND KEVIN DONOVAN STAFF REPORTERS
A family cluster of five people with SARS-like symptoms went undetected at North York General Hospital in the weeks leading up to the announcement that a new wave of the deadly respiratory infection was sweeping through the hospital.
Nurses say they raised serious concerns which were dismissed by doctors. Even a member of the exposed family pleaded with hospital staff: "Does anybody realize we all have this thing?"
Still, not enough was done, charge two emergency room nurses who spoke to the Star yesterday on condition of anonymity, for fear of being fired.
"There was a hurriedness to be done with SARS," said one.
Dr. Glenn Berall, co-chair of the hospital's SARS management team, denied the accusations: "I don't have the same impression as the nurses. I respect their professional opinion, but I don't have the same impression."
During this time, through patient transfers and walk-in traffic, SARS was spread, leading to the current outbreak at five health-care centres and thousands of people being quarantined in the community.
The investigation included an examination of suspicious cases in other parts of the hospital.
"We sounded alarm bells, which were silenced, days before it became undeniable," said one of the nurses.
They said they still have concerns about the way North York General is treating SARS. For example, the hospital's SARS unit is so overloaded with patients that some suspected SARS cases are being treated in emergency. The nurses say the only barrier protection provided are some hastily erected shower curtains, which they say they had to fight to have installed. Typically, people with SARS symptoms are treated in isolation, in a negative-pressure hospital room if possible.
Staff concerns boiled up on May 20, just after the Victoria Day holiday weekend. Staff say they told their superiors they feared a SARS outbreak in the hospital because a family of patients had SARS-like symptoms.
They say Berall, along with Dr. Barbara Mederski, the hospital's infectious disease specialist, dismissed their concerns. Mederski did not respond to calls from the Star over the past two days. A hospital spokesperson said she was having "some well-deserved rest."
Hospital president Bonnie Adamson, a nurse, knew of the meeting, but did not attend. She was unavailable for comment yesterday. Nurses say she has been trying to advocate on their behalf.
Berall said public health officials investigated the family cluster, but ruled out SARS, given what they knew about the virus at the time.
"The original diagnosis of SARS required an epidemiological link. ... This particular family didn't have an epidemiological link. There was no link to any SARS patient or to travel in China and, therefore, the diagnosis of SARS couldn't be made," he said.
Now public health officials say a SARS diagnosis may not require such a link.
"There's an expression in English, hindsight is 20-20. All the experts are experiencing that along with us," Berall said.
Here's how the outbreak developed at North York General, according to the nurses, public health officials, doctors and a hospital spokesperson.
It took place in an atmosphere of increasingly relaxed restrictions on mask wearing and other protocols instituted as a result of Toronto's original SARS outbreak. Nurses interviewed include the media in a list of groups that they believe contributed to the relaxed vigilance. They note that, after the World Health Organization removed the travel advisory against Toronto on April 29, the media dramatically scaled back coverage of the disease.
At North York General Hospital, in mid-April, a 96-year-old man arrived at emergency with a fractured collarbone and pelvis. He had an operation April 19. The man was short of breath, which staff at the time attributed to his broken collarbone and post-operative atelectasis, or a partially collapsed lung. He died May 1, still without anyone thinking he had SARS. He had been treated on the fourth floor, in the orthopedic ward.
-------------------------------------------------------------------------------- `Hindsight is 20-20. All the experts are experiencing that along with us.'
Dr. Glenn Berall, co-chair of North York General's SARS management team
--------------------------------------------------------------------------------
The following week, on May 10, the man's 90-year-old wife developed pneumonia-like symptoms and came to North York General Emergency. She was admitted. Doctors, nurses say, decided she got pneumonia due to exhaustion. She has since died.
Then, on the May 17-18 weekend, the couple's 67-year-old daughter and her husband came to emergency with similar symptoms. They were both admitted.
Later, either on May 18 or 19, that couple's daughter (the granddaughter of the 96-year-old patient) came into the hospital with SARS-like symptoms.
The nurses said chest x-rays of the family members showed some type of pneumonia and were identical to x-rays of known SARS patients.
Worried about the number of her relatives becoming ill, the 67-year-old woman contacted the hospital, according to the nurses, and asked a staff member, "Does anybody realize we all have this thing?"
The cluster of SARS-like cases in one family prompted the nurses to take action on May 20. They requested a meeting with Berall and Mederski, which was attended by about 20 nurses, along with administration officials, a pharmacist and others.
The nurses said they were sure there was an outbreak of SARS in the hospital. They said they were worried about colleagues in other parts of the hospital — like those on the fourth-floor wing where the 96-year-old patient had been treated — who were not wearing protective garb like their ER counterparts.
"It was too much to be a coincidence," said one nurse. She said some other doctors agreed with them and said the family cluster is either SARS or "the most amazing coincidence."
But the concerns fell on deaf ears, they charge.
"(Berall and Mederski) were basically saying we don't need to (wear our masks), it's over, there's no SARS; he was saying you guys are overreacting," the nurses recounted.
Several people walked out of the meeting in disgust, they said.
Berall recalls it differently: "They opted to spontaneously come and they all seemed to appreciate having the opportunity to have a conversation."
Two days later — on May 22 — public health officials went public with news of the new outbreak at North York General Hospital.
"Staff are pouring in sick," the nurses now lament, certain that had their concerns been immediately heeded, the outbreak would not be as bad.
Those sick with SARS include 15 nurses from the fourth floor orthopedic wing and two doctors.
A pharmacist and a hospital case manager are considered "under-investigation" cases.
One of the sick nurses is on a ventilator in the intensive care unit. She is the mother of the student from Father Michael McGivney Catholic Academy in Markham that was recently closed after that student developed SARS symptoms.
Berall said the five family members were officially diagnosed with SARS May 23 after a meeting attended by him, Mederski, microbiologist Dr. Donald Low, and officials from Toronto Public Health.
Berall insists that, knowing what he did at the time, the hospital went beyond the call of duty to protect staff.
"What's really important here," he told the Star, "(is) we did it different than almost every other emerg in the city by going more cautious." Others, he said, "completely de-masked and left the masking of their (ER) triage nurses, who first greet and evaluate the patients, at the call of the triage nurses. We did not.
"The nurses in triage were masked and gowned and (wore) protective gear. For the rest of the emerg, we had identified that for patients with any respiratory illness we would continue the masking and garbing policy. So we set up something different than the majority of the rest of the city in order to be cautious and conservative. I think that probably shows a lot of foresight and it shows a lot of caution
This is my favorite quote in the whole article. Since we are dealing with human beings and viri too small to see with the naked eye a visible link can always be out of view. Anyone who would presume they see all is guilty of such hubris that they deserve extreme punushment but it seems innocent hospita staff will recieve the punishment through infection.
Bad news. I hope she makes it.
translation
Berall insists that, knowing what he did at the time, the hospital went beyond the call of duty to protect the status quo.
Welcome to Shark City Hospital. (insert) Jaws theme music
Can you believe this? It is like the guy who kills his parents and then asks for sympathy because he is an orphan. I would laugh if it was not so tragic. We are so screwed.
The syndrome that infects the public health officials there could well also be present in the USA we shall see.
The syndrome that infects the public health officials there could well also be present in the USA we shall see.
Pathetic.
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