A recent newspaper article in Miami (FL) states on 10/11/12 that: “A Miami federal judge ruled in favor of a veteran who says shoddy hygiene practices at a Veterans Administration hospital caused his hepatitis infection. Air Force veteran Robert Metzler and his wife in a lawsuit are seeking $30 million in damages.”

This newspaper adds that: “The ruling Thursday says damages will be settled later. Many similar cases have been filed around the country. The plaintiffs’ attorney Ervin Gonzalez contends Metzler contracted hepatitis C after undergoing a colonoscopy with unclean equipment at the Miami VA hospital in 2007. Metzler was one of thousands of veterans in five states to receive letters from the VA in 2009 urging them to get blood tests after being treated”; and that “the VA contended in court it did not cause Metzler’s infection and should not pay damages.”

Settlement

More recently, on 11-23-2012, another newspaper reports that Mr. Metzler and his wife “have won a combined $1.25 million lawsuit against the U.S. government because he likely contracted hepatitis C at the Miami Veterans Administration Medical Center,” adding that “U.S. District Judge Adalberto Jordan ruled Wednesday (11-21-2012) after a nonjury trial that the center’s staff didn’t properly clean colonoscopy equipment, probably causing 70-year-old Robert Metzler’s infection” (the couple having reportedly sought $30 million notwithstanding).

This newspaper reports also states that: “The hospitals used equipment that had been rinsed after each patient rather than being sterilized by steam and chemicals as called for by the manufacturer. Investigators who took apart water tubes on some of the equipment that was supposed to be clean and ready for use instead found ‘discolored liquid and debris’.”

Infection risk

This legal settlement brings into focus, once again, the debate about whether GI endoscopy is associated with a significant, or negligible, risk of disease transmission. According to a medical expert cited in this aforementioned Miami (FL) newspaper article, “there is less than a 0 percent chance” Metzler contracted hepatitis through his colonoscopy. The judge concluded, however, that Metzler had no other risk factors associated with contracting the virus.

Reply

I have researched the specific types of reprocessing breaches that were encountered at this medical center in Miami (FL). Click here for a list of these breaches (placing focus on this link’s Table 2).

For as many as 5 years, the VAMC in Miami (FL) reportedly:

(1) failed to reprocess the MAJ-855 after each procedure, instead merely flushing or rinsing this tubing with (sterile) water;

(2) often connected the MAJ-855 to the colonoscope while the procedure was already in progress; and

(3) did not discard the short irrigation tube (that connects the MAJ-855 to a flushing pump) at the end of the day.  In addition, “debris” had been identified in the auxiliary water channel of “reprocessed” colonoscopes.

This ruling, as well as another recent one in Pennsylvania, place renewed emphasis on risk management, infection control, quality assurance, and the importance of proper reprocessing of reusable semi-critical instruments, namely, of GI endoscopes after each use.

Literature

The following articles I wrote provide important recommendations to reduce risk and prevent disease transmission during GI endoscopy:

A.  In 2006, I co-authored (with Douglas Nelson, MD) a peer-revised article entitled “Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy,” which can be read by clicking here.

B.  More recently I published an article in The Q-Net Monthly entitled “A Legal Case about an Improperly Disinfected Flexible Endoscope” – click here to read it – that discusses a legal case about a hospital in Pennsylvania that was found by a jury (in July, 2012) to be “negligent” for having failed a few years ago to reprocess for some months one of the colonoscope’s internal channels, namely, its auxiliary water channel.

C.  “The Risk of Infection Associated with GI endoscopy.”

D.  Prevention of the specific incident that is the focus of the aforementioned Miami (FL) newspaper article (see: Table 1 and Box A).

E.  Prevention of disease transmission associated with the misuse of the Olympus MAJ-855 auxiliary water tube.

In closing, the Veterans Administration (VA) notified (as required) the patients of the medical center (VAMC) in Miami, FL, of its identified instrument-reprocessing breaches.

In contrast, however, and for unclear reasons, the VA did not similarly notify U.S. veterans of the medical center (VAMC) in San Juan, PR, who were similarly affected by instrument-reprocessing breaches that also posed an “increased” risk of infection. This decision by the VA not to notify patients of the VAMC is San Juan I have questioned, and my rational is provided here.- read here.

Post by: Lawrence F Muscarella PhD posted on 10/15/12 (revised 1-7-13)

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