July 13, 2015 — South Carolina’s Greenville Health System has settled a wrongful death lawsuit with the family of a surgical patient who died in 2014 from an unusual infection contracted at Greenville Memorial Hospital, in Greenville (SC).
According to a court order approving the settlement last month, in June, 2015, GHS offered $600,000 to settle claims arising from GMH’s medical treatment of Ella Mae Mattison.
More of this settlement’s details are discussed in Greenville Online‘s article, “Greenville Health System settles wrongful death lawsuit,” published last Saturday, June 11, 2015.
Fifteen of this hospital’s patients were infected (or colonized) with Mycobacterium abscessus between 2013 and 2014.
Twelve of these patients, including Ms. Mattison, had undergone cardiac surgery at GMH. The three other patients underwent abdominal surgery (n=2) and a neurological procedure (n=1). Mattison expired along with three of the other 15 infected patients.
Two TV interviews, Comment: Two WPSA News 7 television aired two interviews of this article’s author (Dr. Lawrence F Muscarella) discussing Greenville Memorial Hospital’s deadly outbreak. Read his comments in WPSA’s July, 2014, article “GHS Infection Investigation Zeros In On Tap Water.”
Hospital officials have acknowledged that this outbreak may have been an important contributing factor to the death of the four infected patients, adding, however, that these patients also had other serious underlying health problems, or comorbidities, at the time of their infection.
In addition to temporarily closing one of its operating rooms that was implicated in this outbreak, the hospital notified approximately 180 patients who may have been exposed to this organism.
At this time, no reports suggest that a flexible endoscope or reusable probe was involved, directly or indirectly, in this outbreak.
Third in a series, Google’s rankings
This article herein is the third in a series by Dr. Muscarella. The first article in this series is: “4th Patient Dies, 15 Infected at Greenville Memorial Hospital Linked to Contaminated Tap Water” (published in June, 2014).
As of last week, this latter article was Goggle’s No. 1 ranked article using the search terms “Greenville mycobacterial infection” or just “Greenville infection.”
The second article in this series is: “Recommendations to Prevent Atypical Mycobacterial Infections Following Surgical Procedures” (published July, 2014).
Quality Reviews for Hospitals, Manufacturers, Patients: Click here to read about how Dr. Muscarella’s can help you reduce the risk of healthcare-associated infections, including both mycobacterial outbreaks linked to contaminated tap water and “superbug” outbreaks linked to contaminated GI endoscopes and other reusable medical equipment.
A claim of negligence
Greenville Online also reported last week that the filed lawsuit alleged that employees of GHS “were negligent in their care of Mattison, resulting in her death.”
According to the court document, GHS denies “any and all liability.”
For its part, GHS published a memo, “Update on Infection Outbreak Investigation” (no date) that provides important details about this outbreak, along with emphasizing a number of important measures it used to prevent additional mycobacterial infections.
M. abscessus, the outbreak’s organism, may be found naturally in water, soil and dust.
It is a slow growing organism with a long incubation period. Infected patients may not display symptoms until weeks or months after exposure.
According to court records, Mattison, who underwent coronary artery bypass surgery in September, 2013, was not diagnosed with M. abscessus infection until March, 2014 – 6 months later, according to the court records. She died in June, 2014.
Healthy patients are usually not affected by M. abscessus, which is an “opportunistic” organism that generally only causes infection in ill or immuno-suppressed patients, such as those with AIDS or undergoing chemotherapy.
M. abscessus is not transmitted from patient to patient, meaning it is not contagious. Rather, contact with a contaminated environmental source is required for infection.
The source of the outbreak’s M. abscessus
In 2014, hospital officials cited tap water as the most likely source of GMH’s outbreak.
Exactly how the 15 surgical patients became exposed to the tap water contaminated with the outbreak’s strain of mycobacteria, however, remains a mystery.
Whether the patients were exposed to the tap water during the hospital’s use of an ice machine or a heater-cooler machine (used during open-chest surgery) remains unclear, although had been suspected initially.
Suggesting mycobacteria in tap poses a more widespread, national concern for U.S. hospitals, a CDC official investigating the cause of this hospital’s outbreak stated that, “We wouldn’t be surprised if we could find these bacteria or similar bacteria in the water supply going to any U.S. hospital.”
In addition to these devices used in the operating room, sinks, shower-heads and faucet aerators, like tap water, have been similarly linked to outbreaks of atypical mycobacteria and other types of waterborne microorganisms in the healthcare setting.
The possibility that the improper disinfection (and water rinsing) or faulty sterilization of surgical instruments might have contributed to this outbreak, while unlikely, has not been ruled out by investigators.
In 2014 GHS installed a new water filtration system on all of its campuses to improve the quality of its tap water and prevent another, similar mycobacterial outbreak.
GMH is managed by the GHS, which oversees 6 other hospitals and 5 other campuses.
Article by: Lawrence F Muscarella, PhD; posted 7-13-2015; updated 2-8-2017.
Note: Dr. Muscarella is the president of LFM Healthcare Solutions, LLC, an independent quality improvement company. Click here for a discussion of his quality improvement healthcare services.