Tuesday, October 30, 2007

Rivera Family Sues After NYC MRSA Death, Why Superbugs Will Take Over

Nobody will argue that the death of 12 year old Omar Rivera was not a tragedy, but why does his name need to be dishonored by suing the hospital and NYC Health and Hospital Corp. This is not a one-sided argument, however. This is the type of high-profile case that vilifies everyone, from the parents, to the hospital that treated the child, to the media, to our entire healthcare and judicial systems. Firstly, this case is already causing a panic in the population because of how it has been handled by the media. This MRSA, or methicillin-resistant Staph Aureus, was first isolated in 1953 and has been a constant battle in hospitals, showing up in the sickest, most stressed and immunocompromised patients. Along with VRE (vancomycin-resistant enterococcus), healthcare workers have constantly put themselves at risk to treat these “superbugs” that are nothing more than the result of our own use of antibiotics. All organisms have the ability to respond to environmental pressure, and since the advent of antibiotics, humanity has pressured bacteria to evolve and adapt to survive our chemical assault. The unfortunate part is, that through irresponsible use of antibiotics, we have hastened this evolution and continue to encourage microbial resistance. As an ER doctor, since moving from Massachusetts to California just 4 years ago, we have gone from treating skin infections, known as “cellulitis”, usually caused by Staph and/or Strep bacteria (which live on all of our skin and you can’t get rid of, no matter how much antibacterial soap you use), with penicillin or a 1st generation cephalosporin like cephalexin (Keflex), to using entirely different classes or multiple antibiotics due to resistance. Currently in California, greater than 50% of skin infections are due to MRSA, which is now classified as “community acquired”, since we no longer see it exclusively in very ill or immunocompromised patients. Because this is such a new phenomenon, I still see primary care doctors and others placing patients on the “old” antibiotics for these newer “superbugs”. It sounds like young Mr. Rivera was placed on amoxicillin for his cellulitis, which just a few years ago, would have been fine. This issue is so new, however, that studies are just coming out that document these new changes in resistance patterns and the proper antibiotic treatment is still under development.

So what can we do? We as citizens need to question any and all antibiotic use. Stop demanding antibiotics from your doctors. Stop using antimicrobial soaps and sanitizers (see this previous rant)- we evolved to live commensualistically with bacteria on our skin, you cannot and should not sterilize yourself. In today’s high-volume, low-reimbursement healthcare system, it is easier for a doctor to prescribe antibiotics for a viral cold than to explain to a demanding, rude, uninformed patient, that antibiotics are only for bacterial infections like pneumonia, cellulitis, and urinary tract infections and do not treat viruses. People expect a “magic bullet”, that by going to the doctor there will be come miracle cure for every ailment and sniffle. Unfortunately this is not the case, but these expectations, along with the corporatization of healthcare, demanding “customer satisfaction” over good medical practice, is indirectly leading to the type of irresponsible antibiotic use that is causing these “superbugs” in the first place. We as physicians need to take the time to discuss the proper use of antibiotics with our patients and give them only what they need, not what they think they need.

I could continue to rant about how our current legal system and our “sue-happy” nation is one of the major factors contributing to the impending downfall of our healthcare system, and how the Rivera family is disgracing the memory of their child by trying to leverage $25 million dollars from their son’s death, but I will leave it at this: Everything we do has an impact, from every bit of fuel we burn contributing to global warming, to each mass produced bit of clothing we buy contributing to the oppression of those workers and dispersing toxins into the environment, to every dose of antibiotic we take contributing to resistance. Most of our problems on a macroscopic scale are being caused by our individual actions on a microscopic scale. If we each educate ourselves and begin making the right decisions, we will see a slowing of these phenomenoae, which represent nothing more than the equal and opposite reaction of our personal and collective actions.


Blogger leanangle said...

No. Sue! Sue! Sue! The problem is greedy health care organizations make surface sanitizing a low priority, sow they can spend their money on new buildings and specialists. They will not act until it starts to hurt their pocketbook. Infection Control Nurses are lazy, complacent and ineffective. This has allowed these organisms to hand washing is not enough! Hospitals and schools need to invest in surface sanitizing to prevent in infections just as they invest (as required by law) in fare suppression technologies. Over 90,000 people in America DIE EVERY YEAR from hospital acquired infections. If only 1% of that number died in hospital fires, there would be Seante hearings but infections are ignored as the AMA , the AHA, APIC and other industry groups suress laws to report infection rates by state and by hospital. We have a right to know that are hospitals have responsible leadership and if not, fire and sue.

2:23 PM  
Blogger Clint Slaughter, M.D. said...

I think that you're very disconnected from the problem. Hospitals, doctors, and nurses, for the most part, aren't greedy at all. It's the insurance companies/HMOs, the lawyers, and the unreasonable, sue-happy general public that are greedy. How often do you really think people sue just so they can "make a change"? People sue because they want to make a quick buck off of a tragedy. Blame anyone except the victim, point fingers, and get some cash.
Also, I don't think that nurses would like you calling them lazy, they're actually often overworked and in some areas underpaid, all while exposing themselves to illness, cleaning up human excrement, and caring for people so that they can get better. True, education has to be improved and we need to continue to encourage proper hygiene. Every hospital I've ever worked at is constantly trying to improve infection control, but it comes down to individual people. It's the same thing as trying to get people to choose between a recycling bin and a trash can for their bottles, even when they're right next to each other, they don't care enough to pick the proper receptacle. You can put up signs and have mandated infection control seminars but getting individuals to practice these techniques properly is harder than you'd think and it is generally not the fault of the hospital administration or the hard-working infection control nurse.
Even with the best of medical care, people will ALWAYS die from infections, hospital-acquired or not, the best we can do is use antibiotics responsibly and practice as best infection control as we can.
You clearly don't work in a hospital environment, and if you do, you're missing the big picture.

7:45 PM  

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