Stories of Survival

A Survivor reacts to a new outbreak

Johnny and Janet Robertson
Johnny and Janet Robertson

Recently West Virginia health authorities announced that a cardiac clinic is at the center of an investigation of a potential outbreak of viral hepatitis through unsafe injection practices. Johnny Robertson of North Carolina is a survivor of a similar outbreak and is an active advocate of injection safety. We are grateful to Johnny for his leadership in patient advocacy. Following is his reaction to the outbreak.

In January 2008, I heard the words, “You have hepatitis C.” This diagnosis changed my life completely.

I contracted hepatitis C during a stress test at a cardiology clinic in North Carolina in 2007. Later, it was revealed that a medical technician administered saline solution to a patient who was infected with this life threatening disease, then reused the same syringe to re-enter the vial. This contaminated the vial of medication with the virus. Subsequent patients who received an injection from the saline solution vial were exposed to the virus. Five patients were infected with the virus, but many more were exposed and were urged by the state health department to be tested.

Several weeks ago, West Virginia’s Department of Health and Human Resources sent letters to 2,300 people potentially exposed to hepatitis B, hepatitis C and HIV through cardiac stress tests at Raleigh Heart Clinic in Beckley. From the recent article (“Hepatitis cases linked to Beckley clinic likely caused by human error,” March 29), we know that 12 patients have been infected with hepatitis C or hepatitis B.

This tragic news strikes an eerily similar tone.

In addition to the dozen patients who have been infected, my heart breaks for the patients who sit and wait and worry while results from blood tests come back. I offer them my deepest support.

Outbreaks like this one oftentimes affect entire communities. Families and friends and colleagues are affected. They take a toll on the human psyche, and they are complicated and costly.

The truth of the matter is this could have been prevented. It did not need to happen.

Generally, healthcare in the United States is very safe. But sometimes, unsafe practices are used—brought about by ignorance, desire to cut costs, or the demand to see more patients in a shorter amount of time.

But there are efforts to educate both healthcare providers and consumers about the absolute need for safe injections in all settings.

I work alongside colleagues at Hepatitis Outbreaks’ National Organization for Reform and North Carolina’s One & Only Campaign. I am proud to serve as a spokesman for this award-winning campaign. I tell my story to healthcare providers throughout the state to help reeducate and advocate for injection safety, urging them to use “One needle, one syringe, and only one time!”

Patients need to have a voice in healthcare. No one in the United States should be infected with hepatitis C while receiving healthcare. My hope is to support those who are going through this very difficult time and allow the conversation to begin about tighter safety protocols, in West Virginia and elsewhere. There is help out there for those who need it. I know because I was once in this same situation.

Johnny Robertson

Not in my backyard! – When outbreaks happen again in our own hometown

Lauren Lollini and Evelyn McKnight
Lauren Lollini and Evelyn McKnight

Several new investigations into healthcare associated transmission of bloodborne pathogens have been reported lately. Lauren recently reflected on an investigation into possible drug diversion by a surgical tech that could result in transmission of hepatitis C from the surgical tech to patients through reuse of syringes in the Denver area. A recent news article reported on a situation in which a nurse employed by an Omaha wellness company reused two syringes to administer 67 flu shots.

Of course we are horrified by these potential outbreaks, as we always are whenever there are reports of unsafe injection practices. Our hearts go out to those affected by the unsafe practices. We know the anxiety, anger and betrayal that many feel, because we have felt those same feelings ourselves when we contracted Hepatitis C through reuse of syringes and medication vials.

But what makes these reports of potential outbreaks even more difficult for us, is that they are linked to our own backyards.

Lauren lived in the Denver area for many years, and was affected by the Rose Medical Center outbreak through drug diversion in 2009. Evelyn lives in Fremont, NE forty miles from Omaha, and was one of 99 people who contracted Hepatitis C through reuse of syringes during chemotherapy in 2002.

Ever since we were harmed by unsafe injection practices, we have worked hard to educate about and advocate for injection safety. We have wept with victims, argued with policy makers, and encouraged healthcare providers, educators and administrators to do the right thing for many years now. The work is consuming, demanding, – but usually rewarding.

But when the outbreaks happen in our own backyard, we feel so many more emotions. Anger. Frustration. Discouragement.

Perhaps the most salient emotion is bewilderment. How can this be? Didn’t everyone read about our outbreak in the newspaper, or see a report on TV? Wasn’t everyone shocked and horrified? Didn’t we hear over and over again – “We can’t let this happen again!”

And yet it did. Of course changes were made – even sweeping changes – right after our outbreaks. We were gratified by the improvements that we saw implemented. But time moves on – people change jobs, memories dim, attention to safety is threatened by the demanding pace, or cost cutting, or a culture of poor communication within the healthcare team. And then reuse of medical equipment intended for one time use happens again, either intentionally or unintentionally.

And then we are back to where we were years ago – weeping with victims, arguing with policy makers, encouraging healthcare providers, educators and administrators – in some instances the very same officials we interacted with at the time of our outbreak.

At times like these we have to sit back, take a deep breath, and reflect on our advocacy. Are our efforts worthwhile? Should we continue? And almost immediately, the answer comes from deep within – “YES!”

For although we learn through the media for months about the number of people who were affected by unsafe injections in our hometowns, we do not know how many people we have saved from injury through our efforts. We know it is a great many. We know that the educational efforts of the One and Only Campaign and the advocacy efforts of the Drug Diversion Prevention Committee are making a difference. We know this whenever someone comes up to us after hearing us speak and tells us, “I’m taking your story back to my co-workers, and we are going to make some changes!” We carry those statements in our hearts, and bring them to the top of our minds at times like these.

So. Back to work. Lets all commit to making “One needle, one syringe, and only one time” happen everywhere in the world, not just in our own backyards.

Summertime and Safe Injections

Dr Tom McKnight is a co-founder of HONOReform and a family physician in Fremont, NE
Dr Tom McKnight is a co-founder of HONOReform and a family physician in Fremont, NE

Everyone agrees that summer is meant for fun, especially fun in the great outdoors. But sometimes injuries happen in the pursuit of fun, resulting in a trip to the Emergency Department.

I practice medicine in a town that is near a state park. Thousands of people flock there in the summertime, boating and swimming in the pretty blue lakes. When I first began my family medicine practice 30+ years ago, our hospital did not have Emergency Room physicians. The primary care physicians on staff were called in to care for patients who needed to be seen. I wish I would have kept track of how many times I trekked to the ER to stitch up a camper from the state lakes, who cut himself on a piece of glass or during a fall while waterskiing. I think it would be interesting to know.

Sometimes the nurse who was helping me would bring out a vial of lidocaine that had been used for the previous patient. I wouldn’t know if the previous healthcare provider had used safe injection practices or if they had reused needles and syringes to access the vial, thus contaminating it. The vial was usually not labeled, either. I would direct the nurse to throw out the previously used vial, and use a new vial. Some of the nurses thought this was unnecessary and it took some time and thoughtful discussion before we all agreed on designating a vial for each patient.

With so many people at the lakes, we might have many emergencies at once. It was not unusual to have 10 people waiting to be seen when an ambulance would roar in and all the doctors and nurses would drop what they were doing and rush to participate in the code. The pace was stressful and fast – a combination that can lead to error. We all had to be on our toes at all times to make sure that every action was safe for the patients as well as the staff. During a code, many injections are given very quickly. With several healthcare providers standing close together around the patient, working rapid-fire, there was the possibility of accidental needlesticks and improper disposal of sharps.

Not long ago I myself was a patient at the ER. I was stung many times while harvesting honey from our beehives – the bees were not going to give up the result of their hard work without a fight! I swelled up like a balloon, and felt my throat closing. We rushed to the ER where I was given IV’s to reduce the swelling. I was so glad that the staff had had had the thoughtful discussions about injection safety. They saved my life that day, and protected me from any disease that could have been transmitted through unsafe injections.

Our hospital now has emergency room physicians on staff. I am grateful, and not just because it frees me from being called in at any time of the day or night. I am grateful for their knowledge of and committment to injection safety, because we are all patients at some time. Although I have given up beekeeping, I haven’t given up waterskiing; I just might need to be stitched up after a fall!

Making Lemonade: One CRNA’s Story of Addiction and Recovery

Anita Bertrand, CRNA, was the featured speaker at this year's AANA annual meeting
Anita Bertrand, CRNA, was the featured speaker at this year’s AANA annual meeting

In healthcare, it’s all about saving lives, right? But what happens when it’s about saving the lives of those who are usually the ones caring for the patients? In the case of the American Association of Nurse Anesthetists, it is truly about saving lives as well as caring for their peers. Thanks to their health and wellness series, they are bringing awareness through education as well as teaching their members to look past themselves while gaining a better care for all. Thanks to their peer assistance program, it is much easier for nurse anesthetists to help one another. Read more

Happy New Year!

Welcome back to the HONOReform blog, aka “Survivor Stories,” for our second full year of publication. We thank everyone who has had a role in making our blog a growing success—contributors and readers and everyone who has suggested to friends that they should check out our blog and pass it on to others.
And we encourage you to please continue to support our efforts.
Here at HONOReform, community-building is a key to emphasizing safe injection practices and doing all we can to educate the public and reeducate providers on the absolute necessity of injection safety.
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“We’re looking for justice” – Emil’s Story

Emil Mueller's family seeks justice for him and all the victims of the Nebraska Outbreak
Emil Mueller’s family seeks justice for him and all the victims of the Nebraska Outbreak

We are so grateful to Desarae Mueller-Fichepain, whose father’s story was featured last week in the article written by reporter Matthew Hansen. And we are grateful to Mr. Hansen, who we got to know when he joined us to take a tour of one of the four factories operated here in the state by our corporate colleagues BD (Becton, Dickinson and Co.).
These exchanges, advocate to reporter and reporter to readers, are essential ones. Continued education and reeducation on proper injection safety is vital. What happened to Desarae’s dad, Mr. Emil Mueller, should not happen to anyone here in the United States—or, we think, anywhere in the world.

It is our honor to share the article, published in the Thursday, December 11, Omaha World-Herald. We thank Desarae, and all of the HONOReform advocates, for their openness, leadership and support.

Hansen: In massive hepatitis C outbreak in Fremont, the victims’ voices went unheard
Emil had fought off prostate cancer for a decade, battled it in the same steely way that he made it through each shift at Fremont’s Hormel plant. He clocked in at the plant each morning. He picked up his knife. He cleaved the fat off of giant, immovable slabs of ham.

Day after day. Year after year. No excuses. No complaining. That’s how Emil worked. That’s how he lived.

And then, in 2000 or 2001, Emil began to see the new oncologist in town, a doctor by the name of Tahir Ali Javed. He’s a nice guy, he told his daughter, Desarae.

But within months, Emil began to change. The color started to fade from his cheeks. His grit faded, too.
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Have a happy, safe Thanksgiving!

Happy Thanksgiving!
Happy Thanksgiving!

Thanksgiving time is family time. We delight in family gatherings with lots of good food and great conversations. We at HONOReform wish you a wonderful Thanksgiving!

Sometimes life’s events mar even Thanksgiving, usually one of the happiest family times of the year. And when those life events are completely preventable, the disappointment is even greater.

Vicky is the daughter-in-law of one of the victims of the Nebraska Hepatitis C Outbreak of 2002. She explained the unrest that the outbreak caused in her family that Thanksgiving. Here is their story in Vicky’s words:

“Shortly after we learned that Dad tested positive for Hepatitis C, Mom called to say that they would not be coming to Thanksgiving at our house. I was shocked. Although Dad was fighting cancer, he was fairly active for an 80+ year old; he got out of the house regularly for errands and coffee with his friends. And above all, Mom and Dad loved spending time with the family, and the precious grandchildren were to be at the dinner.

When I pressed Mom for a reason, she was evasive, but finally she gave their reason: they didn’t want to risk transmitting the virus to any of the family. They were worried that by taking food off the same platters, perhaps an accidental reuse of forks or spoons would transmit the virus. Maybe even by being in the same room, the virus would be transmitted.”

Their concern was not uncommon among the community that autumn. The Nebraska Hepatitis C outbreak of 2002 was uncovered shortly before Thanksgiving. Public health officials determined that nurses at the Fremont Cancer Clinic reused syringes to access a large saline bag that was used for port flushes on many patients throughout the day. Because a patient with known Hepatitis C was treated at the clinic, the saline bag was contaminated with his blood, and therefore with Hepatitis C. Nebraska Health and Human Services notified the exposed patients, urging them to be tested for Hepatitis C, Hepatitis B and HIV. Of all the people who were tested, 99 were diagnosed with Hepatitis C, composing the largest outbreak of Hepatitis C from a single source in US history.

Because so many people in the community was affected by the outbreak, and because fear and ignorance about the disease was so rampant, it is likely that the conversation between Vicky and her in-laws was repeated in many households that Thanksgiving. Of course, viral hepatitis can ONLY be spread through blood-to-blood transmission, such as through unsafe injections. But at that time the community needed much education about this fact; the need for education about viral hepatitis continues to this day throughout the country.

Vicky went on to share:
“When I strongly assured Mom that the virus was not transmitted through the air or through saliva and that it could only be transmitted through blood, she was still reluctant. She said that even though that may be true, they didn’t want anyone to be uncomfortable by their presence. She thought it would be a jollier time for everyone else if they stayed home.

I told her no, it would not be a jolly time without you; all the family would all miss you too much. Iasked her to call her family physician and talk to him about the situation. After more argument, she finally agreed and said she would call back.

She did call back a week later and said that her family physician assured them it was safe for Dad to attend the family gathering and that they would be coming to Thanksgiving. But she was still worried for the others – worried that they would be uncomfortable with their presence. I offered to call each adult family member and assure them that they would not be at risk for contracting Hepatitis C from Dad at Thanksgiving dinner. She was very relieved by this and thanked me profusely.

We had a wonderful Thanksgiving gathering that year, perhaps made even more dear by our heightened concern and love for our dear Dad. We sat at the table a long time, reminiscing and telling family stories. It was a wonderful day, and my only regret was Mom and Dad’s worry, that nearly kept them from sharing that warm, loving family time with us.”

Vicky’s family had a lovely Thanksgiving that year, but not everyone who contracts disease through unsafe injections is so fortunate. Some will be too sick from their illness, others will let fear and worry keep them away from holiday gatherings. And all because of an illness which is completely preventable!

At your family gathering this year, do yourself and everyone else a favor. Share with your loved ones this advice from the One and Only Campaign:

In order to ensure that you are receiving safe injections, ask your healthcare providers the following questions before you receive an injection:

1.    Will there be a new needle, new syringe, and a new vial for this procedure or injection?
2.    Can you tell me how you prevent the spread of infections in your facility?
3.    What steps are you taking to keep me safe?

It’s very important to keep your eyes open because this could happen anywhere”

Healthcare providers can be 'survivors' of unsafe injections
Healthcare providers can be ‘survivors’ of unsafe injections

 

Usually in this space we share stories from patients who have survived an unsafe injection. Today we are sharing the survival story of a physician who stopped colleagues from performing unsafe injections during her residency.

Here is Susan’s story

My story of improper injections is from my residency. I was in my third year of family practice residency in Minnesota and I was starting a procedures rotation. The attending physician and nurses were preparing for procedures that day – mainly mole removals and simple skin techniques. I noticed that after the first procedure the nurses took the needle off of the syringe and put a new needle on it in order to use the same syringe of anesthetic for the second patient.

I told them, “You can’t do that.”
They explained that because the attending physician was not drawing back it was actually safe to use the same syringe with a different needle.

I told them that it was NOT the case and then we put the needle and syringe into the sharps container. After class that day I spoke with the program director and several others at the residency. By the next week when I was back on that rotation the procedure had changed. I noticed that there was some conversation between the attending physician and the nurses about how that change had come about.

I was just shocked and appalled at the time. Residency is very stressful. In addition to the stress of learning so many things, I didn’t think I would have to be stressed about watching healthcare providers to make sure they were using proper injection technique. Its just very important to always keep your eyes open because this could happen anywhere.

Antibiotics and Injection Safety

Lexington Insurance recently invited Tom and Evelyn McKnight to speak to Risk Management on injection safety
Lexington Insurance recently invited Tom and Evelyn McKnight to speak to Risk Management on injection safety

Tom and Evelyn McKnight were recently sponsored by Lexington Insurance to speak to hospital risk management on injection safety in Honolulu. While there, they learned about public health threats to the native Hawaiians through disease before antibiotics. Here are some of Tom’s thoughts about the importance of injection safety when delivering antibiotics.
Antibiotics and Injection Safety

Following is a written transcription of the video:

Aloha!
And welcome to the beautiful state of HI.
I’m tom mcknight and i’m a family physician. With my wife Evelyn, I am a co-founder of the organization HONOReform.

We have been invited to the state of Hawaii by AIG to speak to risk managers about injection safety.

As you might remember, the early days of the Hawaii were fraught with many diseases, many of which were brought by western civilization. Chicken pox, measles and even Hansen’s disease had a devastating effect on society. With the advent of antibiotics and injections in 1940’s and 1950’s, their health has become much safer.

But every injection needs to be a safe one. So our organization is promoting safe injection practices, because every injection needs to be handled and distributed properly.

So join with us and all of our co-sponsors in promoting needle injection safety.

Mahalo!

It Takes Courage to Speak the Truth

Lauren is the survivor of the 2009 Hepatitis C Outbreak in Colorado who chose to take a first step to passing legislation to make patients safer.
Lauren is the survivor of the 2009 Hepatitis C Outbreak in Colorado who chose to take a first step to passing legislation to make patients safer.

As a therapist, I often find myself congratulating clients for taking the first step as that is usually the most difficult. That first step might be making a phone call and asking about what resources are available for help or quite literally taking that first step into my office. So, too, do I congratulate the past contributors to our blog who have gone above and beyond to take that first step to share their stories. By speaking their truth, they have risked much, but were still undeterred.

You simply need to scroll back through the last few months and you will find many heroes who could no longer stay silent. Most recently, Anita Betrand shared her journey from addiction as a CRNA to that of an advocate speaking out so others can learn from her. Her struggle in and of itself was an arduous one, yet Anita chose to take that one next step to help educate so other healthcare workers finding themselves in a similar circumstance know there is a light at the end of the tunnel.
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