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Did Sewage Leaks in ORs Cause Deadly Infection?
Burning Time SEWAGE SEPSIS Carol Leonard, 70, died of sepsis 5 days after undergoing surgery in a sewage-infested OR.

A woman died of a surgical site infection 5 days after she underwent a routine thyroidectomy in a sewage-infested OR. A wrongful death lawsuit filed by the family of Carol Leonard, 70, implicates the sewage that for nearly a year had seeped into the basement-level operating room from a clogged toilet in the cath lab directly above.

The lawsuit alleges that MedStar Washington Hospital in Washington, D.C.:

  • knew that sewage was leaking into its ORs from pipes above and around the ORs since at least 2015, yet continued to operate on unsuspecting patients; and
  • should have administered antibiotics to Ms. Leonard due to the increased infection risks associated with the sewage leaks.

D.C. health officials say they found at least 7 sewage leaks during an 11-month period between September 2016 and August 2017. The surgical staff had a code word for the sewage: black water. When the odor became unbearable, they'd use portable fans to blow the stench away.

CMS placed the hospital in "immediate jeopardy" of losing its Medicare and Medicaid funding, according to the 2016 report unless they met the deadline for compliance, says health officials. CMS removed the designation 3 days after MedStar Washington submitted a plan for correction, according to USA Today.

In a statement, MedStar Washington said: "A recent media story created a false impression of MedStar Washington Hospital Center's facilities. Last summer, we found minor leaks in an operating room. We closed the room immediately, conducted necessary repairs, cleaned and sterilized it, and brought in an outside hygienist to ensure that the room was safe for patient care. We have had no new leaks since August 2017. We are in full compliance with the facility action plan accepted by the D.C. Department of Health. In addition, we are fully licensed by the Health Department and accredited by The Joint Commission, both of which thoroughly and regularly review our OR standards and protocols for providing a safe environment for every patient."

JoEllen McBride, PhD

Jury: Spine ASC Discharged Patient Too Soon
Sharon Kimble TOO SOON? Sharon Kimble was discharged two hours after surgery; she was dead before morning.

L ast week a jury awarded $20 million to the surviving spouse and heirs of a woman who died soon after she was discharged — prematurely, according to her lawyer — to a nearby hotel 2 hours after undergoing spinal surgery.

Sharon Kimble, 50, had suffered from chronic back pain that she took opioids to treat when she saw an advertisement on television for Laser Spine Institute. Told she could be back on her feet after a quick procedure on her spine, Ms. Kimble underwent surgery at the facility located in the Chester County suburbs outside Philadelphia on Jan. 29, 2014.

At the surgery center, Ms. Kimble allegedly received 6 times more Dilaudid (hydromorphone) than was originally planned. Despite this, she was discharged 2 hours after the surgery to a nearby hotel.

"She should never have been discharged with that much narcotic in her system," her lawyer wrote in a trial memorandum.

Later that night her husband found her dead. The official cause of death: "adverse interaction of drugs." The liability lawsuit was filed against both Laser Spine Institute and the anesthesiologist, Glenn Rubenstein, MD.

A defense expert witness argued that the dosage of Dilaudid Ms. Kimble received was necessary because of a high tolerance developed over years of treating her back pain. The defense further argued that Ms. Kimble was appropriately discharged.

Ms. Kimble's lawyer, Lane R. Jubb, Jr., argued that she was pushed out of the facility too quickly so the space could be used for another procedure. "People should not be discharged to a Marriott 2 hours after spinal surgery," says Mr. Jubb.

In a statement, Laser Spine Institute said: "While we respect the judicial system and the service of its jurors, we must respectfully disagree with the Chester County Court's jury decision in returning a verdict in favor of the plaintiff, the spouse of a Laser Spine Institute patient who passed away after leaving our care in stable condition. We plan to explore all of our options, including an appeal of the verdict."

Dr. Rubenstein did not respond to requests for comment.

Richard Abowitz

Did Surgeon Spray Nurse With Fluid Waste as Part of Hazing Ritual?
Abuse Allegations ABUSE ALLEGATIONS Kirsten Maxfield, RN, says she's a victim of repeated gender discrimination.

A surgeon is accused of spraying a nurse with fluid waste at UMass Memorial Medical Center in Worcester, Mass. The question remains: Was the alleged incident indicative of a male-dominated culture of abuse within the surgical department or a tall tale cooked up by a tattling nurse?

Kirsten Maxfield, RN, says general surgeon Hongyi Choi, MD, sprayed her with contaminated irrigation solution during a procedure performed in April 2017 and laughed along with other members of the surgical team. Ms. Maxfield calls the incident part of a twisted OR hazing ritual and "nothing short of assault" in a report she filed with the Massachusetts Commission Against Discrimination (MCAD) that claims the incident was part of a series of aggressive and inappropriate behavior she endured from male superiors.

The complaint says Ms. Maxfield reported the incident to UMass Memorial's OR nurse manager, who told her that Dr. Cui admitted to spraying her but claimed it was unintentional. The nurse also allegedly "found it hard to believe" Dr. Cui was capable of the act because he "has prestige" and "is a good surgeon," according to the complaint.

After reporting the incident, Ms. Maxfield says she was subjected to hostile and abusive language from some of her co-workers. She also alleges the hospital did not take her claims seriously and failed to investigate them properly. Ms. Maxfield repeatedly requested to be removed from the "abusive environment" in the OR, but her requests were denied. She was also put on paid administrative leave pending further investigation of the alleged incident, according to the complaint.

Ms. Maxfield claims hospital leadership told her during a July 2017 meeting that she made the whole incident up and that the attack didn't happen, despite Dr. Cui having reportedly admitted to spraying her. She was then given 3 choices, according to the complaint: return to the OR, apply for other open nursing positions within the hospital or move to the hospital's "float pool" staff. Ms. Maxfield deemed none of the options acceptable and decided to resign.

This wasn't the first time she alerted management about alleged mistreatment by male superiors. In August 2016, she reported abusive behavior by an "aggressive" employee who called her "wimp" and showed her the middle finger. She also filed complaints of male staff members using abusive, foul language during procedures and slamming instruments down.

"It is clear that UMass will go to any length to protect its male doctors at the expense of the female staff they victimize," notes the complaint.

"[My client's] story fits into what is sadly a familiar pattern of businesses protecting their male superiors at the expense of their female employees," says Christopher Wurster, the attorney for Ms. Maxfield. "Women shouldn't have to worry about being placed on administrative leave and enduring other consequences for reporting harassment and assault by their supervisors."

Mr. Wuster claims his office has been contacted by other current and former UMass employees who claim to have endured similar experiences. "There seems to be a culture at UMass of dismissing reports of discrimination," he says. "That needs to end."

UMass spokesman Anthony Berry says the medical center takes the allegations very seriously and plans a vigorous defense against them. "We have conducted a thorough investigation of each claim — in accordance with standard procedures — and found no support for the charge's allegations," he adds.

Daniel Cook

InstaPoll: Are You Having a Hard Time Getting Fentanyl?

Are you impacted by the nationwide shortage of fentanyl, which has many surgical facilities scrambling for alternative drugs? Tell us in this week's InstaPoll.

Opinions were split as to whether it's a good idea for patients to stay overnight at ambulatory surgery centers. More than one-third of the 488 surgical facility leaders we polled think recovering patients should be able to spend the night at ASCs, while 57% disagree with surgery center sleepovers.

Should ASCs be able to keep patients overnight?

  • Strongly agree 19%
  • Agree 15%
  • Neither agree nor disagree 9%
  • Disagree 27%
  • Strongly disagree 30%

Dan O'Connor

News & Notes
  • Anesthesiologists take grievances to airwaves Dramatic TV and radio commercials are putting Atrium Health, a North Carolina based hospital system, on the offensive after they decided not to renew an over 3-decade contract with Southeast Anesthesiology Consultants. The anesthesiology firm claims the new anesthesia model will rely more on CRNAs and puts patients at risk. The owner of Scope Anesthesia of North Carolina says the ratio of physicians to nurse anesthetists won't change when they take over the contract on July 1.
  • Warm up before surgery Surgeons perform safer and faster surgeries after they've had a chance to limber up, according to a study published in the British Journal of Surgery, which suggests surgeons schedule simpler cases in the morning and warm up to more complex procedures later in the day. The researchers next want to determine if making warm-up routines for surgeons standard practice is feasible and practical.
  • California sues Sutter Health for anti-trust violations Last week the state of California filed an antitrust action against Sutter Health, accusing the conglomerate of anticompetitive practices that are driving up healthcare costs in Northern California. Sutter Health operates 24 acute care hospitals, 9 cancer centers, 6 specialty care centers, 9 physician groups and 31 ambulatory surgery centers in Northern California. California Attorney General Xavier Becerra noted in a statement that healthcare costs were 30 percent higher in Northern than Southern California. In response, while arguing that generally Sutter Health charges less than other Northern California health providers, Karen Garner, a Sutter Health spokesperson said in a statement to Outpatient Surgery "We are currently reviewing the complaint, so we cannot comment on specifics.