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City faults Children's on disease reporting
Orders training after lag over whooping cough
City health officials have ordered staff training at Children's Hospital Boston to improve reporting of disease outbreaks -- the first time the Boston Public Health Commission has ever issued such a mandate.
The action, detailed in a memo obtained by the Globe, is in response to the hospital's failure last month to expeditiously notify the agency about an outbreak of whooping cough that eventually sickened 33 hospital employees. State law requires that such
infectious disease clusters be reported within 24 hours, but Boston health authorities did not learn of the outbreak until several weeks later -- and even then, only indirectly.
The move by the health commission is the most striking example of a yearlong push to make sure doctors, clinics, and hospitals abide by their responsibility to report cases of certain infectious diseases as soon as a diagnosis is made. The sooner public health agencies know about a hospital-based outbreak, specialists said, the sooner they can stem its spread into the community.
"If the physician waits too long to report, you miss the opportunity to prevent disease," said Dr. Jeffrey S. Duchin , chief of communicable disease control in Seattle and a leading member of the Infectious Diseases Society of America . "The clinicians who see the patients are really the eyes and ears of the public health system."
At the same time the order was sent to Children's, the
Boston health department issued memos to all of the city's hospitals stressing the importance of prompt reporting, noting that "delayed notification of a recent infectious disease outbreak made it more difficult for us to take measures to contain its spread."
Health commission officials said the delay in reporting by Children's was especially troubling because some of the infected workers had second jobs at other medical facilities and could have exposed patients and staff there, although there is no evidence that the outbreak extended beyond the Longwood-area hospital.
A spokeswoman for Children's, Michelle Davis , said the hospital has already taken steps since the outbreak of whooping cough to prevent a repeat of the reporting delay, including establishing redundancies in its notification system. The city's order gives Children's until Dec. 15 to submit a plan to educate staff on their legal responsibilities.
"My sense is that the
public health department is going to be pleased with the way that we're moving forward and attempting to comply with our reporting requirements," Davis said. "We're taking that responsibility seriously."
Nationally and globally, a series of events during the past five years demonstrated the importance of intervening swiftly to arrest disease outbreaks.
First, in 2001, there were the anthrax attacks. Then, in 2003, SARS -- severe acute respiratory syndrome -- hopscotched from East Asia to Canada, taking root in a Toronto hospital.
Most recently, avian influenza has fueled fears of a global flu epidemic that could result in millions of human deaths.
Public health authorities in Massachusetts have increasingly recognized that physicians and medical institutions are not always complying with reporting laws, including in 2004, when Boston University waited nearly two weeks to report that three lab researchers had been exposed to
the bacterium tularemia while conducting experiments.
In September, the public health commissioner in Worcester said authorities at St. Vincent Hospital did not alert him to a whooping cough outbreak until nearly three weeks after the first diagnosis. Whooping cough is also known as pertussis.
In Boston, the public health department in 2004 strengthened its rules governing disease reporting, providing $1,000 fines for lapses in reporting any case of more than 75 diseases, such as hepatitis, measles, and rabies. No fines have been levied so far.
"We did put a little bit of teeth into the regulation," said Dr. Anita Barry , Boston's director of communicable disease control. "If people continually fail to report and don't have some kind of corrective action, then I think we're really pushed into having to assign penalties just to get people's attention."
When health agencies get reports on disease outbreaks, they typically try
to contain the disease by identifying other potential victims, giving them preventive treatment when possible and, when necessary, isolating them.
Barry said the public health commission did not learn of the outbreak at Children's until Oct. 25, even though the hospital internally had identified and moved to contain a cluster of whooping cough cases by late September.
The health agency, Barry said, found out about the cases only when the state lab forwarded results of a positive pertussis test to a city nurse.
She followed up by dialing a telephone number on the report. "It was Children's Hospital occupational health, and the response to our nurse was, 'It's just another case related to the outbreak,' and our nurse said, 'What outbreak?' " Barry recalled.
Stephen Smith can be reached at stsmith@....
© Copyright 2006 Globe Newspaper Company.
