HIV infections will never be traced to VA? Liar, liar, pants-on-fire.

Because we support our troops and honor our father and mother SO MUCH in the USA (GOD BLESS the USA!), we treat our veterans like shit. Literally.

Case in point: Instead of properly cleaning colonoscopy equipment, physicians/nurses at Department of Veterans Affairs hospitals have been using the same equipment allllllll day long, exposing patients later in the day to bodily fluids from patients earlier in the day (and for all we know, patients from days before).

Now, shock of shocks, patients are popping up with HIV-1 and hepatitis.

Fantastic.

The VAs response to this?

Dr. Jim Bagian, the VA’s chief patient safety officer, said the patients won’t be able to prove they were even exposed to endoscopic equipment that wasn’t properly sterilized.

“At this point I don’t think we’ll ever know” how the patients were infected, Bagian said.

Hi Dr. Bagian!

No offense, but you are a lying sack of shit!

I can think of a few ways to figure out whether you infected these people with HIV-1.

1– Easy peasy– did the infected people have appts on the same day? Duh. If they did, sequence their virus, see if it clusters in a tree.
2– You know who received treatment at the same time as the newly infected patients. Test everyone who had treatment several days before (no, I dont believe the equipment was sanitized every day– if you dont do it between patients, you arent going to do it every day because you are a worthless lazy scum). If someone at an earlier time was actually pos and didnt know it, and thus ‘infected’ the new patient, their sequences will cluster.
3– If a known HIV-1(+) person received treatment, and the equipment was not sterilized between patients (omfg if this happened…), again, sequence and do phylogenetic analysis on the new people.

These arent ‘advanced’ ideas.

For some reason I just get the idea that just because its expensive, and it might turn out very, veeeeeery bad for the VA, its not going to be done. Im going to try to hunt down ‘Mike Sheppard’, the guy mentioned as a lawyer for some of the patients…

But at least these veterans are going to get treatment.

“We look at these as our patients,” Bagian said. “We are not going to quibble about ‘Was it caused because you are an IV drug user?’ … Suppose it was drug use. We are still going to treat them anyway.”

Wow, Bagian! You must be a great guy, cause you will even treat DRUG USERS! Veteran drug users (not many of THOSE!) Wow, you dont sound like a complete douchbag at all.

Comments

#1 Jeremiah
May 10, 2009

This is fucking embarrassing.

Dr. Jim Bagian and any M.D.s who knew the equipment wasn’t being sterilized between patients should be fired. No excuses.

Ugh. I hope you get ahold of Mike Sheppard, to offer scientific consultation on how these patients can be shown to have contracted the virus from the colonscopies (among other things).
#2 Comrade PhysioProf
May 10, 2009

Jesus fucking christ! More consequences of the Bush regime destruction of the expert bureacracy, cause, you know, government can’t do anything right! (Once you intentionally destroy expertise and replace it with abject partisan hackitude.)
#3 Sili
May 10, 2009

JESUS FUCKING CHRIST ON A WANKWAFFLE!!

I knew that the VA had a bad reputation but this is un-fuckin’-believable.

Excuse me while I go lose my dinner. (It was a meh omelet anyway – not that I’m looking forward to tasting it again.)

Hellin’ fuck. Blame the victim. Always blame the victim.

How the shitecrisp does that guy face his family when he go home? Hippocrates must be clamouring to get out of his grave and kick his arse.

Fuck.
#4 a lurker
May 10, 2009

The doctors who knowingly used equipment that was not sterilized should be subjected to civil lawsuits. And arguably should be given a few years to think about their actions in a small locked cell. And of course they should forever lose their licenses to perform medicine.

After all, the vast majority of fifth graders know that such equipment should be cleaned.
#5 a lurker
May 10, 2009

Is it possible to leave any part that should be disassembled during cleaning disassembled and parts in plain view overnight? The idea is to make it obvious to a supervisor, the doctor who comes in the morning, or anyone else in the hospital that the job was not done. Obviously one could every once in a while test just how clean the “clean” equipment is.
#6 Whitecoat Tales
May 10, 2009

The doctors who knowingly used equipment that was not sterilized should be subjected to civil lawsuits.

They should be subject to criminal lawsuits. Knowingly not sterilizing your equipment has got to be criminal neglect.
Unknowingly, one can have sympathy for mistakes, and address systematic problems. but knowingly demands punishment.
#7 Anonymous
May 10, 2009

This in is no way meant to diminish the stupidity of the quote from the Dr., or the excellent take down. But, the equipment in question was being disassembled and cleaned after each patient, in accordance with written procedures. The problem is that the procedures, written and signed off by someone with authority, were wrong. Contaminated fluids traveled passed a valve, in to a part of the equipment where the cleaning procedures assumed only clean fluids could go. The VA employees were most likely thinking they were doing it right in following these wrong directions, which is why the same problem occurred at every VA hospital that was using this particular brand of equipment. It is clearly a VA problem instead of an equipment problem, since non-VA hospitals followed correct cleaning procedures.
#8 Stacy
May 10, 2009

Fuuuuuck!! I think I’ll cancel my “PAP” for next month.
#9 Tsu Dho Nimh
May 10, 2009

@7 … How did the VA hospitals get the WRONG procedures while the non-VA hospitals had the correct ones?

What idiot decided to change the manufacturer’s cleaning instructions? And why?
#10 Monado
May 10, 2009

That’s why experts must always take the time to talk to their technical writer. It can save lives and liability.
#11 foxfire
May 10, 2009

This sucks beyond belief. One would think the 2007 disaster at Walter Reed would have made the point that our people who volunteer to defend our country deserve the best medical treatment. Apparently not.

I’m fairly certain an AIG or Goldman Sacks or Halliburton or any other executive of a major U.S. corporation, and any politician, would not have experienced this problem. Maybe the vets should have entertained a career path that encouraged personal gain and discouraged physical jeopardy in accordance with the the Neocon/Wall Street models? Apparently so.

#7 above by Anonymous offers an interesting perspective and information that needs to be pursued. Abbie, perhaps the people who didn’t clean the equipment properly are so overwhelmed by demand and lack of resources, that they just followed directions and missed things that should have been obvious? Perhaps the problem is that we can spend unconscionable amounts of money promoting and supporting war and very little taking care of the people who actually experience it.

Whatever. Abbie if you want to pursue this and could use some help, you have my email.
#12 Mind Over Splatter
May 10, 2009

I first heard this story a few days ago on NPR, and lill’ ol’ me with only aseptic procedure from first year micro-, was appalled.
#13 WalkingTree
May 10, 2009

I hope you’re able to find the lawyer, cause they need people like you who know what’s up and can help keep them from lying.
#14 Ranson
May 11, 2009

I heard the VA guy on the radio the other day; he was clearly in “We ain’t gonna admit liability” mode. The interviewer clearly knew the guy was screwed, but didn’t press.
#15 daedalus2u
May 11, 2009

I think the VA is trying to protect themselves by hiding behind patient confidentiality. The obvious technique is to look at people who are HIV positive who received colonoscopies before people who recently seroconverted and see if the sequences match.
That matching is something the VA will never do unless forced to by a court, and then they will fight tooth and nail to try to “protect” the “privacy” of the HIV+ patients by not looking at their records.

An alternative method is for the lawyer to advertise for people who were treated by the VA during that time period and who know they were HIV+ at the time.

It isn’t really that expensive to do. You test everyone (which they already did or are doing), then all the positives you sequence. You do that for hepatitis, you do it for HIV.

You should try to get yourself asked to testify at the congressional hearings on this that will be held in June. If a real expert in HIV genetics is going to testify, maybe the faux experts won’t perjure themselves by saying it is impossible to figure out.

I think the issue isn’t cost. I think the issue is the military chain of command and fuck-ups that happen on your watch. If people under your command fuck-up, it is your responsibility, unless you can sleaze your way out of it.

Who ever signed off on an inadequate sterilization procedure did a massive fuck-up. Under the chain of command, any superior who let someone incompetent sign off on something is equally culpable of that fuck-up.
#16 daedalus2u
May 11, 2009

To elaborate more on my previous comment. It is like “the right stuff”, the mythical ability that test pilots believed they had that made every fatal crash of a test aircraft be due to “pilot error”, or in other words because the pilot didn’t have “the right stuff”.

It was the mythology of the right stuff that allowed test pilots the delusion that they were in control of whether they lived or died.

The chain of command forces subordinates to act as if they believe that their commanders have “the right stuff”, that the commander will never give them a bad or illegal order and never order them to do something that is impossible or wrong. It is only when someone has demonstrated that they don’t have “the right stuff”, by having a fuck-up happen on their watch, that they are proven to be not suitable to be in the chain of command.
#17 Barklikeadog
May 11, 2009

I’ve worked in health care for 27 years. Never once did I ever use an endoscope that was not properly sanitized. I would personally check on that & if I wasn’t 100% sure I would have it re-sterilized. I even did cultures on them on the off days to make sure. This was even before AIDS was so prevelant. Even before I’d heard about it. Who in their right mind wouldn’t sterilize the equipment? What a bunch of assholes. And the response from the VA Admin. Priceless. Assholes the lot!
#18 Sili
May 11, 2009

Impotent rage is impotent.

If what anonymous says is right, I have a little sympathy for the underlings. But this is still a systemic error. (Which are of course the hardest to deal with. And I’m not even a position where it really matters, but it still bugs me when I see it.)
#19 Prometheus
May 11, 2009

Yuck.

On a lighter note, ERV, will your suggested protocol withstand a Daubert challenge?

http://en.wikipedia.org/wiki/Daubert_Standard

Now that you are a newly minted Mistress of the neo-evolutionary virological dark arts you need to start thinking a little about forensics. It takes a bit of training but you are good with an audience and you can moonlight as an expert witness. $$$$$$$.
#20 Paul Lundgren
May 11, 2009

I actually mailed my congressman about this. This is a disgrace.
#21 foxfire
May 11, 2009

@ Paul # 20: Paul, this is an excellent suggestion! I will follow suit.
#22 TomJoe
May 11, 2009

On a lighter note, ERV, will your suggested protocol withstand a Daubert challenge?

http://en.wikipedia.org/wiki/Daubert_Standard

Like with what happened with the anthrax cases, select single nucleotide polymorphisms (SNPs) will need to be identified and selected. Based on this, and assaying a larger viral “community” they’ll need to come up with a number that identifies the probability that the VA patients acquired the infection from the VA (based on their clustering of these particular SNPs) or elsewhere (based on their clustering of these particular SNPs with SNPs from cases which are clearly outside the VA). In all likelihood, it should stand up in court, though it will depend on a number of factors (most importantly, how long it took to catch all these cases and how badly the virus mutated amongst all the patients and the original cases).
#23 Anonymous
May 11, 2009

I’m #7, back with more details since I was working from memory. Here are links to a news stories and to the equipment manufacturer’s safety warning.

http://www.wsmv.com/health/18675966/detail.html

http://www.olympusamerica.com/files/TubingSafetyAlert.pdf

Multiple problems, including tubing that should have been cleaned “once-per-patient” instead being on the “once-per-day” cleaning list.

Also, the machine has a one-way valve to divide the dirty side of the machine from the clean side, so that only the dirty side needs to be sterilized after each patient. This is common in all sorts of medical equipment.

Instead a no-valve connector intended for use during maintenance was used for exams. The wrong connect may have been used for several years before it was noticed. And the same wrong-valve problem may have occurred at multiple VA locations.

Like most disasters, there is likely a long chain of people who ignored things that didn’t seem right or just did their job without thinking about whether the directions made sense. That is a system problem, and Dr. Bagian’s job title of chief patient safety officer means that he is ultimately responsible – to take the responsibility for what happened and to deal with the consequences.
#24 ERV
May 11, 2009

What Ive suggested is done when someone infects their partner by having unprotected sex, while not telling said partner they are positive.

The ‘defense’ goes along the lines of ‘that bitch was a whore, she coulda gotten it from anywhere!’, but then you sequence viruses and they nest quite nicely. HIV-1 ‘mutates a lot’, so Average Joes might think infections are ‘untraceable’, but related HIV-1s cluster. No big whoop. Not hard.

But in those cases, you know who the donor is, and who the infected is, so its all pretty easy. This case is more complex…
#25 Brian
May 11, 2009

It’s going to be even easier for the HepC infected people – the virus is even more variant than HIV.
#26 Prometheus
May 12, 2009

Ding! And ERV gets to pick any item from the top shelf.

Daubert is funky. It looks like the courts are just determining whether or not a protocol conforms to scientific method, but they aren’t. ‘Cause they are judges. Dumb judges. They always revert to precedent. They are trying to make experimental protocols work like the common law. Which is super duper dumb.

Thus every expert witness is looking for a starting point and you spotted precisely the hook I was thinking of, on which the attorney can hang his hat.

You are now in the precedent door.

The only thing dumber than a judge is a jury. So how do you develop a presentation that will remain coherent in the minds of twelve Walmart shoppers.

Extra degree of difficulty…..Case is in south Florida. Double dirp!
#27 Prometheus
May 12, 2009

Oh and sorry for the double post but Anon #7 and #23 is working an angle you are going to get asked about because these depos turn into a clusterf*ck and everybody is going to be looking for the hiccup that lets them sue the manufacturer. They are looking for the screw up in the way that it was used to be “forseeable”. Then they will all foist their responsibility onto the Globochem Conglomerate makers of the Intruder 3000 Colonoscope.
#28 William Wallace
May 13, 2009

Nationalized medicine, umn, umn, good.
#29 William Wallace
May 13, 2009

Also, a case should be brought against the M.D.s to the board of medicine in whatever state they are licensed, and these doctors should be forced, at the very least, to undergo 1 year’s worth of additional training, if their licenses to practice medicine aren’t suspended as well.
#30 LanceR, JSG
May 13, 2009

Yes, Limp Willy. Nationalized medicine. Woefully underfunded, nearly destroyed by 12 years of Rethuglican mismanagement, most people just want it swept under the rug nationalized medicine.

I don’t think your argument is going where you think it’s going.
#31 a lurker
May 14, 2009

The doctors who knowingly used equipment that was not sterilized should be subjected to civil lawsuits.

They should be subject to criminal lawsuits.

Did you stop reading at my first sentence? Criminal aspect of this was covered by my very next sentence which was:

And arguably should be given a few years to think about their actions in a small locked cell.

Civil lawsuits do not get one locked up small cells for a few years. Only criminal charges can do–indeed these would be felony charges. I thought I was clear but to make it crystal clear I suggested that they face civil lawsuits, criminal charges, plus loss of their license to practice medicine. I did not explicitly mention losing their jobs, so I do so now.
#32 Magnus
May 14, 2009

Holy fucking batshit what?
#33 Ben
May 26, 2009

I take it you are familiar with the famous Lybian case?

http://www.bioafrica.net/manuscripts/HIVLybiapaper.pdf
#34 Malcom Reynolds
October 22, 2010

Yikes! That is absolutely wrong and awful! That kind of practice and behavior needs swift and harsh punishment. That isn’t fair to let that sort of thing happen to our Vets. I hope these offenders are brought to justice.