Legalitis infects St. 's Medical Center

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This doctor needs are wakeup call.

Legalitis infects St. 's Medical Center

Ventura County Star - Ventura county,CA*

By Cary Savitch

stophiv@...

Sunday, July 29, 2007

http://www.venturacountystar.com/news/2007/jul/29/legalitis-infects-

st-johns-medical-center/

Americans need to treat driving as though it were their job

Do you feel lucky? Pick a card. Better yet, pick a fungus.

A $20 million experiment is planned for St. 's Regional Medical

Center in Oxnard. Hospital officials conclude the best way to fix

the perception of a health problem is to shut down, evacuate and

pump an explosive gas into its belly.

The best-case scenario: Common sense prevails and the experiment is

called off. The next-best scenario: Nothing fixed, but no injuries.

The worst-case scenario: An explosion, and Catholic Healthcare West

goes down.

More than 200,000 patients have received care at St. 's since

1992. The number of emergency-room visits during this period is in

excess of 400,000. There have been hundreds of thousands of

visitors. Tens of thousands have worked there daily.

During this 15-year period, there have been no identified health

problems relating to any mold infestation at the hospital.

Administrators have repeated there is no health problem, only

the " perception " of a problem, and they want to bury the perception.

The fumigation to rid the building of mold might just dig up a new

can of worms, another infestation of lawyers. Expect someone to

claim he has emphysema as a consequence of a five-day stint at the

hospital three years ago for a femur fracture. Toxic mold exposure

will be blamed for the leukemia that occurred two years after the

appendix was removed.

The obvious question, with judge and jury a few feet away: " If there

was nothing wrong with your facility, why did you spend millions of

dollars to fix it, and why did you wait so long? "

Millions spent on litigation

What is actually broken? There have been water leaks and some water

damage. The result: millions of dollars already spent on litigation.

Lawyers representing St. 's threw out a large net and anyone

caught was fair game. Some subcontractors risked being hammered into

extinction, even if they were innocent of any water damage.

Insurance companies watched the coffers get drained. It appears from

court records that any company touching this building got in

trouble. Contractors subsequently hired to do building remediation

have also been sucked into the legal vacuum cleaner.

If one finds 100 years of free time, review case number CIV222353,

Catholic Healthcare vs. Centex Rodgers Inc. So far, the most serious

environmental problem I could identify is the number of trees cut

down to provide paper for all the legal proceedings.

Not every fungus is created equal. Many fungi are benign, even

healthy. We eat mushrooms. Other fungi are deadly. Candida on a

heart valve kills. Cryptococcus in the brain kills. The yeast used

to ferment wine makes you happy. The two fungi most in question at

St. 's are Stachybotrys and Aspergillus.

Stachybotrys

What is Stachybotrys, the black mold fungus? In the U.S., this is

the critter that has caused your homeowners insurance to jump up. It

has the potential to produce a neurotoxin, but it takes a massive

exposure to cause illness. In my career, I have never seen a single

case of illness associated with this fungus. Most colleagues share a

similar experience.

Mycologists regard this fungus as a plant pathogen. Many lawyers

regard this fungus as a winning Lotto ticket. Can it kill? Yes. How

likely? Near zero.

Stachybotrys is most common where there is high humidity. Many

buildings sustain water damage, and this fungus may appear,

unbeknownst to the inhabitants. Stachybotrys is more likely to get a

black paint warning than a red alert. It is found in virtually every

country in the world. Yet, it is a health concern in the U.S.

Silicon and asbestos litigation began to dry up for U.S. lawyers.

The unscrupulous ones needed to find something wet. They stumbled

onto the wood in homes and workplaces — the perfect culture medium

for black mold and new litigation. Science could be twisted and

erroneous expert testimony could be purchased. Stachybotrys became

the Boston strangler.

If clinical science still matters, the position papers by the

Institute of Medicine, the federal Centers for Disease Control and

Prevention, the American College of Occupational and Environmental

Medicine, and the American Academy of Allergy, Asthma and Immunology

should clear up the misconception that Stachybotrys is a hazardous

pathogen. According to Abba Terr, M.D., University of California,

San Francisco, a review of the world's literature confirmed " no case

of a human systemic or local infection caused by any species of

Stachybotrys, even in immunosuppressed patients. "

The fungus does produce a mycotoxin, and in Siberia in the 1930s,

horses fed barley, corn and wheat stored under snow conditions

ingested large doses of Stachybotrys. The horses developed

gastrointestinal bleeding and some died. A few of the local farmers

also became ill. There were no lawsuits by the farmers or the horses.

What does all this mean? To the lawyers, lots of loot. To the rest

of us who shell out the money through insurance premiums, less

available resources for schools, healthcare and everything else we

require for a better quality of life. I would rather be robbed by

pirates.

Aspergillus

What about Aspergillus? This is certainly a more dangerous fungus

and more likely to be associated with allergic reactions and

occasionally death. While common in the air, especially in the

outdoors and on plants, it is rare to cause disease.

We are frequently exposed to Aspergillus. People who are severely

immuno-compromised have the greatest chance of illness. The greatest

exposure risks are on fruits and vegetables, and when the spores

become aerosolized. Has there been a higher rate of infections

caused by Aspergillus at St. 's than at other healthcare

facilities? Not that it claims.

Are the Aspergillosis counts from air samples significantly higher

at St. 's than in other comparable buildings in Oxnard or

Seattle? Please tell us.

Maybe our communities would be safer fumigating the lawyers and

leaving the mold alone.

No one claims the physical structure at St. 's is mold-free. I

also believe there is mold in the home in which I am writing this

opinion and in the building in which you are reading it. This

includes Stachybotrys and Aspergillus.

One of my colleagues calls Stachybotrys the " hogwash fungus. " Yet,

an army of attorneys has created an industry litigating over it. At

this very moment, some of these fungulators (I made up the word, sue

me) might be dining at a fancy garden restaurant, surrounded by

plants and waterfalls and fungi. They might be served yeast-enriched

sourdough (nice fungus) to accompany their blue cheese (colorful

fungus) covered salad (mixed fungus). A few truffles (expensive

fungus) on the steak wouldn't be so bad. They might even toast their

good fortune with a bottle of wine fermented for years (work-horse

fungus). Before bedtime, if they dare to take a sauna at a health

club, with indoor pools and surrounding plants, they could be

encased in the creeping crud.

Common sense is on life support.

Before the great rush to gas, what is the actual mold problem in the

facility? One can ask the remediators of the building, who are

receiving millions of dollars, if there is a mold problem and, no

doubt, the answer will be yes. How else can they justify doing the

work? But, how much mold? How does this hospital differ from other

healthcare facilities anywhere else? Are the mold counts different?

What are the controls and normal values?

Before any experimentation with chlorine dioxide, show all the data.

The way the courts are settling this case, it appears " show me the

money " comes before " show me what's wrong. "

How does one justify the expenditure of millions of insurance

dollars obtaining laboratory information, but give no thought to

interpreting the data? Hiring a microbiologist just to tell you that

one day this fungus could possibly be a problem is not good science,

but it is certainly ammunition for winning a court battle. Is there

a higher mold count indoors than outdoors at St. 's?

If the mold counts return to similar numbers in a year from now,

does the hospital get regased? If a hospital across the county turns

up with similar mold counts, should it be gased, chelated,

pasteurized or just left alone? If our homes show similar mold

counts, do we move out?

Every structural engineer and fumigation expert I have spoken with,

regardless of their opinion on the health risks of Stachybotrys or

the safety risks of chlorine dioxide gas, agree on one thing: You do

not fumigate any structure unless the envelope is sealed. If there

are still any leaks, you fix the leaks first. Then you decide on

whether anything more needs to be done. Are all the leaks fixed at

St. 's?

A done deal?

St. 's regards the fumigation plan as a done deal. Hospital

employees and county officials have been told exact dates when

hospital services will be halted and when the hospital will be

vacated, tented, gased and then reopened.

So, who gets to do the gas job? The community has been informed

Sabre Oxidation Technologies has been chosen. We were told it did

the anthrax cleanup in the Senate Hart Building in Washington, D.C.

A little background check is in order. The General Accounting Office

reported on the anthrax cleanup. More than $27 million was spent on

the operation. Sabre's share was less than $20,000 — $19,850, to be

exact. Included in the government report on page 39 is the job

description of Sabre: " Provide engineering support during the

assessment of the feasibility and design of the systems for

fumigating air handling return system. "

While everyone is gearing up for the gasing, I am still left asking

exactly what role did Sabre play in the anthrax cleanup.

The use of chlorine gas as a fumigant is not currently approved in

California. The industry recognizes it as corrosive and explosive.

Experimentation at any concentration may be dangerous. Yet, St.

's officials tell us the green light is on, the gasing will

happen. It has yet to receive the 24C special-need permit issued by

the California Department of Pesticide Regulation. When asked about

the permit status Friday, DPR Communications Director Glenn Brank

said: " We have NOT issued any permit, period. We are working

cooperatively with the hospital contractor, but at the same time, we

can't put public health and safety at risk to meet an artificial

deadline. We are not second-guessing anyone, but this is an unusual

situation, and we have a public duty to go through the regulatory

process in an orderly, thoughtful, and responsible manner. "

State pesticide regulators are concerned about public safety. Unless

an unusual life-threatening problem exists that cannot be remediated

any other way, experimental fumigation is not permitted. There are

circumstances that may warrant extreme measures.

But, anthrax is not the problem at St. 's Hospital. It is

dealing with what many of us have in our own homes and gardens.

Fifteen years have passed without a single confirmed health problem

relating to the water leaks. The need for any fumigation is in

question. The need for chlorine gas is absurd.

How many tax dollars, and how much time has been spent by Ventura

County agencies (fire, police, sheriff, ambulance) on support and

contingency plans? Will this money ever be returned if the gas

valves are never turned on? There has been a breach of public trust.

Does St. 's plan to return any of the insurance payoffs if the

gasing does not take place? These are the bucks insurance companies

collect from all of us when we pay for homeowners insurance. I want

to be paid back.

Duty to question

Sister Carmelita remains my friend in spirit. She died of cancer

several years ago. She is still alive in my heart, and I am sure she

is looking down from heaven. We worked together at the old and new

St. 's hospitals. We both regard St. 's as a guardian of

public health and safety. I have no hesitation having my family

cared for by the excellent staff there. While the hospital does many

things right, on this issue, I believe it is dangerously wrong.

Perhaps it has been blinded by its own litigation. The treatment

plan offered is more dangerous than the illness.

I know Sister would be upset if any of her medical staff felt there

was a threat to public safety and remained silent.

This world is not perfect. St. 's Hospital may just have to limp

along with some water and some mold as it has for the past 15 years.

While America stews in lawsuits, the rest of the world is

engineering our future. Until common sense is restored in this

nation, litigation will continue to trump health and safety.

— Cary Savitch, M.D., of Ventura, is a board-certified infectious

disease specialist. His e-mail address is stophiv@....