When a hospital gets sick

[Guest guest]

Issue #20.05 :: 08/27/2008 - 09/02/2008

When a hospital gets sick

Internal documents show that complaints about mold and other

environmental concerns plague MCG Health, but administration denies

the problem

Metro Spirit - Augusta,GA*

BY TOM GRANT

http://metrospirit.com/index.php?

cat=1211101074307265 & ShowArticle_ID=11012708083185642

AUGUSTA, GA - Complaints from workers in the Pediatric Intensive

Care Unit at MCG Children's Medical Center began early in 2006.

" The symptoms we discussed then were headaches, which occur mainly

while folks are at work. Some other folks are expressing that they

are having cold/allergic symptoms only while at work, sometimes

severe (and then resolve upon leaving work), " wrote supervising

nurse Basso in an e-mail in February 2006.

She related the story of a nurse who arrived on a Thursday night

then quickly began to sneeze and get a runny nose. It got worse

during the night.

" By the time I got home, I thought I was dying, " the nurse

said. " But when I woke up around noon I was fine. "

The worker's illness recurred the next day. Co-workers also had

recurrent sicknesses.

" Multiple nurses, secretaries, RTs, even residents have complained

about getting sick when they are in this unit, " the nurse said.

Basso wrote in another e-mail: " The grandmother of one of our

patients has complained today that `something up here makes me

sick.' "

Even people who came to investigate got sick. " Jodie and I got a

headache shortly after entering PICU to investigate a complaint

regarding smells of mildew/mold, " one wrote.

" Both of our headaches disappeared (without medication) upon our

return to our own department. "

Yet with nurses and family complaining the ward was making them

sick, no one seemed to ask the big question: When a hospital

Pediatric Intensive Care Unit itself gets sick, what does that do to

the patients?

That's a big question for MCG Health because the hospital has a long-

running battle against environmental contaminants. Records obtained

by the Metro Spirit show complaints dating back to 1993, well before

the non-profit management entity MCG Health Inc. existed.

Our inquiries began more than two years ago, when someone complained

to the Metro Spirit that mold in one of the MCG Health buildings was

making them ill. MCG Health has not responded to any of our verbal

or written requests. However, as records obtained as part of a

lawsuit against MCG Health show, workers have complained for years

about illnesses that appear to them or others to be related to mold

and mildew.

The hospital denies it's a problem. Deborah Humphrey of the MCG

Health public information office said the hospital would not grant

an interview on the subject because none was needed. " Problem

identified, problem solved, " she said.

However, Metro Spirit has obtained documents in which a hospital

employee has accused MCG Health of having such serious mold and

mildew problems that it has contributed to the death of a patient.

Todd Brandenburg first made a documented complaint about mold and

mildew in April 2005. He was later written up by MCG Health

for " improperly reporting a mold issue. "

MCG Health said the complaint caused a waste of manpower, even

though mold was later discovered and remediated as a result of his

complaint, Brandenburg said. He was fired a few months later.

" All I wanted to do was be a good employee and alert the hospital to

a potential problem, " he added. " I did not know it would lead to me

being fired. "

As part of his grievance against that firing, a grievance that has

now grown into a lawsuit, Brandenburg laid out his concerns about

mold causing health problems at MCG Health.

" I was told that the suspected mold problem was simply a

housekeeping issue and that the mildew I saw growing was only dust, "

Brandenburg wrote in his grievance. " The mildew smell remains

prominent in that area. "

He spoke directly to the seriousness of the matter. " There was a

patient death due to environmental issues with the facility carpet

(notably in the CMC [Children's Medical Center]), not to exclude the

infection rate from the growth of bacteria in the five NICU sinks.

This lends evidence to the fact that the `mold' issue has (in all

likelihood) not been fixed. "

MCG won't discuss Brandenburg's allegation.

Mold is not generally seen as a killer, at least no more than bees,

peanuts or shellfish. However, according to a published report by

Dr. Tolan of Drexel University College of Medicine, a rare

condition known as fungal endocarditus can cause death in babies and

children.

The Centers for Disease Control (CDC) accepted this theory at one

point, then reversed itself and asked for further study.

In a statement on its Web site, the CDC says, " Mold can cause or

worsen certain illnesses (e.g., some allergic and occupation-related

diseases and infections in health care settings).

No conclusive evidence exists, however, to associate mold exposure

with a multitude of other health problems, such as pulmonary

hemorrhage or memory loss. "

However, if you dig deeper within the CDC Web site, it cautions all

immuno-supressed patients to stay away from mold: AIDS patients,

cancer patients, patients suffering from asthma, cystic fibrosis

patients, or heart, lung or kidney transplant patients purposefully

taking immune suppressant drugs. All of these people can suffer from

fungal infections.

Fungal infections, according to the Joint Commission on

Accreditation of Healthcare Organizations, account for 9 percent of

all nosocomial infections within the hospital settings. Mold is

an " opportunistic pathogen in infection control in healthcare

facilities. " Simply put, it preys on the sick.

The National Institute of Allergy and Infectious Disease

says, " Fungal infections have recently emerged as a growing threat

to human health, especially in persons whose immune systems are

compromised in some way. "

Hospitals acknowledge that some people die for unexpected reasons.

For instance, in 2004, the year before Brandenburg's complaint, the

MCG Health Inc. Joint Conference Committee received a report in

closed session about six " sentinel events " experienced in six

months. Sentinel events are incidents in which a patient suffered

death or serious injury not related to the natural course of their

illness.

In addition, many infection deaths apparently go uninvestigated. In

2002,estimates for the number of infection deaths in the nation

ranged from 90,000 to 103,000.

Mold is a known health hazard for hospitals, and one that can be

expensive and difficult to handle. Most reactions to mold are

allergic. However, mold can also cause significant problems for

asthmatics and show up as a recurring respiratory problem. Mold is

often associated with " sick building " concerns.

At MCG and MCG Health, the administration maintains a list of what

it originally called the " Sick Building Complaint Response Record. "

In recent years, it became the " Indoor Environmental Quality Log. "

The earliest documented complaints about mold and mildew date back

to 1993, according to records obtained by the Metro Spirit. In May

of that year, a worker in personnel complained, " She and others in

her area were smelling mold, mildew and dust, and were sneezing and

coughing. " The hospital ordered the in-ceiling air handlers checked

for dirt and mold odor, then treated with algaecide.

The Metro Spirit looked at sick building records from 1993 to 2006

(MCG Health has declined to produce later records), and found 110

complaints about the Annex building.

The original complaint to the Metro Spirit in 2006 identified the

Annex as the site of mold problems. The complaints talk about

smells " like 100 dead rats. " Workers complained of headaches and

allergy symptoms. At least two tests found mold in the air.

Mold complaints were not limited to the Annex. Concerns about mold

were raised in the G. Lombard Building, Protein Chemistry

Laboratory, School of Dentistry, Pavilion I, II and III, MCG

Hospitals and Clinics Talmadge Building, Murphey Building, Dugas

Building, Sydenstricker Building, Ambulatory Care Center,Children's

Medical Center, Residence IV, MCG Village Apartments D, Walter

Shepeard Building, Alumni Center, Faculty Office Building, Marks

Building and the Georgia War Veteran's Nursing Home.

Even employees working for Employee Health complained of suffering

from effects of mold.

Mold is everywhere, said mold expert Dr. Dahlgren. " It

releases spores. Some of them are volatile. A lot of times it only

affects people by giving them allergy-like symptoms such as

sneezing, coughing and sometimes a runny nose. Other times the

spores release what are known as mycotoxins, and they are volatile,

and can have very harmful effects. "

Dahlgren consulted for et al vs. PG & E, the lawsuit that was

made into the movie " Brockovich. " He also treats New York City

firemen who were exposed to chemicals and harmful substances at

Ground Zero on Sept. 11.

MCG does not share Dahlgren's concerns about the toxic nature of

mold.In a broadcast on WJBF, MCG said toxic mold doesn't exist. To

that, Dahlgren said, " They are misinformed. There is tons of

literature out there on the subject. "

The CDC writes, " Some people are sensitive to molds. For these

people, molds can cause nasal stuffiness, throat irritation,

coughing or wheezing, eye irritation, or, in some cases, skin

irritation. People with mold allergies may have more severe

reactions. Immune-compromised people and people with chronic lung

illnesses, such as obstructive lung disease, may get serious

infections in their lungs when they are exposed to mold. "

The Environmental Protection Agency (EPA) is more direct on the

subject. In a footnote to materials on remediation of mold in public

buildings, the EPA says, " Molds are know allergens and may be

toxic. " It advises workers to check with their doctor before working

on mold remediation projects or even checking potentially moldy

areas.

In the 1990s, an investigation of a cluster of cases in Cleveland of

acute idiopathicpulmonary hemorrhage among infants, which was fatal

in many cases, suggested an association with exposure to mold.

" Twenty-six of 29 infants (89 percent) lived in water-damaged homes,

25 of 28(89 percent) lived in homes containing toxigenic fungi, and

27 of 30 (90 percent) were exposed to ETS [environmental tobacco

smoke] in the home, " wrote the researchers. " The protection of young

infants from moldy environments continues to be a prudent public

health approach. "

However, a review of that investigation by CDC showed that no

association had been clearly established, and called for more

investigation.

In Georgia, mold grows easily because of the humid conditions. Mold

spores need only a few things to prosper — a food source, which can

be any organic material such as walls, floors, clothes and stuffed

animals; the right temperature (between 40-100 degrees Fahrenheit);

and moisture.

The most easily controlled factor is moisture. If a leak or water is

not cleaned up, mold can begin to grow within 48 hours.

" If you can smell it or see it, get rid of it because it's probably

a problem, " Dahlgren said.

" You may suspect hidden mold if a building smells moldy but you

cannot see the source, or if you know there has been water damage

and building occupants are reporting health problems, " EPA materials

say.

It is possible to keep mold from growing in homes and buildings

through use of dehumidifiers and eliminating moisture.

Ridding a building of mold is difficult. People try to paint over

it, or simply wipe it away, but that doesn't solve the problem.

" It is because they are only cleaning the surface. It is inside the

walls, " Dahlgren said. " A lot of times the walls have to be knocked

down and replaced. "

The EPA says three things must be done to fix mold problems. First,

the water or humidity problem must be resolved.

Second, the EPA says, " Continue to communicate with building

occupants,as appropriate to the situation. Be sure to address all

concerns. "

We have been unable to find any evidence from MCG Sick Building

documents that occupants were given any such cautionary warnings.

Finally, it says to carefully contain and remove moldy building

materials. Some larger remediation actions may require full

containment of the area, air pressure management to prevent the

spread of spores and full protection of the workers.

One common way MCG Health deals with mold problems it considers

minor is to use an " ozone ionizer. " However, the EPA suggests that

ozone ionizers may not be an effective choice.

" Ozone, a lung irritant, is produced indirectly by ion generators, "

the EPA writes. " Although ozone can be used in reducing odors and

pollutants in unoccupied spaces (such as removing smoke odors from

homes involved in fires) the levels needed to achieve this are above

those generally thought to be safe for humans. "

Methods used to respond to mold complaints at MCG Health may be

helping to spread mold though the air conditioning systems.

In a case in 1998 in the cerebral vascular neurology department,

black particles were found coming out of the ceiling vents. People

were sick with symptoms described a painful breathing, intermittent

headaches andcoughing up mucus. Three species of mold were found.

That same year, investigators found mold in vents in Georgia War

Veterans Nursing Home.

In 2004, mold was found in air handlers in Employee Health. In 2005,

employees were sick and mold was found on a number of the air

conditioning vents in the annex.

In such a case, the EPA says, " Do not run the HVAC system if you

know or suspect that it is contaminated with mold. "

In no case in the 13 years of sick building reports is there a

report of shutting down the HVAC system because of mold concerns.

In October 2006, MCG Health moved the Pediatric Intensive Care Unit

to temporary quarters to try to fix the mold problems in the ward.

According to the Infection Control Risk Assessment Form, the PICU

was relocated to the fifth floor.

Handwritten notes dated Aug. 10, 2006, show that not only had there

been more than six months of complaints leading up to the remodeling

of the PICU, but there also had been discovery of mold hiding behind

the sinks in exposed press board. " Mold behind sink, " the note

reads. " Dialysis H2O access. "

People who were inside the unit say the counters were designed in

such a way that water could run behind the countertop, where the

mold could grow unseen.

The remediation effort called for maximum containment. The area was

sealed off with plastic. Negative air pressure was used to keep

spores from escaping.The carpet was removed from PICU.

The handwritten notes show that before and after the move, spore

traps were set up in the area. Particle counts were taken inside and

outside of the PICU.

" Move everything and cover, " the notes said. " Clean everything

inside out. "

The renovation took 10 days. By Nov. 1, 2006, PICU had moved back to

its home, now with tile instead of carpet.

Fifteen days after moving back into the PICU, the next complaint

came in.

" Please be aware that at work I have been coughing with a great deal

of regularity (this all started when I arrived this evening to

PICU), with sore-ish throat, and feel like my throat is tickling.

Can't quite clear my throat, " the worker wrote. " Please have

epidemiology check out the `new' unit! I am really tired of this…

Thought it was supposed to be better with the new blazing white

tile. "

Inside the PICU, sources say one room remains closed off today

because of a leaking ceiling. That source says the complaints

continue.

That seems to be the story of the battle against mold at MCG Health.

In the sick building reports from 2006, the most recent year of

reports obtained from MCG Health, the problems are much the same as

they were in 1993.

— Workers complain of intermittent headaches and point to " something

black growing on the carpet " in psychiatry.

— Workers discover black mold above a ceiling in emergency medicine.

— The School of Nursing complains about a musty odor in the office.

— A two-month-old roof leak leads to complaints of odor and

headaches in pharmacology.

— The School of Allied Health asks for mold testing after repeated

bouts of sickness.

— Mold growth and allergies are reported in epidemiology.

— Humidity rises to 70 percent in one building, stimulating mold

growth " on a number of surfaces, " causing an allergist to recommend

that one of the affected workers stop going to work.

Some researchers believe such ongoing complaints about mold must be

addressed by hospitals as a serious concern to the health of

patients.

An article in the Journal of Solar Engineering called " Airborne

Infection Control in Health Care Facilities " points to " hospitals

where immune-compromised patient mortality has been directly linked

to increased indoor airborne fungal contamination caused by

construction activity. Inhalation of viable Aspergillus spores often

results in invasive pulmonary aspergillosis, a disease with a high

fatality rate. "

According to an article published in 2002 by Health Facilities

Management, airborne mold and fungi spores, which can be released in

dust of construction projects at hospitals, may contribute to as

many as 5,000 patient deaths each year.

The risk is not only that patients maybe harmed, but that the

hospital will be sued. In the case of the MCG Health Pediatric

Intensive Care Unit, all the elements are in place for a lawsuit.

The PICU deals with some of the sickest patients in the hospital,

young people with families who are facing the most devastating

consequences.

Metro Spirit provided MCG Health with the supporting documents and

offered to show the hospital the story to obtain a comment last

week. Again, the hospital declined.

Riney contributed to this article.