A British Columbia health authority under fire for its handling of a highly infectious superbug has confirmed 13 cases in which the bacteria was believed to be a contributing factor in a patient's death.
Burnaby Hospital slid under the microscope this week after a letter signed by eight of its physicians was released by the B.C. New Democratic Party. The letter, sent to Fraser Health Authority's chief executive officer in January, claimed 84 patients died and hundreds more suffered serious complications following outbreaks of the bacteria Clostridium difficile between 2009 and mid-2011. The letter said infection rates at the hospital were two or three times the national average and the lack of control bordered on medical negligence.
Fraser Health conceded Thursday it's been a challenge reducing C. difficile rates at Burnaby Hospital due to the aging facility's relative shortage of isolation rooms and sinks. However, the health authority said it's extremely difficult to conclude the bacteria contributed to a patient's death.
"It is possibly true that 84 patients have died with a measurement of C. difficile at some time during a hospital stay in Burnaby. That does not mean that C difficile caused the death," Andrew Webb, vice-president of medicine at Fraser Health, said in an interview. "The only way of demonstrating causality is by postmortem and many patients don't have a postmortem examination."
Dr. Webb said in 2010-11, there were 13 cases at Burnaby Hospital in which the bacteria was believed to be a contributing factor in a person's death. Of those, eight patients were over the age of 80 and all of the cases involved other complicating medical conditions. Dr. Webb said he did not have data on C. difficile outbreaks at the hospital from 2009.
He said the health authority was well aware of the problems at the facility and, on top of a series of improvements commissioned over the last several years, ordered a report on the matter last fall. That report was delivered on Feb. 20. Dr. Webb said Fraser Health is already implementing 10 of its recommendations, but is still discussing what to do about the final three – including how to support staff described in the report as overwhelmed and working in underresourced infection-control programs.
Dr. Webb said Fraser Health had planned to release the report next week, but instead issued it Thursday, once the doctors' letter entered the public domain. He bluntly stated the hospital is safe.
When asked if he'd term the health authority's response to the C. difficile outbreaks as negligent, Dr. Webb said no.
"I wouldn't have suggested such terminology in a letter to the chief executive or anyone else," he said.
In his letter, pathologist Shane Kirby said Fraser Health's "ineffectual response" to the outbreaks – which led to unprecedented medical unit closures in July, 2011, and again in November – "could objectively be considered medical negligence."
Dr. Kirby wrote there were 473 serious cases of infection between 2009 and mid-2011 at the hospital. He did not say all 84 deaths were directly caused by C. difficile. He said there were questions about how many deaths were directly attributable to the bacteria, rather than simply associated with it.
Linda Wong, a medical malpractice lawyer at Pacific Medical Law, said Fraser Health could be held liable civilly if it could be proven it knew about problems and didn't act to fix them. She said such complex litigation would undoubtedly be expensive, since expert witnesses would have to be called.
A February report by the Provincial Infection Control Network of B.C. said 1,496 cases of C. difficile were reported in the first and second quarters of 2011-12. The report said 46.6 per cent of those were from Fraser Health. Surrey Memorial Hospital and Royal Columbian Hospital – both Fraser Health facilities – had high rates of infection during that period.
When asked why that would be, Dr. Webb pointed to overcrowding.
The report commissioned by Fraser Health, written by Dr. Michael Gardem, said the health authority's infection prevention and control programs were underresourced compared to other jurisdictions in Canada.
"My impression … was that [infection-control staff]are clearly dedicated to their roles, but also overwhelmed," the report said. "Their days are spent 'putting out fires' and they are unable to work on more preventative activities."