Maryn McKenna

Journalist and Author

UK: Hospitals’ MRSA deaths could bring manslaughter charges

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Last Wednesday was the first day of the new federal fiscal year, and therefore the day on which HHS’s new “non-reimbursement for medical errors” rule went into effect. Under this new rule (blogged here and here and covered in this New York Times story), the Center for Medicare and Medicaid Services will no longer reimburse hospitals for the increased care that a patient needs after an extreme medical error has happened. While infecting a patient with MRSA is not specifically disavowed in the rule, it outlaws reimbursement as of this year for infections associated with vascular catheters and coronary artery bypass graft surgery, and next year (Oct. 1, 2009) for surgical site infections following orthopedic procedures. (Disappointingly, CMS rejected requests to define staph septicemia and nosocomial MRSA infection as “never events.”)

Now, however, it seems that the UK government is willing to go much further than our own. According to a story in The Independent (first flagged here by ace flu blogger Crawford Killian), “tough new manslaughter laws” will allow corporations — including healthcare institutions — to be held accountable for deaths in which corporate behavior plays a role:

Maria Eagle, the Justice minister, told a meeting of more than 100 chairs and non-executive directors of NHS trusts that where managers ignore warnings of health risks, prosecutions may follow. She said: “Putting the offence into context, imagine that a patient has died in a hospital infected by MRSA and the issue of corporate manslaughter has been raised. Could the organisation be prosecuted and convicted? The answer is ‘possibly’. (Byline: Robert Verkaik, law editor)

Public attitudes in the UK are ripe for this change. In July, there was significant protest after it emerged — via a government report — that 345 patients died of Clostridium difficile infection at three hospitals, after government warnings, with no punishment to the hospitals. In fact, according to The Independent, the chief executive of the trust that operated all three was allowed to resign with $150,000 in foregone pay, and is now suing for additional compensation.

So far, US protests and citizen action over nosocomial MRSA infections have been within individual states (see this recent post on the new Nile’s Law in California). But isn’t it interesting to see what coordinated national action — granted, in a smaller country — can do.

Good news from California

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Last night, California Gov. Arnold Schwarzenegger signed an extremely important bill, California SB 1058. The new law, formally called the Medical Facility Infection Control and Prevention Act, requires California hospitals to do MRSA screening on high-risk patients (such as in ICUs, admitted from long-term care facilities, or known to have a previous MRSA infection) and to report their rates for hospital-acquired infections including MRSA to a newly created body with the state Department of Public Health.

This new law puts California in the vanguard of states who are requiring healthcare institutions to count and track MRSA infections. (For a complete list, visit the database maintained by Consumers’ Union’s Stop Hospital Infections project.) This is vital not only for controlling MRSA, but also simply for helping us to understand how much MRSA is out there. Because MRSA has not been a reportable disease, and is not subject to any national surveillance, state counts like these are one of the best ways of assembling a fuller picture of the bug’s spread.

The most important reason to hail the passage of this law, though, is that it represents a memorial to a MRSA victim, and a determination by his survivors that no one else should meet the same fate. SB 1058 is also known as “Nile’s Law.” Nile is Nile Calvin Moss, who died in 2006. In response, his parents Carole and Ty Moss founded Nile’s Project and became tireless advocates for MRSA surveillance and screening. Among other efforts, Carole was appointed by Schwarzenegger to a state commission on hospital-acquired infections, where she is the sole voting member representing health-care consumers.

It is no small thing to step out of your grief and make your loss into a force for change. Carole and Ty Moss deserve congratulations.

News round-up

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I’m deep into writing again and therefore slipping on posting; apologies to regular readers! But here are some items of importance from the past week:

  • Wednesday (Aug. 20) marked the first anniversary of Illinois‘ signing and immediately enacting the MRSA Screening & Reporting Act, the first state law to mandate that hospitals screen all ICU and other high-risk patients for MRSA colonization and to isolate and treat them until they are clear. This law would never have been passed without the extraordinary advocacy of MRSA survivor Jeanine Thomas, founder of the MRSA Survivors Network (site here and in the blogroll).
  • Also as of Wednesday, California came within one step of passing its own MRSA laws, SB 1058 and SB 158. They await the signature of Gov. Arnold Schwarzenegger — but with California’s budget in a $15.2 billion deficit freefall, new legislation there may be held hostage until a budget deal is agreed. Important addition: SB 1058 is also called “Nile’s Law,” after Nile Calvin Moss, who died of MRSA in April 2006. His parents Carole and Ty have pushed relentlessly for a MRSA law in his memory.
  • Plus, a great find thanks to Carole Moss: The Washington State Department of Health has put together an excellent pamphlet, Living with MRSA, that explains MRSA infection, colonization, decolonization and infection-control care at home in excellent everyday language.
  • And finally, another blog worth knowing about: GERMblog, written by Dr. Harley Rotbart, professor and vice-chair of pediatrics at University of Colorado School of Medicine and author of Germ Proof Your Kids: The Complete Guide to Protecting (Without Overprotecting) Your Family from Infections. I interviewed Dr. Rotbart recently for a magazine story and his advice was clear, science-based and sensible. His blog is now in the blogroll.