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For the week of November 8 through 14, 2000

Two left partially blind after eye surgeries

Source of infections remains a mystery

Express Staff Writer

The Wood River Medical Center and the Idaho Department of Health and Welfare are investigating the causes of infections that left two local residents blind in one eye following consecutive cataract surgeries at the Hailey hospital this summer.

Dr. Stephen Graham, the Ketchum-based ophthalmologist who performed the operations on July 25, said alpha strep bacteria infected both patients and caused the blindness. Graham said the patients were two of six on whom he performed cataract surgeries in Hailey that day. Authorities have not yet determined the source of the infections.

A retina specialist at the Intermountain Eye Clinic in Boise cured both patients’ infections.

One of the affected patients is Ketchum resident Hilda Moseley, 77. Her husband, Mose Moseley, said his wife wanted her cataracts corrected because she is an avid reader. Now, "to try to adjust to one eye, it’s affected her coordination," he said. With her remaining sight, she can read a newspaper, see the television, and drive a car a little, though with difficulty.

The other patient chose to remain anonymous.

The Wood River Medical Center is owned by Blaine County and the city of Sun Valley, and managed under contract by a branch of the Boise-based St. Luke’s Regional Medical Center.

The Wood River Medical Center has suspended further eye operations at the Hailey hospital. The hospital is scheduled to close Nov. 19 in any case, when St. Luke’s opens its new hospital south of Ketchum.

Graham said he voluntarily ceased eye surgeries at Wood River Medical Center, choosing instead to go to Twin Falls or Boise to operate on patients.

St. Luke’s public relations manager Kerry George stated in an e-mail message that the investigation is being conducted under the authority of the publicly owned Wood River Medical Center, not St. Luke’s. "Further," she stated, "it is the Wood River Medical Center’s medical staff who is responsible for overseeing the quality of medical care until November 19.

"St. Luke’s authority only extends to care provided after November 19, not before."

So far, investigators have disclosed little about what went wrong with the infected eye patients, and no one takes responsibility for the problem.

"The source of the infection has not been found in or on any of the equipment, solutions, or surfaces we have tested," George stated.

The Bureau of Facility Standards, a division of the Idaho Department of Health and Welfare, has completed a separate investigation, and plans to release its report to the public this week. The Bureau of Facility Standards protects healthcare recipients in Idaho by enforcing state and federal regulations, and providing information and education.

Not all infections that appear after surgery are later determined to be hospital- or surgeon-related. The two patients could have been infected after leaving the hospital, stated both Graham and Wood River Medical Center CEO Jon Moses, an employee of St. Luke’s. Graham, however, called that scenario very unlikely.

Graham said he learned from the Boise-based retina specialist that the bacteria infecting each patient came from the same colony, which indicates they came from a single source. When asked if that suggests the infections may have come from within the hospital, public relations manager George stated, "It is neither legally appropriate nor professional to speculate on its source."

Despite these two infection cases, cataract surgery is considered to be a low-risk procedure. Only 17 out of 23,625 operations performed nationwide result in infection, according to the 1999 volume of "Duane’s Clinical Ophthalmology," a common reference source for eye doctors.

The same infection occurring in two consecutive patients undergoing surgery in the same operating room should be almost impossible, Graham said. George stated no statistics are available on the odds of such an occurrence.

As the valley’s only ophthalmologist, Graham performs more than 100 eye surgeries each year. The equipment he used was rented by the hospital, Moses said. George acknowledged in a written statement, however, that the Wood River Medical Center and its equipment suppliers "each have varying levels of responsibility" for ensuring that supplies and equipment are sterile during the procedures.

Graham said microscopic amounts of alpha strep transferred from skin to surgical instruments can cause an eye infection. Alpha strep bacteria live in the ears, eyes, nose and lungs of humans. It infects the entire eye, causing swelling, severe redness, pain and destruction to the retina, which leads to blindness. Graham described the retina as a delicate, easily damaged part of the eye with the consistency of a "wet piece of tissue paper."

Moses stated that the hospital is trying to identify the source of the infections by taking cultures, testing equipment and reviewing procedural techniques.

Also, hospital medical staff are conducting a peer review, Moses stated, which "is not uncommon."

Graham contended the hospital is trying to defer blame to him with the peer review. He refused to participate in it, he said, because "it really is an inappropriate venue to discuss the hospital’s infection control problems."

On June 5, before the operations occurred, the medical center released figures from an infection control report that stated the hospital’s infection rates have not only always been "below national norms," but they were decreasing.

Out of 6,035 surgeries of all kinds performed at the hospital since 1996, a press release stated, 59 resulted in infections, a rate of about .98 percent (less than 1 percent). The press release compared that figure to the Atlanta-based Centers for Disease Control national benchmark rate, which the hospital stated was 2 percent. In 1999, the hospital stated its infection rate fell to .82 percent (less than 1 percent).

"The low and steadily decreasing infection rates at the WRMC are a tribute to the excellent care provided to patients by the hospital and medical staff," the release quoted Dr. Kurt Stevenson as saying. "The numbers reflect the high priority the administration at WRMC is placing on infection control activities and quality improvement."

As chairman of WRMC’s infection-control committee since 1998, Stevenson was responsible for compiling the hospital’s report on infection, the release stated.

Graham called it ironic that on Aug 9, the same day he said he diagnosed Moseley’s infection and reported it to the hospital, the hospital administration sent physicians a memo and an "Infection Control" pamphlet that reiterated much of the information contained in the June 5 press release.

"We are proud of the very low rates WRMC has and will continue, with your help, to spread this great news and keep fear of [hospital-based] infections to a minimum," the memo stated.


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