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VA pledges probe into St. Louis hospital sterilization lapse

Tuesday, July 6, 2010 | 5:54 p.m. CDT; updated 9:42 a.m. CST, Thursday, February 17, 2011

ST. LOUIS — A top Veterans Administration system official pledged on Tuesday to appoint an internal panel within days to investigate concerns that dentistry sterilization lapses at the St. Louis VA hospital may have exposed nearly 2,000 veterans to viruses.

William Schoenhard, a Veterans Health Administration deputy undersecretary, toured the medical center's dentistry operation just days after revelations that veterans who received services there may have been infected by a sterilization mistake exposing them to hepatitis B, hepatitis C and HIV.

Schoenhard sidestepped questions about anything unsettling he may have found during his walkthrough, ceding to the "complete review" he expects from a three-person board he plans to fill this week. Once seated, that internal national Administrative Investigation Board must report its findings within 60 days.

"We have a very good sense of what has occurred," Schoenhard said without elaborating.

The VA sent letters last week to 1,812 veterans who had dental procedures at the St. Louis site from February 2009 through March 11 of this year, when the problem was uncovered.

As of Tuesday, 480 of the veterans have come in for free blood screenings for hepatitis B, hepatitis C and HIV, said Rima Nelson, the St. Louis VA's acting director. Those tests should be completed within a couple of weeks, she said.

Schoenhard called the risk of exposure to the viruses "very low" and voiced confidence in the dental unit's staff — and the VA system as a whole — in trying to tamp down anger among many veterans that their health may have been compromised through dental work.

The VA said last week it was placing the St. Louis VA's chief of dental services on administrative leave. Danny L. Turner identified himself as that administrator, telling the St. Louis Post-Dispatch that he blames politics for distorting the situation.

Dr. Robert Petzel, a VA undersecretary for health, said last week the problem arose because workers prewashing dental equipment failed to use a detergent before the equipment was sterilized. He said that failure allowed for a "phenomenally remote" chance that sterilization might not have been effective.

On Tuesday, VA officials insisted the agency had tightened procedures to make them more uniform across the VA's network of hospitals, confident any recurrence has been abated.

A few veterans questioned by The Associated Press outside the VA site on Tuesday didn't appear concerned about the infection risk that has drawn outrage from Illinois and Missouri members of Congress.

Just moments after having some grinding done on his dentures there, Air Force veteran James Reed of Piggott, Ark., said he hadn't heard about the VA's warning last week about the dentistry-sterilization concerns, Reed, 73, appeared stunned to hear about it from a reporter.

Yet, "I figure they'll take care of it," he said, satisfied with the VA care he's gotten over the years, including radiation treatment for cancer.


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Comments

Lawrence Muscarella PhD July 7, 2010 | 11:42 a.m.

This incident raises, too, concerns about the standardization of veteran care, and, too, medical ethics and, to be sure, trust.

According to this article, the Veterans Health Administration (VHA) concludes that the risk of infection from this specific infection-control lapse in St. Louis was "very low" and "phenomenally remote."

Other reports similarly conclude that the risk of infection associated with this lapse was "extremely low" and "infinitesimally small."

Notably, despite these assessments of a very low risk of infection, patients of this St. Louis dental clinic were appropriately notified of the identified breach.

Fair enough, but why, then, having confirmed similar infection-control breaches within the past year at a number of medical facilities within the VA's Caribbean Healthcare System, including in San Juan, Puerto Rico (the VHA concluded that these breaches, which included improper disinfection of transvaginal ultrasound probes, posed a "negligible" risk of infection), did the VHA this time NOT notify the veterans?

In short, why did the VHA notify some veterans of infection-control breaches that the VHA claims pose a negligible or remote risk (e.g., the patients in St. Louis), while the VHA chose not to notify veterans in Puerto Rico of infection-control breaches that, ironically, the medical literature suggests are associated with a potentially *higher* risk of infection - for example, the improper disinfection of transvaginal probes poses an increased risk of patient-to-patient transmission of the human papilloma virus - than the improper cleaning of dental instruments (prior to terminal sterilization)?

Such inconsistent assessments of risk call into question the scientific merit of the VHA's published conclusions and risk assessments.

Representative Bob Filner (D-CA) asserts in a CNN transcript that the VA's failure to tell the patients of this dental clinic in St. Louis is a "cover-up."

Well said, but if the failure to notify patients for 3 months is, in Congressman Filner’s words, a "cover-up," what would he call it when, worse, the VHA - in violation of its patient disclosure policy - failed to notify the veterans of this VA Caribbean Healthcare System (Puerto Rico) of these infection-control breaches?

Something would appear to be in error vis-a-vis the VHA's assessment of risk posed to U.S. veterans outside of the U.S. (as opposed to those within the continental U.S.)

Lawrence F Muscarella PhD

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