Longview hospital's high infection rates: ‘I saw a worrying trend'

A KGW investigation found Longview's PeaceHealth St. John Medical Center had the worst MRSA infection rates of any Washington state hospital in 2015. 

KGW Investigation: Hospital Infections

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LONGVIEW, Wash. – Marie Triplett began feeling a strong pain in her left leg in late 2013.

Marie, then in her early 80s, went to see a doctor at PeaceHealth St. John Medical Center in Longview, Wash. She was diagnosed with restricted blood flow in her leg, which required surgery.

It was a major procedure, but everything seemed to go smoothly at first.

“She walked in under her own steam, even though her leg hurt. She walked out under her own steam, was doing fine,” her son Jeff Triplett said.

Several weeks later, he said the family started to notice problems. There was puss forming around the surgical incision, so Marie headed back to the doctor. 

The Triplett family didn’t know it at the time, but a state and federal investigation would later determine that while in the hospital Marie had contracted a dangerous antibiotic-resistant infection called MRSA.

A KGW investigation found the problem of MRSA infections at St. John Medical Center went beyond just Marie Triplett. KGW analyzed Medicare data and found a trend of increasing MRSA cases between 2013 and 2015 at the hospital.

By 2015, St. John Medical Center was the worst-performing hospital in Washington state when it came to hospital-acquired MRSA infections, the Medicare data shows.

Tap to view interactive

“I saw a worrying trend,” said Doris Peter from the Consumer Reports Health Rating Center, after examining the data. “That hospital had the worst ratio for hospitals in the state. And it is much higher – three times higher – than the national rate or national benchmark.”

MRSA is a major concern for hospitals because it can be so tricky to treat. The CDC says it can lead to severe problems, such as surgical site infections or pneumonia. Left untreated, MRSA can cause sepsis and even death.

“MRSA is highly lethal,” Peter said.

MRSA rates are compared between hospitals using something called a “standardized infection ratio.” The score is calculated by taking the actual MRSA cases and dividing that number by the expected number of MRSA cases. The expected rate is calculated by the size of the hospital, services they offer and other factors.

A score of “1” means a hospital had as many MRSA cases as projected. Anything above 1.0 is worse than expected and a score below 1.0 means the hospital performed better than expected.

In 2015, St. John Medical Center’s SIR was 3.0656. It was the only hospital in the state with a score above 3.0 that year. Two other hospitals had a score above 2.0: Highline Medical Center in Burien and MultiCare Tacoma General Hospital.

Two other PeaceHealth hospitals in Washington – PeaceHealth Southwest in Vancouver and PeaceHealth St. Joseph in Bellingham – both had scores below 1.0 in 2015.

Family’s complaint leads to state and federal investigation

Triplett eventually grew frustrated with the hospital and filed a complaint to the state of Washington about his mother’s treatment. A subsequent state and federal investigation found that St. John Medical Center failed to comply with multiple federal health and safety regulations.

Triplett also said the hospital was slow to release details of his mother’s infection and when he asked for financial help, the hospital failed to provide compensation.

Although his mother was in and out of the hospital several times between her first surgery in December, 2013 and May 2014, Triplett said the hospital never directly informed his family about the MRSA infection.

Triplett said he first heard about the infection when a hospital worker gave his mother's medical records to a visitor. The family didn’t see any official statements about his mother’s MRSA diagnosis until he received the final state investigation in September 2015.

That same investigation found she acquired MRSA either during the initial surgery or a follow-up surgery a month later.

The family said a hospital official told them they wouldn't have to pay for care related to treating MRSA but failed to follow through on that promise. 

“I felt like a little bit of me died inside because I couldn’t help her,” Jeff Triplett said. “It was very difficult.”

Marie Triplett died on May 20, 2016. Her cause of death was listed as heart failure and “pulmonary insufficiency.” She was 85 years old.

In June 2015, Jeff Triplett filed a complaint with the Washington Department of Health. That led to a state and federal investigation being launched two months later.

The investigation confirmed that Marie Triplett contracted MRSA while in the hospital, but also uncovered several areas where St. John Medical Center was out of compliance with federal safety regulations.

Those problems led to a threat from the Centers for Medicare and Medicaid Services: St. John Medical Center needed to clean up its act fast or face losing all Medicare payments.

State and federal reports obtained by KGW show several areas where the hospital was faulted for violating federal standards, including:

  • The hospital did not maintain an “active, hospital-wide” program to either prevent infections or stop them from spreading.
  • The hospital did not have an “infection prevention professional” since the beginning of 2014. Hospitals are required to have an active program to prevent infections, which investigators said St. John Medical Center did not have. The hospital did hire an apprentice infection prevention professional in July of 2015, but the investigators found that person did not have the proper credentials as required by the Centers for Disease Control.
  • The hospital did not have a written policy designating its “infection control officer.”
  • The hospital did not “flag” a MRSA patient and implement proper isolation precautions to prevent the spread of infection.

“Failure to assure the ‘Infection Control Program’ is functioning places patients at risk for acquiring infections while hospitalized,” the investigator wrote in her report.

In September 2015, Medicare put St. John Medical Center on what is called a “90-day termination track.” That meant the hospital had 90 days to implement reforms or face losing all Medicare payments.

 

 

St. Johns Medical Center claims about-face

“Any time you receive that kind of letter from the department of health it’s obviously serious,” said Dr. Eleen Kirman, the Chief Medical Officer at St. John Medical Center.

Hospital administrators say they have since turned things around when it comes to hospital-acquired MRSA infections. In 2016, they said the hospital had no cases of hospital-acquired MRSA.

Medicare did not follow through on their threat to revoke payments, due to corrections the hospital made.

 “We have continued to take this very seriously and instituted a number of infection prevention practices,” said Kirman.

The public data from Medicare isn’t yet available to corroborate that claim, but hospital administrators sent KGW a screenshot of the CDC reporting system that shows no new MRSA cases in 2016.

 

 

 

According to Kirman, the Longview area has a high rate of so-called “community-acquired MRSA.” That’s when the infection is spread person-to-person outside of the hospital.

Kirman said that the hospital lost its infection prevention specialist in 2014 and had a hard time filling the position. She said other prevention specialists in their network helped cover the Longview hospital, although MRSA cases spiked when the position was vacant.

The hospital hired a full-time infection prevention specialist in 2015.

Kirman pointed to several other reforms the organization has made in the last 18 months, including adding new equipment to help isolate MRSA patients and a renewed focus on hand hygiene for doctors and nurses.

“I feel very confident now that any patient may see very safe care in our organization,” she said.

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What can a patient do to protect themselves?

Jeff Triplett said looking back he wishes he knew more before his mother chose to visit St. John Medical Center.

“I wish I would have been a better and more informed advocate when this started,” he said. “I would have done everything in my power to convince my parents to go elsewhere.”%INLINE%

Jeff Triplett said he was taught growing up to respect institutions like hospitals. He didn’t ever see the need to question a medical doctor.

But Doris Peter with Consumer Reports says patients shouldn’t be afraid to speak up.

MRSA spreads through direct contact. One of the most effective ways to prevent its spread is something children are taught in pre-school: wash your hands.

“The first thing you think of is hand hygiene,” Peter said. “If there is improper hand hygiene from staff then you’re going to be passing it from one person to another and it’s going to spread throughout the hospital.”

Peter said that patients and visitors should not be afraid to ask a doctor or nurse if they’ve washed their hands when entering and leaving a room.

St. John Medical Center has instituted World Health Organization guidelines for hand hygiene since the investigation. They require care providers to wash their hands at five separate points during their work: before touching a patient, before cleaning, after exposure to bodily fluid, after touching a patient and after touching patient surroundings.

“I can’t believe we’re still talking about (hand hygiene) but that is still a big problem in hospitals,” Peter said.

“This is something that is a concern in hospital all over the country,” Kirman said. “MRSA is not going away.”

The CDC says the MRSA infections in hospitals can be largely prevented by following safety guidelines. In addition to hand washing, guidelines include carefully cleaning hospital rooms, isolating MRSA patients in their own rooms and wearing gloves and gowns during care.

Visitors may also be asked to wear gloves and gowns with MRSA patients.

If you or a family member were recently treated in a hospital, the CDC recommends taking several steps to help prevent infections such as MRSA:

  • Wash your hands and body regularly
  • Keep wounds clean and covered until they have healed
  • Avoid sharing personal items, such as razors and towels

If you think you or someone in your family might have MRSA or other infection, the CDC recommends covering the area with a bandage, washing your hands and calling a doctor. The agency says that it is especially important to call a doctor if the patient has a fever.

CDC information for MRSA patients

KGW viewer Jeff Triplett contacted our investigative team concerned about his mother's experience at a Longview hospital. That led our team to look into the MRSA rate for that hospital, which was the worst in Washington in 2015. Our report uncovered the state and federal probes into the issue, and what the hospital has been doing in recent years to address this issue.

Have a tip for the KGW News investigative team? Let us know at investigators@kgw.com

 

 

Kyle Iboshi contributed to this report

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