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Beleaguered Grady Memorial Hospital in the News

By Dr. David Edward Marcinko; MBA, CMP™

The economically dreadful status of Grady Memorial Hospital Corporation [GMHC], here in Atlanta Georgia, is well known to those in the industry. We personally wish its new CEO, Michael A. Young, of the hospital’s recently privatized BOD much professional success. As the region’s only level-two trauma center – an important public service is provided to us all.

Current Development at GMHC

And now, tests of water samples from varied hospital locations at GMHC have focused a Legionella Pneumonia investigation on upper parts of Water Tower A.

Link: http://www.ajc.com/gwinnett/content/metro/atlanta/stories/2009/02/12/legionnaires_disease_grady.html

As originally suspected, the water source on units 11-A and 12-A tested positive for Legionella bacteria, and were treated with hot water [284 degrees] and heated hyper-chlorination, as inpatients centered on the 11th and 12^th floors were temporarily unable use their shower facilities as a precaution.

Link: http://www.gradyhealthsystem.org/lpneu.asp

First Anecdote

I initially learned of Legionnaires’ disease while a medical student at Temple University, in Philadelphia. The community paranoia and patient deaths surprised us all back then, as well as the ultimate general simplicity of treatment with the antibiotic erythromycin. In fact, two incidents quickly come to mind as this story unfolds.

First, I returned to the same hotel about a decade after the incident while serving on the residency selection committee for a local hospital. I was astonished to learn how few of our interviewees knew about the condition; not medically of course, but its rich history in the very same hotel accommodations where we stayed. While having dinner one evening in the hotel’s restaurant, I met former heavy weight boxing champion, Smok’in Joe Frazier, who invited me to his table for a drink. Even he recalled the original Legionnaire’s incident, and hotel venue, just as he regaled me with his nascent training escapades at the Center City Athletic Association on North Broad Street. I regaled him in-turn, with stories of my own dad, an amateur fly-weight Baltimore City boxing champion circa 1945; and stories of my services as boxing-ring physician’s assistant at the old Philadelphia Spectrum. He was a gracious and charming champion, indeed. My dad was thrilled when I recounted this story.

About Legionnaires‘ Disease

Legionnaires’ disease got its name in 1976, when an outbreak occurred in the Bellevue-Stratford, a land-mark Philadelphia hotel during an American Legion convention. Pneumonia-like symptoms include fever, chills, cough, muscle aches and headaches. Chest X-rays, and other tests can be done on sputum, as well as blood or urine to find evidence of the bacteria. The bacteria grows best in warm water, like the kind found in hot tubs, saunas, cooling towers, hot water tanks, large plumbing systems, or parts of the air-conditioning systems of large buildings. Transmission is through mist or vapor-like steam from sources not been properly cleaned and disinfected. The bacteria are not spread from one person to another person. Outbreaks occur when two or more people become ill in the same place at about the same time, such as patients in hospitals. Hospital buildings have complex water systems and many people in hospitals already immune compromised and have illnesses that increase their risk for Legionella infection. Other outbreaks have been linked to aerosol sources in the community, on cruise ships etc, with the most likely sources being whirlpool spas, cooling towers and water used for drinking and bathing.

Unfortunately, Legionnaires’ disease can be very serious and can cause death in up to 5% to 30% of cases. Most cases are successfully treated with antibiotics and healthy folks usually recover from infection. Current antibiotic treatments are with quinolones and macrolides. Those used most frequently are levofloxacin and azithromycin. Macrolides are used in all age groups while tetracyclines are prescribed for children above the age of 12, and quinolones above the age of 18. These antibiotics are effective because they have excellent intracellular penetration and Legionella infects cells.

Second Anecdote

The second incident that comes to mind is my recollection of Dr. Leonard Bachman, the former Pennsylvania Commonwealth Health Secretary at the time of the first Legionaire’s crisis, thirty-three years ago. Dr. Bachman is a former Commanding Officer of the US Public Health Service’s Disaster Response Team, Director of Health Services for the National Oceanic and Atmospheric Administration, and Director of the Public Health Service. During his long and distinguished career, he assisted with the establishment of the National Disaster Medical System (NDMS), coordinated the original investigation into the initial outbreak of Legionnaire’s Disease in Philadelphia, and was responsible for the medical response to Hurricane Andrew. Today, although semi-retired, Dr. Bachman provides consultancy services to the US Marshall Service and numerous other organizations. So, imagine how shocked I was to see him interviewed on TV a few weeks ago! Now, at Emory University, his advice and experience was again sought during the current GMHC incident. What a blast from the past!

Assessment

GMHC is a downtown Atlanta public facility with 950 beds. It normally sees about 2-3 cases of Legionaiire’s disease each year.

Proper antibiotic use: http://www.tufts.edu/med/apua/mrsa/mrsa.html

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Please opine on GMHC, the sweet-science, or related topics of interest. Is this outbreak, for example, related to the Peanut Corporation of America salmonella outbreak in Blakely, GA, in any systemic way? Or, does this state simply lack governmental oversight in multiple areas?

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Filed under: Breaking News, Drugs and Pharma, Ethics, iMBA, Inc., Op-Editorials, Research & Development | Tagged: Bellevue Startford hotel, erythromycin, Grady Memorial Hospital, Joe Frazier, Legionnaires’ disease, Leonard Bachman MD, Macrolides, tetracycline | Leave a comment »