Chas­ing prof­its, Pope’s hospi­tal put chil­dren at risk

Kuwait Times - - HEALTH & SCIENCE -

Doc­tors and nurses at the Vatican’s show­case pe­di­atric hospi­tal were an­gry: Cor­ners were be­ing cut. Safety pro­to­cols were be­ing ig­nored. And sick chil­dren were suf­fer­ing. The Vatican’s re­sponse was swift. A se­cret three-month in­ves­ti­ga­tion in early 2014 gath­ered tes­ti­mony and doc­u­men­ta­tion from dozens of cur­rent and for­mer staff mem­bers and con­firmed that the mission of “the pope’s hospi­tal” had been lost and was “to­day more aimed at profit than on car­ing for chil­dren.”

What hap­pened next sur­prised many in­volved: The re­port was never made pub­lic. While some of the rec­om­men­da­tions were car­ried out, oth­ers were not. And the Vatican com­mis­sioned a sec­ond in­quiry in 2015 that af­ter a three-day hospi­tal visit - con­cluded noth­ing was amiss af­ter all. An As­so­ci­ated Press in­ves­ti­ga­tion has found that Bam­bino Gesu (Baby Je­sus) Pe­di­atric Hospi­tal, a cor­ner­stone of Italy’s health care sys­tem, did in­deed shift its fo­cus in ways big and small un­der its past ad­min­is­tra­tion. Un­der lead­er­ship that gov­erned from 2008 to 2015, the hospi­tal ex­panded ser­vices and tried to make a mon­ey­los­ing Vatican en­ter­prise turn a profit - and chil­dren some­times paid the price.

Among the AP’s find­ings: Over­crowd­ing and poor hy­giene con­trib­uted to deadly in­fec­tion, in­clud­ing one 21-month su­per­bug out­break in the cancer ward that killed eight chil­dren. To save money, dis­pos­able equip­ment and other ma­te­ri­als were at times used im­prop­erly, with a one-time or­der of cheap nee­dles break­ing when in­jected into tiny veins. Doc­tors were so pres­sured to max­i­mize op­er­at­ing-room turnover that pa­tients were some­times brought out of anes­the­sia too quickly.

Some of the is­sues - such as early awak­en­ing and the fo­cus on prof­its - had been iden­ti­fied in 2014 by the Vatican-au­tho­rized task force of cur­rent and for­mer hospi­tal doc­tors, nurses, ad­min­is­tra­tors and out­siders. The AP cor­rob­o­rated those find­ings through in­ter­views with more than a dozen cur­rent and for­mer Bam­bino Gesu em­ploy­ees, as well as pa­tients, their fam­i­lies and health of­fi­cials. The AP re­viewed med­i­cal records, civil court rul­ings, hospi­tal and Vatican emails, and five years of union com­plaints.

Bam­bino Gesu dis­puted the AP’s find­ings and threat­ened le­gal ac­tion. It said the AP in­ves­ti­ga­tion was based on in­for­ma­tion that was “in some ways false, in other ways se­ri­ously un­founded and out of date by two years but above all clin­i­cally im­plau­si­ble and defam­a­tory on a moral and eth­i­cal level.” The hospi­tal cited its rep­u­ta­tion as a cen­ter of ex­cel­lence. It draws top-notch sur­geons to work there and celebrity vis­its, in­clud­ing one by US First Lady Me­la­nia Trump in May.

Bam­bino Gesu also pointed to the Vatican’s sec­ond in­ves­ti­ga­tion, led by Amer­i­can Catholic health care ex­pert Sis­ter Carol Kee­han, as ev­i­dence that the al­le­ga­tions were false. “While there are many things we could have missed or been mis­led about, we came away from this eval­u­a­tion with a real sense that on the ma­jor charges and the ma­jor is­sues al­leged, we have been able to dis­prove them,” Kee­han’s re­port said.

Facts are hard to come by in the se­cre­tive halls of Bam­bino Gesu, which does not make pub­lic fi­nan­cial de­tails or its mor­tal­ity and in­fec­tion rates. Perched on a Ro­man hill­side just up the road from Vatican City, the pri­vate hospi­tal sits on Holy See ter­ri­tory and en­joys the same ex­trater­ri­to­rial sta­tus as a for­eign em­bassy - mak­ing the Ital­ian tax­payer-funded in­sti­tu­tion im­mune to the sur­prise in­spec­tions other Ital­ian hos­pi­tals un­dergo. It is fi­nanced by Italy’s pub­lic health sys­tem, but its main cam­pus isn’t even tech­ni­cally in Italy.

A myth has fallen

There is no in­di­ca­tion that the Vatican ever shared the re­sults of ei­ther in-house in­ves­ti­ga­tion with the Ital­ian health min­istry, which in 2015 re­ported that the hospi­tal of­fered qual­ity care “in such a way that as­sumes char­ac­ter­is­tics of ex­cel­lence.” Pro­vided with AP’s find­ings in De­cem­ber, the health min­istry promised to in­ves­ti­gate. “If this is true, a myth has fallen,” the min­istry’s then-spokesman Fabio Mazzeo said. “We have to ver­ify.” Mazzeo’s suc­ces­sor, reached in June, said he had no fur­ther in­for­ma­tion, say­ing the hospi­tal be­longs to the Vatican.

All of the hospi­tal em­ploy­ees who talked to the AP spoke on con­di­tion of anonymity, fear­ing they would lose their jobs if their names were used. Out of con­cern for the chil­dren, they said, they broke what the hospi­tal’s union has called the “omerta,” the Ital­ian code of si­lence Staff mem­bers told AP that some of the con­di­tions they first re­ported in early 2014 have im­proved since the sur­prise res­ig­na­tion of Bam­bino Gesu’s pres­i­dent in 2015.

The new ad­min­is­tra­tion, they said, fo­cuses less on vol­ume and shows more re­spect for pro­to­cols. But some of the task force’s most im­por­tant rec­om­men­da­tions have not been im­ple­mented, in­clud­ing the re­place­ment of Bam­bino Gesu’s med­i­cal direc­tor. And in its July 2016 news­let­ter, the hospi­tal’s main union said prob­lems re­main.

“Ten years ago, the ERs were jammed and they still are. Ten years ago, pa­tients waited on stretch­ers and they still do. Ten years ago you en­tered with one ill­ness and left with two hospi­tal in­fec­tions, and still do,” it wrote. “What has changed in 10 years? The ma­chines are bet­ter, the phar­ma­ceu­ti­cals are bet­ter, but the level of care is not.” Pope Fran­cis him­self used the oc­ca­sion of a 2016 Christ­mas au­di­ence with thou­sands of hospi­tal staff mem­bers and pa­tients to ex­hort Bam­bino Gesu not to fall prey to cor­rup­tion, which he called the “great­est cancer” that can strike a hospi­tal.

“Bam­bino Gesu has had a his­tory that hasn’t al­ways been good,” the pope said, jet­ti­son­ing his pre­pared re­marks to de­cry the temp­ta­tion to “trans­form a good thing like a chil­dren’s hospi­tal into a busi­ness, and make a busi­ness where doc­tors be­come busi­ness­men and nurses be­come busi­ness­men, ev­ery­one’s a busi­ness­man!” “Look at the chil­dren,” Fran­cis said in Ital­ian, point­ing to the young pa­tients gath­ered at his feet in the Vatican au­di­to­rium. “And let each one of us think: ‘Can I make cor­rupt busi­ness off these chil­dren? No!’”

Pro­duce, pro­duce, pro­duce

The se­quence of events that re­sulted in the two in­ves­ti­ga­tions be­gan in early 2014, when the Vatican be­gan re­ceiv­ing re­ports that the qual­ity of care was suf­fer­ing un­der the hospi­tal’s then-pres­i­dent, Giuseppe Profiti. Since he was ap­pointed in 2008, Profiti’s ad­min­is­tra­tion had been fo­cused on boost­ing vol­ume and open­ing satel­lite branches around south­ern Italy while cut­ting costs. Vin­cenzo Di Ciommo Lau­rora, a re­tired Bam­bino Gesu epi­demi­ol­o­gist, de­scribed the hospi­tal’s cul­ture at the time this way: “The more you do to a pa­tient, the more money you bring in. You have to pro­duce, pro­duce, pro­duce.”

As part of an un­re­lated study, he re­viewed the charts of 11 cancer pa­tients who had died and said he was struck by the “ex­treme num­ber of med­i­cal in­ter­ven­tions,” in­clud­ing kid­ney dial­y­sis per­formed on chil­dren who were nearly dead. “When these chil­dren don’t have any or­gans work­ing, when noth­ing is work­ing, when they’re full of in­fec­tion, should we con­tinue to do dial­y­sis and heroic ther­a­pies?” he asked. His con­cern re­flected a long-stand­ing eth­i­cal de­bate about when pal­lia­tive care is more ap­pro­pri­ate for ter­mi­nally ill chil­dren - a de­bate that can be even more acute in a Catholic hospi­tal.

Founded in 1869 by a Ro­man no­ble fam­ily to treat poor chil­dren, Bam­bino Gesu was do­nated to the Vatican in 1924 and has grown to be­come the main pe­di­atric hospi­tal serv­ing south­ern Italy. In 2015, the 607-bed fa­cil­ity per­formed over 26,000 sur­gi­cal pro­ce­dures more than a third of all chil­dren’s oper­a­tions na­tion­wide. The Ital­ian health ser­vice re­im­burses it for most of its ser­vices and a leaked au­dit re­ported that, in 2012 alone, the hospi­tal re­ceived re­im­burse­ments and re­search grants that to­taled 270 mil­lion eu­ros ($290 mil­lion).

One of the main ar­eas of ex­pan­sion dur­ing the Profiti ad­min­is­tra­tion was in trans­plant ser­vices and on­col­ogy, where thou­sands of chil­dren have been suc­cess­fully treated. But in 2011, a 4-year-old with acute leukemia caught an in­fec­tion, an ex­tremely drug-re­sis­tant form of Pseu­domonas aerug­i­nosa, one of the lead­ing causes of blood in­fec­tions and pneu­mo­nia in hos­pi­tals. The out­break in­fected 27 chil­dren and wore on for 21 months - from March 2011 to De­cem­ber 2012 - be­fore the hospi­tal brought it un­der con­trol.

Eight chil­dren dead

By then, eight chil­dren were dead. “All wards of the onco-hema­to­log­i­cal de­part­ment were in­volved,” Bam­bino Gesu staff wrote in 2014 in the jour­nal BMC In­fec­tious Dis­eases. The bug’s spread, they wrote, could have stemmed from the “hands of health care work­ers or use of non-crit­i­cal med­i­cal equip­ment” a clear vi­o­la­tion of good hy­giene prac­tice.

All hos­pi­tals have prob­lems con­trol­ling in­fec­tions, many are plagued by over­crowd­ing and even the best strug­gle to con­tain out­breaks of drug-re­sis­tant bac­te­ria. But sev­eral ex­perts con­tacted by AP called the Bam­bino Gesu out­break “ex­treme,” un­usual in its du­ra­tion and rare for this par­tic­u­lar strain to be found in chil­dren. Nigel Brown, an emer­i­tus pro­fes­sor of mi­cro­bi­ol­ogy at the Univer­sity of Ed­in­burgh, said the prob­lem should have been iden­ti­fied “within a mat­ter of days” and that more ag­gres­sive man­age­ment could have quickly con­fined the out­break.

In a state­ment, the hospi­tal said it was “ab­surd and spe­cious” to cite the out­break against the hospi­tal, call­ing its in­fec­tion con­trol achieve­ments “an ex­am­ple of good prac­tice.” The hospi­tal said it had suc­cess­fully brought in­fec­tion rates un­der in­ter­na­tional and na­tional bench­marks in re­cent years, though it doesn’t pub­lish the in­for­ma­tion in its an­nual re­ports. Bam­bino Gesu’s union, a branch of Italy’s largest trade association CGIL, has re­peat­edly com­plained about hy­giene prob­lems, not­ing that the hospi­tal has gone through five clean­ing firms in as many years with un­san­i­tary re­sults.

In its Novem­ber 2014 monthly mag­a­zine, the union noted that the neona­tal surgery ward had “sadly be­come fa­mous” in­ter­nally for its rates of in­fec­tion and death. Part of the prob­lem, the union said, was the route some staff would take from the chang­ing room to the ward. “The path they have to take is equiv­a­lent to an open sewer, past garbage bins where var­i­ous types of refuse are po­si­tioned,” the union wrote the pre­vi­ous month. “And we ask why hospi­tal in­fec­tions in­crease? If even such a sim­ple prob­lem is ig­nored, imag­ine those that are more com­pli­cated.”

In 2011, phar­ma­cist Eu­ge­nio Ci­acco wrote the hospi­tal pres­i­dent to alert him that the phar­macy had stopped ster­il­iz­ing nee­dles and other equip­ment prop­erly, a prac­tice Ci­acco said was lead­ing to “ex­treme dan­ger for the health of our young pa­tients.” In 2013, the hospi­tal was or­dered by Rome’s civil tri­bunal to pay 2.2 mil­lion eu­ros to a fam­ily whose child was left par­tially par­a­lyzed and brain-da­m­aged by a hospi­tal-borne in­fec­tion in 2006 that wasn’t di­ag­nosed or treated quickly enough.

Staffers in the phar­macy re­ported other con­cerns: One told AP two com­mon an­tibi­otics in­tended to be con­sumed within a few hours some­times were used for up to two days to save money. Over­crowd­ing and hy­giene prob­lems were still an is­sue in Oc­to­ber 2015 when Fed­er­ica Bianchi’s 17-month-old son Edoardo was treated for breath­ing prob­lems in an ER ex­am­i­na­tion room where she said other chil­dren had been re­ceiv­ing in­tra­venous re­hy­dra­tion drips. Two days later, Edoardo be­gan suf­fer­ing bouts of se­vere di­ar­rhea and vom­it­ing. — AP

Pope Fran­cis is sur­rounded by chil­dren as he speaks with pa­tients and care­givers from the Vatican’s Bam­bino Gesu Pe­di­atric Hospi­tal. Dur­ing the au­di­ence in the Vatican’s Paul VI hall, Fran­cis ex­horted hospi­tal staff not to fall prey to cor­rup­tion, which he called the “great­est cancer” that can strike a hospi­tal. — AP Pho­tos

Fed­er­ica Bianchi’s twin sons play in their room at home in Rome. In Oc­to­ber 2015, Bianchi brought Edoardo to Bam­bino Gesu’s emer­gency room with breath­ing prob­lems. He im­proved, but came down with an­other ill­ness two days later that caused se­vere di­ar­rhea and vom­it­ing.

This il­lus­tra­tion made avail­able by the Cen­ters for Dis­ease Con­trol and Pre­ven­tion in At­lanta de­picts Pseu­domonas aerug­i­nosa bac­te­ria.

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