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Deadly Medicine

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The Edmondsons of Rocklin, Calif., are a family obsessed—at least on Sundays. That’s when oldest daughter Jenna, 17, a star defensive player on the Placer United Spirits soccer squad, can invariably be found kicking and head-butting her way down the field, with her parents, Jim and Tami, both 40, raucously cheering her on. Jenna has a reputation as a competitor with a killer edge, and she rarely lets her teammates down. “I like taking people out,” she says. “I like to tackle.”

But Edmondson’s on-the-field feistiness landed her in serious trouble during a tournament game in July of last year. Lunging toward the ball, she collided with another player and felt a pop in her right knee, followed by a jolt of agonizing pain. Diagnosed with torn ligaments, Edmondson had routine surgery on Aug. 31, 2001, at the Sutter Roseville Medical Center in Roseville, Calif. Her recovery, however, was anything but routine. In and out of the doctor’s office for four months, the high school junior lost 15 lbs. and suffered from high fevers and nearly constant pain in her knee before a biopsy finally revealed an infection caused by the germ pseudomonas aeruginosa—a microscopic warrior that, like a demonic Pac Man, eats away at bone and tissue.

According to Jim, Jenna’s surgeon said she had likely picked up the bug at the hospital. With that, the Edmondsons, who co-own two small businesses, hit the roof. “We saw this healthy, vibrant young lady go through something that she shouldn’t have had to endure,” says Tami, who helped the oldest of her three girls through six weeks on powerful antibiotics, excruciating daily cleanings of her wound and a second operation to remove dead tissue. Jenna has now fully recovered but says her year on the bench has undermined her chances for a college athletic scholarship—not to mention her faith in doctors. In July her family sued Sutter Rosevile Medical Center for negligence, contending it failed to maintain adequate infection-control procedures (the hospital declines to comment because the case is still pending). “When your hospital fails you,” says Tami, “you feel helpless.”

Yet as rough as the Edmondsons had it, the outcome for Jenna could have been far worse. Each year hospital-acquired infections kill an estimated 100,000 Americans, making them the fifth-most common cause of death in this country after heart disease, cancer, stroke and respiratory ailments. However, most of us are only vaguely aware of the serious risks posed by the germs that prey on hospital patients, despite publicity given to such recent cases as Rosie O’Donnell‘s bout with staph after hand surgery in New York City. Health care facilities are understandably loath to disclose the problem—one malpractice lawyer calls it the industry’s “dirty little secret”—and state health codes rarely require it. “Patients don’t understand just how common these infections are,” says Dr. Brent C. James, coauthor of a landmark 1999 study on hospital mishaps. “They’re painful,” says James bluntly. “They kill.”

That was the case during an outbreak of infection at an Oklahoma City hospital eventually traced to pseudomonas germs found under the long fingernails of three nurses; it killed 16 newborns between 1997 and ’98. In Brooklyn, an anesthesiologist infected 19 patients with potentially deadly hepatitis C last spring by reusing tainted vials and needles. And last year in Evanston, Ill., two women were attacked by flesh-eating bacteria after having cesarean sections. Both survived, and their babies were unaffected.

Carmella Hohner and Mary Adkins, 45-year-old twin sisters from Baltimore, fight back tears as they describe seven months spent nursing their elderly mother, Mary Carmella Wallace, following back surgery and a stroke, only to lose her to a staph infection that apparently entered her body through poorly treated bedsores. The worst part, they say, was the reluctance of doctors and nurses to discuss the cause of the painful affliction even as it took over their mother’s body. “We found out by accident,” says Adkins. “One day we came into the hospital and there was a quarantine sign on her door and the nurse was putting on a mask and gloves.” Wallace, 72, died last January. (For advice on protecting yourself from hospital infections, see page 69.)

While acknowledging that killer germs can lurk in almost any hospital, public health officials and hospital administrators contend that the infections they cause almost always prey on elderly and seriously ill patients in the grips of chronic and sometimes terminal diseases. Dr. Steven L. Solomon, acting head of the Centers for Disease Control and Prevention’s health care quality division, says, “The bottom line is, we’re dealing with very, very sick people who are getting very strong immune-suppressing medications or who undergo multiple invasive procedures like catheters that enter into the body and make them much more susceptible to infections.” Dr. Dennis Maki, chief of infectious diseases at the University of Wisconsin Medical School, adds that most victims would not even be alive and at a hospital if it weren’t for recent medical breakthroughs that extend life longer than ever before. “Infections today are a consequence of the advances of medicine,” says Maki. “There is no free lunch.”

But to other experts, the toll from hospital—acquired infections remains unconscionably high—especially since so many are preventable. “There’s a tremendous amount of human error out there,” says Georgia Dash, president of the Association for Professionals in Infection Control and Epidemiology, who estimates that as many as half of all such illnesses could be avoided through strict compliance with known sanitary procedures. Perhaps the most effective is simply washing hands between patients, a practice that kills 99 percent of bacteria and takes less than a minute. And yet because of cost-saving cuts at many hospitals, overworked staffers now often complain they simply don’t have time. “When the staff is overwhelmed,” says Elaine Larson, a nursing and public health professor at Columbia University who keeps close tabs on the profession, “they are definitely more likely to make mistakes.” Indeed, a study published in the New England Journal of Medicine last May linked nursing shortages with a wide range of infections.

An even more frightening trend is the rapid evolution of germs so virulent that the most powerful antibiotics available today are becoming ineffective at fighting them. Two years ago, retired teacher Sharon Pauly, a competitive golfer with a four handicap, checked into a hospital near her home in Palm Beach Gardens, Fla., for heart bypass surgery. Appalled at the lack of attention she received, Pauly, now 65, a divorced mother of three, enlisted help from her family circle. “A friend was bathing me,” she says. “My son took me to the bathroom.” Somehow, staph microbes penetrated the wound in her chest, igniting an infection that threatens to flare up at any time. “I was told I could have it the rest of my life,” says Pauly, who has undergone 14 operations to treat the illness, known as MRSA (for methicillin resistant staphylococcus aureus). So little remains of her sternum that Pauly must wear a bullet-proof vest when driving to protect against a sudden inflation of her air bag, which could crush her heart.

Twenty years ago her infection might easily have been knocked out with penicillin. But today overuse of antibiotics—caused both by doctors who prescribe them as a cure-all and patients who demand them at the first sign of a sore throat—has allowed microbes to mutate into new organisms that can survive even the strongest drugs available to modern medicine. “The struggle is between man and microbe,” says Dr. Victor Yu, chief of infectious diseases at Pittsburgh’s Veteran Affairs Medical Center, “and the microbe is winning today.” Reacting in part to a twofold rise in the rate of MRSA infection in the past decade, last March the CDC issued a 12-point memorandum to physicians that stresses more selective use of antibiotics. The agency has set a 10-year goal to cut hospital infections by half.

Hospitals are facing another sort of challenge as well. Last April Sharon Pauly joined 105 former cardiac surgery patients at Palm Beach Gardens Medical Center who are suing the 204-bed facility for allegedly failing to detect and contain debilitating infections. Collectively, the plaintiffs seek millions of dollars in damages. The hospital declines to discuss the cases but has denied the charges in court papers.

For secretary Nik-Cole Johnson, 30, who filed a request for arbitration with a Sacramento hospital earlier this month, even the legal remedy seems like too little, too late. After checking in for bed rest while awaiting the birth of twins last year, Johnson, who had suffered two previous miscarriages, came in contact with pseudomonas microbes, possibly through a urinary catheter or an IV. Her temperature spiked above 100 degrees, and Johnson, then six months pregnant, had an emergency C-section. Doctors fought furiously to save her preemies, both of whom were infected in the womb. But on Aug. 12, 2001, less than a month into his life, little Adrian Johnson was pronounced dead from blood poisoning and respiratory failure. “It doesn’t make any sense,” says Johnson, still aching from the ordeal as she and her husband, William, 33, a computer technician, raise their now-healthy surviving son, Miles, and daughter Zaire, 5. “Hospitals are supposed to be the safest and most sanitary places around. You don’t go into the hospital and get an infection, you go there to get one cleared up.”

Patrick Rogers

Emily Bazar and Melissa Schorr in Sacramento, Linda Trischitta in Miami, Andrea Billups in Baltimore, Giovanna Breu and Barbara Sandler in Chicago, Robin Reid in Washington, D.C., and Diane Herbst in New York City