8 Patients May Have CJD
From Reused 'Sterile'
Surgical Instruments
By Suein Hwang and David Hamilton
The Wall Street Journal
Tulane University Hospital and Clinic is grappling with a serious medical accident that may have exposed several of its patients to a fatal neurological disease.
The incident originated last March with a patient who checked into New Orleans-based Tulane, underwent brain surgery and died. In the weeks that followed, the patient's surgeon, Christopher Mascott, used and reused the washed and sterilized instruments he had used on the deceased patient. No one during that period apparently knew that the patient, dubbed internally as "patient zero," had been suffering from Creutzfeldt-Jakob disease (CJD), the mysterious and deadly ailment that wastes away the brain.
So in May, when the original patient's condition was discovered in an autopsy, Tulane's top officials were confronted with a horrifying reality: that the hospital may have exposed numerous patients to a baffling disease that can take decades to develop, has no known cure and can't be accurately diagnosed until the sufferer is already dead.
The hospital added that the instruments have been taken out of service, saying it has "no indication" that anyone else has been exposed. When the statement was released midday on Wednesday, Tulane said the patients potentially exposed "are being notified." By later that night, a hospital and university spokesman said that all eight affected patients had been contacted.
The statement raises almost as many questions as it answers. Doctors have known it is possible to transmit the disease in surgery for nearly three decades, back to 1974, when a patient contracted CJD in an eye operation. Many medical experts now recommend the use of disposable instruments in neurosurgery, where the risk of coming into contact with highly infective CJD tissue is particularly high, though they acknowledge that certain instruments are too costly simply to throw away.
Tulane, however, declined to identify which instruments were used, or to describe the brain surgery that patients received, or the sterilization procedures in any detail. An individual familiar with the situation said that the concerns center on so-called stereotactic electrodes, which neurosurgeons insert into the brain to map electrical currents or to stimulate regions of the brain with electric current.
The spokesman also declined to discuss why it appears to have taken nearly half a year for the hospital to contact potentially exposed patients. People familiar with the situation say the hospital convened a panel of ethicists and experts in the disease to determine what it should say to the affected patients.
Tulane's accident reflects how little is truly understood about CJD, a variant of which has been linked to "mad cow" disease in Britain, sparking a public outcry that has yet to die down. Not only is the disease difficult to diagnose and impossible to cure, scientists are still arguing over exactly what causes it and how it spreads.
Stanley Prusiner, a researcher at the University of California at San Francisco, won a Nobel Prize in 1997 after postulating that CJD and similar diseases are caused by infectious proteins he dubbed "prions." Dr. Prusiner's prion theory, however, remains controversial.
All that leaves the Tulane patients in an agonizing bind. They must now face the possibility that they may, or may not, have a fatal disease without any way to know for sure. CJD can incubate without symptoms for years, depending on how much infected material a patient has come in contact with, though the disease typically progresses more rapidly if a patient's brain or spinal tissue is exposed directly to CJD-infected material.
Once the disease is established, its early symptoms range from depression and personality changes to problems with muscular coordination. As the illness progresses, patients frequently suffer muscle spasms and dementia, and usually die within several months to a year.
The situation also deals a potential blow to HCA, which has been working mightily to get beyond its troubled past. Last May, the company dropped its old Columbia/HCA Healthcare Corp. moniker, eliminating the name that had become synonymous with the biggest Medicare-fraud investigation in history. One of the first for-profit hospital chains, HCA was dogged by accusations that it was falsifying and inflating medical bills for government reimbursement.
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