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Date: Wed, 12 Jul 2006 23:02:34 -0400 (EDT)
From: Victor L Yu <vly@pitt.edu>
To: "Jain, Rajiv" < Rajiv.Jain@va.gov>,
"Moreland, Michael E" <Michael.Moreland@va.gov>
Cc: frederick.derubertis@med.va.gov , nina singh <nis5+@pitt.edu>, muder
robert <rmuder1@aol.com>, david.eibling@med.va.gov , david.macpherson@med.va.gov,
mark.wilson@va.gov, perri.john@vaphcs.med.va.gov , peter.cohen@va.gov,
atwoodcw@msx.upmc.edu, Tom Cacciarelli <Thomas.Cacciarelli@med.va.gov >,
"Rogers, Paul L" <Paul.Rogers@med.va.gov>, Paul.Palevsky@med.va.gov,John D
Rihs < john.rihs@med.va.gov>
Subject: Destruction of the Clinical Microbiology Lab
Dear Dr Jain and Mr Moreland
Given our record of clinical excellence, it seemed reasonable for me to
interview the new supervisor of the Clinical Microbiology Lab. However,
this reasonable request was denied, and an unqualified individual was hired.
It took over 20 years to raise the VA Special Pathogens Lab to a lab of
excellence that was self-sufficient and internationally-recognized.
Similarly, we elevated the VA Clinical Microbiology Lab to be the most
responsive lab to clinicians at this hospital. However, the lab also became
a lab of excellence as documented below.
In a period of 2 weeks, both of you took part in the destruction of 2 great
labs in the US because of a presumed bureaucratic issue.
In sadness,
-----Original Message-----
From: Victor L Yu [mailto:vly+@pitt.edu]
Sent: Wednesday, July 12, 2006 3:42 PM
To: Jain, Rajiv VAPHS; Moreland, Michael E
Cc: DeRubertis, Frederick R; nina singh; muder robert;
butta@dom.pitt.edu; atwoodcw@msx.upmc.edu ; Grum, Emily E;
grumee@msx.upmc.edu; Rogers, Paul L; Khurana, Ajay; Eibling, David E;
Macpherson, David S; Deng, Jau-Shyong; Dresser, Michael C;
george.pazin@va.gov; Good, Chester B; Alexandroff, Kathy A; Coax, Warren
A; Cacciarelli, Thomas V; muder robert; Cohen, Peter Z;
mark.wilson@va.gov; perri.john@vaphcs.med.va.gov; Rihs, John D
Subject: Unqualified Clinical Microbiology supervisor
Dear Dr Jain and Mr Moreland
My request to select a highly-skilled microbiologist who could maintain the
level of excellence which Jack Rihs brought to the laboratory was a
reasonable one. With new pathogens and multidrug resistance now major
problems in a tertiary-care hospital, the qualifications of the candidate
supervisor should have been of utmost priority. Given the fact that the
clinical microbiology laboratory is now short-handed, it is traditional that
on occasions, the supervisor assist in critical situations and make
identification of rare and unusal pathogens based on knowledge. Providing
excellent lab service for patient care should always be the mininmal
criteria.
As you know, Dr Melhem selected an individual who has been inactive in this
field for many years. In fact, every one of the microbiology technicians in
the lab are more qualified than he in clinical microbiology. If he is to
assist on the bench, this clinical microbiology supervisor must be
supervised by one of his technicians.
This is unacceptable, and from a patient care perspective, it is my
responsibility to inform you that another candidate must be selected now.
Please attend to this deficiency asap. I am receiving complaints about the
erosion of service including a horrifying ancedote about a specific case.
Victor L Yu
-----------------------------------------------------------------------------------------------------
On Thu, 11 May 2006, Victor L Yu wrote:
> Dear Dr Jain and Mr Moreland
>
> Thank you for your patience in agreeing to hear about our concerns
> about the decision of Dr Melhelm to remove Janet Stout from the
> Special Pathogens Lab and demoting her to work as a bench technician
> in the Clinical Microbiology lab. Moreover, Dr Stout is no longer to
> report to me, but to Dr Melhelm who has no experience in either
> microbiology and infectious diseases.
>
> The personnel of the Clinical Microbiology Lab reminded me that the
> position of the supervisor of this lab is now being recruited, and I
> am not to interview this individual. Given the fact that a decision
> is yet to be made on the dismantling of the Special Pathogens lab and
> my removal from the workings of the Clinical Microbiology Lab, I
> request that recruitment for this position be postponed or that I be
> allowed to interview any individuals applying for this position,
>
> Keep in mind that the Clinical Microbiology Lab has an outstanding
> record of service to the clinicians especially to the Hemodialyis
> Unit, the Orthopedics Dept, the Critical Care and Pulmonary ICUs, and
> the Transplant service.
>
> The personnel in the lab and the clinicians are appropriately
> concerned about the quality of the indiviudal being recruited.
>
> This lab like the Special Pathogens Lab has a national repution.
> The following pathogens were first described as human pathogens by
> this VA clinical microbiology lab:
> Roseomonas species - the CDC has proposed that one of the species be
> named Roseomonas rihsii - after Jack Rihs who first described its
> pathogenicty and the microbiology of this newly-discovered pathogen.
> Mycobacterium monacense - pathogenicity first described by Jack Rihs
> Oerskovia xanthineolytica - pathogenicity described by Jack Rihs
>
> The current method of diagnosing spontaneous bacterial peritonitis in
> the microbiology lab was devised by Jack Rihs and the Clinical
> Microbiology Lab.
> The isolation of Legionella from Bactec blood culture was devised by
> Jack Rihs and the Clinical Microbiology Lab.
>
> The first widespread application of the use of nasal eradication of
> Staph aureus was developed by the VA clinical microbiology lab and
> reported by us in NEJM in 1986. 7 studies on the link of Staph carriage in
> the nose to infection were spearheaded by the VA Clinical Microbiology
Lab.
> In 1993, the VA consensus committee for prevention of MRSA made the first
> national recommendations for using eradication of nasal carriage of Staph
> aureus; this recommendation was based on studies by our clinical
microbiology
> lab (Mulligan Am J Med 1993).
> In 1990, the most cited study by SCI criteria on community-acquired
pneumonia
> was published from the Pittsburgh VA. Personnel from the VA Clinical
> Microbiology Lab were co-authors (Fang, Medicine 1990). In this article,
the
> discovery was made that Chlamydia pneumoniae and Legionella were common
> causes of cap. Therefore, macrolides or quiniolones, not cephalosporins,
> should be the drugs of choice for cap.
> The standard for anaerobic antibiotic susceptibility for the US is
> headed by a consortium of 10 clinical microbiology labs of excellence
> in the US: They include Massachusetts General (Harvard), Johns
> Hopkins, Mayo Clinic, Pittsburgh VA, etc.
>
> In 2007, Becton-Dickinson was to fund a breakthrough trial for the first
PCR
> for cap in the Pittsburgh VA under the aegis of the Pittsburgh VA Clinical
> Microbiology Lab; this PCR has been designed to diagnose Legionella,
> Mycoplasma, and Chlamydia within 15 min from a throat swab. Michael Towns,
VP
> of Becton-Dickinson, who was to have overseen the trial with Jack Rihs,
was
> one of the many scientists who were trained in
> the VA Special Pathogens Lab. In addition to funding, Becton-Dickinson was
to
> have donated the multiplex PCR equipment to the VA Clinical Microbiology
Lab
> after the completionof the study. Given the dismal condition of the
current
> microbiology lab, the study will be moved
> elsewhere probably to UPMC.
> The manufacturer of BACTEC blood culture instrumentation has agreed to
fund a
> study and provide all supplies to assess the possibility of a new approach
to
> distinguishing colonization from bacteremia in patients with hemodialysis
> fistulas and vascular catheters. Jack Rihs was to be the PI, since he
> participated in the study design. However, since his position has been
> terminated, the study will be moved elsewhere.
> Dr Melhelm's plan to sever the link between the Clinical Microbiology
> Lab and the infectious disease section serves no useful purpose.
>
> In summary, if a new microbiology supervisor is to be named, we
> should have the opportunity to interview this individual and insist on
> an individual who is motivated and competent.
>
>
> Victor L Yu MD (111E-U) Direct: 412-688-6643
> Infectious Disease Section Secretary: 412-688-6179
> VA Medical Center Direct Fax: 412-688-6507
> University Drive C Cell ph: 412-901-7707
> Pittsburgh, PA 15240 Home: 412-343-7429
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