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Date: Thu, 13 Jul 2006 08:58:26 -0400
From: "Palevsky, Paul M" <
Paul.Palevsky@va.gov>
To: Victor L Yu <vly@pitt.edu>
Cc: "Jain, Rajiv VAPHS" <Rajiv.Jain@va.gov>,
"Moreland, Michael E" < Michael.Moreland@va.gov>,
"DeRubertis, Frederick R" <Frederick.DeRubertis@va.gov>
Subject: RE: Destruction of the Clinical Microbiology Lab
Victor-
I have already seen evidence of decreased quality of service in the lab. We
had a patient admitted late last week with ESRD and impaired immunity due to
multiple myeloma who was admitted with catheter related
bacteremia. Blood cultures were drawn both at his community dialysis unit
and sent to a community hospital in West Virginia and several hours later at
the VA. I was not able to obtain the ID and antibiotic sensitivities on the
cultures from the VA lab over the weekend and was told by the tech in the
microbiology lab on Sunday that due to the changes in staffing that there
was no one to set up the plates over the weekend - that it would have to
wait until Monday. Fortunately for the patient, the microbiology lab at the
community hospital in West Virginia was able to provide ID and sensitivity
on Sunday, allowing us to discontinue a potentially ototoxic antibiotic and
switch to a much safer agent. The results from our lab were not available
until Tuesday. This
delay in establishing the ID and sensitivity of infectious agents over the
weekend is absolutely unacceptable and will have a severe adverse impact on
patient care. Fortunately for this patient, we were able to rely on results
from an outside community hospital - but that should not be the case for a
major referral medical center.
Paul M. Palevsky, MD
-----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
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