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Date: Fri, 4 Aug 2006 18:10:44 -0400 (EDT)
From: Victor L Yu < vly@pitt.edu>
To: "Cord, David P" <David.Cord@va.gov>
Cc: frederick.derubertis@med.va.gov
Subject: R&D forms faxed
Mr Cord
Today I faxed you R&D forms for the Legionella and Pneumococcal studies
(total 8 pages).
I also emailed you the documentation for the Special Pathogens Lab by VACO.
Please acknowledge receipt of the fax and email attachments - all sent today
and promised by me at the last hearing. If there is any other information
that you need, please let me know at once.
Finally, I wanted to make an additon to the issue of whether I disobeyed Dr
Fred Derubertis request to obtain the names of the 15 clients. As I told you
and Dr DeRubertis, the clients had been promised confidentiality. On the
other hand, I did agree to give him the names, if he would allow the Special
Pathogens Lab microbiologists to read the culture plates that had already
been processed. Since all the work was done and only the results had to be
interpreted, this was a reasonable request and a win-win situation for the
local VA administration and the hospitals, government agency, water
treatment consultants, and a patient . The VA administation had won, since
they closed down the Pittsburgh VA Special Pathogens Lab and the clients
would win, since they would have the information for public health
intrventions for a serious infectious disease. This offer to Dr DeRubertis
is documented in an email to Mr Moreland, 5 US Congressmen, and 15 clients
(who requested confidentiality).
In a hieracrchy, how does one decide when to obey a directive when the
directive will clearly harm individuals at risk for infectious diseases? Dr
DeRubertis asked me to no longer process specimens for several hospitals
including a VA hospital which had sent specimens for Legionella testing. If
the specimens were not processed, then this VA hospital would not be able to
assess whether water distribution disinfection was required for their
veteran patient, it was critical for them to obtain this information. So, I
disobeyed Dr DeRubertis directive because it would cause potential harm to
the veteran patients at the hospital. My refusal would not harm Dr
Derubertis or the administrators who ordered him to do something unethical.
I would be the one who would be harmed since I decided to help this VA
Hospital. As you may know, this hospital was colonized with Legionella at
very high levels, and they have now informed their physicians of the danger
and have initiated disinfection. In this case, my conscience had the
intended effect of doing my duty and performing a public service.
On the issue of breaking confidentiality to clients who had been promised
confidentiality vs Dr DeRubertis directive to obtain contact information,
who would be harmed? In this case, I was willing to break the promise of
confidentiality of the clients if the Pittbsurgh VA Administration would
allow the cultures to be read. The clients were told that I would violate my
pledge to them, so they could learn if Legionella was present in their
specimens. In this case, violating my pledge to them was less of an ethical
problem, since the clients would now have the information to aid their
patients, hospitals, and other facilities. Again, if the Pittsburgh VA
Administration would have followed their conscience, and placed the welfare
of the public as first priority, they may have agreed to let the cultures be
read. Instead, they refused to allow the cultures ot be read, and one set of
water cultures turned out to be from an indvidual who had contracted
legionnaires' disease. The end
of this story remains to be told.
In summary, some of us have the opportunity to follow our conscience or to
obey a directive which would lead to harm to others. What each individual
does is a personal one especially, if the goal of the administration is not
directed to the public good, but to preserve their hierarchy. In my case,
the decision was less noble since I am a physician; and physicians have been
trained to do the right thing even if they face punishment from their
superiors.
Victor L. Yu , MD
Professor of Medicine
University of Pittsburgh
Chief, Infectious Disease Section
VA Medical Center
Pittsburgh, PA
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
On 7/26/06, Matt Freije <
mfreije@hcinfo.com> wrote: VA
Administration
I am one of the fifteen clients to which Dr. Yu referred.
Eighty-three samples that I collected from a large hospital arrived at
the Special Pathogens Laboratory on July 19 and 20. It is my understanding
that the samples have been plated and need merely to be read. The results
from this testing will affect hospital infection control decisions, as they
are used to assess the success of disinfection and other control measures.
Considerable time and effort were made by the hospital to send these samples
(for which we will seek reimbursement from the VA if we have to do it over),
and the results are crucial for patient care.
It would be unfortunate if the laboratory's good work and worldwide
respect became tainted by a poor finish. To close the laboratory without
sufficient notification is outrageous—it is unprofessional, irresponsible,
inconsiderate, and perhaps even criminal. In the interest of patient care,
and to prevent financial losses and waste, I urge you to keep the laboratory
open at least until the samples received have been fully processed.
Sending the samples to another laboratory without our consent is
unacceptable, as we must have confidence in the laboratory that performs the
analysis, and that transporting the samples does not affect the test
results.
We need a decision as soon as possible. If we
do not receive word by 5:00pm ET today that the samples will be processed,
we will make arrangements to collect them again.
Matt Freije
President HC
Information Resources Inc.
---------------------------------------------------------------------------------------
From: Moreland, Michael E < Michael.Moreland@va.gov >
Date: Jul 26, 2006 8:56 AM
Subject: Re: Should Moreland allow the Special Pathogens Lab team finalize
the results for the 15 institutions or let the cultures go unread
To: victorlyu@gmail.com, "Cord, David P" <David.Cord@va.gov>, "Jain, Rajiv
VAPHS" < Rajiv.Jain@va.gov>, "Nealon, Patricia A" < Patricia.Nealon@va.gov>
Dr Yu,
You are again directed to contain your question, concens and communications
to your chain of supervision. Specifically, communicate with Dr DeRubertis,
Dr Jain or Ms Nealon. Your questions to VA Central Office have been
answered. Your inquiry to congressional offices have been answered.
As such, you communications are to be to your supervisory chain.
MM
Michael E. Moreland
Director
VA Pittsburgh Healthcare System
Date: Tue, 25 Jul 2006 09:11:31 -0400 (EDT)
From: Victor L Yu <vly@pitt.edu>
To: arthur.hamerschlag@va.gov
Subject: Refusal to release Legionella samples in incubators (fwd)
Mr Hamerschlag:
Regardless of your biases. You must assist us on this issue. I feel it is
almost your moral obligation to keep Mr Moreland from making a grievous and
unforgivable action.
Ask Moreland to let the culture plates come into our possession.
This is the current situation, over 500 water specimens have been
processed and are now on culture plates that need to be interpreted. They
include samples from 3 hospitals: Geisinger Medical Clinic, Danville PA,
Huntington Memorial Hospital Pasadena, CA, Bayview Hospital (Johns Hopkins)
Baltimore, MD, and several governmental facilities. Interpretation is
relatively easy once the cultures have finished incubating. Mr Moreland
refuses to let us into the Lab to interpret the plates. He has
removed microscopes and reagents.
Another lab in Pittsburgh is generously allowing us to use their facilties
for interpretation since it is so simple to do. However, as you can see
from the email below, Mr Moreland will not allow us to obtain the results
for these hospitals and other water sites. We have offered to remove the
culture plates under the eye of security police and then hand-deliver them
to the other lab. We can then forward the results to over 15 clients. The
specimens are irreplaceable.
Please call Mr Moreland to persuade them to release the specimens!
Victor Yu, M.D.
---------- Forwarded message ----------
Date: Mon, 24 Jul 2006 16:58:13 -0400 (EDT)
From: Victor L Yu <vly@pitt.edu>
To: "DeRubertis, Frederick R" <Frederick.DeRubertis@va.gov>
Cc: "Jain, Rajiv VAPHS" < Rajiv.Jain@va.gov>,
"Moreland, Michael E" <Michael.Moreland@va.gov>,
"Melhem, Mona F" < Mona.Melhem@va.gov>, arthur.hamerschlag@va.gov
Subject: Refusal to release Legionella samples in incubators
To: Frederick DeRubertis
Fr: Chief, Infectious Disease Section
I did indeed continue to process specimens. However, as you and Mr Moreland
know, I informed you that there were humanitarian reasons to do so. We are
the premiere high quality lab for processing Legionella specimens as
documented in evidence presented to you and the administration
previously. None of the specimens were solicited. As outbreaks occur and
hospital surveillance continue, specimens are sent to us. Since our database
lists over 800 institutions, health depts, governmental buildings, and
other clients , it proved not practical to inform all of these facilities
especially when the lab personnel were under pressure to complete all the
work with the constant interruptions by the administration personnel
(documented in Sue Mietzner's email ) especially in the last week the lab
was open.
And, one of the institutions that submitted specimens was a major VA
Medical Center and the environmental culture results revealed 68%
Legionella positivity, a danger cutoff point for preventive interventional
action by the hospital facility. Had I followed your directive, this VAMC
(as well as others) would have been left unprotected.
The contact information was blacked out for confidentiality reasons as I had
previously informed you; however, the specimens from the 3 Pittsburgh VAMCs
were not blacked out. If you will release all of the specimens, I will
violate the confidentiality agreement because my first responsibility is to
the patients that we all serve.
The administration has succeeded in destroying the Pittsburgh VA Special
Pathogens Lab. However, you have been informed that healthcare institutions
and other facilities in which Legionella may pose a risk still need to have
the results of our testing.
Can you and the administration honestly defend the decision to close the lab
with 1 day notice? Keep in mind that this lab had served the public good
for over 20 years. There was no humanly-way possible to do everything that
you administrators required . You fired the entire scientific staff with 1
day notice, and yet they continued to process the Pittsburgh VA patient
specimens knowing that their salaries were gone, and when the administrators
froze the funds for supplies, individual lab members arranged to obtain the
supplies from their own monies.
Your arguments are bureaucratic. My argument is humanitarian, and a
responsibility that any physician could readily accept.
I predict when VACO and the Congress reviews what you have done, I hope they
will find that this wonderful team behaved heroically under siege without
regard for their professional future.
Victor L. Yu , MD
Professor of Medicine
University of Pittsburgh
Chief, Infectious Disease Section
VA Medical Center
Pittsburgh, PA
---------------------------------------------------------------------------------------------
On Mon, 24 Jul 2006, DeRubertis, Frederick R wrote:
> Department of Memorandum
> Veterans Affairs
>
> Date: July 24, 2006
> From: Frederick R. DeRubertis, MD
> Subj: Special Pathogens Lab Samples
> To: Victor Yu, MD
>
> You continue to be non-compliant with my directives. The information
> you provided was a list of samples you needed to process that had the
> contact information blacked-out.
>
> I direct you to provide complete contact information of all samples that
> are unfinished at the present time by close of business today, July 24,
> 2006.
>
> You will not be permitted to enter the Special Pathogens Lab to retrieve
> residual samples. I would remind you that you were directed not to
> process any samples received after July 7, 2006. Clearly these samples
> were received after that date since you were given two weeks to process
> any samples in your hands on July 7, 2006. Therefore you ignored the
> directive not to accept new samples.
M
Date: Mon, 24 Jul 2006 11:20:26 -0400
From: "Moreland, Michael E" < Michael.Moreland@va.gov>
To: Victor L Yu <vly@pitt.edu>,
"DeRubertis, Frederick R" <Frederick.DeRubertis@va.gov >
Cc: "Nealon, Patricia A" <Patricia.Nealon@va.gov>,
"Jain, Rajiv VAPHS" <Rajiv.Jain@va.gov >, jes20ebsol@gmail.com,muder robert <rmuder1@aol.com>,
"Hamerschlag, Arthur" < arthur.hamerschlag@va.gov>
Subject: RE: Legionella samples in lab must be saved
Dr. Yu,
Please contain your communications to your direct supervisor, Dr.
DeRubertis. He has given you direction and you should provide
information and discuss actions with him. If you have questions,
discuss with Dr. DeRubertis.
MM
-----Original Message-----
From: Victor L Yu [mailto:vly+@pitt.edu ]
Sent: Monday, July 24, 2006 8:01 AM
To: DeRubertis, Frederick R
Cc: Moreland, Michael E; Nealon, Patricia A; Jain, Rajiv VAPHS;
jes20ebsol@gmail.com; muder robert; Hamerschlag, Arthur
Subject: Legionella samples in lab must be saved
Dear Fred
Over 200 specimens remain in the incubators and need to be read and
interpreted. All processing has been completed. This can be done on
Tues and Wed.
For humanitarian reasons, we request that we be allowed to finish these
samples and send the results to the hosptials.
Mr Moreland has succeeded in closing the Special Pathogens Lab. We have
informed the hospitals of that fact. However, the unfinished specimens are
part of public health investigations or infection control monitoring.
Most of these specimenns are irreplaceable. Destruction of those samples
will be seen as a vindictive action.
Victor L. Yu , MD
Professor of Medicine
University of Pittsburgh
Chief, Infectious Disease Section
VA Medical Center
Pittsburgh, PA
--------------------------------------------------------------------------------------------
On Fri, 21 Jul 2006, DeRubertis, Frederick R wrote:
> Victor,
>
> I have discussed with the Associate Director, Pat Nealon, your patient
> safety concerns about patient samples for Legionella testing recently
> received by the SPL from outside facilities whose analysis the SPL will
> not be able to complete by COB July 21, 2006. We want to assist you in
> contacting these facilities to inform them of this fact and recommended
> that they use commercial sources for the testing needed. Please provide
> specific contact information on the critical outside patient samples in
> your possession ASAP.
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