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St. Louis HIV scare at the VA/VA Tech Says She Warned of Sterilization Problems/Reading List

Alex Constantine - July 18, 2010

VA Hospital May Be Responsible for Mass HIV Infection - OneRiot.com

Veterans may have gotten AIDS, hepatitis during dental treatment... The Army veteran said he was treated cavalierly when he called the St. Louis VA hospital ...

VA tech says she warned of sterilization problems 

AP | July 13th, 2010

hiv virus budding off cell1 - St. LouisST. LOUIS — A former medical supply technician at the St. Louis VA Medical Center told a congressional hearing Tuesday that she warned more than a year ago that dental equipment sterilization was inadequate, but her pleas were ignored.

Earlene Johnson spoke at a special hearing in St. Louis called by the House Committee on Veterans’ Affairs. The committee convened the hearing after the VA sent letters two week ago, warning 1,812 veterans treated at the St. Louis dental clinic that lapses in sterilization of dental equipment potentially exposed them to viruses including hepatitis B, hepatitis C and HIV.

A VA official said Tuesday that some veterans have since tested positive for the viruses but it was too soon to tell if the dental equipment was the cause.

Johnson had worked at other VA hospitals and went to work in St. Louis in December 2008 in the sterilization division. She did not work directly in the dental division but said she saw flaws in dental sterilization.

She said that starting in March 2009, she tried to alert VA officials at the St. Louis center and in Washington about the inadequacies, but no one listened. It was a full year later that VA notified veterans of the sterilization problem and urged them to get blood tests. Meanwhile, Johnson was fired — she believed because of the concerns she raised. She is appealing to get her job back.

“What happened in the dental clinic shouldn’t have ever happened,” Johnson said during emotional testimony. “If people were taking their jobs seriously, not passing the buck and pointing the finger, none of this would have happened.”

The VA determined in March 2010 that lapses in dental sterilization had occurred from Feb. 1, 2009, through March, 11, 2010. As part of the investigation, dental services chief Danny L. Turner was put on administrative leave. An internal investigation is planned in addition to the congressional inquiry.

Dr. Robert Petzel, VA undersecretary for health, said the problem arose because workers prewashing dental equipment failed to use a detergent before the equipment was sterilized.

“Even though the risk of infection to our veteran patients is in this instance statistically low, the psychological consequence of the error is a high price to pay for those men and women who have already paid so much on behalf of this nation,” Petzel said in written testimony to the committee.

Procedures have been corrected, Petzel said, so those who have undergone procedures since March 11 are not considered at risk.

Dr. George Arana of the Veterans Health Administration said 950 veterans have come in for free blood screenings so far, and some have tested positive for hepatitis B, hepatitis C and HIV. He would not say specifically how many have tested positive nor what viruses they had but stressed that more testing is necessary to determine the cause.

St. Louis VA medical facilities provide services for veterans in Missouri and Illinois. Five members of the Missouri delegation and two from Illinois participated in the St. Louis hearing in a packed courtroom of the Eagleton U.S. Courthouse.

Veteran Terri Odom told the committee she went to the dental clinic for partial dentures and noticed “dirty and rusty” molding pieces and a filthy room. Odom told the committee she suffers from severe post-traumatic stress disorder from military sexual trauma while serving in the Navy.

“So with my panic attacks and anxiety level already on overdrive, this terrible mistake by the VA has made me even more anxious,” she told the committee.

Veterans Affairs Committee chairman Bob Filner, D-California, said his concerns extend beyond the inadequate sterilization. He wondered why problems were substantiated in March, but no one was told until the June 28 letter and news release.

“I think that’s intolerable that it took those four months before everybody was notified,” he said. “It just seems to me we have to do a far better job, not only with the transparency of the mistake, but in the counseling and handling of people.”

Petzel agreed the response was too slow.

“We did not respond quickly enough,” he said under questioning from Filner. “We took too long to investigate this and we took too long to notify you.”

VA officials have said the delay was because officials were evaluating the risk posed to veterans.

Other VA centers around the country have had problems in recent years.

In 2007, Walter Reed Army Medical Center in Washington came under scrutiny over concerns about conditions at the hospital and treatment of veterans. That same year, a surgeon at the VA hospital in Marion, Ill., resigned after a patient bled to death following gall bladder surgery. The VA found at least nine deaths between October 2006 and March 2007 resulted from substandard care at the Marion hospital.

In 2008, inadequate sterilization of endoscopy equipment at VA centers in Florida, Georgia and Tennessee potentially exposed 10,000 veterans to viruses including HIV and hepatitis.

“The problem I have is every time we have a hearing on one of these incidents, VA says we’ve put in new procedures and controls and it’s not going to happen again,” said committee member Jeff Miller, R-Florida. “But it happens over and over again.”


Reading List

AP MIAMI -- The Veterans Administration Hospital director in Miami has been temporarily reassigned after officials found that 79 colonoscopy patients ... MiamiHerald.com ( 7/6/2010 12:48:20 PM -08:00 )

HIV scare at the VA
By Ed O'Keefe Lawmakers plan to hold hearings next week in St. Louis after the Department of Veterans Affairs informed more than 1800 veterans treated there ... Washington Post ( 7/6/2010 8:16:30 AM -08:00 )

VA hospital under fire for possibly infecting 1800 patients with HIV
Another veteran's hospital is coming under fire this morning, for possibly infecting 1800 patients WITH HIV. The John Cochran VA Medical Center in St. Louis ... WPEC ( 7/7/2010 4:56:35 AM -08:00 )

Hearings soon following VA's announcement about veterans
Next week at the St Louis, lawmakers plan to hold hearings following information given by the Department of Veterans Affairs that about 1800 veterans who ... TopNews Arab Emirates ( 7/7/2010 3:57:31 AM -08:00 )

Investigations continue in St Louis following sterilisation blunder
Investigations are underway after a sterilisation blunder threatened the health of more than 1800 veterans in St Louis. Yesterday, the deputy undersecretary ... Cosmetic Dentistry Guide (press release) ( 7/7/2010 2:32:19 AM -08:00 )

Deputy under secretary tours John Cochran Medical Center
St. Louis • An independent panel investigating how hundreds of veterans may have been exposed to viruses from dental work performed at the St. Louis VA ... St. Louis Post-Dispatch ( 7/6/2010 9:03:49 PM -08:00 )

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ST. LOUIS — A top Veterans Administration system official pledged on Tuesday to appoint an internal panel within days to investigate concerns ... Columbia Missourian ( 7/6/2010 3:09:44 PM -08:00 )

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ST. LOUIS -- A week before he opens hearings on the improper sterilization of some dental instruments at John Cochran VA Medical Center, the Chairman of the ... KMOX.com ( 7/6/2010 2:49:16 PM -08:00 )

Miami VA Hospital Faces Another Colonoscopy Scandal
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Insult to Injury: VA Hospital Forgot to Tell Patients About HIV Scare
79 patients who may have been exposed to HIV a year ago are just now being notified. By TODD WRIGHT The Miami Veteran Administration Hospital has added ... NBC Miami ( 7/6/2010 1:35:55 PM -08:00 )

VA board to investigate John Cochran sterilization problem
ST. LOUIS, MO -- A high level Veterans Affairs official says they have a 'very good sense' of what happened at the John Cochran Medical center to expose ... KMOX.com ( 7/6/2010 12:59:17 PM -08:00 )

VA finds more veterans at risk for infections
The Veterans Affairs Department's problems with improperly cleaned medical equipment that may have left veterans exposed to...
NavyTimes.com ( 7/6/2010 11:28:30 AM -08:00 )

VA official visits hospital under investigation
ST. LOUIS, MO (St. Louis Public Radio) - A top official with the Veterans Administration system toured a St. Louis VA hospital Tuesday. ... KWMU ( 7/6/2010 9:02:22 AM -08:00 )

Filner slams VA over possible HIV exposures
House Veterans Affairs Committee chairman Rep. Bob Filner (D-CA) is condemning the Obama administration over its slow response to an... FederalNewsRadio.com ( 7/6/2010 8:32:19 AM -08:00 )

St. Louis Veterans Suffer HIV Risks Due to Poor Sanitation
It has been alleged that as many as 2000 St. Louis area veterans have been infected with diseases including Hepatitis B and C and HIV, because of the ... TopNews United States ( 7/6/2010 8:18:16 AM -08:00 )

Top 10 Veterans Stories in Today's News
1. Concern With Administration's Handling Of VA Hospital Incident. In continuing coverage, the “Briefing Room” blog for The Hill (7/6, Berman,... Veterans Today Network ( 7/6/2010 8:00:21 AM -08:00 )

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The Hill: "The Democratic chairman of the House Veterans Affairs Committee lambasted the Obama administration over its handling of an incident at a St. ... Kaiser Health News ( 7/6/2010 5:46:30 AM -08:00 )

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The Hill (blog) ( 7/5/2010 5:11:32 PM -08:00 )

“Exposed” veteran weighs in on St. Louis VA debacle
Susan Maddux is one of the almost 2000 St. Louis area veterans that may have been exposed to diseases like Hepatitis B and...
Missourinet.com ( 7/5/2010 4:15:37 AM -08:00 )

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