Diphtheria in QLD

About a month ago, a friend's husband died at the age of 59. He had been a fairly healthy man though his diet left a bit to be desired and his stress levels were through the roof. Despite this, he had no obvious health problems until approximately 4 weeks before his death.

He had a gastric bleed that was very severe - so severe that he was having chest pains from loss of blood and required 5 units of blood on admission to the emergency department of his local hospital.

He was kept in for 5 days of testing but the doctors could not find why he had been bleeding or where the blood was coming from so on the 5th day, they sent him home.

Approximately 10 days later, he had severe pains in his shoulder and was readmitted to hospital where an x-ray discovered a blood clot in his lung.

Now, keep in mind that this is a man who had only just had an unidentified bleed and who, for all the hospital knew, might have still had internal bleeding. Despite this, the hospital put him on a course of Warfarin, a blood thinner, a medication which is contraindicated (not recommended) for, amongst other things, anyone who has a history of gastric bleeding. Not only did this man have such a history - the history was very recent and of unknown origin. In addition, neither he nor his family were given any information about the risks of this treatment or about symptoms they should be on the lookout for that would indicate any problems. It was just another drug - just another patient.

As the family discovered later, when someone is first prescribed Warfarin, they are supposed to be closely monitored so that the levels of the drug can be adjusted and uncontrolled bleeding or gangrene don't ensue (both known side effects of this and similar drugs). Instead, this man was never given a blood test to determine his blood levels of Warfarin. Had this simple step been done, perhaps a tragedy would have been avoided.

Instead, about one and a half weeks after starting the course of warfarin, he was admitted to hospital with a cerebral haemorrhage, was comatose within hours and his family had to make the difficult decision to turn off his life-support system. A wife was left without her husband; children were left without their father; a man was cheated out of his twilight years - all because of medical error or negligence.

In fact, as the family discovered later, these problems were so common that in 2006, the FDA (Food and Drug Administration) forced the manufacturer of Warfarin to add a black box warning to this product (emphasis added):

The new black box notes that warfarin can cause major or fatal bleeding. It says that bleeding is more likely to occur during the starting period and with a higher dose (resulting in a higher INR). Risk factors for bleeding are listed as: high intensity of anticoagulation (INR greater than 4.0), age 65 or over, highly variable INRs, history of gastrointestinal bleeding, hypertension, cerebrovascular disease, serious heart disease, anemia, malignancy, trauma, renal insufficiency, concomitant drugs, and long duration of warfarin therapy.

The black box also contains the recommendations that regular monitoring of INR should be performed on all treated patients; those at high risk for bleeding may benefit from more frequent INR monitoring, careful dose adjustment to desired INR, and a shorter duration of therapy; and patients should be instructed about prevention measures to minimize risk of bleeding and to report immediately to physicians signs and symptoms of bleeding.

The FDA Medwatch announcement also notes that warfarin prescriptions will also be issued with a new patient medication guide warning about potentially serious bleeding with the drug. FDA regulations state that such medication guides are to be provided with each prescription that is dispensed for products that the FDA determines pose a serious and significant public health concern.

And the really, really sick thing is that this death wasn't even put down to medical error. There was no internal investigation in the hospital; no doctors or medical staff were held responsible; and no newspapers ran front page headlines stating - Father of Two Mistreated Leading to His Death - read more on page 2.

No, this was just business as usual in the hospital system - you win some, you lose more.

Last week, I received a phone call from a woman who had recently given birth to identical twins at 36 weeks' gestation.

She had gone to the hospital for a routine ante-natal visit and was told that she needed to have an emergency caesarean delivery because her placenta was not functioning properly.

Healthy twins were delivered - one weighing 1.8kg and the other was 2.2kg at birth.

This woman, who has an older child, does not believe in vaccinating. She didn't have her birth plan with her because of the emergency nature of the admission, but as they were wheeling her into the delivery suite, she told the nurses that her babies were not to receive the Hep B vaccine which is scheduled to be administered within 72 hours of birth. When the doctor came into the room, she repeated this to him. When her husband went to the nursery with the babies while they were checked out and his wife was stitched up, he repeated the instructions that there were to be no vaccinations. And when the mother was taken to her room with the larger of the twins (the smaller was kept in the nursery for observation), she asked again if they were aware that there were to be no vaccinations of these babies.

At every step of the way, the staff stated that they understood and that the children would not be vaccinated.

Something 'went wrong' however and the baby who was in the nursery for observation was given the Hep B vaccine without any written permission form from either parent and against the wishes of this family.

This baby developed problems sucking, was not sleeping well and was cranky and unsettled for the entire 3 weeks it had to stay in the nursery. The other baby was able to go home within a matter of days.

Again, there were no front page headlines - Child in Hospital Vaccinated Against Parent's Wishes - Suffers Adverse Reactions - Investigation Ordered.

Investigation? Again, this is business as usual. Either this was an 'honest' mistake or, as has happened countless times before, some staff member decided that parents who don't vaccinate obviously don't know what they are doing and decided to take matters into their own hands.

Who is responsible for these problems and deaths? Nobody.

And these are just 2 of the more than 18,000 cases of death from medical error in Australia and more than 240,000 injuries annually from the same cause.

Front page news? Not a bar of it! This is so common, you just yawn when you hear about it - unless, of course, it is your loved one who has been harmed.

But this week, we have had a huge front-page story reported out of Queensland.

You see, a 22 year old woman died from diphtheria and the entire country is being urged to ensure they are vaccinated. On the surface, it looks like a valid warning. But wait!

The last case of diphtheria in QLD was in 1993 so where did this unlucky woman get the disease from?

It seems that she contracted diphtheria from her fully-vaccinated friend who had just returned from overseas.

Did the headline read: Fully Vaccinated Person Gives Friend Fatal Case of Diphtheria - Vaccine Effectiveness Checks Urgently Needed

Of course it didn't! Instead of being a factual story of a fully-vaccinated individual transmitting the first Australian case of diphtheria for almost 20 years - a case that had fatal consequences, this story was used to - you guessed it - try to push people to get vaccinated. And even though the person who had the disease was vaccinated against it and the vaccination status of the person who died is unknown, more vaccinations were being urged.

When the Herald Sun reported on this case, they said of the woman who died, "It's believed she wasn't immunised." Trust me, if there was proof that this woman was unvaccinated, that would have been shouted from the mountain tops. But there is no evidence that she was or was not vaccinated and so, they assumed that she wasn't. Quite an assumption!

Even more interesting was this report from ABC News:

Queensland Health says there is no risk for those who are fully vaccinated against the disease.

Chief health officer Dr Jeannette Young says a diphtheria outbreak is unlikely because the vast majority of Australians are immunised.

Well, if there is truly no risk for those who are fully vaccinated, how did a fully vaccinated person contract and then, transmit the disease? And again, if the vast majority of Australians being vaccinated against diphtheria means that an outbreak is unlikely, how did this vaccinated person get sick? This was such an illogical thing for QLD Health to say.

The outcome is that one (possibly vaccinated) person has died from a so-called vaccine-preventable illness and this is front page news across the country. Yet the eighteen thousand people who die every year at the hands of hospital doctors as a result of medical error or adverse reactions to properly prescribed medications don't even rate a mention in the media. It does make one wonder who or what is driving the press in Australia.