Mother questions lack of outreach in tuberculosis investigation

When Danielle Greisen gave birth in July to a daughter at Summerlin Hospital Medical Center in Las Vegas, she had no idea another infant there had tuberculosis.

Greisen didn’t know the other baby contracted the disease from her mother, and that the hospital initially didn’t know the mother was infected. She didn’t learn the sick preemie died Aug. 1, the day after her own daughter was born, until this week when the investigation into the TB cases became public knowledge.

In Greisen’s view, that word came way too late. She wonders why the hospital didn’t tell her sooner about the potential for TB to pass to someone else and why she hasn’t been told to get tested.

What if she and her baby are in danger?

“I’d like to know who’s responsible for telling patients,” the 31-year-old hair salon owner said Thursday. “A hospital is where people go when they need help. Where’s the care? It just seems to me like the hospital was more concerned about their reputation.”

Greisen’s questions arise the week the Southern Nevada Health District expanded testing for potential exposure to TB – the same week that many learned 2-month-old Abigail White died of tuberculosis in Summerlin Hospital’s Level III neonatal intensive care unit, where the sickest babies go. The baby’s mother, 25-year-old Vanessa White, died from tuberculosis in July at a Southern California medical facility. The baby’s twin sister, 21-day-old Emma White, died in June from respiratory failure and extreme prematurity. She had not been tested for TB.

Public health officials and hospital leadership say they did everything the law and internal protocols require. As soon as Summerlin Hospital staff knew there was a risk of further infection, for instance, they isolated the sick baby.

After agencies communicated, public health and hospital leadership then notified patients and the public of the health risks.

In this case, some parents whose babies were in the Level III NICU received letters from the Health District in August telling them about the TB exposure. At that time, parents were told their children weren’t at risk. But after some hospital staffers were among 26 people who tested positive – and at least two of the 26 were contagious – the Health District changed course and now wants about 140 more babies and their parents to get tested, in addition to the 200 people who’ve already been screened. By the time that’s done, the agency will have tested about 400 people.

The hospital is providing free chest X-rays to children who need additional follow-up as part of the Health District investigation.

This week the Health District issued a press release saying some babies and parents should be tested but that patients outside the NICU weren’t at risk for contracting TB. But informing the news media doesn’t always happen when people need to be tested.

Health District staffers reach out to people individually when they have contact information, spokeswoman Jennifer Sizemore said, as they are doing right now.

A press release also went out this time because officials knew an incidence of contagious tuberculosis would draw attention, Sizemore said. The Health District wanted to ensure an accurate message got through.

“Because we knew this affected a relatively small group at Summerlin we wanted to make sure that was part of the message that was getting out – that patients at other parts of the hospital didn’t need to be worried about it,” Sizemore said.

The release said a patient at the Summerlin Hospital NICU had tuberculosis, but not that anyone there had died.

Health District and hospital leaders won’t discuss many particulars about the mother and baby who died from TB, citing medical privacy. That makes it difficult to surmise why doctors didn’t detect TB when admitting the mother so she could give birth to the twins.

Part of Summerlin Hospital’s TB plan includes questioning incoming patients about coughing up mucus or mucus with blood, fever and weight loss, according to Gretchen Papez, spokeswoman for the Valley Health System, which includes Summerlin. Those who answer yes to all three could be isolated.

Employees who enter those hospital rooms wear special respiratory masks. Signs are placed outside the door alerting visitors to the potential of contagious disease.

Hospital staffers also are tested annually for TB.

But if staff followed protocol, why didn’t someone notice this woman had TB?

At least one national expert said because TB cases have been declining in the United States, they have become harder to detect.

“As we raise new medical doctors in our schools, they’re trained on things that are more common in our country,” said Jim Gallarda, a senior program with the Bill & Melinda Gates Foundation, which funds TB research. “It’s not surprising in this case that the attending doctor may not have recognized it simply because it’s so rare.”

There were 9,945 TB cases reported in the United States in 2012, according to the Centers for Disease Control and Prevention. That was lower than the previous year and the fewest reported since national record keeping started in 1953.

None of that comforts Danielle Greisen, who still has plenty of unanswered questions. She called Summerlin Hospital because she wanted herself and her baby tested TB, spread by coughing, talking and sneezing.

She said the hospital said she didn’t need it, but to contact the Health District.

One thing that stands out in her mind: After delivery, staff took her baby to another room because she had jaundice. Where did they go – and did someone there have TB?

Greisen also wonders what doctor delivered the baby infected with TB.

“Who’s to say that my doctor didn’t deliver her baby?” Greisen said.

One thing she knows: she won’t go back to Summerlin Hospital. And she may file a formal complaint.

Contact reporter Adam Kealoha Causey at acausey@reviewjournal.com or 702-383-0361. Follow on Twitter @akcausey.