Monday, 10 July 2017

Suffer Little Children - For Money

Pope Francis is surrounded by children as he speaks with patients and caregivers at Bambino Gesu in December 2016.
Credit:AP Photo/Alessandra Tarantino
'Pope's hospital' put children at risk as it chased profits

If you're a Catholic and you have a sick child, you know really that prayer doesn't work so you send them to a hospital where they apply science instead, unless of course it's the 'Baby Jesus' children's hospital, run by the Vatican with branches throughout Italy.

These hospitals were dirty, badly run money-making organisations that had little to do with curing and caring or sick children. Corners were cut, safety protocols were ignored and sick children were suffering as a result.

In typical Vatican style, a 2014 report on the secret three-month investigation following complains from staff and patients' families, was itself kept secret. Some of the recommendations were allegedly implemented, but many were not.

Then the Vatican commissioned a second report which, after a cursory three-day visit to a hospital, concluded that all was in order and there was nothing amiss and that the first report had been wrong.

However, an investigation by Associated Press has found the the Bambino Gesu Paediatric Hospital did indeed lose focus. Between 2008 and 2015 the hospital expanded it's services and focused on turning loss-making services into profitable ones. Amongst the AP findings were:

  • Overcrowding and poor hygiene contributed to deadly infection, including one 21-month superbug outbreak in the cancer ward that killed eight children.
  • To save money, disposable equipment and other materials were at times used improperly, with a one-time order of cheap needles breaking when injected into tiny veins.
  • Doctors were so pressured to maximize operating-room turnover that patients were sometimes brought out of anesthesia too quickly.

The Vatican's reaction was swift; it threatened AP with legal action, denied the allegations and cited the cursory 2015 report as evidence that everything was fine. Taking a leaf out of Donald Trumps book, it branded the AP investigation 'a hoax'. Bizarrely, it also cited a visit by Malania Trump last May to pose for photographs trying to look compassionate by smiling beatifically at the children, as evidence that all was well.

Secrecy is now the watchword of Bambino Gesu which does not publish financial accounts, or mortality and infection rates. Staff would only talk to AP reporters in strictest anonymity, fearing that they would be sacked if they were identified. It soon became clear that the Vatican neglected to tell the Italian health ministry of either in-house investigation. The ministry continued to say the hospital offered a quality of care "in such a way that assumes characteristics of excellence." Initially, a health ministry spokesman, Fabio Mazzeo, said "If this is true, a myth has fallen. We have to verify." By June, Mazzeo had been replaced and a spokesman would only say they had no further information and anyway the hospital belongs to the Vatican.

The Italian health ministry reimburses Bambino Gesu for its services. Although the financial details are kept secret a leaked memo showed that in 2012 the hospital received €270 million ($290 million) in payments and research grants.

The AP report revealed:

The sequence of events that resulted in the two investigations began in early 2014, when the Vatican began receiving reports that the quality of care was suffering under the hospital’s then-president, Giuseppe Profiti. Since he was appointed in 2008, Profiti’s administration had been focused on boosting volume and opening satellite branches around southern Italy while cutting costs.

Vincenzo Di Ciommo Laurora, a retired Bambino Gesu epidemiologist, described the hospital’s culture at the time this way: “The more you do to a patient, the more money you bring in. You have to produce, produce, produce.”

As part of an unrelated study, he reviewed the charts of 11 cancer patients who had died and said he was struck by the “extreme number of medical interventions,” including kidney dialysis performed on children who were nearly dead.

“When these children don’t have any organs working, when nothing is working, when they’re full of infection, should we continue to do dialysis and heroic therapies?” he asked.

His concern reflected a long-standing ethical debate about when palliative care is more appropriate for terminally ill children — a debate that can be even more acute in a Catholic hospital.

Founded in 1869 by a Roman noble family to treat poor children, Bambino Gesu was donated to the Vatican in 1924 and has grown to become the main pediatric hospital serving southern Italy. In 2015, the 607-bed facility performed over 26,000 surgical procedures — more than a third of all children’s operations nationwide.

[...]

One of the main areas of expansion during the Profiti administration was in transplant services and oncology, where thousands of children have been successfully treated. But in 2011, a 4-year-old with acute leukemia caught an infection, an extremely drug-resistant form of Pseudomonas aeruginosa, one of the leading causes of blood infections and pneumonia in hospitals. The outbreak infected 27 children and wore on for 21 months — from March 2011 to December 2012 — before the hospital brought it under control. By then, eight children were dead.

“All wards of the onco-hematological department were involved,” Bambino Gesu staff wrote in 2014 in the journal BMC Infectious Diseases. The bug’s spread, they wrote, could have stemmed from the “hands of health care workers or use of non-critical medical equipment” — a clear violation of good hygiene practice.

All hospitals have problems controlling infections, many are plagued by overcrowding and even the best struggle to contain outbreaks of drug-resistant bacteria. But several experts contacted by AP called the Bambino Gesu outbreak “extreme,” unusual in its duration and rare for this particular strain to be found in children. Nigel Brown, an emeritus professor of microbiology at the University of Edinburgh, said the problem should have been identified “within a matter of days” and that more aggressive management could have quickly confined the outbreak.

In a statement, the hospital said it was “absurd and specious” to cite the outbreak against the hospital, calling its infection control achievements “an example of good practice.” The hospital said it had successfully brought infection rates under international and national benchmarks in recent years, to an estimated 1.8 percent last year, though it doesn’t publish the information in its annual reports.

Bambino Gesu’s union, a branch of Italy’s largest trade association CGIL, has repeatedly complained about hygiene problems, noting that the hospital has gone through five cleaning firms in as many years with unsanitary results. In its November 2014 monthly magazine, the union noted that the neonatal surgery ward had “sadly become famous” internally for its rates of infection and death. Part of the problem, the union said, was the route some staff would take from the changing room to the ward. “The path they have to take is equivalent to an open sewer, past garbage bins where various types of refuse are positioned,” the union wrote the previous month. “And we ask why hospital infections increase? If even such a simple problem is ignored, imagine those that are more complicated.”

In 2011, pharmacist Eugenio Ciacco wrote the hospital president to alert him that the pharmacy had stopped sterilizing needles and other equipment properly, a practice Ciacco said was leading to “extreme danger for the health of our young patients.” Other staffers in the pharmacy reported related concerns: One told AP two common antibiotics intended to be consumed within a few hours sometimes were used for up to two days to save money.

In 2013, the hospital was ordered by Rome’s civil tribunal to pay 2.2 million euros to a family whose child was left partially paralyzed and brain-damaged by a hospital-borne infection in 2006 that wasn’t diagnosed or treated quickly enough.

Overcrowding and hygiene problems were still an issue in October 2015 when Federica Bianchi’s 17-month-old son Edoardo was treated for breathing problems in an ER examination room where she said other children had been receiving intravenous rehydration drips. Two days later, Edoardo began suffering bouts of severe diarrhea and vomiting. She didn’t know it then, but he had contracted rotavirus, an extremely common and contagious disease that can cause dehydration. “He started to lose weight at the speed of light,” Bianchi said.

After Edoardo’s twin also caught the bug, she took both boys back to Bambino Gesu’s overcrowded ER. Twice over the coming days, staff sent her home with instructions to spoon-feed the boys water, even though Edoardo was so dehydrated his skin was “like parchment,” Bianchi said. When the boys’ father returned from a trip, he took one look at the limp twins and took them to another hospital, where they were quickly diagnosed with rotavirus and isolated to contain the infection. “I went to Bambino Gesu because I thought it was the best hospital in Rome,” Bianchi said.

She won’t go back.

Hospital spokesman Alessandro Iapino said there is no proof that Edoardo contracted rotavirus at Bambino Gesu, and added that germs are a fact of life in hospitals “because people are sick.”

Cardinal Pell. Brought in Sister Carol Keehan.
The AP investigation revealed the cursory nature of the 2015 report. This had been arranged by Cardinal Pell when members of the original 2014 investigative team went to him over the head of Dr Steven Massoti, head of the 2014 task force. Massotti seems to have seen his role as protecting the reputation of the hospital and ensuring things carried on much as before.

In an extraordinary email to Colleen McMahon, an American paediatric nurse and member of the task force, Massotti had complained, "This proposal, if implemented, will significantly limit CEO’s power and cripple his ability to reduce the quality of childcare in order to increase revenues." [My highlight]. Increasing revenue was to take precedence over child care!

In another email to McMahon, when she pressed him for action, he said, "We are dealing with the Secretary of State of His Holyness (sic), the man that God Himself appointed to lead His Church. Is that clear?". He then emailed the members of the task force telling them, "Our job is over".

Sister Carol Keehan
It was Pell who contacted Sister Carol Keehan, president and CEO of Catholic Health Association, to set up the 2015 task force. This team seems to have seen it's role as rubbishing the 2014 task forces work carrying out only the most rudimentary of checks. For example, to check the reports that children were being brought out of anaesthetic too soon in order to increase through-put in operating theatres, Keehan simply asked the doctors about their procedures. She then said this had 'disproved' the eye-witness accounts of early-awakening in the 2014 report.

To check the reports of sub-standard needles that broke in the veins of children being used, Keehan asked the nurses if they had the equipment they needed. When they said they did, she cited this as proof that the report of sub-standard needles was false. To check on the reports of poor hygiene and over-crowding of the operating rooms, she observed two OR changeovers and reviewed three OR schedules before announcing that all was well.

She interviewed only two staff members of the 2014 task force and dismissed them both as unreliable saying they exaggerated and had a vendetta against the Hospital. She did not interview any other staff member from the list of 20 she had been given.

In other words, this staunchly Catholic nun and 'medical expert', appointed by the Vatican's financial controller who is himself now facing trial for child-abuse related offences, had been looking for excuses to discredit the 2014 report. When asked by AP, she denied ever having heard of the super-bug outbreak that killed eight children.

Just as with the psychological and physical welfare of its child abuse victims, the health and welfare of sick children are very much lower on the Vatican's scale of priorities then defending and protecting the Church and, of course, maximising income. As always, secrecy and cover-up is the order of the day in the cesspool of greed and corruption known as the Vatican.

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