By Lindsey Cavallaro
Early this January, the Center for Disease Control (“CDC”) released an urgent alert notifying the public of a recent bacterial outbreak in Tijuana, Mexico. The CDC reported that several American travelers were infected with an antibiotic-resistant bacterium, also known as a “superbug”, following surgical treatments they received at the Grand View Hospital in Mexico. The report specifically names the Grand View Hospital as a site of the bacterial infection and urges individuals to avoid getting surgery at that site until the Mexican government can confirm that the bacteria has been eradicated from the hospital. Beyond identifying the site of the outbreak, the CDC report offers informational resources on the risks of being exposed to infectious disease, tips on how to deal with sickness following travel and suggestions for individuals planning to travel. Pre-travel tips include advice to see a United States doctor for travel guidance, medical information abroad and vaccinations. All in all, the report aims to protect U.S. citizens from exposing themselves to superbugs abroad. It highlights the fact that many of these antibiotic-resistant infections are rare in the United States and cannot be treated. But are superbug outbreaks really that rare in the United States, or do we just not hear about them?
Superbugs in the U.S.
You might be surprised to know that the statistics of antibiotic-resistant infections in 2013 estimated that nearly 2 million people are infected by superbugs and 23,000 die from these infections each year in the United States. Since 2013, just one type of superbug fungus has had 587 reported cases. The CDC is aiming to have a new report published this coming fall with updated figures for 2019. So, if superbug outbreaks aren’t actually that rare in the United States, where are all of the reports cautioning U.S. patients to avoid infection sites?
In 2016, there was an outbreak of a drug-resistant pathogen known as carbapenem-resistant Enterobacteriaceae (“CRE”) in a rural hospital in Kentucky. The CDC did not release a report on that outbreak until 2018, where it still failed to name the specific hospital where the infection was located. In another instance between 2012 and 2014, more than three dozen people at a Seattle hospital were infected with a superbug from a medical scope. The hospital, Virginia Mason Medical Center, did not feel the need to disclose the outbreak when it occurred, and eighteen people lost their lives as a result. The lack of reporting to warn patients can be attributed to an agreement between the CDC and states that prevents the CDC from publicly identifying hospitals or facilities that are infection sites for these outbreaks.
Confidentiality or Full Disclosure?
The argument behind keeping these two American medical sites confidential is two-fold. First, and probably most obvious, is that medical facilities and hospitals want to maintain their reputations as effective and successful centers for medical services. People are less likely to see a hospital as effective in its treatment if those doctors can not treat patients with these infections or keep those infections from spreading.
This kind of “bad press” would also spark a distrust of the facilities where patients would normally go for treatment. Patients might ignore the need for medical treatment or refuse a life-changing surgery for fear that they might contract an infectious disease that was once reported at a certain hospital. In reality, patients might refuse treatment out of fear of infection of the disease when their risk of exposure is extremely low. The vice president of the American Hospital Association, Nancy Foster, has pointed out that hospitals are large places, and if a patient is just coming into the hospital for a noninvasive procedure at one end of the hospital, you may not be at any risk of infection from something at the other end of the hospital. Still, the stigma of a “superbug” outbreak may prevent people from seeking treatment they need.
Proponents of the movement towards transparency argue that this should be the patients’ issue to grapple with, instead of nondisclosure. If a patient needs an invasive procedure such as open-heart surgery or a hip replacement, they have the right to know whether they are exposing themselves to infectious disease. Even with informed consent for regular procedures, doctors are required to disclose the smallest risks to the patient, even if they are highly unlikely to occur. The entire basis of informed consent is centered around the fact that the patient has all of the relevant information and is free to make a decision regarding their health and body based on that information. Withholding this kind of information from the patient arguably violates their right to autonomy.
Potential Legislation
There have been a number of attempts at passing legislation that would address hospital and CDC lack of reporting of infectious drug-resistant diseases. In 2014, introduced a bill that would require hospitals in the area to implement a variety of strategies to reduce antibiotic use and track superbug infections. While he was successful in the effort to reduce overuse of antibiotics, the superbug tracking provision was stripped from the bill for concerns on reporting standards and implementation costs. More recently in 2018, federal legislation introduced by Ohio Senator Sherrod Brown aimed to heighten surveillance and data collection on super bugs stalled, having yet to emerge from a Senate health committee. Ultimately, it seems hospital administrators and public health officials maintain their position that confidentiality is more important than full disclosure in this area. With the threat of antibiotic-resistant infections only heightening, the legislature will eventually have to address the question of whether ignorance really is bliss in this situation. Until then, patients will continue being left in the dark about whether their health facilities have been exposed to infectious outbreaks, and whether they are exposing themselves to potential disease and death.
Lindsey Cavallaro is a 2L day student at Suffolk University Law School who is interested in the practice areas of criminal law and trusts and estates. She has worked as a judicial intern at the Plymouth County Superior Court, as well as a law clerk at a local trust and estates firm.
Sources
https://www.nytimes.com/2019/04/08/health/candida-auris-hospitals-drug-resistant.html
https://wwwnc.cdc.gov/travel/notices/alert/drug-resistant-infections-mexico
https://www.nytimes.com/2019/04/06/health/drug-resistant-candida-auris.html?module=inline
https://www.cdc.gov/drugresistance/biggest_threats.html
https://www.cdc.gov/eis/field-epi-manual/chapters/Legal.html
Disclaimer: The views expressed in this blog are the views of the author alone and do not represent the views of JHBL or Suffolk University Law School.