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Hospital in hot water

A Jacksonville Naval Hospital surgeon’s postoperative notes appear to verify a Navy wife’s claim that she was operated on using instruments exposed to another patient during a previous surgery — and to contradict the hospital’s initial claim that it couldn’t have happened.

Hospital skipper Capt. Raquel Bono also appeared for the first time to acknowledge Friday an error in surgical protocol during the procedure, telling the Florida Times-Union newspaper that “a mistake” had been made. She didn’t elaborate, citing privacy law and ongoing litigation in the case.

And in a broadcast interview Thursday with First Coast News, Bono, without acknowledging the error or the specific case, said that in a medical sense, the word “unsterilized” could refer to sterilized equipment that was “opened in a clean area, like in an operating room, and then reclosed.” In other words, she suggested that instruments so exposed might have remained uncontaminated.

Bono declined Navy Times’ request for comment Thursday.

“We have already made a statement,” said Terresa White, referring to the Nov. 29 press conference at which Bono denied any contaminated instruments had been used on the woman, Jennifer Backman of Jacksonville. “What we don’t want to do is play it out in the media.”

The notes, typed out on a standard form and obtained by the attorney representing Backman in her $5 million claim against the Navy, state that she was called and informed of “occupational exposure in [the] operating room” that took place when “an unsterilized tray exposed to another patient was used during her [Aug. 30] surgery.”

“Occupational exposure” refers, according to the Occupational Safety and Health Administration, to “reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties.” The “tray” refers to the metal surgical tray containing instruments that are supposed to be sterilized and custom-packed for each individual surgery.

The notes, written by Cmdr. (Dr.) Eugenio G. Concepcion, also confirm Backman’s recollection that he called her later that day. She was “notified of the mistake,” he wrote, and advised of the recommended precautions. These included lab tests for exposure to hepatitis, HIV, syphilis, along with administration of antibiotics.

Backman’s blood tests showed no infection. She was told the male petty officer who allegedly was previously operated on was “low-risk.” Still, Backman was placed on a regimen of antibiotics that she said lasted 10 days.

Backman, 35, married to a Navy officer and the mother of a 2½-year-old daughter, filed her personal injury claim for “severe emotional distress and physical injury” Nov. 28. The government now has fewer than five more months to decide whether the claim is valid or not and how much to pay out if the lawyers rule in the woman’s favor. If it takes no action, the claim will likely become a Federal Tort Claims Act lawsuit, and a federal judge will rule on the case.

Backman’s attorney said the note confirms his client’s previous statements. “It says exactly what she was told,” said Sean Cronin of Jacksonville. “She was exposed to unsterilized instruments during her surgery and as a result of that, she and the other patient had to be tested.”

On Nov. 29, the day after Backman filed her claim, Bono told reporters that while she couldn’t discuss the specifics of the case, “In no instance have we used instruments contaminated by one patient in another patient. … Our procedures safeguard that.”

That same day, the hospital’s director of surgery said Backman’s claim was “inconceivable.” Cmdr. (Dr.) Craig Shepps said that when a surgical tray is opened and instruments are removed from it, “the process that’s in place is that that tray leaves the room. Immediately.”

Bono did say that “there was something that occurred” and said that the hospital’s standard procedure is to call patients when “unanticipated events” occur, “regardless of how remote the possibility that an infection could actually occur.”

The surgery in question, repair of an umbilical hernia, was performed using laparoscopy, a minimally invasive technique in which the surgeon employs a fiber-optic tube and other long, slender instruments. The previous patient also underwent a laparoscopy, Backman said she was told during her post-surgery conversation with Concepcion.

Concepcion’s note doesn’t make note of that, nor does it state that the exact same instruments were used on Backman, as opposed to, say, additional instruments in the surgical tray that went unused during the previous patient’s surgery but were in the operating room at the time and somehow possibly exposed. Or perhaps, Cronin suggested, a nurse’s gloved hand could have contacted the exposed instruments while retrieving and handing them to the surgeon during the previous surgery.

“As we go forward, we’ll find out exactly what happened,” Cronin said. But, he added, “It probably doesn’t matter. The surgeon was sufficiently concerned that there was the possibility of infection that he called the patient, tested the patient and treated the patient — because she had been exposed.”

Backman had initially balked at having the surgery done at Jacksonville, having seen news accounts of documented malpractice problems at the hospital during the previous six years. From 2000 to 2005, as reported in March by Navy Times, medical malpractice at the hospital left at least 12 patients dead and another four disabled or crippled, according to federal court papers.

The problems prompted the Navy to send Bono to Jacksonville. A specialist in developing and maintaining high standards in Navy health care facilities, Bono arrived in August 2005 and launched a new “strategic plan” to get the hospital back on track. In a January interview, however, she said she had found no systemic problems or negative trends at the hospital.

Backman changed her mind about having the surgery at the hospital after talking to her husband, friends and reading a letter from Bono, widely distributed, that Backman said acknowledged the problems and promised improvement.