Thursday, 4:30 PM
City orders improved reporting of outbreaks
By Stephen Smith, GLOBE STAFF
Boston health officials ordered the Hebrew Rehabilitation Center today to improve reporting of infectious disease outbreaks, after it took the city nearly two weeks to find out about a wave of gastrointestinal illness that sickened more than 200 elderly residents and 100 staff members.
The Boston Public Health Commission is giving the Roslindale facility until April 15 to draft a plan to educate its doctors, nurses, and other workers on the importance of timely reporting of disease clusters. Under city and state law, healthcare facilities and physicians must report suspected infectious disease outbreaks within 24 hours.
Representatives at the facility notified the state Department of Public Health within a day of the Feb. 21 start of the outbreak, which is being blamed on the norovirus. But the city health agency learned of the illnesses Tuesday and then only incidentally.
John Auerbach, executive director of the Boston health agency, said in an interview that it is especially critical for local health departments to be involved, so outbreaks in healthcare institutions do not seep into the broader community.
"Knowing sooner rather than later gives us greater possibilities of containing an outbreak," said Auerbach.
Hebrew Rehabilitation could face fines for its tardy reporting, although Auerbach said any decision on fining the institution will be deferred until the required plan is submitted.
Auerbach, who earlier this week was selected by the Patrick administration to be the state’s next public health commissioner, pledged that in his new role he will enhance the working relationship between the state and local agencies to better fight infectious diseases.
"It’s important for the state and locals to work hand in hand when there’s an outbreak, particularly when there’s an outbreak of this magnitude," he said.
By today, the spate of nausea, vomiting, and diarrhea at Hebrew Rehabilitation appeared to be subsiding, with three new cases reported among residents. The 721-bed facility also moved to reopen some units that had stopped accepting new patients, said Joseph Martini, vice president of marketing and communications.
One patient, an 87-year-old man, died after developing gastrointestinal symptoms, but it remains uncertain how much that illness contributed to his death.
Late this afternoon, Martini said that Carl J. Zack, Hebrew Rehabilitation president, was speaking to Auerbach, promising the facility would move swiftly to address the city’s concerns.
"We will certainly comply and come up with a plan that meets the requirements of the Boston health department," Martini said.
Hebrew Rehabilitation officials, he said, had believed that it was sufficient to alert state disease trackers about the outbreak of norovirus, the largest this winter in Boston; state officials thought the city knew about the problem. Auerbach said that an ongoing city investigation has found no evidence that Hebrew Rehabilitation’s failure to notify the Boston agency placed any residents or staff members at risk.
The duty of healthcare facilities and physicians to report disease clusters has been in the spotlight for the past two years. Boston University waited nine days in fall 2004 to notify government health agencies that laboratory researchers had been exposed to tularemia.
Last year, Boston health authorities for the first time censured a healthcare institution for waiting too long to report a disease outbreak: Children’s Hospital Boston, like Hebrew Rehabilitation, was ordered to implement staff training after the hospital took several weeks to report an outbreak of respiratory illness.
"The bottom line is if we’re going to work together to minimize disease, we have to know about it, and we have to know about it early," said Dr. Anita Barry, the city’s director of communicable disease control. "People have got to start reporting in a timely fashion."
Smith can be reached at stsmith@globe.com.
