Dr. JNE writes in:

Honorable physician, 

Read your post re aspergillis meningitis. Good to have a voice of reason. 

You may be interested in another incident: “A Never Event” documents a hep C outbreak from an oncology clinic in Fremont, NE. Scary story of idiocy, hubris, and possibly malice along with bueraucratic no-nothingism which resulted in 100 (!) cases of Hepatitis C. 

Your loyal servant, 

JNE, MD

Dr. J. was not familiar with this story but let teh google do the walking. Basically an oncologist moved to rural Nebraska to peddle his wares, and due to reusing contaminated syringes, exposed 850 patients to Hep C, resulting in the contracting of the virus in about 100 of them.

In the post HIV era, most medical equipment, including syringes, needles, towels, OR drapes, and some surgical instruments are reusable. Endoscopic and surgical equipment that are reusable have very strict protocols for cleaning. When standard operating procedures are not done properly, either due to malice (rare), negligence, or accident (such as unknown breakdown in water filtration or malfunction of an autoclave), that is when iatrogenic outbreaks occur. All are a tragedy, most are preventable, and usually when they happen the culprits do the right thing to make amends.

There was an update to the steroid story worth mentioning. Dr. J. discussed the NECC fungal meningitis with a pharmacist pal. The gentleman informed Dr. J. (before the news broke to this fact) that a compounding pharmacy handles individual prescriptions. So if Dr. J. wrote prescriptions for The Czar’s wart cream, ‘Puter’s anal fissure ointment, and a prescription for tiny escalating doses of penicillin to desensitize The Mandarin so he can treat his syphilis, a compounding pharmacy is where he would send each individual for their tailored prescription.

Now, if Dr. J. wanted a 20 or 30 vials of inaprovaline for the Castle Infirmary, he would have to purchase it from a manufacturer. NECC, was getting around stricter regulations for manufacturers by calling themselves a compounding pharmacy. As a consequence, they weren’t held to stricter manufacturing practices and it ended up biting them in the but and killing a lot of people.

Dr. J.