As the children began to get high fevers caused by a mysterious virus, the medical director of the detoxification center said he had not seen a crisis. Until the death of the fourth child.
The supervising physician, Maged Ghaly. According to a report by federal inspectors, he had initially thought that the state's Department of Health had "overreacted" last October, according to a report by federal inspectors, which said highlighted the epidemic of virus that killed 11 children and returned dozens of other patients last year to Wanaque Nursing and Rehabilitation. Center.
The lack of leadership, the absence of an infection control plan and the appointment of an off-site medical director allowed the epidemic to spread for 11 weeks in a facility in Passaic County that is home to affected children. chronic disability who require 24-hour care to survive, the report alleges.
In a letter to federal inspectors, Wanaque's lawyer, Andrew P. Aronson, attacked the report aggressively, calling it "fundamentally inaccurate, sown with factual inaccuracies … and sensational accusatory findings." without any support ". Wanaque will appeal the findings, said Aronson.
Most of the federal inspectors' criticism went directly to the medical director of the institution, who told the investigators that he had never been clearly informed of his responsibilities.
"I did not understand what medical director meant," he told federal inspectors.
"I have been here for 11 years. I was one of the pediatricians and I am now the only one left to me. They all bailed on me. When they asked me to be the medical director, I accepted it. Nobody gave me a job description and I signed the contract, "he told the inspectors.
Investigators said that the chief medical officer of the institution was barely there and instead sent his nurse practitioner to a regular meeting. According to the report from the Centers for Medicare & Medicaid Services, he also seemed not to understand his role well. Although it is not named in the report, other documents and testimonies presented to the state legislature have identified it as being Dr. Maged Ghaly, who practices in a cabinet of pediatrics in Jersey City.
State regulation does not require medical directors or physicians in general to spend a specific time in a nursing facility.
The report also reported failures in providing "timely interventions and care" to sick children, as well as insufficient administrative oversight as factors in the number of deaths and the scope of the virus.
The federal results, first reported by NorthJersey.com, described a facility that was ill-prepared to respond to the rapid spread of the virus through its pediatric services monitored not only by its absent but also controlled medical director. mediocre infections. as a "failure to provide timely interventions and care".
Ghaly told the inspectors that he thought for the first time that the state health department had overreacted when the virus first struck facilities in northern Passaic County.
"I said how will it spread? It was in October, "he told investigators. "I knew we had a problem after the 4th death."
The Ministry of Health publicly confirmed the outbreak only on October 22nd and the deaths of the first six children on October 23rd.
Ghaly did not call back calls to his office and home.
The stark narrative was part of a 118-page survey on the status of impairments published by CMS, which also mentioned delays in seeking treatment for sick children, resulting in more than 20,000 deaths. significant medical complications, as well as inadequate administrative supervision.
The state health department is preparing its own report on a crisis that has raised questions from advocates, elected officials and the department itself about the response of the long-term care home in pediatric care when children began to die.
Health officials in New Jersey have limited entries to Wanaque until a new plan for preventing the spread of infection is approved. They also proposed the imposition of a $ 20,965 penalty for infection control violations discovered during the outbreak.
"The ministry has no comment," said state health department spokeswoman Donna Leusner, about the federal report.
However, the state's findings were neither as extreme nor exaggerated as those of the federal government, said Paul Fishman, Wanaque's lawyer.
"The state was there for six weeks. CMS was there for only 5 days. The Ministry of Health has not formulated any of these conclusions, "Fishman said. They had access to the same people and looked at the same files. "
The deficiencies cited by CMS were extensive and targeted not only the medical director of the Wanaque Center, but also his administrator, claiming that not to "develop and implement plans of action to monitor the situation". epidemic and its results directly contributed to delaying the containment of the disease ". the virus."
At the same time, the report pointed to delays in the identification and treatment of highly transmissible disease in a medically vulnerable population, which would have resulted in 33 out of 53 pediatric residents under ventilators tested positive for adenovirus , ranging from toddlers to teenagers. Of these, 34 had to be transferred to the emergency room or hospital. Finally, 11 are dead.
In one case, according to the report, the medical director and a nurse practitioner waited a week before sending a child to the hospital.
"This delay in treatment and transfer has resulted in the return of the resident with a tracheostomy," the report says. A tracheostomy is a surgical procedure consisting of making an incision in the neck, opening the direct airways in the trachea to help the patient breathe.
According to health department officials, the first children to have contracted the virus at the Wanaque Center were diagnosed on 26 September.
The adenovirus includes a number of strains of respiratory viruses that can cause mild or severe disease. In a few weeks, 36 had contracted viral infections. A staff member was also diagnosed with adenovirus, but was cured.
In response to the federal inspection report Edward J. McManus of ID Care, the Infectious Diseases Service was hired after the state health department ordered Wanaque to take action corrective, called "unavoidable" epidemic.
"From my professional point of view, the epidemic itself was inevitable, and its scope and consequences were attributable to a particularly dangerous strain of virus that was affecting a very vulnerable population," McManus said in a statement. "The adenovirus strain that caused the outbreak has a period of incubation of up to two weeks and is highly contagious."
McManus described the medical, nursing and administrative staff as "professional, competent, committed, compassionate and responsive at all stages that may mitigate the effects of the epidemic and prevent future recurrence" .
He also defended Ghaly.
"As a primary care pediatrician for children who have resided in Wanaque for more than 10 years, he is very familiar with each of their medical history, treatment conditions, medications and treatments. I also found that even when he was not at the facility, he could be contacted by the nurse practitioner and the nursing staff whenever necessary. " , wrote McManus.
At the Wanaque Center, a worker who requested anonymity for fear of reprisal, said that Ghaly was unfairly targeted.
"They are trying to blame this guy. You can call him, leave a voicemail message, everyone, they have his mobile phone, and he also tells them to send him an SMS, so that there is no way not to be in contact " said the employee in pediatrics. "Should he have been more aggressive? It could probably be in some cases, especially when it started to spread.
The worker, however, said the responsibility should be shared at the summit, noting that there was an assistant director of nursing all day, a nurse in charge all day and the administrator of the facility.
State Sen. Joseph Vitale, chair of the committee on health, human services and seniors, who held a legislative hearing on the outbreak in Wanaque, said that all issues raised in the CMS report would be processed.
"There will be a regulatory and legislative solution, based not only on this report, but on the report of Commissioner (Shereef) Elnahal," he said.
One of these patches may include staffing requirements for a medical director.
"An institution of this size and with significant acuity presupposes, in my opinion, the presence of a medical director on site," said Vitale.
State officials have stated that the New Jersey regulations do not require the number of hours of a doctor's presence on the site.
He said that he was also troubled by Ghaly's statement in the report that he did not understand his role.
"I do not know what part of the title of medical director he did not have. This is for the least disturbing.
Yet he said the doctor could not be held responsible. Rowena Bautista, the Wanaque Center's administrator, must be held responsible, Vitale said.
"There has been a break in the whole chain of command, from the top to the caregivers," he said. "Leadership counts here. There were leadership issues. There was clearly a break in the protocols along the way. "
Lawyer Paul da Costa, who represents the families of some people sick or died of adenovirus-related complications at the Wanaque Center, said the findings of the federal government confirmed that they believed to be true.
"My clients have entrusted their children to this facility, which has been shown to be able to treat these medically fragile children to acceptable standards of care. But unfortunately, it now appears more than ever that infection prevention and prevention measures in place were inadequate, including the inability of the Wanaque Center to be able to predict a blooming outbreak. infection such as adenovirus, which would inherently require space in its facilities. separate patients to control the spread of infection, "he said.
He added that his clients were also troubled by reports that the medical director was not even aware of his role and responsibilities and appeared to have been disengaged from daily clinical care and patient treatment.
"The intentions of my clients, based on what we have determined in medical records and the apparent findings of the investigation conducted by the federal government, are to sue Dr. Ghaly for medical negligence in the past. fulfilling his duties as medical director and pediatrician, "he said.
Editor's note: Do you have a family member in the Pediatric Unit of the Wanaque Nursing and Rehabilitation Center or a child affected by the viral outbreak? NJ.com would like to hear from you. You can reach us at (732) 902-4559 or write to Susan Livio at email@example.com, Spencer Kent to firstname.lastname@example.org Ted Sherman at email@example.com.