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Critics are calling for more transparency into infection outbreaks at clinics as more patients come forward with stories about developing meningitis and other serious infections at a Toronto pain centre.

Vince Talotta / Toronto Star Order this photo

Saundra Kacho learned Saturday that she was one of nine patients infected with bacteria while getting an epdidural sterioid injection at the Rothbart pain clinc in 2012.

Critics are calling for more transparency into infection outbreaks at clinics as more patients come forward with stories about developing meningitis and other serious infections at a Toronto pain centre.

“It boggles the mind,” said NDP health critic France Gelinas, adding that the health ministry is ultimately responsible for making such information public.

“There is no excuse for secrecy. We are putting the health of Ontarians at risk,” she charged.

Since the Star ran a story Saturday about a 2012 outbreak at the Rothbart Centre for Pain Care, the paper has heard from more patients who say they developed serious bacterial infections after getting epidural steroid injections there.

They include Saundra Kacho, 69, of Fonthill, in the Niagara area, who said she was rushed to hospital on Oct. 25, 2012, two days after visiting the clinic for treatment of back pain.

“The whole thing was awful,” she said, weeping during a telephone interview. “I remember not knowing what was going on in the hospital because I was so out of it. And I remember seeing the fear in my family’s faces. I feel angry that everybody was put through that.”

Kacho’s son twigged to the fact something was wrong with her when he kept getting calls at work from his father, who suffered from a stroke and has cognitive impairments, recounted her daughter, Alexis Kacho-Sinke. During the first calls, the father said his wife was still sleeping in bed.

But during a call later in the day, the father said, “I’m lonely, I need you to come over and talk to me.”

“Then my brother realized, she wasn’t just lying in bed, she wasn’t even talking to him. So my brother rushed over there and found her incoherent,” Kacho-Sinke said.

At St. Catharines General Hospital, Kacho was diagnosed with meningitis, she said. At first, health-care workers didn’t know whether she had fungal, viral or bacterial meningitis, so they were forced to try a number of different drugs on her, she recounted.

Kacho said her health was placed at even greater risk because she had a kidney transplant four years earlier and all of the drugs were tough on her new organ. The drug to treat fungal meningitis was like “a knife to my kidney,” she said a doctor later told her.

Kacho has polycystic kidney disease and the donated kidney came from her daughter. She said she has always been cautious about taking any medication and putting strain on the organ.

The retired university instructor said she has more back pain today than when she went to the Rothbart clinic and now uses a cane.

Nine patients of the clinic developed serious bacterial infections, including meningitis and epidural abscesses, between August and November 2012. Some were left with permanent nerve damage, causing bladder and bowel incontinence and an inability to walk without canes.

Two patients profiled by the Star said they became sick shortly after getting epidural steroid injections from anesthesiologist Dr. Stephen James. TPH said all nine patients were injected by the same individual working at the clinic.

James said he was unknowingly “colonized” by Staphylococcus aureus bacteria. The bacteria was on his skin but had not made him sick. About 25 per cent of people have the bacteria on their skin and in their noses. It can make people sick if it enters a wound.

Patients profiled by the Star said no one volunteered to them that they were infected at the clinic — not the Rothbart clinic, not James, not Toronto Public Health (TPH), which investigated the outbreak, and not the College of Physicians and Surgeons of Ontario (CPSO), which has regulatory oversight of such clinics, known as “out-of-hospital” premises.

The TPH investigation included an infection-control audit, done in conjunction with Public Health Ontario. It found 170 deficiencies, including improperly sterilized equipment. TPH has never made the results of its investigation public.

The CPSO inspected the clinic a number of times after the outbreak. Its online register shows that it gave the clinic “conditional” passes for three inspections, with conditions related to improving infection control.

But there is no mention on the CPSO website that there was an outbreak, that there were infection-control breaches or that people were made ill.

Gelinas said she is “really, really worried” that the province is moving services out of hospitals and into clinics that do not have the same level of oversight and accountability.

Health Minister Eric Hoskins said in a written statement that improving transparency in the health system is a top priority. He noted that the CPSO last year amended a bylaw allowing details of inspection outcomes to be posted on its website.

“With this bylaw, the CPSO has the tools to ensure that the public is well informed about the results of CPSO inspections,” he said.

“Ontarians have my commitment that we will work with our partners, including the CPSO, Public Health Ontario and our local public health units, to identify new ways that we can make information available to patients and improve the transparency of our system,” Hoskins added.

Kacho only learned on Saturday evening that her meningitis was linked to her treatment at the clinic. That’s when she said she got a “shocking” phone call from a TPH official.

TPH has been trying to reach the nine patients infected during the outbreak since Friday, the day before the Star article appeared.

“We are in the process of contacting these individuals as a courtesy and to ensure transparency. Our goal is to ensure that patients were aware that an investigation that they were part of was likely going to be profiled by a media outlet,” TPH spokesperson Lenore Bromley said.

TPH earlier this month told the Star that the infected patients had been contacted during the outbreak, at which time they were informed of the investigation into the clinic and told there had been breaches in infection control. But Bromley last week corrected that information, saying a review of how the outbreak was handled revealed not all patients had been given that information.

Source: http://www.thestar.com/life/health_wellness/2014/09/23/infection_outbreak_at_pain_clinic_sparks_calls_for_greater_transparency.html