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Two women developed serious infections after getting needles at Rothbart Centre. But it took a freedom-of-information request to learn more patients had been infected.

Two weeks after Anne Levac went to a Toronto pain clinic for an injection of steroids for chronic back pain, the 68-year-old Fenelon Falls woman fell seriously ill. She was rushed to hospital by ambulance, she says, while falling in and out of consciousness and suffering excruciating pain.

Two months later, in October 2012, a similar scenario played out after Tracey Martin, 46, visited the same clinic. The woman, who lives north of Toronto, says that 11 days after getting an epidural steroid injection at the Rothbart Centre for Pain Care she ended up in a hospital ER in rough shape.

Both women developed bacterial infections in their spines following their visits to the Dufferin St. clinic: Levac was diagnosed with an epidural abscess and Martin with bacterial meningitis, as well as an epidural abscess.

Today, they live with disabilities caused from permanent nerve damage. They cannot control their bladders and bowels and are unable to walk without canes.

A Star investigation found Levac and Martin were not the only ones who developed serious bacterial infections following visits to the clinic. The probe also found:

Nine patients were infected with Staphylococcus aureus bacteria during an outbreak at the clinic between August and November 2012. Four developed meningitis.

Authorities responsible for investigating the outbreak and for inspecting the clinic — Toronto Public Health (TPH) and the College of Physicians and Surgeons of Ontario (CPSO), respectively — never made the outbreak public.

A December 2012 inspection revealed 170 deficiencies in infection control at the clinic.

All nine patients were given injections by anesthesiologist Dr. Stephen James, who was unknowingly “colonized” with the bacteria, meaning it was present on his skin but never made him sick.

Two of the infected patients developed meningitis and epidural abscesses, one developed meningitis and bacteremia (bacteria in the blood), one got meningitis and five got epidural abscesses.

Bacterial meningitis is a potentially deadly condition in which the brain and spine’s protective membrane becomes inflamed. An epidural abscess is a rare infection between the outer membrane of the spinal cord and the bones of the spine. It is also potentially life-threatening.

James argues that though staph A was present on his skin it is difficult to know whether he was the source of the bacteria that infected the patients. Three different surfaces tested by Toronto Public Health at the clinic were also found to be contaminated.

He also says: “I am very remorseful and regretful (about what) happened to these people … I think about it every day that I hurt these people.”

Dr. Peter Rothbart, founder and medical director of the clinic, says he was unaware there was an infection control problem, pointing out the clinic passed a CPSO inspection a year before.

Toronto Public Health does not consider it part of its mandate to post outbreak inspection results on its website.

The college, which has regulatory oversight of the clinic, provides few details of inspection outcomes on its website. There is no mention on its online register that there had been an outbreak, that nine patients became ill or that there were 170 infection-control deficiencies.

The CPSO requires physicians to disclose to patients when harm has been incurred during the delivery of health care. It recognizes harm is not always preventable or indicative of substandard care.

James never contacted Levac and Martin to explain what went wrong, according to the women. He never volunteered that he learned during the Toronto Public Health investigation that he was colonized with the bacteria, they say.

Critics argue there must be more public disclosure about the kind of problems that occurred at the clinic, particularly at a time when the clinic sector is growing rapidly. The province is pushing more services out of hospitals and into community clinics, known as “out-of-hospital premises.” There are 274 such clinics in Ontario today, up from 251 in 2012. Among the services they provide are pain treatment, colonoscopies and cosmetic surgery.

Tom Closson, former president of the Ontario Hospital Association and a proponent of moving services out of hospitals, says it’s important for patients and physicians to know whether clinics have safe track records so they can make informed decisions about using them.

“If you are a physician who is going to refer your patients to a particular clinic, you would want to know whether there are any issues with that clinic, and if there are issues, what has been done to address them. Certainly, as a patient, you would want to know the same,” he says.

Steve Rastin, president of the Ontario Trial Lawyers Association, is puzzled that Toronto Public Health doesn’t make public the results of inspections, like the one it did on the clinic.

The public health unit posts online inspection results for restaurants, tattoo parlours and nail salons, he points out. As well, its website shows weekly updates of outbreaks at hospitals, nursing homes and retirement homes.

“It’s disturbing to the Ontario Trial Lawyers Association that public restaurants appear to be held to a higher standard of accountability than clinics that provide medical services to the public,” Rastin says.

Medical negligence lawyer Paul Harte, who represents Levac, says the public should have access to Toronto Public Health investigation results and college inspection outcomes: “Those are two easy steps which are going to prevent future harm from happening and there is really no reason not to do those two things.

“As these women struggled with their health, the clinic and Dr. James withheld critical medical information from their patients,” Harte says. “TPH also raised unnecessary barriers to their right to know. Patients have a right to know. It shouldn’t be like pulling teeth.”

Rothbart says it would be helpful to clinics if there were more public information about problems other clinics have run into.

“We should be constantly learning and constantly up to date on any new information,” he says.

Toronto Public Health began investigating the clinic in late November 2012 after learning some of its patients had come down with meningitis. Cases of meningitis must be reported to public health authorities.

During the probe, James told public health officials he had heard from other patients who had also developed infections.

More sick patients were found during a “lookback,” during which calls were placed to 264 patients who had visited the clinic in preceding months to see how they were doing.

Source: http://www.thestar.com/life/health_wellness/2014/09/20/public_not_told_of_infection_outbreak_at_private_toronto_pain_clinic.html