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22 infected by Hep C SGH outbreak, but MOH no need to inform public

Papsmearer

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First world health care system? Highest paid Health Minister in the world? This kind of fucked result? Uniquely singapore. Fucking PAP

Public not told earlier 'as there were no signs of acute hepatitis C cases' -

As shocked Singaporeans digested the news about the hepatitis C virus outbreak in Singapore General Hospital (SGH) and began asking many questions, such as why it took the authorities so long to inform the public of the situation, the Ministry of Health (MOH) said yesterday (Oct 7) that there had been no signs earlier to suggest that these were cases of acute viral hepatitis C.

Under the Infectious Diseases Act, cases of acute viral hepatitis C have to be reported to the ministry within 72 hours, whereas chronic cases need not be reported.

In the case of the outbreak at SGH, which saw 22 renal patients infected with the hepatitis C virus possibly because of a lapse in the use of multi-dose medication vials, the MOH had received earlier notifications of these cases from the hospital’s laboratory.

However, at that point in time, the cases did not have symptoms — such as jaundice — or a history of exposure to suggest that they were acute.

“As it can be difficult to detect such asymptomatic hepatitis C based on blood tests alone, doctors generally look for a link to an event of relevant exposure, such as current intravenous drug use or a needle-stick injury,” said an MOH spokesperson yesterday, adding that most acute hepatitis C virus infections tend to be without symptoms.

A subsequent review showed that the outbreak at SGH included acute cases, and they will be updated on the MOH’s Weekly Infectious Diseases Bulletin in the next report.

SGH first noticed a spike in cases in June, but only reported the outbreak to the ministry in late August. On Tuesday, Health Minister Gan Kim Yong said he was gravely concerned and disappointed over the outbreak. Four of the eight deaths among the pool of affected patients are possibly linked to the infection. One other death is still under review.

After the incident was made public on Tuesday, many Singaporeans, including netizens, have questioned the time lag in making the news public.

Yesterday, MOH set out the timeline of its actions in greater detail.

After being informed of the cluster in late August, the director of Medical Services Benjamin Ong met SGH clinicians on Sept 3 to seek clarifications on the hospital’s initial investigations, said an MOH spokesperson.

Associate Professor Ong said SGH needed to “conclusively verify where the gaps leading to these infections were and that an external review would be required”.

He also requested for several things to be completed within two weeks. First, external parties to be found to sit on the two committees SGH was to set up to review clinical matters, as well as infection control and patient safety processes. He also asked for SGH’s phylogenetic analysis of the affected patients’ samples to be externally verified, and the hospital to put up a plan for screening its healthcare staff for hepatitis C — as of Sept 25, screening results of 76 staff members were negative for hepatitis C.

On Sept 4, an MOH team led by Dr Daphne Khoo, group director of the ministry’s Healthcare Performance Group, visited SGH’s renal ward (Wards 64A and 67) for a process walk-through. Three days later, external verification of SGH’s phylogenetic analysts was completed and confirmed the initial findings that the 21 cases were related.



Actions taken as outbreak unfolded

Late August: SGH reported its identification of a cluster of 21 hepatitis C cases and the outcome of its investigations.

Sept 3: After reviewing SGH's report, Associate Prof Benjamin Ong, MOH's director of Medical Services met SGH clinicians to seek further clarifications.

Sept 4: A MOH team visited the renal ward (Warm 64A and 67) for a process walkthrough with SGH.

Sept 7: External analysis by an A*STAR laboratory confirmed SGH's initial findings that the 21 cases were related.

Sept 9: SGH started hepatitis C screening for all doctors and nurses involved in the direct care of the affected patients. As of Sept 25, 76 staff members have been screened. All were found to be negative for hepatitis C.

Sept 18: Having assessed that the additional investigations requested had largely been completed, Assoc Prof Ong reported the identification of the cluster to Health Minister Gan Kim Yong. Mr Gan asked SGH for a briefing. SGH requested that it takes place on Sept 25 to allow SGH sufficient time for investigations to be completed.

Sept 21: MOH notified of the 22nd case

Sept 24: SGH report submitted to MOH

Sept 25: Mr Gan was given a briefing. He instructed that an independent review committee be set up, and for SGH to make public its preliminary findings.

Oct 6: SGH held a media briefing on the hepatitis C virus outbreak.
- See more at: http://www.gov.sg/news/content/toda...-acute-hepatitis-c-cases#sthash.eAjuUDJk.dpuf
 
What is missing in SGH report

It must be the briefest statement to end a brewing crisis. And it was said with a firm air of finality.

“There is no evidence to suggest that the escalation from the director of medical services to the minister was deliberately delayed,” Leo Yee Sin, chairman of the committee that investigated the Hepatitis C scare at SGH, said last week.

Their report was damning, exposing lapses in protocols at Singapore’s oldest hospital. This pride of Singapore’s health care industry was tardy in recognising the outbreak, its own investigations were messy and there were delays in reporting the matter to the Ministry of Health.

But the team cleared the ministry’s director of medical services, Benjamin Ong, of deliberate delays in reporting the affair to his minister. Chairman Leo shed no light on what questions were put to the director and how they arrived at the verdict.

It took him more than two weeks, from the time he was officially told of the outbreak on Sept 1 by his ministry, to inform the minister. He seemed to have wanted a clearer picture and so asked A*Star to verify the analysis by SGH. That verification came on Sept 7 and the minister was told 11 days later.

Why this delay? What went through his mind? Why didn’t he think the loss of lives, the unusual spread of the illness and the fact that the cases are linked were not serious enough to escalate the matter? What is the standard operating procedure when it comes to escalating the matter to the big boss?

We will never know because the committee did not dwell on these questions at its press conference. Benjamin Ong is no novice to leadership positions. In his 27-year career at the National University Hospital, he has held prime positions such as chief executive of NUHS and chairman of the hospital’s medical board.

With that kind of experience in government-related jobs, Ong should be well-versed with reporting procedures. And the civil service is the most anal about proper information flow between employee and boss and between boss and the big boss. Break that chain, and it can lead to all kinds of problems for the organisation.

This was no ordinary situation. Seven lives had already been lost, SGH had shown extra ordinary lapses in infection control and information flow to the ministry. In fact, the first official word to the Ministry came only three months later.

Ong was not satisfied with the briefing SGH gave him and so asked for an external party to review of the hospital’s findings. He also made the right decision to suspend kidney transplants at the hospital as the outbreak took place in its renal wards.

But why wait to clear all doubts before having an audience with the Minister?

We might never know -- and that is the biggest flaw in what otherwise is a thorough and no-holds-barred report.
 
It appears to have been handled in a reasonably professional manner plus those that were infected were already liabilities so it's no big deal. It's not as if important individuals were put at risk.

I agree that we should just move on.
 
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