Wednesday, April 18, 2007

Disease in The System

April 17, 2007 Victoria Australia

THE first symptoms were isolated cases of vomiting and diarrhoea. It was the Thursday before Easter and staff at the up-market Broughton Hall nursing home in a stately old mansion in Melbourne's eastern suburbs were initially not alarmed. As more came down with the same symptoms, however, it was clear there was not only a problem, but that the problem was spreading.

The best guess by the nursing staff at the home, which also houses 50 low-care hostel residents, was they were dealing with an outbreak of viral gastroenteritis.

On Good Friday it was decided to alert Victoria's public health authorities. A call was placed to the main health department switchboard but, in the words of Sharon Callister, the chief executive of Benetas, the Anglican Church's aged-care organisation, "the phones rang out". It was a public holiday. The home's staff had the option of calling an after-hours emergency number. "They chose not to take that option," Callister explained yesterday. "But that was based on their professional expertise at the time and the symptoms that were prevailing."

Things at Broughton Hall started to deteriorate, with more residents falling ill. The total would eventually reach 21. The first death, that of a 73-year-old man, occurred on Easter Sunday. A second male resident died the next day. But staff did not at first associate it with the gastro outbreak racing through the home.

"These deaths were not unexpected as both residents were elderly and frail," Broughton Hall's executive manager Sharon McGowan says. But more deaths were to come.

On Tuesday, April 10, Broughton Hall staff finally called the health department to alert it of the outbreak, as required by law. But no mention was made of the two deaths. It was only the following day, when a third male resident died, that the home told the department of the mounting death toll.

The fourth victim, an 88-year-old woman, died the next day.

On Friday, tests from a Broughton Hall resident taken to hospital showed she was suffering from salmonella; in layman's terms, food poisoning. Salmonella is particularly deadly in the very young and very old.

While public health officials swung into action to try to identify the cause of the deaths, no one within the health department had apparently thought it necessary to tell state Health Minister Bronwyn Pike that people were dying just down the road in Camberwell. She learned of the growing tragedy on Saturday, the same day her department issued a media release revealing the deaths.

On Sunday, a "very distressed, very angry and very disappointed" Pike took what she described as the drastic step of sacking the state's top public health bureaucrat Robert Hall, saying the communication breakdown was the latest in a string of such failures that had caused her to lose confidence in him.

The last to discover the tragedy were the people of Victoria. Asked why it had taken so long to make the details public, the assistant director of the health department's communicable diseases control unit, Rosemary Lester, says authorities had been "very busy" dealing with the matter.

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