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Covering supergerms

mrsaBy W.J. Hennigan

A killer was on the loose in Washington state hospitals for decades before anyone took notice. The threat went overlooked. The body count mounted. And all the while, the killer – an antibiotic-resistant supergerm called MRSA – grew stronger.

In November 2008, The Seattle Times moved to end the threat. The Times published a three-part investigation entitled, “Culture of Resistance,” which exposed the abysmal infection control in Washington hospitals and reported a death toll previously hidden from the public.

The reaction in the Washington community was immediate. The series led to an overhaul in the state’s public policy and tightened safety standards in hospitals.

However, the story behind the series did not begin in Seattle. It started when the series’ lead reporter, Michael J. Berens, was an investigative reporter at the Chicago Tribune several years earlier.

Berens had written a number of health care-related stories for the paper and was working on one such story when his phone rang. It was a local woman looking for help getting attention to MRSA or methicillin-resistant Staphylococcus aureus.

Jeanine Thomas asked Berens how she could raise public consciousness about the supergerm, which is spread by touch or contact, mainly in health-care facilities because of lack of infection control. Berens, consumed with the story he was looking into at the time, told her the best way was to do it herself.

“I said, ‘From what I have seen in the past, reform typically begins with one person,’” He said.

Thomas, a MRSA victim, heeded his words. She founded the MRSA Survivors Network, a consumer organization. She also shepherded the first law dealing with MRSA through the Illinois legislature. With this under her belt, Thomas contacted Berens again. Berens, now at The Seattle Times, was ready to take on the story.

The Quest Begins

In mid-2007, Thomas provided Berens with background on MRSA. Berens jumped headlong into the project, acquiring a database from the Washington Department of Health, called the Comprehensive Hospital Abstract Reporting System (CHARS). The database included information like: what the patient was diagnosed with, how the patient was treated, and how much it cost.

The database was coded. So after getting “data dictionary,” to read the codes, they plugged the information into Microsoft Access and Excel. Out of the database’s 13,367 diagnosis codes, none accounted for MRSA.

With this, Berens knew the Times were on to something. It was proven that MRSA had been killing people for years, yet CHARS did not indicate it.

Berens and the Times staff found that there was a code indicating whether a patient was diagnosed with an antibiotic-resistant organism. They used the code to find potential MRSA patients. They pared down the numbers even further by eliminating any other germs that even hinted at being something other than MRSA.

The Times applied this formula to the data, year by year. When they were done, they were struck by the figures.

In 1997, the number of admitted patients with MRSA was 141. By 2007, that number had ballooned to 4,723.

The Times also wanted to know how many people died from the supergerm. So they obtained death-certificate data. But again, a problem arose. The certificate data didn’t account for MRSA either.

A Pleasant Surprise

One day, in a stroke of luck, Berens was reading a story in the The Spokesman-Review, which quoted a Department of Health official discussing the number of MRSA-related deaths in Washington. Berens was mystified on where the numbers came from. So he called the department looking for an answer. The department dropped a bomb on him.

It turned out that since 2003, the department kept a separate death-certificate database, which was never disclosed to the public. The database, called “the literals,” included notes written by doctors, going into gritty detail of a person’s death.

At first, the department did not want to hand over the database, saying that the information could be embarrassing for the deceased and their families. But after the Times threatened with legal action, the department relented.

“We explained very clearly that a death certificate is a public record by law,” Berens said. “Just because you type it in a database, doesn’t mean it’s confidential.”

The database turned out to be the “Rosetta stone” for the series, Berens said. The Times exposed that the infection caused 672 deaths, which up to that time had not been revealed.

“The database really painted the picture of what was going on,” he said.

From now on, Berens said if he is covering the government, he makes a Freedom of Information Act request for a list of databases it keeps – just to be sure.

Ken Armstrong, another investigative reporter with the Times, joined the MRSA investigation in the summer of 2008. Ironically, he also worked at the Chicago Tribune at the same time as Berens. But for one reason or another, the pair never worked together.

With an extensive background in legal reporting, Armstrong used his sourcing in the legal world to find any law suits in which MRSA patients were named. He also nailed down interviews with MRSA victims, shading in the human element of the piece.

“One of the biggest challenges was finding patients,” Armstrong said. “We really wanted to illuminate as many aspects of MRSA as we could.”

In one instance, Armstrong had to connect the dots from clues in a 1982 medical journal entry about an unnamed Washington MRSA victim. He linked it to a death certificate, then to the victim’s family.

The hard work paid off. When the story ran in November 2008, the community response was swift. By the series third installment, Washington announced hospitals would have to report any cases linked with MRSA.

Only months later, two bills were signed into law, strengthening infection control and requisite screening for at-risk patients – a test that costs only $20.

The story also picked up a slew of awards. But more importantly, Berens said, is that the series raised the nation’s awareness of MRSA. He encourages reporters to localize the story, so MRSA can be contained even further.

It’s low cost. The databases are free. It just takes a lot of time and hard work, he said.

“If this story shows reporters anything, it’s to challenge conventional wisdom,” Berens said.

W.J. Hennigan is a former intern at the Reynolds Center. He now covers business for The Los Angeles Times.

In Beats.

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