|
TESTIMONY OF CARLOS OMENACA, MD, FCCP, INFECTIOUS DISEASE AND CRITICAL CARE
SPECIALIST AT MIAMI HEART CENTER BEFORE THE SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS of the VETERAN’S AFFAIRS COMMITTEE U.S. HOUSE OF REPRESENTATIVES November
14, 2001 Mr. Chairman and
members of the Committee, thank you for inviting me to testify at this
hearing. I am Carlos
Omenaca, MD, FCCP, Specialist in Infectious Diseases and Critical Care
Medicine practicing in Miami, Florida.
I was directly involved on the diagnosis and treatment of
inhalational anthrax in one of the cases recently diagnosed in
Florida. I was asked to share
my personal experience in the management of such an unusual case, in
order to place in perspective and review the roles of the Departments
of Veterans Affairs and Defense in educating the Nation’s medical
students and current health professionals to diagnose and treat
casualties when weapons of mass destruction have been used. What if you were
confronted with a large number of people suffering from an unknown
severe illness? How would
you decide what they were suffering from?
How would you determine if a biological weapon was involved?
How would you treat them? How would you keep the disease from
spreading to others? These
are all questions that belong to the introduction section of a course
in Bioterrorism and Biological Warfare.
None of them crossed my mind six weeks ago when I was asked to
evaluate a 73 year-old man admitted to the hospital with a severe case
of pneumonia. What
initially looked like a flu-like illness and evolved to a rapidly
progressing bilateral pneumonia, was confirmed days later as the
second case on inhalational anthrax, third case in 25 years in the
United States. As a result of that
initial suspicion of a possible second case of anthrax exposure in the
same place of work, the level of alertness in the Nation for a
potential bioterrorist attack increased dramatically.
Hundreds of people were tested for possible exposure to the
anthrax bacillus. Only a
few tested positive. Of
those, fewer acquired the infection, and only four died from a lethal
and rapidly progressing infection.
People receiving prophylactic antibiotics are counted in the
thousands. Our patient,
managed by a multidisciplinary team, was discharged home in good
condition after 23 days of hospitalization, including several days of
stressful care in the ICU. Two
other patients, diagnosed of inhalational anthrax were recently
released home safe. These facts seem on
one hand concerning and even frightening, given the large number of
people potentially exposed to a lethal infection.
On the other hand, they may resemble something close to a
success story, given the low number of casualties and people affected
with a real infection. However,
the truth is that, behind those statistics and success stories, there
is a tremendous amount of frustration, confusion, lack of information,
and in some cases, chaos. We
were just lucky, not to have lost more lives during these weeks.
In my opinion, we are not sufficiently prepared for a large or
even small scale bioterrorist attack.
Our medical
personnel, including myself, do not have the training to recognize
illnesses that have not occurred in this country in decades.
Smallpox, anthrax, plague, Q fever, tularemia, brucellosis,
viral hemorrhagic fevers, botulism, are among the pathogens utilized
as biological weapons. We
rarely see these infections in this country in the XXIst century.
They are not emphasized in the core curriculum in our specialty
programs. Remember,
“you do not diagnose what you do not think of, and you do not think
of what you do not know about”.
Some of the clinical presentations are almost forgotten in our
most recent medical publications.
Some of them, as we are currently seeing in the cases of
inhalational anthrax, are being updated in terms of their clinical
presentations, newer diagnostic tools, such as DNA testing, and
therapeutic means, with the latest groups of antibiotics.
Research is needed to test latter against biological warfare
agents. The degree of
alertness of a potential bioterrorist attack is key in the prompt
diagnosis and successful management of potentially affected people.
Early treatment makes a difference in devastating infections
such as pneumonic plague or inhalational anthrax.
Without this level of continuous awareness, infections caused
by biological warfare agents will not be timely diagnosed, and lives
may be lost. Continuous
Medical Education (CME) targeted to all practitioners would serve as a
tool in maintaining open eyes towards the diagnosis of future exposure
to biological agents. A greater degree of
coordination between doctors directly involved in the management of
patients suffering from a bioterrorist attack and official
institutions is needed. I
detected potential deficiencies in communications between clinicians,
Health Departments and perhaps the CDC.
They all should work together in a very standardized and
coordinated effort. Our
doctors need training when it comes to a team effort with these
institutions with which they do not work in their daily practice.
Teaching specifics about medical ethics to keep classified
information confidential, while keeping patients and families
punctually updated about their clinical condition, are needed. Our healthcare
workers do not seem prepared to deal with unknown infections.
I have seen tremendous confusion and stress among nursing staff
caring for our patient diagnosed with inhalational anthrax in Miami.
I sensed the same degree of concern and lack of information
among most of the nurses in our emergency departments and ICUs.
They have not been trained to care for this type of patients. Our laboratory
technicians and ancillary personnel have been overwhelmed by large
numbers of samples reaching their premises for testing.
I was sensing lack of standard procedures and perhaps some
degree of disorganization when samples were collected, labeled, and
sent to outside laboratories for specialized testing during the
management of our patient with anthrax in Miami.
I would not be surprised if similar situations have occurred in
New York, New Jersey and Washington DC.
A greater degree of coordination is needed when two or more
institutions are involved in the care or screening of people
potentially suffering from a bioterrorist attack.
Written policies to this respect should be implemented. In summary, a number
of potential deficiencies in our system have been recognized during
the management of a patient diagnosed with anthrax in Florida. All of them are the product of inexperience on treating such
cases. Most of them are
easily amendable by implementing written policies and enhancing our
educational system. Strategies
that deserve further discussion and possible incorporation to our
educational programs would include among others the following:
It is vital that
prompt action take place in order to better deal with potential future
exposures to biological agents. Mr. Chairman and
members of the Committee, I am honored to be asked to testify today in
this hearing. I would be
happy to answer any questions the Committee may have. Thank you. Back to Witness List |