State officials have fined a Tucson-area hospital for waiting too long to isolate two measles patients, including the one believed to have ignited the area's recent outbreak.
The outbreak, thought to have begun with a 36-year-old Swiss tourist, was one of the nation's largest measles outbreaks in recent years. It started in February and was finally declared over this week.
The state says Northwest Medical Center kept the woman in the emergency department — first in a hallway bed and then in a holding room — for more than 12 hours after a physician ordered that she be placed in isolation. No isolation precautions were taken during that time, according to a newly released state enforcement report.
The report says Northwest, at 6200 N. La Cholla Blvd., has agreed to pay $1,000 to the Arizona Department of Health Services for failing to isolate two local measles patients, the Swiss woman and another patient.
The fines amounted to $500 per day for infractions identified on two days — the maximum fine allowed under state law for those violations, health department officials said.
Kim Chimene, director of marketing for Northwest Medical Center, said: "This is an opportunity for improvement and learning. We take the safety of our employees, patients and visitors very seriously.
"Since then, we've developed an action plan to address the findings of the health department," Chimene said.
The hospital has submitted a correction plan to the state, but the plan had not been approved for public release Tuesday, and Chimene would not disclose details.
The unidentified Swiss woman became sick while here in February and went to Northwest Medical Center's emergency room for care on the morning of Feb. 12. The state report says the woman complained of flulike symptoms, a physician prescribed an antibiotic, and the tourist was discharged.
Like all Tucson-area ERs at that time, Northwest's was packed to overflowing with flu-stricken patients, setting the stage for massive exposure to the measles virus, and an outbreak that cascaded through the community.
The report says the woman returned to Northwest the next morning, still sick and this time complaining of a fever and tightness in her chest. She had rashes on her abdomen and face. She was admitted to the hospital, and a physician ordered isolation, though she remained in a hallway bed in the emergency department until 10 p.m., the report says.
The manager of the emergency department told state officials that the isolation order should have been clarified with the physician.
As the day continued, the woman developed what a physician described as a salmon-colored rash in her midsection, face and upper extremities. She remained in the emergency department until the following morning, when she was transferred to a hospital room.
In the other measles case cited by state health officials, a patient showed up at Northwest's emergency room three times over a 16-day period in March complaining of various symptoms. On her third visit, she had a rash, fever and shortness of breath, and she was immediately placed in isolation.
But the next day, she was transferred to a intensive-care-unit bed that was not an isolation bed, and she remained there for 15 hours, the report says.
Pima County declared the measles outbreak over this week and also said the disease wasn't as rampant as the county Health Department had previously thought.
Forty-two days have passed since the last reported case — long enough to declare an end to the outbreak, county Health Department spokeswoman Patti Woodcock said.
Though health officials originally counted 22 cases, they have since revised that number to 13 confirmed cases, along with four "probable" cases.
The revised figures came about after an analysis by the U.S. Centers for Disease Control and Prevention, the state Department of Health Services and the Pima County Health Department.
"When everything calmed down, we were given an opportunity to go over the cases," Woodcock said.
No one died of measles here, although several victims suffered complications that included fever-related seizures, pneumonia and many ear infections among children. Three patients were sick enough to require hospitalization.
In the effort to gain control of the outbreak, more than 9,000 doses of the MMR vaccine — the combination for measles, mumps and rubella — were injected. More than 500 suspected cases were evaluated. To date, cost estimates exceed $400,000 incurred by the county Health Department.
Though the case count is not as high as county officials previously had thought, Woodcock still classifies the local outbreak as a public-health emergency.
"One case is considered an outbreak," she said. "Measles is about to be eradicated in the U.S."
Top local fine
Arizona Daily Star archives indicate that the largest state health department fine levied against a Tucson-area hospital in recent years was a $12,750 civil penalty against Kino Community Hospital in 2003 for its role in the death of a psychiatric patient who suffocated while being improperly restrained.