Surgeon infected patients during heart procedure, Cedars-Sinai admits

A heart surgeon at Cedars-Sinai Medical Center unwittingly infected five patients during valve replacement surgeries earlier this year, causing four of the patients to need a second operation.

The infections occurred after tiny tears in the latex surgical gloves routinely worn by the doctor allowed bacteria from a skin inflammation on his hand to pass into the patients' hearts, according to the hospital. The patients survived the second operation and are still recovering, hospital officials said.

The outbreak led to investigations by the hospital and both the L.A. County and California departments of public health. The federal Centers for Disease Control and Prevention was also consulted.

Hospital officials called it a "very unusual occurrence" probably caused by an unfortunate confluence of events: the nature of the surgery, the microscopic rips in the gloves and the surgeon's skin condition. Valve replacement requires the surgeon to use thick sutures and tie more than 100 knots, which can cause extra stress on the gloves, they said.

Nevertheless, the hospital's goal is to have zero infections, said Harry Sax, vice chairman of the hospital's department of surgery. "Any hospital-acquired infection is unacceptable," he said.

The infections raise questions about what health conditions should prevent a surgeon from operating and how to get the best protection from surgical gloves. Surgeons with open sores or known infections aren't supposed to operate, but there is no national standard on what to do if they have skin inflammation, said Rekha Murthy, medical director of the hospital's epidemiology department. She added that there were also no national standards on types of gloves used, whether to wear double gloves or how many times surgeons should change those gloves during a procedure.

Healthcare-acquired infections are very common throughout the United States. Each year, infections cause 99,000 deaths in the country, including about 12,000 in California. Hospitals in the state are required to report certain infections to the California Department of Public Health. That reporting makes the public more aware of the quality of care provided at local hospitals and is an important tool for reducing infections, said Debby Rogers, deputy director of the department's Center for Health Care Quality.

Cedars-Sinai has low rates for hospital-acquired infections compared with the state and national average but has not performed as well on other surgical quality measures recently, according to the Leapfrog Group, an employer-backed nonprofit focused on healthcare quality. The organization gave the hospital a C rating last month on its national report card, down from an A in June, though it was not related to the infection outbreak.

"Clearly this hospital is making attempts to reduce infections, but they have more work to do," said Leah Binder, Leapfrog's chief executive.

Cedars-Sinai Medical Center conducts about 360 valve replacement surgeries each year and said infections occur in fewer than 1% of its cases — lower than the national average.

The hospital learned about the problem in June after three patients who had undergone valve replacement surgery showed signs of infection. Doctors diagnosed the patients with an infection called endocarditis. Concerned there might be a connection among the cases, epidemiologists analyzed the bacteria, staphylococcus epidermidis, and determined that it was an identical strain and therefore must have come from a single source. "It led to the question of gee, I wonder where it came from?" Murthy said.

Epidemiologists homed in on the surgeon with the skin inflammation. The bacteria matched, and then they made a surprising discovery: microscopic tears in the gloves typically worn by surgeons after performing valve replacement surgery. The surgeon, whose name was not released, was not allowed to operate again until he healed. He is still a member of the medical staff but no longer performs surgeries at the hospital.

The hospital soon found the same infection in two more patients. Officials also reached out to 67 patients who had heart valve replacements with the same surgeon but didn't find any other cases. One of the five infected patients was treated with antibiotics, and the other four had new valve replacement surgeries. Sax said the hospital apologized to the patients and has continued to monitor their health. The hospital has also covered the cost of their care, including follow-up treatment and all the related surgeries.

All surgeons doing valve replacements are now required to change gloves more frequently, officials said. Some surgeons are wearing double gloves during the operations, Sax said.

Following the outbreak, Cedars-Sinai did the proper follow-up to ensure the safety of their patients, said Dawn Terashita, a medical epidemiologist with L.A. County, who was notified in September. What occurred at Cedars-Sinai was an unintentional consequence of the surgery, she said.

"There is no way to keep a room entirely sterile and all the people in it sterile," she said. "You will always have risk of infection."

anna.gorman@latimes.com

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New Crowdfunding Site Seeks to Protect Backers of Industrial Design

Entrepreneur Jamie Siminoff wants to build more credibility into crowdfunding — so he’s launching a new platform that takes responsibility for ensuring the viability of new projects.

The crowdfunding process, pioneered by sites like Kickstarter, has had its share of huge successes, as well as failures. The problem, says Siminoff, is that when a venture fails, the funders are left holding the bag. That’s all well and good if you were investing in an artist’s crazy project. It’s much more of a problem if you thought you were pre-ordering a nearly finished gadget.

The biggest culprit for these kinds of issues are physical products. Witness the anger unleashed when Kickstarter darling Pebble announced a further delay alongside underwhelming color choices.

This kind of issue is why Kickstarter recently made some changes, undertaking a combination of education and rule revision. They reminded consumers that Kickstarter is not a store while requiring that all projects disclose risks and challenges, as well as forbidding renderings and concept videos in hardware products.

Siminoff’s answer is Christie Street, a crowdfunding site devoted exclusively to physical products. The promise of Christie Street is that it will vet the projects that it launches carefully, and provide guarantees of progress along the way. The idea is that these protections will make consumers feel safer about the products they’re backing. “We built something that we felt we needed,” he says.

Christie Street, named for the New Jersey road where Edison’s workshop was located, will require that all funders go through an auditing process before they are allowed to go live. Siminoff says that the idea will be to check for basic viability, a kind of sanity test.

“You look at the chips they say they want to use, the size of components that will need to fit in, and so on,” he says, “You check that things conform to what’s available on the market.” From there, they also perform third-party audits of the places where the product will be manufactured, and look at things like production cost and likely shipping time, to ensure that all of this seems realistic.

It’s an all-or-nothing audit. Either the new project meets Christie Street’s approval or it doesn’t. “Our feeling is that the customer that’s buying doesn’t have the sophistication to make the right decision [about whether a design's production targets are reliable],” says Siminoff, “The only way is create a place where you can trust to buy.”

Even after the initial approval, Christie Street stays involved in the project. Successfully funded projects get their money in stages, with Christie Street holding the rest in escrow. Inventors get one-third of the money on funding, one-third of the money once they have a production-ready prototype, and the final one-third when they have a golden prototype, which means they are ready for full manufacturing.

If at any time along the way the project fails, Christie Street will can the project and refund the remaining money to investors.

What constitutes failure? Siminoff ticks off four conditions.

First, the inventor could for whatever reason announce that they couldn’t finish.

Second, if the project ends up more than six months late. “This forces people to be more careful with their delivery dates,” says Siminoff.

Third, if the product falls short of what was promised. “If the pre-production sample is more than 15 percent worse than what was promised, we will not allowed you to manufacture the product,” says Siminoff. (For example, if you promised me 512GB and only delivered 256.)

Last, says Siminoff there are other nuances that they’ll have to work out as the site develops. For example, if a product ends up requiring significant redesign, then Christie Street might end up withholding funds. “Design is a tougher one to quantify,” he says, “but it’s important that the design overall fits what was promised to the customer.”

For the extra cautious, Christie Street goes even further than the refund of remaining money. For 10 percent of their pledge value, backers can insure their entire pledge. If the project goes wrong they’ll get all of it back. Combine that with a pledge from inventors that the product will retail for at least 10 percent more than the pledge amount, and you can either take a 10 percent discount for some additional risk or pay full retail, with a money-back guarantee.

In effect, Christie Street is navigating a space between crowfunding sites like Kickstarter and Indiegogo, which expect backers to handle a lot of their own due diligence while allowing the inventors to be entrepreneurs, and crowdsourcing design sites like Quirky, which handles all of the business elements in-house.

Christie Street is an effort at drawing the lines of trust in a new way, one tied directly to the realities of post-industrial product design. Rather than a blanket ban on renderings and early designs, or a Wild West ‘anything goes’ approach, they instead seeks to tame the parts where production can go really wrong, in the devilish details of prototyping and manufacturing. It leaves questions of whether or not the thing is cool to the wisdom of the crowds, while taking on the question of whether or not the thing is possible.

This is obviously a lot more intervention between middleman and inventor than you’d see on a site like Indigegogo or Kickstarter. Siminoff says that they can still take the same 5 percent cut as their competitors because physical products tend to be involved higher dollar-value projects from the start. “If all goes well, we’ll be doing 10 to 15 live projects a months a year from now,” he says, “We think we can be profitable in the product world.”

“We’re not trying to make it where inventors are just be a name on a product,” says Siminoff, “We still want them to be entrepreneur and build this thing. We just want to make sure that they don’t fail in a way that hurts the customer.”

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TNT’s “Leverage” could end this month, producer warns

LOS ANGELES (TheWrap.com) – This could end up being a very un-merry Christmas for “Leverage” fans.

Dean Devlin, executive producer of the TNT drama, penned an open letter to the show’s viewers on Thursday, telling them that he and fellow “Leverage” executive producer John Rogers crafted the show’s Season 5 finale – airing December 25 – as a series finale, because it just might be.

TNT has not yet decided whether it will renew the series, which stars Timothy Hutton as the leader of a squad of shady characters who use their skills to right corporate and government injustices. And judging from the tone of Devlin’s letter, he’s not terribly confident that they will.

“As of the writing of this letter, we still do not know if there will be a season six of our show. Just as we didn’t know when we created the last three episodes which are about to air,” Devlin wrote. “Because of this uncertainty, John Rogers and I decided to end this season with the episode we had planned to make to end the series, way back when we shot the pilot. So, the episode that will air on Christmas is, in fact, the series finale we had always envisioned.”

Of course, should “Leverage” get the go-ahead for a sixth season, Devlin notes, “Everyone involved with the show, from the cast, the crew, the writers and producers, would like nothing more than to continue telling these stories. But, in case we do not get that opportunity we felt that, creatively, after 77 episodes, we owed it to you, our fans, to end the show properly.”

The December 25 episode, according to Devlin, is “the most powerful episode we’ve ever done.”

So far this season, “Leverage” has averaged 3.5 million total viewers, down 11 percent from last season’s average, with 1.3 million in the 18-49 demographic most important to advertisers, an 18 percent decline from last season.

TV News Headlines – Yahoo! News

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Supreme Court to rule on California's Prop. 8 ban on gay marriage

Justices will rule for the first time on same-sex marriage by deciding the constitutionality of Prop. 8.

The Supreme Court announced Friday it will rule for the first time on same-sex marriage by deciding the constitutionality of California’s Proposition 8, the voter initiative that limited marriage to a man and a woman.

The justices also said they would decide whether legally married gay couples have a right to equal benefits under federal law.

The California case raises the broad question of whether gays and lesbians have an equal right to marry.

FULL COVERAGE: The battle over gay marriage 

If the justices had turned down the appeal from the defenders of Prop. 8, it would have allowed gay marriages to resume in California, but without setting a national precedent.

Now, the high court has agreed to decide whether a state’s ban on same-sex marriages violates the U.S. Constitution. The court’s intervention came just one month after voters in three states — Maine, Maryland and Washington — approved gay marriages. This brought the total to nine states having legalized same-sex marriages. 

But the justices also left themselves a way out. They said they would consider whether the defenders of Prop. 8 had legal standing to bring their appeal.

The justices made the announcement after meeting behind closed doors. They did not say which justices voted to hear the appeals.

Last year, the U.S. 9^th Circuit Court of Appeals struck down Prop. 8, but it did so on a narrow basis. Judge Stephen Reinhardt reasoned that the voter initiative was unconstitutional because it took away from gays and lesbians a right to marry that they had won before the state Supreme Court.

The justices now will have at least three options before them: They could reverse the 9^th Circuit and uphold Prop. 8, thereby making it clear that the definition of marriage will be left to the discretion of each state and its voters.

They could rule broadly that denying gays and lesbians the fundamental right to marry violates the Constitution’s guarantee of equal protection of the laws. Such a decision would open the door to gay marriages nationwide.

Or as a third option, they could follow the approach set by the 9^th Circuit and strike down Prop. 8 in a way that limits the ruling to California only.

In the other gay-marriage cases, the court will decide the constitutionality of part of the Defense of Marriage Act  that denies federal benefits to legally married couples. Judges in New England, New York and California have ruled this provision unconstitutional.

The justices are expected to hear arguments in the two sets of gay marriage cases in March and issue decisions by late June.

FULL COVERAGE: The battle over gay marriage 

Follow Politics Now on Twitter and Facebook

david.savage@latimes.com

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Say Goodbye to Free Google Apps

I kick myself for not signing up for Google Apps earlier. I wanted a custom e-mail address using my website’s domain name and the easiest option is signing up for a free Google Apps for Business account. The 7-year-old service provides Gmail, Calendar, Docs, and file storage for businesses. Until now, you could sign up for a free account as an individual, or pay a few dollars per month for a business account. On the Google Enterprise blog Thursday, the company announced that it’s killing off those free accounts.

Google Apps was born when Google first experimented with student e-mail accounts for San Jose State University in 2006. Since then, the service has grown into a full-fledged business suite of e-mail, calendar, word processing and spreadsheet apps, along with backups of e-mail and control over multiple accounts. Businesses often use Google Apps to set up corporate e-mail and collaborate on private documents.

The search engine giant cites demand for more features from its business customers as the main reason to dump the free version, which is used by individuals and small businesses with 10 or fewer users. “Businesses quickly outgrow the basic version and want things like 24/7 customer support and larger inboxes,” writes Clay Bavor, Director of Product Management, Google Apps on the company’s blog.

Google says that “millions of businesses” are using the service, which has prompted it to cash in on all those users. Getting rid of free accounts could also mean that Google is working on more services and functionality for its cloud-based office suite, which competes with Microsoft’s desktop-based software Office.

If you signed up for a free account before December 6, 2012, your account will stay free. There are now two options for Google Apps: Apps for Business with or without Vault. Without Vault, a service that gives you e-mail archiving and control over multiple e-mail accounts, you’ll pay $5 per user per month, up to $50 per user per year. If you want Vault, it costs $10 per user per month. Schools can still sign up for a free Google Apps for Education account.

Businesses with 10 or fewer employees can either pay up for Google Apps, or individually sign up for a regular Google account (which is what you get with a Gmail account). That could be a boon for Google+, since you automatically get an account for the still-growing social network when you create a new Google account. Sadly, that Google+ account doesn’t come with a custom e-mail address.

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Nurse who took prank call about royal Kate found dead

LONDON (Reuters) – A nurse who answered a prank call at the London hospital that was treating Prince William‘s pregnant wife Kate for morning sickness has been found dead, the hospital said on Friday, in a suspected suicide.

The death comes days after the King Edward VII hospital apologized for being duped by an Australian radio station and relaying details about Kate’s condition which made headlines around the globe.

“It is with very deep sadness that we confirm the tragic death of a member of our nursing staff, Jacintha Saldanha,” John Lofthouse, the King Edward’s chief executive told reporters outside the central London hospital.

“We can confirm that Jacintha was recently the victim of a hoax call to the hospital. The hospital had been supporting her throughout this difficult time.”

Police said they had been called at 9:35 a.m. (4:35 a.m. EDT) about a woman found unconscious at an address near the hospital. The woman was pronounced dead after ambulance staff arrived.

Police said the death was being treated as unexplained but they we’re not looking for anyone else, indicating the nurse had taken her own life.

William and Kate, who left the hospital on Thursday, said they were “deeply saddened” by the death of the nurse, who was married with two children.

“Their Royal Highnesses were looked after so wonderfully well at all times by everybody at King Edward VII Hospital, and their thoughts and prayers are with Jacintha Saldanha’s family, friends and colleagues at this very sad time,” a statement from William’s office said.

CONFIDENTIAL DETAILS

The radio station launched its stunt in the wake of a frenzy of media attention in Britain and worldwide after officials announced Kate was pregnant with a future British king or queen.

Two presenters from Australia’s 2Day radio station called the hospital early on Tuesday British time, pretending to be William’s grandmother Queen Elizabeth and his father, the heir-to-the throne Prince Charles.

Despite unconvincing accents, presenters Michael Christian and Mel Greig were put through to the ward where Kate was being treated and were given details about how she was faring.

Saldanha had answered the call as it was early morning and there were no receptionists on duty, and had passed it to a nurse on the ward. Saldanha, who had worked at the hospital for four years, had not been facing any disciplinary action, a source said.

“She was an excellent nurse and well-respected and popular with all of her colleagues,” Lofthouse said.

William’s office said there had been no royal complaint about the breach of confidentiality, although the hospital said it was reviewing its “telephone protocols”.

“On the contrary, we offered our full and heartfelt support to the nurses involved and hospital staff at all times,” a royal spokesman said.

William’s father, Prince Charles, had made light of the intrusion, joking to reporters after the incident: “How do you know I’m not a radio station?’

The private hospital is one of Britain’s most exclusive and has a history of treating members of the royal family, including the Queen’s husband Philip who was admitted in June for a bladder infection after taking part in a jubilee pageant on the Thames river.

PRESENTERS “SHOCKED”

The prank call and its tragic aftermath comes as Britain’s own media scrambles to agree a new system of self regulation and avoid state intervention following a damning inquiry into reporting practices.

A recording of the call was widely available on the Internet and many newspapers printed a transcript of the call.

The Australian radio station and its owner Southern Cross Austereo said the presenters were shocked and would stay off their show until further notice out of respect for Saldanha’s death.

“Southern Cross Austereo (SCA) and 2Day FM are deeply saddened by the tragic news of the death of nurse Jacintha Saldanha from King Edward VII’s Hospital and we extend our deepest sympathies to her family.

“Chief Executive Officer Rhys Holleran has spoken with the presenters, they are both deeply shocked and at this time we have agreed that they not comment about the circumstances,” an SCA statement said.

The two presenters deleted their Twitter accounts shortly after the news broke and there was widespread condemnation of their actions on the social media website.

“Remember that #RoyalPrank …? Yeah, the girl you humiliated is dead. You must feel great,” one wrote.

Facebook tribute pages swiftly set up after the nurse’s death attracted messages of sympathy, some echoing calls for the radio station to pay compensation to her family and for the presenters to resign.

Saldanha’s body was removed from the red brick, five-storey building where it was found, and transferred to a small private ambulance, shortly after the hospital confirmed her death, a Reuters reporter at the scene said.

She had been staying in staff accommodation in the building, away from her family in the city of Bristol, western England, a source said.

Her family said they were deeply saddened and asked for media to respect their privacy “at this difficult time”, in a statement released by police.

(Additional reporting by Peter Schwartzstein and Michael Holden; Editing by Louise Ireland)

Celebrity News Headlines – Yahoo! News

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The New Old Age Blog: A Son Lost, a Mother Found

My friend Yvonne was already at the front door when I woke, so at first I didn’t realize that my mother was missing.

It was less than a week after my son Spencer died. Since that day, a constant stream of friends had been coming and going, bringing casseroles and soup, love, support and chatter. Mom hated it.

My 94-year-old mother, who has vascular dementia, has been living in my home in upstate New York for the past few years. Like many with dementia, mom is courteous but, underneath, irascible. Pride defines her, especially pride in her Phi Beta Kappa intellect. She hates to be confronted with how she has become, as she calls it, “stupid.”

The parade of strangers confused her. She had to be polite, field solicitous questions, endure mundane comments. She could not remember what was going on or why people were there. It must have been stressful and annoying.

That night, like every night since the state troopers brought the news, I woke hourly, tumbling in panic. As if it were not too late to save my son. Mom knew something was wrong, but she could not remember what. As I overslept that morning, she must have decided enough was enough. She was going home.

In a cold sky, the sun blazed over tall pines. As I opened the door, the dogs raced out to greet Yvonne and her two housecleaners. Yvonne often brags about her cleaning duo. They were her gift to me. They were going to clean my house before the funeral reception, which was scheduled for later that week. This was a very big gift because, like my mother before me, I am a very bad housekeeper.

Mom’s door was shut. I cautioned the housecleaners to avoid her room as I showed them around. Yvonne went to the kitchen to listen to the 37 unheard messages on my answering machine; the housecleaners went out to their van to get their instruments of dirt removal.

I ducked into Mom’s room to warn her about the upcoming noise. The bed was unmade; the floor was littered with crumpled tissues; the room was empty.

Normally, I would have freaked out right then. I knew Mom was not in the house, because I had just shown the whole house to the cleaners. Although Mom doesn’t wander like some dementia patients, she does on occasion run away. But I could not muster a shred of anxiety.

“Yvonne,” I called, “did you see my mother outside?”

Yvonne popped her head into the living room, eyebrows raised.“Outside? No!” She was alarmed. “Is she missing?”

“Yeah,” I said wearily, “I’ll look.” I stepped out onto the front porch, tightening the belt of my bathrobe and turning up the collar. Maybe she had walked off into the woods. The dogs danced around my legs, wanting breakfast.

I had no space left in my body to care. Either we would find her, or we would not. Either she was alive, or she was not. My child was gone. How could I care about anything ever again?

Then I saw my car was missing. My mouth fell open and my eyeballs rolled up to the right, gazing blindly at the abandoned bird’s nest on top of the porch light: What had I done with the keys?

Mom likes to run away in the car when she is angry. She used to do it a lot when my father was still alive — every time they fought. Since Mom took off in my car almost a year ago, after we had had a fight, I’d kept the keys hidden. Except for this week; this week, I had forgotten.

I was reverting to old habits. I had left the doors unlocked and the keys in the cupholder next to the driver’s seat. Exactly like Mom used to do.

“Uh-oh,” I said aloud. Mom was still capable of driving, even though she did not know where she was going. I just really, really hoped that she didn’t hurt anybody on the road. I pulled out my cellphone, about to call the police.

“Celia!” Yvonne shouted from the kitchen. She hurried up behind me, excited. “They found your mother. There are two messages on your machine.”

At that very moment, Mom was holed up at the College Diner in New Paltz, a 20-minute drive over the mountain, through the fields, left over the Wallkill River and away down Main Street.

Yvonne called the diner. They promised to keep the car keys until someone arrived. By that time, Yvonne had to go to work. She drove my friend Elizabeth to the diner, and Elizabeth drove Mom home in my car.

Half an hour later, they walked in the front door. Mom’s cheeks were rouged by the chill air and her eyes sparkled, her white hair riffing with static electricity. “Hello, hello,” she sang out. “Here we are.” She was wearing the flannel nightgown and robe I had dressed her in the night before. It was covered by her oversized purple parka, and her bare feet were shoved into sneakers.

I started laughing as soon as I saw her. I couldn’t help it. Elizabeth and Mom started laughing too. “You had a big adventure,” I said, hugging them both. “How are you?”

“I’m just marvelous,” said my mother. Mom always feels great after doing something rakish. We settled her on the sofa with her feet on the ottoman. By the time I got her blanket tucked in around her shoulders, she had fallen asleep.

Elizabeth couldn’t stop laughing as she described the scene. “Your mother was holding court in this big booth. She was sitting there in her nightgown and her parka, talking to everybody, with this plate of toast and coffee and, like, three of the staff hovering around her.”

The waitress said Mom seemed “a little disoriented” when she got there. Mom said she was meeting a friend for breakfast, but since she was wearing a nightgown and didn’t know whom she was meeting or where she lived, the staff thought there might be a problem. They convinced Mom to let them look in the glove compartment of the car, where they found my name and number.

It was then that I realized I was laughing – something I’d thought I would never be able to do again. “Elizabeth, Elizabeth, I’m laughing,” I said.

“Ha, ha, ha,” laughed Elizabeth, holding her belly.

“Ha, ha, ha,” I laughed, rolling on the floor.

And she who gave me life, who had suffered the death of my child and the extinction of her own intellect, snoozed on: oblivious, jubilant, still herself, still mine.

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