Sewage leaks in operating rooms still plagued Washington's hospital for VIPs, reports show

"A black, grainy foul-smelling substance" coated the floor of an operating room at the MedStar Washington Hospital Center, which also suffered from at least one "active leak" of sewage, according to a review by the District of Columbia health department last August.

That health department report was cited in a lawsuit filed against the hospital by the husband of a woman who died from a post-operative infection after surgery at the hospital, where the operating rooms had suffered from leaks of bacteria-filled sewage for months.

Carol Leonard, 70, had thyroid surgery February 2017 at MedStar Washington Hospital Center, which is the go-to hospital for Congress and the White House. The surgery was so routine, she was told she'd be out the next morning or possibly the same day.

Within a week, the grandmother of six was dead. 

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Leonard’s surgery was five months after Washington's health department issued a chilling report in August 2016 that detailed sewage leaks in several operating rooms and was only recently released. Investigators returned there August 18, 2017 to find continued problems with sewage. 

Staff and contractors the hospital identified as being responsible for cleanup told investigators they were not made aware of a leak in an operating room where several patients were operated on last July, according to the health department report reviewed by USA TODAY. The sewage leaks were known as "black water" leaks, employees told the inspectors. 

"MedStar Washington Hospital Center has not experienced any new leaks, and we have completed all of the physical plant work identified in our 2017 action plan," Washington Hospital Center spokeswoman So Young Pak said in a statement. 

The recent report, which was not provided after USA TODAY filed a Freedom of Information Act request last fall, shows the hospital was placed in “immediate jeopardy” of losing its Medicare and Medicaid funding, because of its failure to protect patients. Since the government tends to be hospitals' largest payers, losing accreditation can be devastating. 

The Centers for Medicare and Medicaid Services defines immediate jeopardy as "a situation in which the provider’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.” Once a hospital gets this rating, CMS terminates its accreditation if it doesn't meet a deadline for compliance. Washington Hospital Center submitted a plan for correction the night of Aug. 18 and the designation was removed Aug. 21. 

"A hospital that is not correcting problems that could pose a real risk of infections to patients including leaking sewage unless prodded and required to do so under the threat of a state inspector's closure due to a declared 'imminent jeopardy' status is not what the public envisions or anticipates when seeking care," says infection control expert and consultant Larry Muscarella, whose blog is Discussions in Infection Control.

Gregory Argyros, the hospital's chief medical officer, called it "the most important hospital in the most important city in the most important country in the world," during an interview August 27. It is the largest trauma center and busiest emergency room in the Washington area and caters primarily to a lower-income, African-American population of Washington when it isn't treating VIPs, such as Rep. Steve Scalise, R-La., who was taken to the hospital after he was shot at a congressional baseball practice last summer. 

"It's important to me that it continues to be about a person," Eugene Leonard says about the lawsuit. "There’s a person and a family that’s really been harmed."

Even though her thyroid cancer was at an early stage and slow-growing, Carol Leonard didn't want to wait months to have the surgery at Inova Fairfax hospital as she feared she'd be the exception to the slow growth and wanted to enjoy her "very, very active" retirement from teaching, Eugene Leonard says. She did water aerobics the day before the operation. 

Eugene Leonard, who now lives alone in the couple's century-old farmhouse in Falls Church, Va., says his family chose the hospital based on the advertising it saw about its thyroid practice and other physicians' recommendations. 

Two of the couple's three daughters are doctors and Erica Leonard, a palliative care doctor in Pennsylvania, says she did online research about the surgeon but not the hospital, due to the relatively minor nature of the procedure. The surgeon also said her practice at the hospital did more thyroid surgeries than any other in the country, Erica Leonard said. 

Besides, Carol Leonard's surgery is known as a "clean" surgery because it carries such a low risk of infection due to contamination, The lawsuit charges Leonard contracted a strep infection and then sepsis while in the hospital. 

Thyroid surgery "is supposed to be relatively simple, they are in and they are out, and the risk of infection is generally really low," says attorney Scott Perry, who represents Eugene Leonard.

Along with the sewage leaks in operating rooms, Eugene Leonard’s lawsuit raises questions about whether the hospital should have given Leonard antibiotics before the surgery due to the hospital's infection risks. It also cites what it describes as the hospital's failure to diagnose and treat the deadly sepsis infection in time to save her life.

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"They knew they had these infection control patterns," says Perry. The hospital then made a decision as to whether to "choose to protect (patients) with antibiotics or not."

Physicians have to weigh the "risks of giving antibiotics to all patients having surgery against the risk and complications of a surgical site infection for the operation being performed," says Dale Bratzler, a physician and professor at Oklahoma University college of medicine, who co-authored three sets of medical society guidelines on prevention of surgical infections. 

With thyroid surgery, the infection risk is considered low in large part because the neck is easy to clean and there isn't the kind of contamination/bacteria found in, say, colon or mouth surgery, he says. In a patient who is healthy, the risk of infection is low and the consequences of the infection would typically be a skin infection which is usually easily treated.

So these patients are not recommended to get antibiotics, but that's only if basic infection control strategies are followed, including maintaining an appropriate surgical operating room environment and sanitized surgical equipment, according to the 2013 infection control guidelines. 

Even without the sewage problems which went on for about two years, there were other complicating issues for Leonard. She had several risk factors, including being obese, diabetic and 70 and the guidelines note the "underlying medical condition of the patient" also plays a big role in whether a patient gets an infection. 

Using a group of proven treatments for sepsis can further increase survival. The Rory Staunton Foundation is pushing states to follow New York and Illinois in requiring hospitals to follow sepsis protocols for fast identification and treatment of sepsis. 

Ciaran and Orlaith Staunton started the foundation after their 12 year old son, Rory, died of sepsis in 2012, five days after cutting his arm in a school basketball game. 

Erica Leonard says the six days she spent in the hospital as her mother died and her review of the medical records convinced her "there was a continual onslaught of sub-standard care, starting with the sewage in the operating rooms."

"I couldn't believe that in the 21st century that basic sanitation would be something a patient and family should have to have on their radar when deciding on a hospital/surgeon," Erica Leonard said.  

While Washington Hospital Center said it couldn't comment on a pending lawsuit, Pak said in a statement,  "we are very sorry for the Leonard family's loss." 

Have a patient safety story to tell? Email jodonnell@usatoday.com