Gordon Robinson | Cornwall sick of Tufton
Last Sunday, I reviewed the UTech team's March 2017 report to Ministry of Health (MOH) on severe health risks at Cornwall Regional Hospital (CRH).
After identifying toxic gases and fumes permeating CRH, the team recommended: "This is a very sick building ... . Staff should be evacuated and relocated until the source(s) of airborne toxicants have been found, except for essential services."
It's widely believed that Minister Tufton over-ruled this recommendation from a team that included MOH's chief medical officer (CMO) and project director/director of the Environmental Unit. He has pleaded the Shaggy Defence ("It wasn't me"), saying that only the CMO can order closure "in law", which he decided against "after a meeting". Yawn. Did Tufton contribute to that meeting? Was the CMO muscled into ignoring his own recommendation? Shortly after Tufton's cartoonesque "renovations-on-track" statement in September 2017, the CMO abruptly resigned. Why?
Tufton often relies on a PAHO report stating: "closing the facility for complete remediation is not a realistic option." So it behoves us to take a closer look at this report dated March 23, 2017.
It (Environment Hygiene Assessment for CRH) was written by PAHO/WHO-contracted consultant JosÈ Carlos Espino of Panama-based environmental parameters/occupational hygiene evaluation company EnviroLab S.A. It also credits five others, including PAHO's Jamaican representative and MOH's chief environmental engineer.
A year before that report, Amazon Treaty Organization's Regional Health Coordinator Luis S·nchez Otero investigated CRH staff exposure and found "problems confined to the first three floors ...", with no involvement of the wards. Suspected cause was a recent central air-conditioning reactivation without due maintenance.
But complaints increased. In September 2016, seventeen of 21 staffers seen at A&E manifested symptoms linked to indoor air-quality issues. Espino's report notes: "Recommendations were made for isolation and decontamination of affected areas, but there was an escalation of symptoms after the intervention ... . Several floors were affected ... ."
Suspicion regarding air conditioning was proven fallacious when a third incident occurred while attempting to clean air ducts: "The contractor brushed the glass fibre ducts, dumping dust and fungus spores in the interior of the duct along with glass fibres." Finally, this environmental assessment was sought.
Espino's findings regarding particle count levels in specific areas included:
"Recovery (Operating Theatre): very high;
Operating Room#2: very high;
Intensive Care Unit: very high;
Obstetrics (incubator room): very high"
Particle counts were "high" in obstetrics; the nursery, and the Central Sterile Supply Department. Mould was everywhere. Abundant Stachybotrys spores (usually less common than other mould species) were found in operating theatre ceiling tiles, while massive quantities of Mycelia (ducts - Ward 6 walls); Cladosporium spp (Ward 6 walls) abundant Cladisporium and Aspergillus/Penecillium-like spores (ducts - Level 2; HVAC room - Level 6) were also discovered. Glass fibres/other mould species were scattered throughout.
What does this mean? Centers for Disease Control and Prevention (CDC) published:
"In 2004, Institute of Medicine (IOM) found sufficient evidence to link indoor exposure to mould with upper respiratory tract symptoms, cough, and wheeze in otherwise healthy people; with asthma symptoms in people with asthma; and with hypersensitivity pneumonitis in individuals susceptible to that condition. IOM also found limited or suggestive evidence linking indoor mould exposure and respiratory illness in otherwise healthy children."
So what should managers of a PUBLIC HOSPITAL treating children daily be doing routinely to prevent mould development? What now that the frightening mould levels permeating CRH in March 2017 have already been allowed to develop?
CDC recommends (for ordinary residences):
"A common-sense approach should be used for any mould contamination inside buildings. Common health concerns from moulds include hay fever-like allergic symptoms. Individuals with chronic respiratory disease (e.g., asthma) may experience difficulty breathing ... . A qualified medical clinician should be consulted for diagnosis and treatment ... ."
But what if qualified medical clinicians work in a mould-infested building?
CDC continues about moulds:
"Growth occurs when there's moisture from water damage, excessive humidity, water leaks, condensation, water infiltration, or flooding. Constant moisture is required for its growth ... .
The most common indoor moulds are Cladosporium, Penicillium, Aspergillus, and Alternaria."
Most of the above saturated CRH in 2017. CDC on sources of mould:
"Mould spores may enter your house from outside through open doorways, windows, and heating, ventilation, and air-conditioning systems with outdoor air intakes."
Suppose mould has already entered and an extraction fan in an unused kitchen work together with poorly maintained elevators to distribute asbestos/fibreglass/mould fumes throughout?
"When mould spores drop on places [with] excessive moisture, such as where leakage may have occurred ... they will grow ... ."
CDC on the effects of mould:
"For [some] people, exposure to moulds can lead to ... stuffy nose, wheezing, and red or itchy eyes, or skin. ... Those with allergies to moulds or with asthma may have more intense reactions. Severe reactions may occur among workers exposed to large amounts of moulds in occupational settings ... . Severe reactions may include fever/shortness of breath."
Did MOH care to enquire whether any CRH staffers fall into any of these high-risk categories?
Independently, the World Health Organization (WHO) published mould guidelines in 2009 (for residential buildings):
- Persistent dampness/microbial growth on interior surfaces and in building structures should be avoided or minimised;
Indicators of dampness/microbial growth include condensation on surfaces or in structures, visible mould, perceived mouldy odour, and a history of water damage, leakage or penetration;
- As the relations between dampness/microbial exposure and health effects can't be precisely quantified, no health-based thresholds for acceptable contamination levels can be recommended. It's recommended that dampness and mould-related problems be prevented;
- Well-designed, well-constructed, well-maintained building envelopes are critical to the prevention/control of excess moisture and microbial growth. Moisture management requires proper temperatures and ventilation control to avoid excess humidity, condensation on surfaces and excess moisture in materials. Ventilation should be distributed effectively throughout spaces. Stagnant air zones should be avoided.
These are guidelines for ordinary homes. How much more due diligence would be required at a public hospital? So, now that Government's disregard for the most basic requirements of hospital maintenance and staffers' health is laid bare, what were the environmental hygienist's conclusions and recommendations IN MARCH 2017?
Among his conclusions:
- Stachybotrys (very toxic and highly allergenic) and Aspergillus (allergenic) fungi produce potent mycotoxins ... ; some are known carcinogens;
- Mould growth throughout [CRH] in air ducts, walls, roofs and ceiling tiles;
- There's an indicator that the fungi migrated from the exterior;
- Particle counts are very high. This is a problem in all clean rooms (surgery; ICU; nursery, dialysis, etc);
- Samples from inside air ducts indicate massive mould growth, dirt and loose glass fibres;
- The lab's ventilation system is inappropriate for the type of work;
- Industrial hygiene monitoring standard and methodology by MOH staff is unsuitable in a hospital setting.
While making 28 recommendations for remediation extending oceans beyond obtaining a new ventilation system, Espino wrote:
"Considering the hospital services cannot be suspended, we recommend the renovation/cleaning work be done in phases per area" and "since closing the facility for complete remediation is not a realistic option, the remediation should start immediately in a well-planned process that allows working in priority areas".
Espino, a Panama-based environmental hygienist, couldn't possibly have first-hand knowledge of any facts establishing the feasibility or otherwise of hospital closure or suspension of services. So those qualifications must've formed part of his instructions from MOH as to the parameters of his work upon which he based his recommendations regarding how to remediate.
It's laughable to suggest those were his independent professional views. Based on the severe dangers his report exposed, no environmentalist worth tuppence would create this hodgepodge remediation method solely to ensure staffers continued exposure to the acute risks his evaluation identified.
But not even Espino's compromise recommendations for well-planned, phased remediation was implemented as Minister Tufton spoke ONLY about "assessment" for more than a year despite at least two assessments available in 2016 and 2017. He's still talking about naming a team, not for Cricket World Cup, but allegedly to assess staff health when this was recommended by Espino in March 2017.
Espino also recommended immediate "remediation of all A/C units supplying air to clean units (operating rooms. ICU, dialysis rooms, nursery, etc.) ... by a competent IH team that can ... at the same time transfer technology, knowledge and experience to CRH/MOH".
Instead, Tufton focused, in 2017, on awarding government contracts to design and build a new ventilation system. May 2018: Operating theatre still toxic; ICU still toxic; nursery still toxic; Tufton still preening before cameras.
How many must suffer long-term health risks or die before government treats a sick CRH as advised? Recently, British Home Secretary Amber Rudd resigned because, according to BBC's political editor, Laura Kuenssberg, "However inadvertently, it seems she misled Parliament" on the Windrush fiasco. Will Tufton accept responsibility for CRH fiasco and resign? Or does Westminster only work that way at Westminster?
Peace and love.
- Gordon Robinson is an attorney-at-law. Email feedback to firstname.lastname@example.org.