In Barry Levinson’s (terrific, scary) eco-horror movie “The Bay,” slug-like sea creatures mutated by toxic waste eat their way through the faces and bodies of the residents of a Chesapeake Bay community, as medical authorities carefully keep the story under wraps from the rest of Maryland and the nation. At the National Institutes of Health Clinical Center in Bethesda last year, a different kind of monster bug was on the loose: the antibiotic-resistant bacteria known as Klebsiella pneumoniae. For six months the bacteria spread, eventually infecting 17 NIH patients, killing at least six of them. Doctors took extraordinary precautions to keep the so-called “superbug” from getting out into the population, but such measures didn’t include telling the city, county or state what was happening, or informing non-physician staff, many of whom were at risk of infection, about the bacteria outbreak. The full story didn’t come to light until August of this year, when NIH researchers published a scientific paper describing the advanced genetic technology they used to trace the outbreak.
After heavy criticism from the press and the community in the wake of the revelations, NIH has announced a new agreement that commits it to notify Maryland and Montgomery County officials of any potentially high-profile diseases or outbreaks, even those that do not pose an obvious public risk. That’s nice, but the question remains: why is such an agreement necessary? Isn’t it obvious that the state and county, as well as the public, have a right to know when there has been an outbreak in its midst? Shouldn’t the NIH have alerted local officials as a matter of responsibility, common sense, fairness and transparency? The Washington Post article yesterday about the new accord states that NIH officials cite three reasons why they kept the fact of the outbreak secret: 1) Healthy people outside the hospital were at “minimal risk.” 2) The infection was not among the infectious diseases required to be reported to the federal Centers for Disease Control and Prevention, and 3) NIH is not required to report health-care-acquired infections and certain other diseases to the state because it is federal facility not licensed by Maryland. In other words, the NIH kept the outbreak secret because the laws and rules allowed it to do so, not because doing so was fair, reasonable or ethical. This is the rationalization known as The Compliance Dodge. No laws were broken; we followed the rules to the letter. It is the calling card of Oliver Wendell Holmes’ “Bad Man,” the law-abiding citizen who only does the right thing if he is forced to or threatened with punishment.
What this incident shows us is that the present management of the National Institute of Health must have a law, regulation or rule in place that thoroughly covers the facts of each unexpected or unprecedented crisis, or it is liable to act to keep its reputation clean and to avoid alarming publicity, even if this means subjecting the community around it to health risks without its knowledge or consent. It can be trusted to do the right thing only if there is a formal penalty hanging over its head for not doing it.
That is just the long way of saying that the NIH can’t be trusted to do the right thing. Don’t be fooled, Maryland.
Pointer: Grace Marshall (Thanks, honey!)
Graphic: Planet of Terror
Ethics Alarms attempts to give proper attribution and credit to all sources of facts, analysis and other assistance that go into its blog posts. If you are aware of one I missed, or believe your own work was used in any way without proper attribution, please contact me, Jack Marshall, at firstname.lastname@example.org.