It sounds like a ripped-from-the-headlines episode of "ER."
A Michigan City, Ind., emergency room physician contracts tuberculosis from patients he treated during a recent outbreak and then sues his hospital for reckless failure to notify him that those patients were infected.
Andrew Garlisi, M.D., 44, was a contract physician with Emergency Consultants at Saint Anthony Memorial Health Centers in Michigan City. Garlisi, who served as the emergency room's medical director for the 202-bed hospital for eight years, charged in his lawsuit filed April 7 in LaPorte County (Ind.) Superior Court that the hospital should have informed him and other hospital workers that patients they treated later tested positive for TB.
Garlisi, a board-certified emergency medicine specialist, also charged the hospital knew of a TB outbreak in 1998 but failed to provide or require appropriate precautionary measures. Three Michigan City TB patients died from complications of the disease.
Kenneth Allen, a Merrillville, Ind., personal injury lawyer representing Garlisi, said 20 patients the doctor treated late last year weren't known TB carriers when he treated them but were later diagnosed with the disease.
However, Allen said, they were later tested after having been referred to other specialists or having been admitted.
"The hospital should have informed ER staff so they could have been tested and treated right away," Allen said.
"There are medicines available now that Dr. Garlisi could have taken that would have drastically reduced the likelihood of his contracting the infection. But they didn't tell him, so he didn't know."
When it became apparent that the hospital was treating a higher-than-average incidence of the disease, Allen said, Saint Anthony should have taken other precautions, such as using a reverse air pressure room, isolating known TB patients and having healthcare workers wear protective masks.
Garlisi tested positive for tuberculosis in January but doesn't know when he contracted it or from whom, Allen said.
Allen said the injuries to Garlisi-and the compensation due him-are significant. He contends that Garlisi suffered personal costs and damages, and lost wages of more than $10 million.
"This is a pretty rough thing. (Garlisi) was on a very strict medicinal regimen-10 to 12 antibiotic pills per day. Nobody would ever want to expose their children, family and friends to this disease," Allen said. "He is not working now, and the hospital asked him to resign his position. It's going to be difficult for him to find a job (while) having TB. We've got to recognize there may be some level of disability."
Allen said Garlisi, who could not be reached for comment, wants Saint Anthony to develop better policies for treating TB patients and for informing and protecting hospital staff. He said Garlisi didn't believe the hospital would do that unless he filed the lawsuit.
Regarding Garlisi's going public, Allen said, "We hope this is a way to make a change."
Saint Anthony spokesman Michael Kelly said the hospital has a TB containment and information policy, which was in effect at the time Garlisi was treating patients.
Chief Executive Officer Bruce Rampage said the hospital has received a copy of the lawsuit and is reviewing it. "The hospital is very assertive and will participate with the county health department with regard to the disease within the community," Rampage said. "Beyond that we have no further comment at this time."
None of Garlisi's family or friends have tested positive for the disease, Allen said. No other hospital workers have tested positive either, according to state health department officials.
The national Centers for Disease Control and Prevention said Michigan City, a community of 34,000 about 60 miles east of Chicago, suffered a TB outbreak late in 1998. LaPorte County reported 21 cases of TB, nearly double the number of 1997 cases, and equaling 11% of Indiana's 188 reported cases. Its rate of 19.25 TB cases per 100,000 population was Indiana's highest, six times the state average.
Seventeen of those 21 cases were in Michigan City.
"Tuberculosis is a curable disease," said Wendy Heirendt, a CDC public health adviser assigned to the Indiana State Department of Health. "We don't expect anyone to die of TB. So when a death does occur, it's abnormal. This can be considered a high number of deaths."
She said the strain of TB circulating was not drug-resistant.
Garlisi is one of only six Indiana healthcare workers and the only physician in Indiana known to have contracted the disease.
Heirendt said the CDC and the American Hospital Association have guidelines requiring hospitals to isolate known infectious TB patients during treatment until they're no longer infectious.
She said while some of the patients had come to the hospital seeking treatment for other conditions, they did not come to the emergency room seeking TB treatment.
"The only patients who would go to the ER were patients who didn't know they had TB," she said. "Certainly a physician who knew he had an active TB patient coming in would take respiratory precautions, such as wearing a mask."
Ideally, she said, isolation rooms should be available for TB patients. Saint Anthony does have special isolation rooms, both in its ER and in the hospital, Heirendt said.
Because there are no TB clinics in Indiana, Heirendt said, public-private partnerships are essential. Local health departments work with hospitals to contain the disease.
Heirendt said the state health department saw a slow but gradual increase in the number of cases reported in Michigan City.
"We decided it was time to take a closer look at the situation," she said. "What we found was a geographic clustering of the cases, some of which had epidemiologic links to one another."
Carmen Quintana, a lawyer at the state health department, said hospitals must follow strict Occupational Safety and Health Administration requirements covering workplace protections.
"Hospitals have responsibilities under the law," she said.
But an OSHA spokesman in Indiana said the agency had not received a complaint about the incident and had not investigated it.
Richard Wade, senior adviser for communications at the American Hospital Association, said the Garlisi suit may be the first of its kind.
Spencer Grover, a vice president at the Indiana Hospital and Health Association who also serves on the state's tuberculosis advisory board, said the suit should remind hospitals to be vigilant against the threat of infectious diseases.
"It does happen. This is an airborne disease, and we ought to take precautions," Grover said. "It is something we all face as healthcare workers."
Roger King, a labor and employment lawyer with the Columbus, Ohio, firm Jones, Day, Reavis & Pogue, said he hasn't heard of a similar lawsuit in his 25 years of practice.
"Emergency rooms are inherently dangerous places," King said. "Physicians who work there assume the risks. They know anyone walking in could have a serious disease."
King said healthcare providers are charged with taking universal precautions to protect themselves, particularly during a known disease outbreak in the community.
"I don't see how he can lay all this on the hospital," said King, who added that hospital risk-management programs should re-examine their policies to ensure they're taking appropriate precautions.