Mon | May 21, 2018

Gordon Robinson | Cornwall tip of the iceberg

Published:Sunday | April 29, 2018 | 12:00 AM
Health Minister Christopher Tufton listens to a presentation during the sitting of the House of Representatives on Tuesday, April 24.
Cornwall Regional Hospital.
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The Jamaica Information Service (JIS) issued the following on April 10, 2018 (edited for word count only):

"... Hon Christopher Tufton has assured Government will continue to take a responsible approach in dealing with the situation affecting the Cornwall Regional Hospital (CRH).

"He noted 33 out of 38 services offered by [CRH] have been relocated to the Falmouth Hospital.

"'It has taken us a year to do it, (but) we had to engage in a number of activities in order to facilitate that relocation' he said ... ."

What exactly has it taken a year to do? Relocation? "Renovations"? Or talk?

On May 5, 2017, Minister Tufton (MOH) visited CRH and addressed staff. He announced two contracts had been signed. Regarding one contract, he said:

"We've been able to sign officially with the project manager. They [project team] will be on site very soon and will take control of management of the project through to completion. ... Part of that project management [will] be assessment of infrastructure, particularly as it relates to plumbing, electrical, the building itself in terms of leaks, and so on. They're also going to be playing a role in looking at process flow ... ."

 

Serious health hazards

 

So CRH needed "assessment", including of "process flow". Meanwhile, medical/ancillary staff continued to work at CRH daily exposed to serious health hazards.

Regarding Contract #2, he said it related to identifying an engineering firm to establish a new ventilation system:

"We've identified ... that entity and they [will] be mobilised in short order. ... They're going to be present in the facility now to start going through, looking and assessing, and they're expected to produce a design for a new ventilation system [which] we'll use to secure a supplier who will manufacture and install that system. We're expecting this phase to last about four months or so, and then after that, we go and get a supplier ... ."

Dangerous air pollutants may be killing you, but no problem, mon. No relocation; not even actual "renovations" required. We'll take a few months to "assess", then find someone to make a new ventilation system. Because, it's the ventilation system, stupid! In the meantime, just take deep breaths as you work!

On September 7, 2017, JIS issued another release headed "Renovations at Cornwall Regional Hospital on Track". MOH said:

"... We're on track with the renovations. We did say ... that we'd have most of the issues solved by the first quarter of next year. We're moving ahead with that. I would think most of the issues would be dealt with and the facility back up and running by [then] ... ."

Relocation, shmelocation! Just some bang on target renovations needed. By end March 2018, CRH will be good to go!

That JIS release stated: "The renovations are to address the problem of noxious fumes emanating from an old ventilation system ... .

"Minister Tufton said, ... 'I think we've been able to cauterise the problem and develop a road map for where we are, and it's now a work in progress.'

So, up to September 2017, the problem was still "noxious fumes emanating from an old ventilation system".

 

Leaked study

 

In March, 2018, after the UTech study of March 19, 2017, was leaked to media, almost the entire building was evacuated in less than 72 hours. Now we're told "relocation" took a year. DWL!

The misdirection continued. JIS's April 2018 release went on:

"Dr Tufton noted that steps are being implemented to remedy the situation at [CRH], which has been beset by air-quality issues."

AIR-QUALITY ISSUES? Ya think? But what's the source of these issues?

Tufton was quoted thusly:

"The main issue, the design of the ventilation system, has taken place and a contract has been awarded for a manufacturer of the system ... ."

Again, the VENTILATION SYSTEM? But, even if that was the problem, no new system has even begun to be built one year later. JIS rambles on:

"Other remedial works to take place include repairs to the hospital's roofing and redesign of some floors ... .

Dr Tufton expects that by the end of the year, repairs and improvements ... will be completed."

End of the year? What happened to the new system in place by end of March?

How did these "renovations"; "remedial works" to roof; and "redesign of some floors" respond to the concerns raised by the March 2017 UTech team report? That report was written by Dr Alverston Bailey, toxicology lecturer and occupational physician, and Michael Wilson, lecturer and industrial hygienist, after visiting CRH together with Professor Winston Davidson, head of school; Professor Homero Silva, lecturer and environmental engineer; the chief medical officer; and the health ministry's project director/director of Environment Unit.

 

Staff symptoms

 

Before the visit, that team reviewed medical/nursing staff's clinical symptomatology data and air-sampling data. This disclosed staff experienced symptoms affecting the eyes, upper/lower airway and skin along with headaches and dizziness IN SEPTEMBER 2016. On September 19, 2016, twenty-one staff members were seen in A&E. Prevalence rates by department: Medical records, 80 per cent; Pharmacy, 50 per cent; Physiotherapy, 80 per cent; Radiotherapy, 75 per cent; Radiology, 100 per cent; Urology Clinic, 100 per cent.

February 15-21, 2017, seventy-seven staffers (mainly doctors and nurses) from all floors were seen in the staff clinic. Presenting symptoms: rash, burning skin, itchy skin, eye irritation, nasal itching/burning, throat itching, tongue irritation, metallic taste, chest discomfort, shortness of breath, cough, hoarseness, dizziness, fatigue and headache.

The 2017 report refers to a 2016 report (did the minister see that one?) and states: "In contrast to the 2016 report, skin and eye irritation appears more pervasive ... . The presence of 'fibreglass' may have contributed to an increased frequency of skin and eye irritation."

Folks, this ain't simple ventilation. Sump'n eena sump'n!

"The symptoms appear to resolve upon leaving the building and atopic persons appeared to have exacerbations of their underlying predisposing condition. In addition, it appears that particles can be transported on clothing, which may explain exacerbations in atopic family members."

Not only was CRH staff endangered, but family members as well!

Some of the UTech team's findings were based on surveys by ESL Environmental Solutions Limited and The National Public Health Lab:

- Most locations encouraged mould growth.

- An odour of unknown origin was noted in the then unoccupied A&E!

- Most naturally ventilated areas had normal temperature and humidity with normal microbial load.

- ICU had the highest microbial count.

- Fibreglass was represented in more than 80 per cent of the ducts.

The UTech's team's independent findings were:

- The boiler room's boilers were corroded and could be a source of gassing of sulphur dioxide, nitrogen dioxide and carbon monoxide.

- The unused kitchen's floor was strewn with fibreglass and what looked like asbestos chunks. The team saw an extraction fan vigorously extracting air from this room to an unrestricted area.

- Third-floor air was toxic and heavy. Team members had acute coughing episodes before putting on N95 masks.

- Elevators were poorly maintained and could be an avenue for airborne toxicants permeating throughout the building.

The team recommended: "This is a very sick building and staff should be evacuated and relocated until the source(s) of airborne toxicants have been found, except for essential services."

This is NOT solely a ventilation problem. This is NOT a leaky roof problem. Asbestos is a carcinogen.

Based on symptomatology, the UTech team suggested: "The ... staff who have been evaluated so far ... have been exposed to any or all the air toxicants listed below: pulmonary irritants; pulmonary sensitisers; acute skin irritants; neurotoxicants; simple/chemical asphyxiants; and microbial volatile organic chemicals."

 

Multiple problems

 

THIS is what was put before MOH more than one year ago. The problem was NOT simply an old ventilation system. The report found: "Sources of air pollution within the hospital may include emissions of chemicals and microbial air pollutants from various sources such as: medical and diagnostic departments; heating; ventilating and air conditioning systems; personal and service vehicles ... ; renovations going on in the hospital itself and traffic outside the main building ... ."

Pause for a moment and think this through. Why's CRH so unlucky? Is it the only poorly maintained public-health facility in Jamaica? One urgent recommendation of the UTech team was: "UTech/MOH, in collaboration with PAHO, or another funding agency, should consider undertaking an IAQ study/research in all government hospitals/facilities."

That team's report, delivered in March 2017, detailed the health profiles of staff affected. What's MOH doing about that? He announced in Parliament on Tuesday, according to JIS: "A study is to be commissioned to examine the health profiles of staff who have reported being affected by air-quality issues at the Cornwall Regional Hospital (CRH) in St James."

Any idea when either study will happen? Are CRH staffers the only ones being risked on the altar of Goodman's Law? What's Goodman's Law? Don't ask if it's about the money. It's ALWAYS about the money.

Peace and love.

- Gordon Robinson is an attorney-at-law.

Email feedback to columns@gleanerjm.com.