WINNEBAGO, Neb. | The clinical director of the Winnebago Indian Health Service hospital conceded Thursday that public confidence in the tribal hospital has been further shaken following reports that up to 35 podiatry clinic patients may have been inadvertently infected with diseases that include HIV and Hepatitis.
Between April 17 and June 2, a podiatry instrument was not properly sterilized between procedures, raising concerns of blood-borne diseases potentially being transferred from patient to patient, according to the hospital. The podiatrist responsible for the error has since been terminated, and the clinic remains temporarily closed.
"I don't know if they're going to trust us. I don't know when we get the trust back," said Dr. Virgilio Cantu, clinical director of the Winnebago hospital, which serves members of the Winnebago and Omaha tribes of Nebraska.
Winnebago Tribal Council Chairman Frank White said the embattled hospital didn't have a vote of confidence from the community to begin with.
"The trust -- it wasn't there before, and this just makes it worse," White said.
White rattled off a myriad of shortcomings at the hospital, operated by the Aberdeen, South Dakota-based Great Plains Area Indian Health Service, dating to well before the latest disclosure.
"In recent years, we've had deaths at the service unit due to incompetent staff," he said.
Root of the problem
The Center for Disease Control and Prevention (CDC) is investigating the latest incident, which Cantu blamed on Dr. John Horblein. Horblein started working in Winnebago in April after the hospital contracted with Arizona-based AB Staffing Services for podiatry services after the hospital's previous podiatrist left.
"During the course of his treating patients, it came to our attention that sterilization of the scalpel handle would not occur between patients," Cantu told reporters Thursday. "That can cause an infection."
The blade of the instrument, Cantu noted, was sterilized between procedures, which reduced the chance of infection.
"The risk, although it's minor, it's very small, it's still a risk," he said.
The hospital's investigation found 35 patients had undergone invasive procedures during that time period. None are currently known to have contracted a disease as a result of the contamination.
The hospital contacted the CDC and the Nebraska Department of Health and Human Services, which advised that all patients be tested for Hepatitis and HIV.
"I'm going to say it this way: we reviewed the records of all the patients that were seen in the clinic, and of those 35, no one had any signs or medical history that indicated they had Hepatitis B, Hepatitis C or HIV," Cantu said.
A nurse noticed the physician had improperly sterilized the instrument. The clinic closed June 3, a day after hospital officials were notified of the problem, Cantu said.
Horblein was immediately dismissed from the hospital. Cantu said Horblein is under evaluation, but he is uncertain whether he remains licensed or is still practicing.
As of this week, he said, the hospital began testing patients for possible infection. If any of the patients are found to be infected with HIV or Hepatitis, Cantu said the hospital is ready to help. Hospital officials are considering working with a group of specialists at the University of Nebraska Medical Center.
Cantu attributed bureaucratic processes for the more than two-month delay in disclosure the matter to the public.
"It was very quick, I've never seen it operate this fast," Cantu said. "But still it caused a bit of a delay. And I guess that's what everyone verbalizes -- 'Why did it take so long?' We want to make sure we had the correct information."
Cantu said it would not have been prudent to administer HIV or Hepatitis tests earlier because the tests can't detect antibodies before a certain amount of time has passed.
"If we were to say, 'We think you've been exposed, come in for testing,' on the fifth or on the sixth, two days, three days later, our immune system hasn't had a chance yet to develop a response," Cantu said. "Any testing we would have done, would have been negative. And the patients would have been sent home thinking, 'My tests are okay.'"
White, the Winnebago tribal chairman, clearly was not happy that it took so long to disclose the incident.
"I believe that they should have shared this with the tribal leaders, at least make us aware of it," he said.
As Cantu got ready to leave the Blackhawk Community Center, he and White exchanged parting words. There was an audible stiffness.
"We'll be in contact," Cantu said to White.
"Yes, we will," White replied.