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methicillin-resistant staphylococcus aureus, or its more common designation, MRSA, is highly sensitive to that particular preparation,” Cynthia shot back, as if it were a fact everyone should know.
    â€œLet’s not get testy,” Angela said. She wanted to keep the meeting friendly and, she hoped, productive. “We are all on the same page here. No one is casting aspersions. What else has been done?”
    â€œEvery hospital room that has seen an infection has also been similarly treated,” Cynthia said. “More important, perhaps, as you all know, every member of the medical staff and every employee of the hospitals are cultured on a recurrent basis, and those who test positive as a carrier are treated with mupirocin until they test negative.”
    â€œAlso at great expense,” Bob added.
    â€œPlease, Bob,” Angela said. “We are all aware of the expense side to this disaster. Cynthia, continue! Do you think culturing and treating the staff and employees is critical?”
    â€œAbsolutely,” Cynthia said. “And we might consider the same for patients as a prelude to admission. Both Holland and Finland had a particularly bad problem with MRSA, and the way that they brought their problem under control was by treating both staff and patients: anyone who tested positive as a carrier. I’m beginning to wonder if we might have to do the same thing. Yet my real concern is that the MRSA is occurring at all three of our hospitals. What does that say? It says that if a carrier is responsible, then that carrier must routinely visit all three hospitals. Consequently, I have as of today ordered the testing and treating of all employees from even here at the home office who regularly visit all three hospitals, whether they have actual patient contact or not.”
    â€œAnything else?” Angela asked.
    â€œWe have mandated aggressive hand-washing after each patient contact,” Cynthia said, “particularly with the medical staff and nursing personnel. We’ve also instituted strict isolation for all MRSA patients, and more frequent changing of medical staff clothing, such as white coats and scrub outfits. We also require more alcohol cleaning after each use of routine equipment, like blood pressure cuffs. We’ve even cultured all the condensate pans of all the HVAC air handlers in all three hospitals. All have tested negative for pathogens, especially the strain of staph that has been plaguing us. In short, we are doing everything possible.”
    â€œThen why haven’t the doctors been admitting patients?” Bob questioned. “As they are all owners, they have to be aware they are taking money from their own pockets by not doing so, especially if we go bankrupt.”
    â€œI don’t want to hear that word,” Angela said, having already been through that demeaning experience.
    â€œIt’s clear why they are not admitting,” Stewart said. “They are terrified of their patients getting a postoperative infection despite all the infection-control strategies. With reimbursement solely based on DRGs, or diagnostically related groups, patients getting a postoperative infection directly cuts down on their productivity, and it is productivity that determines their income. Besides, there’s the malpractice worry. Several of our plastic surgeons and even two of our ophthalmologists are being sued over these recent staph infections. So it’s pretty simple. Despite being equity owners, it makes economic sense for them to go back to University or the Manhattan General, at least in the short run.”
    â€œBut all hospitals are having trouble with staph,” Carl said, “particularly methicillin-resistant staph. And that includes both the University and the General.”
    â€œYeah, but not over the last three months, nor at the rate we have been seeing it,” Herman said. “And despite all these efforts that Dr. Sarpoulus