Stanford Hospital sued after donor acquires infection

The pool and fountains at Stanford University Medical Center

So, Stanford University Medical Center and all it’s various sub-entities are being sued by a blood donor who believes an infection he suffered was the result of giving blood. The details are scarce, but allow me to discuss some problems with the scenario. First, let me just say that I in no way intend to make light of Mr. Bui’s (the plaintiff) plight or the suffering he’s gone through, or to suggest that Stanford handled the situation in the right way because, honestly, they probably suck as much at providing compassionate care as any other Administrator-helmed, for-profit facility. Before anyone jumps down my throat, “not for profit” on paper doesn’t mean the CEO doesn’t make $500,000+ a year. But America’s health care system is not the topic of this post.

I’m assuming it was a Staph infection that Mr. Bui contracted, resulting ultimately in the removal of his collarbone. How he came to the conclusion that donating blood was the cause would probably be best answered by his attorney, Joseph Carcione, Jr.. I’m not aware of any pathogen associated with sterile blood collection devices, possibly Mr. Carcione’s vast medical training as a lawyer leads him to think otherwise. Staph, however, lives just about everywhere else. Especially your skin. As a blood donor’s arm is vigorously sterilized (as in killing everything) with a chemical called povidone-iodine before that equally sterile needle goes into it, it seems much more likely to me that Mr. Bui picked up the infection shaving that morning, or from a hangnail, or any other break in his skin that hadn’t been sterilized. In any case, the source of Mr. Bui’s infection was environmental, most likely the bug was growing on his own skin, and not the needle.

There are ways of checking to see if it is likely that Mr. Bui’s donation caused the infection.

Most obviously, did that unit of blood cause an infection or reaction in the person who received it? If it grew in Mr. Bui, it would most likely grow in the blood that came out of him also. If so, the FDA would be made aware, as it is required that all such events be reported. If random platelets were manufactured from Mr. Bui’s donation, this would be the most likely product contaminated, so start there. Platelets are stored at room temperature (as opposed to red blood cells, which are stored at 4-6 C) and bugs love to grow in them. It would be very serendipitous if Mr. Bui’s unit of platelets were further selected for quality control testing (a certain number of this product must be tested monthly for bacterial growth, among other checks, as mandated by the FDA). Of course, if the recipient were taking antibiotics this check wouldn’t be much help.

Locate the source of Mr. Bui’s infection. I’ll give 10 to 1 odds that it is still growing somewhere on Mr. Bui, like behind his ears. Bacteria have “fingerprints” just like people, and molecular techniques can identify bugs to that degree of specificity. If the bacteria were resistant to the -cillins (i.e. MRSA), so much the better. It will most assuredly still be growing on Mr. Bui, once you’re colonized with MRSA you’ve pretty much got it for good.

Does the Stanford Donor Center have a record of problems infecting donors or drawing blood contaminated with bacteria? The literature reports 1 in 225,000 blood donors experience local infection (incidence of septic infection not reported but likely much much lower) following their donation (see also Roback JD, ed. AABB technical manual. 16th ed. Bethesda, MD: American Association of Blood Banks Press; 2008: p195). Is Stanford’s record worse than this, indicating a local problem with the staff not properly sterilizing the site prior to phlebotomy?

I could go on and on and none of this will prove one way or another where Mr. Bui’s infection came from, but the point is there are many, many more or equally likely sources of the infection than his blood donation. Donors and potential donors need not fear that donating blood will make them sick and (again not excusing Stanford for their treatment of Mr. Bui and not suggesting their asses shouldn’t be sued) such media pandering on the part of his attorney can only cause harm to the very community Mr. Bui so generously donated of himself to help. Any benefit from his previous blood donations has now been negated, and then some, by the loss of future donations that will result from Mr. Carcione’s sensationalism.