Prepare for a pandemic

Q What should the lab be doing to prepare for a
pandemic like swine flu? What are our legal responsibilities if, for
instance, there is an outbreak of a contagious disease, and we are
overburdened and understaffed?

A Failing to prepare for catastrophic events can leave
an institution open to legal action. One would like to think that in the
wake of a disaster, the possibility of lawsuits would be would
eliminated. This is not the case. Recriminations and legal proceedings —
civil and criminal — followed Hurricane Katrina. Four years later,
healthcare facilities in the affected region continue to defend
themselves against bodily-injury and wrongful-death claims. The H1N1
(sometimes called swine flu) pandemic probably will not create as
precipitous an event, but the implications for care could be almost as
dire over time.

The prediction that a serious pandemic of major
proportions is in the works gives labs time to plan and prepare. In the
case of a pandemic, developing a continuity plan is essential.
Healthcare facilities are in a unique position — at the same time they
may be suffering losses of staff because of illness, they are the very
institutions charged with caring for the sick. If too many teachers are
sick, schools can shut down — but hospitals and their labs have to keep
working, even with short staffs. Short staffing itself does not set up a
potential legal situation, but failing to have a contingency plan to
make the best use of remaining resources could.

A good place to start is a rigorous cross-training
program, so technologists can cover one another in the case of an emergency.
Update policy and procedure manuals, and confirm these are easy to follow.
Record the location of necessary reagents and components. Make the
procedures easy for anyone to follow in order to facilitate matters if
temporary help needs recruiting. These “common sense” preparations should be
second nature for any laboratory. Ignoring them can set in motion a chain of
events that could not only compromise care but also end in a lawsuit.

Healthcare facilities are in a unique position — at the same time they may be suffering losses of staff because of illness, they are the very institutions charged with caring for the sick.

Current seasonal influenza vaccines do not protect
against the novel H1N1 virus, but H1N1 vaccines are expected to be available
by the end of October. In consultation with your infection-control
resources, offer vaccinations to staff. Keep in mind that an employer may
offer vaccinations but cannot compel them. Develop a plan for reducing
workplace exposure with strict hand-washing guidelines and clear policies
about sick employees not returning to work until past the contagion stage.
Just as with nosocomial infections, permitting an employee to work while
infectious with an easily transmitted illness like H1N1 could result in a
lawsuit if a patient contracts the illness. Check with the state health
department about the requirements for reporting infectious diseases and for
any special procedures that it has in place — or plans to implement — in the
face of the H1N1 pandemic.

The Centers for Disease Control and Prevention (CDC)
website posts the latest information about
case definitions, specimen collection, screening, confirmatory testing,
antiviral testing, and biosafety for laboratorians handling potential H1N1
specimens. The CDC recommends that laboratory workers who have occupational
exposure to confirmed infectious H1N1-flu material (akin to occupational
exposure to HIV material) be treated immediately with antiviral agents, so
make certain staff is trained on the signs and symptoms of the illness, as
well as the procedures for reporting and receiving treatment following
exposure. Failing to comply with recommended procedures can raise the
likelihood of liability if a technologist becomes infected and has a
protracted illness or dies as a result of suboptimal treatment or the
failure of the lab to offer post-exposure prophylaxes.

Biosafety procedures for H1N1 are somewhat different, so
provide adequate advance training for staff on appropriate safety measures.
Clearly define the epidemiologic and procedural triggers that might make
these enhanced safety procedures necessary. Communicate quickly and
effectively with staff at all times. Enforcing safety procedures is always
important but is particularly necessary in situations where an infection
like H1N1 can move out of the lab and be transmitted by relatively casual

Even during a catastrophe or pandemic, the lab is
expected to provide appropriate tests and accurate results — which can
stress the ability of the lab to function at normal capacity. Prepare a plan
for reducing services when necessary. Decide what tests, generally, are of a
lower priority. Develop a way to “triage” need and demand, and designate a
team to help manage staffing loads and test requests. Get the input and
approval of the medical staff, so, if and when the time comes, operations
can run smoothly and conflicts that threaten to delay and complicate lab
services can be avoided.

Barbara Harty-Golder is a pathologist-attorney
consultant in Chattanooga, TN. She maintains a law practice with a
special interest in medical law. She writes and lectures extensively on
healthcare law, risk management, and human resource management.

MLO’s “Liability and the Lab”is intended
to provide risk management and human resource management education; it
is not intended to provide specific legal advice. If you require legal
advice, the services of an attorney should be sought. Dr. Harty-Golder
welcomes your questions, which can be sent to her at
[email protected]
Unless otherwise noted as “confidential”
by readers, all queries will be considered for publication without
further notice to them. Names, institution, city, and state will be
removed before publication.