County’s E. coli response questioned

Boy's aunt feels health department should have alerted the public




The aunt of 4-year-old Ronan Wilson, who died April 8 after contracting E. coli at his Hazel Dell in-home day care, said Wednesday she wants to know why the Clark County Department of Health did not let the public know about the outbreak until the day after Ronan died.

Savenia Falquist also questions why the day care children and their siblings continued attending school, possibly putting other children at risk, and why the health department did not at least alert health care providers about the outbreak.

When Ronan’s mother first took him to a doctor on March 29, the doctor did not think it was necessary to test for E. coli and diagnosed Ronan with the flu. Other parents of children at the day care have said they initially had difficulty getting doctors to approve a stool test, the only way to test for E. coli.

Falquist told Clark County commissioners at their monthly Board of Health meeting Wednesday that she’s trying to educate herself on the county’s policies for informing the public about communicable diseases.

“The intention is not to go after a county department that’s funded by the public,” Falquist said after the meeting. “What I really want to do is rule out complacency.”

Clark County’s public health officer, Dr. Alan Melnick, said after the meeting that health officials are reviewing how the case was handled and will give a comprehensive report to commissioners.

John Wiesman, the director of the health department, said the county typically only issues public health warnings when health officials can’t personally contact those potentially affected by a health threat. For example, a news release would be issued if a food services worker tested positive for hepatitis A and the county would have to warn people who ate at the worker’s restaurant.

He said health care provider alerts are sent out when there’s a specific group of known at-risk residents but the health department can’t contact them all. An example is an outbreak at a school.

A provider alert was not sent out about the E. coli outbreak at the day care because owners Larry and Dianne Fletch had contact information for all of the parents whose children attended the center, Wiesman said.

The day care has had its license revoked by the state Department of Early Learning, a move the Fletches appealed. According to the state, the Fletches waited too long to contact the county health department after children started becoming ill.

While no source of the E. coli has been confirmed, the state, in its letter to the Fletches that explained why their license was being revoked, suggested that the bacteria may have been brought into the home by an infant who had diarrhea for 10 days.

“The infant was identified as being one of the first children to exhibit symptoms of E. coli, and may have been the source of the illness,” wrote Darcy Taylor, licensing supervisor for the Department of Early Learning.

14 test positive

E. coli O157:H7 is the most common toxin-producing bacteria in North America. The original source of an infection is often cattle manure, which can enter the body with undercooked hamburger or unpasteurized milk or fruit juices. An infected person can spread the infection to another person through human stool, when people don’t thoroughly wash their hands after using the toilet or after diapering a child.

A total of 14 people at the day care tested positive for E. coli O157:H7 bacteria. Three were hospitalized and 10 people had mild symptoms.

Ronan, who was born 12 weeks premature and was sick a lot his first few years of life with colds and ear infections but was expected to outgrow other health problems, died after a week at Doernbecher Children’s Hospital in Portland.

A doctor initially didn’t think he had E. coli because he didn’t have bloody diarrhea; by the time that symptom showed four days later, he was admitted to Doernbecher.

The E. coli first attacked Ronan’s kidneys, then his colon. He didn’t wake up after surgery April 3 to remove part of his colon, and brain scans showed the E. coli had destroyed large sections of his brain. Anthony and Bonnie Wilson said during an April 24 interview that they knew when Ronan’s brain began swelling it was time to say goodbye, and Ronan’s ventilator was turned off.

Ronan’s death was the first from E. coli in Clark County since at least 1988, which is as far back as the state’s computer database goes.

Children who tested positive were not allowed to go to a day care until they had two negative stool samples, 24 hours apart, Melnick said Wednesday. He said older children at the center or older siblings of children at the day care were still allowed to go to school because there aren’t the same concerns about transmitting the bacteria with older children. There aren’t diapers being changed, for example.

“The kids are older, and their hygiene is better,” Melnick said.

There’s no cure for E. coli O157:H7, so doctors can only treat what it does to the body. Generally speaking, Melnick said, the course of treatment is hydration to help avoid kidney failure.

Falquist said she wants to make sure the county, when deciding on whether to send out public alerts or provider alerts, errs on the side of protecting its most vulnerable residents rather than worrying about causing panic.

“Information is what helps us advocate,” she said.