Last year, events, conditions and responses at the Wanaque Center for Nursing and Rehabilitation in Passaic County combined to kill 11 children. The case and the consequences for the center and its officials provide serious warnings to other providers of care to those most at risk.
The Wanaque Center experienced an outbreak of adenovirus in late summer. That’s a common virus, so outbreaks of it aren’t unusual, and it typically causes cold-like symptoms, including sore throat, bronchitis, pneumonia, diarrhea or pink eye. But this strain, one of at least 49 types of adenovirus, was more harmful.
Tests at New Jersey’s other four pediatric long-term care facilities found several cases of adenovirus at Voorhees Pediatric Facility in Camden County — but fortunately, a milder strain that killed no one there.
The facilities care for children with severe disabilities who need constant support to survive even when they’re not infected or otherwise ill. Many are on ventilators for breathing.
The layout of the Wanaque Center’s respiratory unit had a problem — the placement of the medically fragile children in the unit made it difficult to safely separate them, an appropriate response in such an outbreak. The state has barred the unit from accepting new admissions until that is remedied.
The final significant factor was reported by a federal investigation into the tragedy. It said the outbreak was made worse because Wanaque Center officials hadn’t planned for such an outbreak and didn’t respond to it quickly enough. Investigators said the center’s pediatric medical director told them he wasn’t sure of his job responsibilities and didn’t know how many children were infected at the time of the outbreak.
The federal Centers for Medicare & Medicaid Services (care for many of the center’s patients is funded by Medicaid) imposed a $600,000 fine on the Wanaque Center. The center’s attorney said it disputes the facts and accuracy of the federal report and will appeal the federal findings.
Families of children who died or were sickened in the outbreak have filed suit against the center. Once the federal report was made public, they added the center’s medical director to it.
Officials at other nursing and rehabilitation centers in the state don’t need to be told to review their operations to ensure they would respond appropriately to the outbreak of a surprisingly strong pathogen. We feel confident they’ve already carefully examined the Wanaque Center case for lessons to benefit their centers and their patients. The resolution of the joint lawsuit will provide another reminder.
Dr. Shereef Elnahal, commissioner of the N.J. Department of Health, said he has set a new internal policy requiring centers to notify him and his principal deputy immediately if a pediatric death has occurred. In fairness to the Wanaque Center, when it notified the department just two of the children had died, so the timing might have been similar. But formalizing and clarifying the notification requirement is appropriate.
The state should also look at how the Wanaque Center was allowed to build and operate a respiratory unit whose layout interfered with safely separating the children. The Department of Health needs to ensure that doesn’t happen at nursing and rehabilitation centers before there’s an outbreak.