Two months after officials declared an end to the deadly adenovirus outbreak at the Wanaque Center for Nursing and Rehabilitation, the state has yet to lift its restrictions on new admissions.
Department of Health officials told the facility the curbs will remain in place until new guidelines to prevent the spread of infection is approved. They also proposed a $20,965 penalty be imposed in connection with infection control violations identified by the state.
In addition, the health department also wants to know how the facility will address the need to isolate young patients who become ill in the future, according to letters sent to Wanaque administrators.
A cause of the outbreak has yet to be determined. But Wanaque was repeatedly cited for deficiencies in hand-washing and infection control, even after the outbreak, according to state and federal inspection reports. Adenovirus virus is spread through respiratory droplets or contact.
The Department of Health was notified of the outbreak on Oct. 9 and was soon on scene, inspecting the facility and later issuing enforcement orders. But documents released under a public records request shows that the Department of Human Services — which administers the state’s Medicaid program — did not react to the tragedy until NJ Advance Media broke the story that kids were dying.
The Department of Human Services in an email on Oct. 24 notified insurance carriers responsible for coordinating the care of residents of “concerns regarding a viral outbreak,” specifically citing an Oct. 6 story on NJ.com that first reported six children dead. They were instructed to get in touch with patients for whom they were responsible.
Asked about the delay in taking action, a spokesman said in a statement that the department responded as soon as it learned about the outbreak.
The Department of Human Services contracts with a number of insurance carriers in New Jersey that serve as so-called Managed Care Organizations, or MCOs, which coordinate the care and needs of patients at facilities such as Wanaque.
“The MCOs have been consistently monitoring and collecting details on each of their members prior to and since the outbreak,” said Tom Hester, a human services spokesman. “The department continues to monitor the situation and coordinate with all necessary parties to ensure a plan of care is in place for all members."
A RAGING INFECTION
The devastating outbreak that swept through the Wanaque Center in Haskell led to the deaths of 11 kids and infected 25 other residents, ranging from toddlers to teenagers. One staff member also was diagnosed with adenovirus, but recovered.
According to health department officials, the first kids to come down with the virus were diagnosed on Sept. 26. Adenovirus includes a number of respiratory virus strains that can cause mild or serious illness.
A series of state inspections of the facility in the wake of the outbreak uncovered failings in infection control. In one incident, a nurse touched the gastrostomy tube (a tube inserted through the abdomen that delivers nutrition directly to the stomach), and then removed her gloves, and touched the tubing connected to the patient’s tracheostomy tube and the ventilator machine without any hand washing, according to an inspection report. Others failed to change gloves between patients.
Following the inspections, the Department of Health issued an enforcement action temporarily prohibiting new admissions to the entire facility and a directive to immediately hire additional infection specialists.
In a letter to Wanaque, the state said it also is looking for a written plan to show how the facility will isolate residents who become ill should there be another viral outbreak. One of the issues that led to the spread of infections, experts have said, is that there was not enough space on the 92-bed pediatric unit to separate sick kids from those who had not been exposed to the respiratory virus.
Dondre Mills Jr. (l), Amaya Bryant (top right), and Dorcase Dolcin (bottom right), were among the 11 children who died in the viral outbreak. (Photos courtesy of the families)
In a statement through a spokeswoman for the facility, Rowena Bautista, the administrator of the Wanaque Center, did not respond to a list of questions, but said the facility has complied with the state’s directives.
“The outbreak has been over for some time. The Department of Health has found the Wanaque Center for Nursing and Rehabilitation to be fully in compliance with all regulations. In addition, we have submitted a plan to cohort patients in the event of a future emergency, as the DOH requested,” Bautista said. “Based upon all of these facts, we believe that the curtailment of admissions should be lifted any day.”
The state is preparing a report on the crisis at Wanaque and Sen. Joseph Vitale, D-Middlesex, chairman of the Health, Human Services and Senior Citizens Committee — who has already held a legislative hearing on the outbreak at Wanaque — said he is looking to see the Department of Health’s findings regarding the questions of what went wrong. He is also contemplating legislative changes.
“When we have the hearing after the report is released, we’ll have answers for all these questions,” he said.
Many parents and staff members have unanswered questions as well.
Interviews with those who work at the Wanaque Center, along with family members, complained that the facility had long been beset by chronic understaffing that only grew worse after it was sold in 2014. Two pediatric workers who asked not to be identified over fears of retribution said the lack of adequate help on the pediatric floor often meant kids in soiled diapers, or routinely left unbathed.
Others have alleged that the facility delayed sending sick kids to the hospital because administrators did not want to lose Medicaid funding when they were moved out — an allegation that the facility has strongly denied.
“Financial considerations and reimbursements never guide decisions about patient care at Wanaque,” said Bautista in her statement.
Ted Sherman may be reached at tsherman@njadvancemedia.com. Follow him on Twitter @TedShermanSL. Facebook: @TedSherman.reporter. Find NJ.com on Facebook.
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