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The Scourge of Skid Row
A staph infection threatens the lives of cops, firefighters and homeless people. But don?t expect any help from county health officials
By CHRISTINE PELISEK
Wednesday, October 18, 2006 - 6:00 pm
Detective Tricia Hauck finished a burglary investigation at Pete?s Caf? and returned to the Central Division station near Skid Row. Her left foot started to feel uncomfortably warm. She wondered if it had anything to do with an ankle fracture she suffered on vacation in Mexico a few months earlier. Within a half hour, the warm feeling turned into pain so excruciating that her leg went numb. Unable to walk, the 39-year-old burglary-investigations supervisor was carried to a patrol car and rushed by her partner to an emergency room.
An MRI detected fluid around her bone. Later that day, a surgeon cut into her foot and removed an abscess. The diagnosis: Skid Row staph, or, more technically, a strain of methicillin-resistant Staphylococcus aureus that is sickening dozens of police officers, firefighters, health-care workers and homeless people. These cases pose a new challenge to county health officials, who so far have refused appeals by Skid Row care providers to step up help to the city?s most down-and-out population. Cops are so accustomed to seeing people with oozing boils that they call them Skid Row cooties.
Doctors inserted tiny tubes in Hauck?s foot to drain the curdled white pus. But the infection proved resistant to six antibiotics. Finally, on September 27, doctors prescribed the antibiotic of last resort ? vancomycin, which she takes intravenously at home, where she spends most of the day in bed.
Twice a week, Hauck?s nurses come to her home to change her IV lines. Doctors fear the infection is eating at her bones, and that her ankle may become so overtaken with bacteria that they will be forced to fuse together the bones in her ankle, rendering her unable to walk without help. Right now, the least of her worries are the medical bills; drugs and supplies alone total around $2,000.
Hauck believes that she caught the highly contagious bug at her station on Skid Row, which has become a giant petri dish for Skid Row staph. Nearly 1,500 homeless people living and sleeping on the streets, with little or no access to proper hygiene, soap or warm water, make it an ideal breeding ground for the bacteria.
?We work in a filthy environment with people who don?t practice good hygiene and are in and out of jail,? Hauck says. ?Officers use each other?s computers all night long. I have my hands on the tables in the interview rooms. Our floors are filthy. It is a huge thoroughfare. These wounds were exposed to my environment, which is as dirty as it could be.?
In 2005, staph infections hit at least 20 Los Angeles city firefighters, many of whom work on Skid Row. A staph infection landed a deputy city attorney, who works out of the Central Division police station, in the hospital for two weeks. An LAPD helicopter pilot, who helped a homeless man across the street, almost had to have his leg amputated. Two doctors working at a wound-care clinic got infected. A chaplain and a night manager working at the Union Rescue Mission got it. So did the director of public affairs and two other employees at Midnight Mission. Besides Hauck, a deputy chief and a rookie officer at LAPD?s Central Division have been diagnosed with Skid Row staph.
?It is very seldom discussed down here, but it is a big fear for my officers every day,? says Captain Andrew Smith. ?There are a lot of things that have been swept under the table, and we are really trying to shine a light on what is happening in Skid Row. I don?t think there is a lot of public awareness of this infection. We convened a meeting with the county one year ago and told them what our concerns are with the virus. I don?t think they were as concerned as we are.?
The Los Angeles County Department of Health Services is doing little to address Skid Row staph. Health officials rejected Midnight Mission?s request for a mobile health unit to monitor and treat homeless people. Instead, the health department gave homeless advocates fliers to pass out. ?The response was nowhere near what we expected,? says Orlando Ward, Midnight Mission?s director of public affairs, who contracted Skid Row staph, along with his wife and a co-worker. ?We are talking about the streets. People who are sleeping outside ? wearing the same clothes with untreated wounds. We need people to be educated across the board.?
Staph came on the scene in the 1960s, infecting nursing homes and hospitals, where some 12,000 people nationwide die from infections every year. Health officials do not track the number of staph-related deaths in L.A. County because, like the flu, cases do not need to be reported. The hospital version mutated into a community version that the Centers for Disease Control calls USA 300, dubbed Skid Row staph in this story.
In the mid-1990s, the community strain started creeping into nurseries, correctional facilities, homeless shelters, locker rooms and military bases. It was also popping up among drug users, gay men and children under 2. It was generally affecting people living in crowded conditions and dirty environments who had no access to good cleaning supplies.
Around the county, a spot check of hospitals shows a half dozen or more cases being diagnosed in some emergency rooms every week. ?It is now the single most common cause of skin infections, which is remarkable, because five years ago it was close to zero,? says Dr. Gregory Moran, clinical professor of medicine in the department of emergency medicine and the Division of Infectious Diseases at Olive View?UCLA Medical Center. ?It has quickly emerged as a cause of these infections in regular people out in the community. We now have showed that it is not just limited to people in specific risk groups. Now potentially everyone in the community is at risk. Healthy young people are getting it.? Moran says he sees one or two fatal cases of Skid Row staph annually.
Health officials do not even keep track of staph cases ? unless they amount to an outbreak, where many people are infected in a short amount of time. Such an epidemic rages in L.A. County?s seven jails, where up to 300 cases are diagnosed every month. Eleven months ago, the infection claimed its first known jail inmate, a 53-year-old Los Angeles man.
The bacterium that transmits staph can be passed through touch, shared surfaces and personal items like razors or towels. It can stay on clothes or bedding for five days. The infection often is dismissed as a large pimple, ingrown hair or a spider bite, but it comes on quickly and is extremely painful. In some cases, it looks more like a rash or cellulitis. Most cases are easily treatable with antibiotics; in rare instances, staph can cause blood, bone and lung infections.
The increase in cases acquired outside the jail has unsettled some city officials, who believe that the city and county are not doing enough to monitor it, and that they are downplaying its seriousness, especially on Skid Row. More and more of the cases seen in the jail system originated on the streets.
?It is hard to believe that nobody has died from it when I have two people in my station who are at death?s door because of it,? says Smith. ?One of my officers has been fighting it for weeks now. If I have two people out of 335 who nearly died from it, and these are young, healthy people with health insurance, I shudder to think of the people who are living in cardboard boxes and on the street that may be dying because of it.?....
The Scourge of Skid Row
A staph infection threatens the lives of cops, firefighters and homeless people. But don?t expect any help from county health officials
By CHRISTINE PELISEK
Wednesday, October 18, 2006 - 6:00 pm
Detective Tricia Hauck finished a burglary investigation at Pete?s Caf? and returned to the Central Division station near Skid Row. Her left foot started to feel uncomfortably warm. She wondered if it had anything to do with an ankle fracture she suffered on vacation in Mexico a few months earlier. Within a half hour, the warm feeling turned into pain so excruciating that her leg went numb. Unable to walk, the 39-year-old burglary-investigations supervisor was carried to a patrol car and rushed by her partner to an emergency room.
An MRI detected fluid around her bone. Later that day, a surgeon cut into her foot and removed an abscess. The diagnosis: Skid Row staph, or, more technically, a strain of methicillin-resistant Staphylococcus aureus that is sickening dozens of police officers, firefighters, health-care workers and homeless people. These cases pose a new challenge to county health officials, who so far have refused appeals by Skid Row care providers to step up help to the city?s most down-and-out population. Cops are so accustomed to seeing people with oozing boils that they call them Skid Row cooties.
Doctors inserted tiny tubes in Hauck?s foot to drain the curdled white pus. But the infection proved resistant to six antibiotics. Finally, on September 27, doctors prescribed the antibiotic of last resort ? vancomycin, which she takes intravenously at home, where she spends most of the day in bed.
Twice a week, Hauck?s nurses come to her home to change her IV lines. Doctors fear the infection is eating at her bones, and that her ankle may become so overtaken with bacteria that they will be forced to fuse together the bones in her ankle, rendering her unable to walk without help. Right now, the least of her worries are the medical bills; drugs and supplies alone total around $2,000.
Hauck believes that she caught the highly contagious bug at her station on Skid Row, which has become a giant petri dish for Skid Row staph. Nearly 1,500 homeless people living and sleeping on the streets, with little or no access to proper hygiene, soap or warm water, make it an ideal breeding ground for the bacteria.
?We work in a filthy environment with people who don?t practice good hygiene and are in and out of jail,? Hauck says. ?Officers use each other?s computers all night long. I have my hands on the tables in the interview rooms. Our floors are filthy. It is a huge thoroughfare. These wounds were exposed to my environment, which is as dirty as it could be.?
In 2005, staph infections hit at least 20 Los Angeles city firefighters, many of whom work on Skid Row. A staph infection landed a deputy city attorney, who works out of the Central Division police station, in the hospital for two weeks. An LAPD helicopter pilot, who helped a homeless man across the street, almost had to have his leg amputated. Two doctors working at a wound-care clinic got infected. A chaplain and a night manager working at the Union Rescue Mission got it. So did the director of public affairs and two other employees at Midnight Mission. Besides Hauck, a deputy chief and a rookie officer at LAPD?s Central Division have been diagnosed with Skid Row staph.
?It is very seldom discussed down here, but it is a big fear for my officers every day,? says Captain Andrew Smith. ?There are a lot of things that have been swept under the table, and we are really trying to shine a light on what is happening in Skid Row. I don?t think there is a lot of public awareness of this infection. We convened a meeting with the county one year ago and told them what our concerns are with the virus. I don?t think they were as concerned as we are.?
The Los Angeles County Department of Health Services is doing little to address Skid Row staph. Health officials rejected Midnight Mission?s request for a mobile health unit to monitor and treat homeless people. Instead, the health department gave homeless advocates fliers to pass out. ?The response was nowhere near what we expected,? says Orlando Ward, Midnight Mission?s director of public affairs, who contracted Skid Row staph, along with his wife and a co-worker. ?We are talking about the streets. People who are sleeping outside ? wearing the same clothes with untreated wounds. We need people to be educated across the board.?
Staph came on the scene in the 1960s, infecting nursing homes and hospitals, where some 12,000 people nationwide die from infections every year. Health officials do not track the number of staph-related deaths in L.A. County because, like the flu, cases do not need to be reported. The hospital version mutated into a community version that the Centers for Disease Control calls USA 300, dubbed Skid Row staph in this story.
In the mid-1990s, the community strain started creeping into nurseries, correctional facilities, homeless shelters, locker rooms and military bases. It was also popping up among drug users, gay men and children under 2. It was generally affecting people living in crowded conditions and dirty environments who had no access to good cleaning supplies.
Around the county, a spot check of hospitals shows a half dozen or more cases being diagnosed in some emergency rooms every week. ?It is now the single most common cause of skin infections, which is remarkable, because five years ago it was close to zero,? says Dr. Gregory Moran, clinical professor of medicine in the department of emergency medicine and the Division of Infectious Diseases at Olive View?UCLA Medical Center. ?It has quickly emerged as a cause of these infections in regular people out in the community. We now have showed that it is not just limited to people in specific risk groups. Now potentially everyone in the community is at risk. Healthy young people are getting it.? Moran says he sees one or two fatal cases of Skid Row staph annually.
Health officials do not even keep track of staph cases ? unless they amount to an outbreak, where many people are infected in a short amount of time. Such an epidemic rages in L.A. County?s seven jails, where up to 300 cases are diagnosed every month. Eleven months ago, the infection claimed its first known jail inmate, a 53-year-old Los Angeles man.
The bacterium that transmits staph can be passed through touch, shared surfaces and personal items like razors or towels. It can stay on clothes or bedding for five days. The infection often is dismissed as a large pimple, ingrown hair or a spider bite, but it comes on quickly and is extremely painful. In some cases, it looks more like a rash or cellulitis. Most cases are easily treatable with antibiotics; in rare instances, staph can cause blood, bone and lung infections.
The increase in cases acquired outside the jail has unsettled some city officials, who believe that the city and county are not doing enough to monitor it, and that they are downplaying its seriousness, especially on Skid Row. More and more of the cases seen in the jail system originated on the streets.
?It is hard to believe that nobody has died from it when I have two people in my station who are at death?s door because of it,? says Smith. ?One of my officers has been fighting it for weeks now. If I have two people out of 335 who nearly died from it, and these are young, healthy people with health insurance, I shudder to think of the people who are living in cardboard boxes and on the street that may be dying because of it.?....