Published Tuesday    December 2, 2008
What killed Bellevue woman? Family says E. coli

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A Bellevue woman and her husband say her mother's death should warn hospitals and doctors that bloody diarrhea can be a sign of deadly E. coli.

Ruby Trautz died in August 2006 during a large, nationwide E. coli outbreak involving tainted spinach.

Her daughter and son-in-law, Polly and Ken Costello, have sued Creighton University Medical Center, Creighton University and Creighton physicians, saying they misdiagnosed Trautz's case.

Although the suit calls for financial damages, the Costellos say what they really want is for Creighton to establish a protocol in which a patient showing bloody diarrhea automatically is tested for E. coli.

They also want a Creighton physician to change the death certificate, which currently says Trautz died of a bacterial infection called clostridium difficile. Federal and state officials include Trautz, 81, among those afflicted in the E. coli outbreak.

"I don't think we're asking for a lot, but we're also pretty inflexible," Ken Costello said.

The Costellos say they might drop the suit if their demands are met. They also want Creighton to create an educational video about the importance of E. coli testing.

The university said through a written statement that it is "vigorously defending" itself and that the case is without merit. Hospital representatives, also through a written statement, said they had reviewed the case extensively and found the Costellos' case devoid of merit.

It is not clear whether other area hospitals automatically test for E. coli when a patient arrives suffering from bloody diarrhea. Nebraska Medical Center and Alegent representatives declined to discuss the matter because it pertained to a lawsuit.

But Dr. Bret Nicks, an emergency room physician and a spokesman for the American College of Emergency Physicians, said such testing is not the "standard of care," or typical, prudent practice.

There are too many other conditions that can cause such a symptom, Nicks said. He is an emergency room physician at Wake Forest University's Baptist Medical Center in North Carolina.

The Costellos said they have talked with the Creighton doctor who signed the death certificate, but he has refused to change his finding. Creighton lab tests did find that Trautz had clostridium difficile, which Dr. Dan Schuller listed as the cause of death.

The Costellos say it galls them that Schuller won't change the death certificate even though the federal Centers for Disease Control and Prevention and Nebraska's state epidemiologist, Dr. Tom Safranek, counted Trautz among those sickened by the bad spinach.

Safranek said he was certain that Trautz was afflicted by the spinach. Spinach in the Costellos' refrigerator was tested and showed the identical genetic fingerprint for E. coli as the E. coli in the outbreak. Trautz lived with the Costellos.

Safranek said that if a patient in the emergency room has abdominal pain, nausea, vomiting and bloody diarrhea, it would be reasonable to test that patient for E. coli. Trautz had those symptoms.

The Costellos also have no doubt that Trautz died of E. coli 0157:H7 from some of that spinach, which they had eaten in salads in August 2006. That form of E. coli is a strain of bacteria that can infect people through food or beverages contaminated by animal manure acquired in the field.

Ken Costello said he was sickened by the spinach, too, although it was days after Trautz's death that news emerged of the outbreak and the Costellos made the connection.

No test results for E. coli were completed on Trautz at Creighton, according to the lawsuit.

Ultimately, several people nationwide died from the tainted spinach and more than 200 became ill in 26 states.

The Costellos said they decided to sue after they were frustrated by a couple of meetings and an exchange of letters with Creighton Medical Center and university representatives.

Ken Costello said he also had a phone conversation with a university attorney. Letters from the university and the hospital show sympathy but don't say changes will be made.

The Costellos said they envisioned Creighton creating a video about E. coli testing and diagnosis. The video would be similar to one Methodist Hospital of Omaha created when a young man died there after his aortic dissection, or tear in the lining of the aorta, was misdiagnosed.

Methodist Hospital now makes the video available nationwide for no charge to health practitioners who seek insight or continuing education credit.

Attorney Van Schroeder, who represents the Costellos, said that in a Nebraska medical malpractice case, the only reward, or "remedy," is financial damages.

"They would prefer to have Mrs. Trautz's legacy be one of learning," Schroeder said.

The Costellos and some other families settled out of court with the California spinach producers.

Ken Costello said he would like to meet with top administrators at Creighton and resolve the matter.

"They just haven't told us anything," he said. "The only way things change is when somebody gets sued."



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