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HELENA — A former employee has filed a lawsuit against the hospital in Fort Benton, claiming the facility didn’t acknowledge or properly respond to a scabies outbreak and that the infestation spread while leadership at the hospital lied about it.

Shannon Walden, a former infection control coordinator, was fired Sept. 1, 2015, after she said she sent an email correcting the Missouri River Medical Center’s director of nursing over what Walden said was incorrect information about the outbreak.

Scabies is an infestation of the skin by the human itch mite, which burrows into upper layer of skin where it lives and lays eggs. It is transferred by skin-to-skin contact or contact with contaminated surfaces. It causes rash, bumps and blisters and severe itching. Those infected can have no symptoms for the first two to six weeks, but can still spread scabies during that period.

Walden is suing for wrongful discharge, saying she was terminated in retaliation for reporting a violation of policy and her firing was without cause. She is asking for four years of lost wages, benefits and interest. Four years is the maximum amount she can sue for in the state of Montana. She was earning $15,000 annually, including benefits, when she was let go.

Her job at the center was to oversee the prevention, spread and management of infectious disease among residents, patients and staff. Walden was supervised by director of nursing Janice Woodhouse and CEO Louie King. The center is a critical-access facility, with a hospital and emergency room. There are seven acute-care beds. It also houses a 45-bed nursing home.

Woodhouse, acting CEO at the center, didn’t return a call for comment Tuesday. Walden’s attorney, William P. Rideg, of Missoula, said he couldn’t comment on the case, which was filed in the 12th Judicial District Court in Choteau County.  

Reporting the outbreak

In March 2015, according to the lawsuit, Walden learned residents and staff at the center had scabies. She recommended the center proactively treat all residents, patients and staff, as recommended by guidelines published by the Centers for Disease Control and Prevention, as well as dermatologists at Benefis Hospital in Great Falls.

Walden, in court documents, said the center ignored her recommendations and the outbreak grew to affect between eight and 10 residents and staff. People in the community complained about the outbreak to the state Department of Health and Human Services, according to court documents. Officials from that agency made a site visit May 11, 2015.

During that visit, Walden said she told the state investigator she was concerned about how the outbreak was being handled. According to documents, Walden told the investigator that the director of nursing was concerned about the cost of treating the outbreak and not following CDC guidelines.

On June 23, 2015, Walden contacted the Occupational Safety and Health Administration over continued lack of response from the center. OSHA, a federal agency tasked with ensuring workers’ safety, visited the center a day later and had a meeting with the DPHHS inspector as well as Walden to review the scabies case log and discuss Walden’s concerns, including using scabies medication to treat what the center called “rashes,” despite recommendations to label the rashes as scabies.

By July 16, 2015, Walden had contacted OSHA again and an investigator made another visit July 22. In the lawsuit, Walden cites these visits as the cause of friction with her employer. “Ms. Walden’s ongoing questioning of The Center’s response, and her repeated engagement with DPHHS and OSHA, was looked upon unfavorably by The Center’s administration,” court documents say.

Fired

Things had not improved a month later, when on Aug. 24, 2015, Walden sent an email correcting statements made by Woodhouse, the director of nursing, during a conference call with physicians and the infection control department at Benefis in Great Falls. According to court documents, Walden sent an email saying that Woodhouse had lied about the number of scabies cases at the center.

That same day, the center’s Board of Directors held a meeting with several administrators and staff. According to documents, at that meeting the directors decided to fire Walden. Documents say the firing was because of a “required reduction in workforce and budgetary shortfalls.” Walden was not at the meeting, nor given immediate notice of the action.

Walden was told Sept. 1 that she had been fired and asked to leave the center immediately. According to documents, the center’s policies call for two weeks’ notice prior to termination. The center has never given Walden written justification supporting her termination, she said.

Walden was hired by the center in March 2004 and was promoted to the position of infection control coordinator, a job she held for six years. Documents say she received positive performance reviews and bonuses.

Outbreak details

A report from the DPHHS Certification bureau summarizing deficiencies at the center provides more information about the scabies outbreak.

Of six residents sampled, all six showed signs of scabies. Most of the residents infected had lived at the center for at least two years and one had been there nearly six.

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Residents were treated with several creams, some of which are specifically for scabies and some meant to address general skin issues such as crustiness and scaling. Some residents’ treatment was designated as prophylactic.

The report notes that medical records were not detailed or well kept for some patients and often didn't note the progress of treatments or initial assessments of rashes.

For example, the report shows a resident who had lived at the center almost two years was ordered to be treated with a cream used to treat itching, crusting and scaling, though not specifically scabies. That was applied on May 10, 2015. On May 21, a doctor ordered a scabies screening, but it was canceled and the doctor instead completed a skin-scraping procedure to test the skin infection. After, the doctor ordered a cream used to treat scabies be applied to the resident’s skin. The doctor did not clarify in medical records what the skin test was for, and a nurse documented the test was positive but did not clarify what it was positive for.

The report shows a lack of isolation measures, including one resident who left the facility for a community function after being treated for a skin infection. A certified nursing assistant who was tested and treated for scabies thought she was infected while caring for a resident.

A housekeeper voiced concerns at a facility management meeting regarding lack of precaution signs posted in resident rooms, according to the state report. That person also said the housekeeping department had delays in communication regarding cleaning and sanitizing needs for residents with transmittable cases.

A nurse’s chart for one resident said the resident had a “confirmed” case of scabies, but documentation didn’t show if steps were taken to ensure bedding, clothing and other items were cleaned and sanitized to avoid cross-contamination. The facility identified the resident had scabies in the morning but that person was not put into isolation until several hours later.

Records show the director of nursing and assistant director of nursing believed one resident was exposed to scabies from a bathroom she shared with another resident.

The federal Centers for Medicare and Medicaid designates the state Certification Bureau to serve as the state survey agency. The bureau conducts surveys at Montana facilities that accept Medicare and Medicaid payments to make sure these facilities meet federal regulations.

The bureau conducts three types of surveys; the one at the Fort Benton facility was a complaint survey, which is done after the bureau receives a complaint.

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