Award

MAINE RURAL HEALTH ASSOCIATION 2003 OUTSTANDING SERVICE AWARD

Recognizing the staff of Cary Medical Center for outstanding service to their patients and community in responding to the Arsenic Crisis which began on April 27, 2003.

A small community hospital in Northern Maine gained the attention of the country by the way that it handled the largest single event of Arsenic poisoning in medical history with quality and integrity. From their work, textbooks on Arsenic poisoning and treatment are being re-written. Never in history have so many patients received such an acute arsenic poisoning and lived to tell about it.

Beyond the quality of service and the relationships of the many agencies involved, we honor the special bond between the patients and their families and their community hospital. The community hospital is there as the people recover from the actual poisoning by the Arsenic and grapple with how such a thing could happen in their quiet and peaceful church and community.

Who can predict what will come into our hospitals? Our community hospitals and the local, regional, state, and national agencies with which they work must be ever vigilant and prepared, and must build and maintain the quality and integrity of the staff that was available at Cary Medical Center on April 27, 2003.

Arsenic Event
Cary Medical Center, Caribou, Maine
By Bill Flagg

Sunday, April 27th seemed like just another early late winter, early spring, or mud season day in Aroostook County. Dr. Dan Harrigan, Board Certified Emergency Medicine Physician at Cary Medical Center was arriving at the hospital for his overnight shift which began at 6:00 p.m. He arrived about 45 minutes early. Dr. Harrigan has been an Emergency Department Physician at Cary Medical Center over the past twenty years. As he approached the Emergency entrance he recognized a patient bending over with his hands on his knees in clear difficulty. Dr. Harrigan knew the patient, like he knows most of the patients that come to the Emergency Department. He recognized his wife who was coming to her husband's assistance with a wheel chair. The symptoms presented by the patient outside the Emergency Room entrance were to be repeated throughout the rest of that day, and into the late night as one by one church goers from New Sweden Maine began arriving to the hospital in various degrees of acute illness.

Three patients were already in the Emergency Department when Dr. Harrigan came on board. One patient, an elder of the Gustaf-Adolf Lutheran Church in New Sweden, was in critical condition. The patient had suffered serious heart problems earlier in the year. He had complications from a by-pass procedure but had recently been recovering. He was an avid golfer and had been talking to friends about getting ready for the 2003 Golf season at the Caribou Country Club. Later that Sunday night, after being admitted to the Intensive Cary Unit, the patient would lose his life from an illness that at first seemed to be like food poisoning. With his death early in the AM of Monday, April 28, Dr. Harrigan, who was the leader of the Code Team that tried unsuccessfully to resuscitate the patient, knew that the symptoms presented by the lost patient and others were more than a common food poisoning.

Throughout the evening, prior to the death of the patient, patient after patient, some 15 in all came to Cary Medical Center complaining of nausea, vomiting, and diarrhea. They all said that they had attended a church social following services at the Lutheran Church earlier in the day. Fortunately the patients did not all arrive at once. Most started coming at about the change of shift for nursing staff. Nurses who were there for the day shift volunteered to stay over until they had the odd incident under control. Families came too. They helped the nursing staff care for the multiple patients with uncontrollable vomiting. Soon a call went out to the State Bureau of Health to report the common symptoms of these many patients. Patty Carson , Infection Control Officer and Laboratory Technologist at the hospital, left her work in the lab to assist in the Emergency Department. She began taking histories of the patients. One by one it became clear that all the patients had at least tasted coffee that was provided at the Church Social. All reported that the coffee tasted bitter and in one case a person became ill just 15 minutes after drinking the coffee. It was clear to the staff in the Emergency Department that this was not a food poisoning but had to be something else. Dr. Harrigan narrowed the culprit down to a potential heavy metal poisoning. Early in the morning, at about 3:00 a.m. he called the New England Poison Control Center and was able to speak with Dr. Tony Tomasoni who agreed with him that a heavy metal was the most likely contributor to the illness.

In all, 16 patients were poisoned. One died. Eight patients remained at Cary Medical Center, seven were sent to Easter Maine Medical Center by Air Ambulance, including a fixed wing aircraft and life-flight helicopter. Cary Medical Center had a near full house before the Arsenic patients arrived and simply did not have the capacity to take on the additional patients. Severe drops in blood pressure and other critical vital signs also played a role in transferring some of the patients to the Tertiary Care Center in Bangor.

Within 24-hours it was determined that Arsenic was the cause of the patient's illness. Rarely in the history of such a poisoning has the specific element been determined so quickly. Thanks to 'Homeland Security' activity which had occurred only days before, stockpiles of the Arsenic Antidote, BAL Brittish Anti-Lewisite, and DMSA were in the State being prepared for distribution to Maine's Hospitals. The antidote medications were immediately shipped to Cary Medical Center and patients began to receive the treatment.

On Monday, April 28th, Dr. Carl Flynn, Board Certified Family Practice Physician and President of the hospitals Medical Staff arrived for his usual rounds at around 6:00 a.m. He was immediately brought up to speed on the Arsenic Event. Over the next 48 hours Dr. Flynn organized a plan for managing the patients and became the point person for the relaying of consulting specialists instructions. Dr. Flynn became the spokesperson for the patients and established a sense of trust and advocacy that lead to a highly compliant and consistent approach to their acute and long-term care.

Over the days and weeks the unfolding of the Arsenic Poisoning Event took on National and International Attention. The world was amazed that a small community hospital in Northern Maine experienced the largest single event of Arsenic poisoning in medical history and managed the incident so well. Thanks to the incredible contributions of so many hospital staff, state agencies, Eastern Maine Medical Center, local police, and the patients themselves, what could have been the largest serial killing in the State's history was avoided. The loss of one life was tragic. Patients and their church along with many hospital personnel held a Memorial Service for the patient who lost his life on the patient care unit where all the patients had been cared for. A special bond was created between these patients, their families and their community hospital. The story is not over. While a lone suspect who committed suicide just five days after the poisoning at the church social has been named, the State Police is convinced that others involved are still at large. Media interest continues and the patients are still in a state of recovery from the actual poisoning by the Arsenic and the poisoning of their spirit for how such a thing could have happened in their quiet and peaceful church and community. Today, the textbooks on Arsenic poisoning and treatment are being re-written. Never in history have so many patients received such an acute arsenic poisoning and lived to tell about it.

Who can predict what will come through the emergency department doors at one of these hospitals. Our community hospitals and the various local, state, regional and national agencies with which we work must be ever vigilant, ever prepared, and we must build and maintain the quality of our staff that was available at Cary Medical Center on April 27, 2003.