|FEATURE | spring 2007
Former political leader Betsey McCaughey crusades against the dirtiest secret in hospitals today
When Betsey McCaughey,
New York’s former lieutenant
governor, read about the
death of a young man who had been
mugged, she jumped in her car and
drove 40 miles to console his mother.
Brad Moore of Washingtonville,
N.Y., had suffered brain trauma during
the assault, yet it wasn’t the head
injury that killed him. Moore was on
the mend after his attack, making
steady progress. But while hospitalized,
he suffered a second assault, this
time by microbes that inhabited the
hospital. “Superbugs” overwhelmed
the weakened 28-year-old and
snuffed out his life.
“That’s when I knew it was time to
stop writing about the problem and
start doing something about it,” says
McCaughey, recalling the moment
five years ago that crystallized how
she would take on America’s hospital
So she founded the nonprofit
Committee to Reduce Infection
Deaths—RID—and began to train a
spotlight on the infectious agents that inhabit hospital bedrails, lurk on stethoscopes
and thrive even on the gloved hands of healthcare workers. Her foes
are not the big-name bugs capturing headlines, such as E. coli or bird flu, but
those whose names many media outlets find too complex to lead the news.
It’s a complex undertaking, but McCaughey (pronounced McCoy) is herself
as complex as a Rubik’s cube. She’s a think-tank scholar and expert on healthcare
reform who was drafted by New York Republicans in the early 1990s to
become a high-profile candidate. She was a card-carrying Republican who
then became a Democrat and ran against her former boss. Now, McCaughey,
58, is deeply entrenched in what she calls her most challenging campaign yet.
What may seem the concern of a bygone era is, in fact, one of the most pervasive
problems facing health-care facilities throughout the United States. Patients
can be admitted to hospitals for anything from a knee replacement to
cancer surgery and wind up with an invasive infection that proves lethal.
Through her advocacy, McCaughey has helped expose one of the dirtiest secrets
in hospitals today.
“I loved campaigning but I actually prefer campaigning against germs,”
McCaughey tells Ms. “The problem is enormous. One out of every 20 people
admitted to a hospital is affected.” Hospital-acquired infections add an estimated
$30.5 billion to the nation’s annual health-care tab in hospital costs
alone, and many of those costs are passed on to consumers as higher health-insurance
FIVE WAYS TO AVOID HOSPITAL INFECTIONS
In addition to demanding that health-care workers sanitize their hands
before treating you, the Committee to Reduce Infection Deaths (RID)
emphasizes several other ways patients can help prevent infections.
1. Before a health-care professional uses a stethoscope, ask that the
instrument’s flat surface be wiped with alcohol to disinfect it.
2. Three to five days before surgery, shower daily with chlorhexidine
soap, available at most pharmacies (a common brand is Hibiclens).
This helps prevent harmful bacteria that may be on your skin from
entering your surgical incision.
3. Avoid a urinary tract catheter, if possible. It is a common cause of
infections. Ask for a diaper or bedpan instead.
4. If you must have an IV in your arm, make certain that it is inserted and
removed under hygienic conditions, and changed every three to four
5. If you need surgery, choose a surgeon with a low infection rate.
Surgeons know their rates for various procedures; ask for it. If they
won’t tell you, consider choosing another surgeon.
“These infections are often transmitted by touch,” McCaughey said. “RID
has shown how deadly poor housekeeping can be in hospitals.”
McCaughey and her team of germ-fighting volunteers conduct seminars
in hospitals, which usually offer the invitation only after she illustrates the financial ramifications of the crisis. “In order to
get through the front door I have to emphasize
the cost to them,” she says.
Brad Moore’s story is one of hundreds that inspire
her. People write and email her almost daily,
describing the unthinkable—infections that have
waylaid patients during recuperation; infections
that persist for years because no drugs exist to control
them; and worst of all, infections that kill.
Maureen Daly, who volunteers at RID, knows firsthand what a hospital-acquired
infection—technically called a nosocomial infection—can do. The
Brooklyn woman’s mother, a robust woman in her early 60s, developed an infection
after a fractured shoulder. Racing through her system, it repelled the
cocktail of antibiotics that doctors gave her.
“Throughout Mom’s illness and after her death, I filed complaint after complaint,”
Daly says. “I quickly discovered that, quite frankly, no one cared what
I thought. I contacted the hospital’s administrators, the Department of Health,
the board of the hospital, media outlets, all to no avail.”
A report about McCaughey on a New York City radio station introduced
Daly to RID. She phoned McCaughey immediately and has been part of the
disease-fighting effort ever since.
The Centers for Disease Control and Prevention agrees that hospital-acquired
infections are a major health issue. The agency estimates 2 million people in
the United States are infected annually in hospitals and nearly 20,000 die of
preventable infections. Other estimates suggest the number of deaths may be
as high as 100,000 a year, up to 90 percent of them preventable.
“Secrecy has allowed this problem to fester too long,” McCaughey says.
She is pressing for stronger public education about bacteria that can be
transmitted in hospitals. On a practical level, RID advocates isolating all newly
admitted hospital patients until tests prove they are free of transmissible
bacteria. It also tells consumers to demand that health-care professionals sanitize
their hands and don fresh gloves before examinations (for other infection-fighting
recommendations, see sidebar below).
“People at the CDC and infection
control officers at hospitals have been
very aware of this problem for years,”
says Rodney W. Nichols, former
president of the New York Academy
of Sciences. “Certainly Big Pharma
has been aware of a need to develop
and make new antibiotics. But what is
novel about RID is that it is action-advocacy
oriented, and in that way it
McCaughey trained in neither
medicine nor nursing—she graduated
with honors from Vassar in 1970
and holds a doctorate from Columbia
University in constitutional history.
Yet her mission against hospital
germs does not come as a surprise.
“As a person Betsy is extraordinary.
She’s a brilliant visonary,” says New
York City lawyer Brondi Borer, who
has known McCaughey for 25 years.
“This is not a topic that everyone
would want to pursue. But Betsy
found something important and
wanted to change the world—and
she’s doing just that.”
McCaughey has been a vocal force
on health-care reform for two
decades, having been a health policy
expert at the Washington, D.C.-based
Hudson Institute and the author
of health-care legislation during
her tenure in New York state politics.
She’s been running RID from her
Park Avenue apartment, where she
transformed her living room, dining
room and the former bedroom of her
three daughters into a base of operations.
Only recently has office space
“Life isn’t a straight line; if you’re
lucky and open your eyes you’ll have
many careers,” she says of her post-political
life. “And yes, I think I’m
lucky. I was in politics for only four
years; I had trained to be an academic.
Motherhood, really, was my first
career [she’s now divorced]. It’s just
that now that my children are grown
up and gone that I have time to work
80 hours a week.”
Politics wasn’t even a career she had in mind until Republican leadership
came courting. During Bill
Clinton’s first term she had written a
series of articles about health care,
including a critical analysis of
Hillary Rodham Clinton’s universal
health-care plan. Republicans loved
it, of course, but it wasn’t political on
“I opposed the Clinton plan because
it limited how much care you could receive,”
she explains. “To me, that was a
form of healthcare rationing.”
Miraculously, within two years, she
shot from anonymity to second-in-command
in New York state government.
While in office she had
supported important health-care legislation,
including bills to end the
practices of drive-through mastectomies
and drive-through childbirth.
Hospital stays had become so short,
she believed, that doctors had little
time to detect complications.
McCaughey and Gov. George
Pataki didn’t hit it off, however. They
frequently disagreed and ultimately
stopped speaking to each other.
BUGS IN THE SYSTEM
The job of infection control in hospitals has become increasingly difficult in recent years
because pathogens are bolder and tougher to fight, according to Edward Chapnick, M.D.,
director of the infectious disease division at Maimonides Medical Center in Brooklyn.
Many pathogens are drug-resistant, thwarting the antibiotics administered to kill them.
Chapnick cites four particularly nasty bugs:
—MRSA (methicillin-resistant Staphylococcus aureus). When left unchecked, MRSA can
race through health-care facilities. The staph bugs once succumbed easily to penicillin,
but now resist the broad-spectrum methicillin as well as several other antibiotics. Long
known as a hospital infection, MRSA increasingly is being spread in gyms and other
places where people are in close contact.
—Acinetobacter. Infectious and frequently drug-resistant, this bug is carried harmlessly
on at least a quarter of all healthy people’s skin. But when transmitted to weakened
hospitalized patients, it can prove deadly.
—Pseudomonas aeruginosa. Sometimes found in poorly maintained hot tubs
and swimming pools, this bug can cause severe infections of the bloodstream
—Klebsiella. Normally found in the large bowel, this bug has been known to cause
pneumonia and other infections when transmitted to hospitalized patients.
“I switched parties over the Patients
Fair Appeals Act,” McCaughey says.
The measure guaranteed an unbiased
evaluation by an independent panel of
physicians when an insurer refused to
pay for doctor-recommended experimental
therapy. “The Democrats were
willing to support my legislation and
Republicans were spurning it. It’s not
like you’re born with a tattoo that
brands you as one party or the other.
Winston Churchill changed parties
In 1998, McCaughey ran against
Pataki on the Liberal Party ticket and
lost. But through RID, she’s once
again making political waves—this
time by pushing legislation that mandates
public reporting of hospital infection
rates. “If you have to go into
the hospital you should be able to
find out which one in your area has
the worst infection problem so you
can stay away,” McCaughey says. “It’s
like the public health reporting on
restaurants. If your restaurant is on the list of dirtiest restaurants, you are less
tempted to go there.”
In November, Pennsylvania became the first state to publish a report on the
number of people who acquired infections while hospitalized at the state’s 168
acute-care facilities. Health officials found that 19,154 people statewide were
sickened in 2005, and that the average hospital stay for patients with hospital-acquired
infections was 21 days—compared with only five for people without
them. Similar reporting laws go into effect in Colorado, New Hampshire,
South Carolina, New York and Connecticut in the next two years. More than
25 states considered such laws in 2006; in California, Gov. Arnold
Schwarzenegger signed into law a weaker bill that requires hospitals to disclose
their infection-minimization strategies but not their infection rates.
For years, the CDC has produced reams of rules on infection control, which
have included hygiene guidelines for virtually every department in hospitals,
but the CDC guidelines do not carry the weight of law. Private accrediting
agencies, however, can yank licenses, causing hospitals to lose Medicare coverage.
The nonprofit Joint Commission, the primary organization that accredits
hospitals in every state, requires rigorous adherence to infection-control
guidelines. Last year, Joint Commission representatives made unannounced
spotchecks to keep infection control teams on their toes.
But three studies published last year in the American Journal of Medical Quality
found that hospitals are not doing a good enough job. For years it has been believed
that hospital infections are inevitable in the weakest patients, but the
studies concluded that if health-care professionals more rigorously followed
simple measures of hygiene, they could drive down infection rates. McCaughey
also cites the overuse of antibiotics as a practice that doctors should rein in.
Relying too heavily on antibiotics, McCaughey says, citing a flurry of scientific
papers, speeds the development of drug-resistant bugs.
Dr. Edward Chapnick, director of the infectious diseases division at
Maimonides Medical Center in Brooklyn, is pleased McCaughey brought her
germ-fighting message to his institution. “There are regulatory agencies that
are very interested in infection control. But the key difference with RID is that
it doesn’t have a punishment component. When state regulators come in they
can punish hospitals. When RID comes in, they’re here to help.”
Delthia Ricks is a staff writer for Newsday specializing in health issues.