Vaccine leaves nurse disabled.
Nurse fights hospital over smallpox shot
The Cincinnati Enquirer • July 12, 2009
Professionally and patriotically, emergency room nurse Amy Alexander thought at the time, it was the right thing to do.
At her boss' request, she took a smallpox vaccine so she could join a bioterrorism response team at Good Samaritan Hospital that would be ready if America's enemies ever tried to spread the deadly disease.
Six years later, she sees it as perhaps the worst decision of her life - a depressing notion that seeps into her thoughts daily as pain and numbness crawl up her legs and arms, as she reaches for the walker she needs to go any farther than room to room, and as she copes with a litany of other health woes doctors traced to a seriously adverse reaction to the vaccine.
Multiple two-foot-high stacks of medical bills and insurance forms line the wall in her dining room and are another constant reminder, as are photos of her sailing, swimming, riding motorcycles - activities she will never enjoy again.
Perhaps the most depressing thought of all, Alexander said, is that Good Samaritan, "a place I held in high regard and felt very fortunate to work at," has hardly lived up to its name in its dealings with its former employee.
For years, the hospital and its insurers have fought Alexander over the costly treatments and medications her doctors insist are needed to minimize her pain and keep her various health problems in check, denying many requests and grudgingly approving others only after protracted delays.
As the dispute heads toward a scheduled court date this fall, hospital representatives, Alexander said, "have acted like there's nothing really wrong, that it's all in my head."
In that, there may be some truth, because Alexander's doctors have detected 23 lesions on her brain stemming from her body's reaction to the smallpox vaccination.
"I'm afraid this is just the way it is today in the hospital and insurance industries," said Alexander, 47, her eyes reddening during an interview in the College Hill house of a friend who took her in after she was forced to sell her own home in Covington at a loss amid medical bills and lost wages totaling more than $250,000.
Good Samaritan officials declined to comment, citing the lawsuit and worker's compensation claim filed by Alexander. The suit, which seeks more than $5 million in damages, is scheduled to go to court in November, while the worker's compensation claim is to be heard next month.
In court filings and other documents, the hospital's attorney primarily has raised legal procedural objections without directly addressing the merits of the case, arguing the state constitution offers Good Samaritan, the insurance companies and a claims adjuster named as defendants immunity. Some of Alexander's complaints, the filings add, have previously been rejected by state administrative boards.
For Alexander, the nightmare began in early 2003, when the Bush administration pushed to vaccinate 450,000 doctors, nurses and other health-care workers to build a nationwide team ready to combat a smallpox outbreak spread by terrorists, a scenario the administration identified as a top post-9/11 bioterrorist threat.
A 1985 graduate of the Good Samaritan School of Nursing - a wall plaque names her as that year's outstanding student nurse - Alexander in late 2002 returned to the hospital to work in the emergency room after running her own home-care nursing business for seven years.
When her supervisor asked her to be vaccinated for smallpox to join the hospital's bioterrorism response team, she had some initial misgivings, heightened by pamphlets and presentations outlining the potentially dangerous side effects. Although the disease has not surfaced in the United States since the 1940s and was eradicated worldwide in 1980, the vaccine is not without risk, with brain inflammation, blindness, even death possible for an infinitesimally small percentage of those receiving it.
Within a few weeks of being vaccinated on March 17, 2003, Alexander began experiencing fatigue, tingling in her hands and feet, dizziness and weakness that made it difficult for her to push patients on stretchers. Always especially proficient at inserting intravenous tubes, she soon "couldn't insert an IV to save my soul."
At first, she thought it was nothing more than the occasional extreme tiredness that comes from working 12-hour shifts under stressful circumstances, something likely to go away after a restful June vacation in San Francisco.
"I never made the connection" to the recent smallpox vaccination, she said.
The vacation, however, did not erase the unsettling symptoms. About an hour into her shift on her first day back at work, Alexander, told a co-worker "I think I'm going to pass out" just before collapsing. "And that was the last hour I worked," she said.
She was admitted to Good Samaritan for four days, but was discharged without a clear diagnosis. Her family physician, however, had a worrisome suspicion after learning of the smallpox inoculation. He referred her to the Cincinnati Health Department, where a doctor determined that she was suffering from post-vaccination syndrome.
Subsequent examinations in Cincinnati and at the Cleveland Clinic reinforced the diagnosis, finding that Alexander was suffering from encephalomyelitis, an inflammation of the brain and spinal cord, and tachycardia, an abnormal heartbeat, along with other ailments.
In her case, doctors said, the smallpox vaccine's very small statistical risk may have been increased by a hepatitis B vaccination she had received a month earlier - and that also had been administered by Good Samaritan.
It did not take long for Alexander to question how the hospital she loved as an employee was treating her now that she was a patient and unable to work.
According to Alexander's Hamilton County Common Pleas Court lawsuit and her Ohio Bureau of Workers Compensation claim, Good Samaritan officials monitored her for only five days after the inoculation, not the 21- to 28-day period recommended by the Centers for Disease Control and Prevention (CDC). The hospital also did not adhere to a CDC recommendation calling for serious adverse reactions to the smallpox vaccine to be reported within one week, the lawsuit charges.
Alexander has spent much of the past six years embroiled in often acrimonious wrangling with the hospital and its insurers over treatments, payments and other matters - a process she says has exacerbated the depression she suffers because of her various physical problems.
Even after the Ohio Industrial Commission in February 2005 allowed for the finding of post-vaccination syndrome, Good Samaritan resisted reimbursing Alexander for her growing out-of-pocket medical expenses, doing so just before a scheduled hearing to address that issue, the lawsuit says.
"In the broad picture, it all boils down to how they can save the company money," said Margo Grubbs, one of Alexander's attorneys. "By denying or delaying claims - even in the face of orders to pay them - that's what they've done."
Alexander alleges that the insurers' hardball tactics have sometimes crossed the line.
She claims, for example, that a form from her doctor requesting monthly treatments for a year - intravenous medication to control inflammation without which, she says, she would be "on the couch about 10 hours a day" in pain - was altered to make it appear that the treatment was for only a single month.
She also contends that a company that helps handle Good Samaritan's workers' compensation benefits staked out her home and placed her under surveillance, a charge the firm denied - at least initially. "We do not currently have a PI watching her, but if we did that is not against the rules and regulations," a claims adjuster wrote in an 2008 e-mail cited in the lawsuit.
The crucial word in that denial, however, may be "currently," because a deposition in the case makes it clear Alexander was under surveillance at some point. A report from the person conducting the surveillance stated that while Alexander sometimes walked with a limp, she "walked normally (and) climbed stairs" at other times.
Alexander, who has been classified as totally disabled by Social Security, made another discovery last year.
Had her health difficulties been reported to federal authorities within one year of the vaccination, all of her medical and related expenses would have been covered under the Smallpox Emergency Personnel Protection Act of 2003, established specifically to compensate health professionals who put themselves at risk. Good Samaritan, however, never informed her of the program, and there is no appeal for missing the filing deadline, she said.
Medical exams ordered by Good Samaritan or its insurers paint a different picture. A 2007 exam, for example, concluded that Alexander "exhibited no evidence of medical impairment" and was able to return to her "prior job activity without restriction or limitation."
Anne Ketzer, a Good Samaritan nurse who has known and worked with Alexander for nearly two decades, said she encouraged hospital officials more than a year ago to do right by her former colleague, whom she describes as "an excellent nurse very good for the hospital."
"I brought it to their attention that she was not receiving compensation or proper attention from the insurance companies," Ketzer said. "I also told them that this wasn't going to get any prettier, that it would get uglier if she wasn't taken care of. I mean, her name's on the wall as one of the outstanding graduates. Good Sam's a wonderful place to work and I don't think they're trying to hurt Amy. I just think this issue has fallen between the cracks."
Today, Alexander, who is single and has a 28-year-old daughter living in Chicago with a grandchild on the way, says she can stand for no more than about 10 minutes. Her trips outside the home are governed by a progressive scale of walking aids - a walker for short excursions, a wheelchair for the mall, a scooter for the grocery store.
She has not worked since June 2003 because of her health problems.
"I've worked since I was 17," she said. "It's very difficult to not be able to do that and to be dependent on others.
"I lost a career that I loved. I lost my identity. I lost my independence. I have been made out to be a malingerer, a fraud, by my employer. I have spent most of the past six years ... trying to be heard."
As she awaits the day in court that will give her that chance, Alexander says one question constantly nags at her.
"I'm left wondering why Good Samaritan hasn't been a good Samaritan to me," she said. "I wish I knew."