October 26, 2023

Congressman Castro Pushes for Answers from Brooke Army Medical Center After Alarming Express-News Report on Contaminated Surgical Equipment

Read his letter

WASHINGTON – Today, after an alarming report from the San Antonio Express-News about ongoing issues related to contaminated surgical equipment at one of San Antonio’s two Level I Trauma Centers, Congressman Joaquin Castro (TX-20) sent a letter asking Brooke Army Medical Center (BAMC) leaders for a detailed explanation of how widespread equipment sterilization failures were allowed to occur and how the institution will protect patients going forward.

In the letter, Congressman Castro noted that BAMC was temporarily forced to close more than half of its operating rooms and reduce elective surgeries after similar issues in 2017. His letter asks for comprehensive responses no later than November 17, 2023.

In the October 25 story, the Express-News reported that dozens of surgeries were canceled over the summer after medical staff discovered leftover tissue, bone, or blood on tools sent to operating rooms by BAMC’s Sterile Processing Department. While BAMC staff have not reported any related cases of infection, the use of contaminated instruments can cause serious bone and joint infections that develop weeks or months after surgery.

“As the military’s flagship medical institution and its only Level I Trauma Center, BAMC provides important care to military families, veterans, and civilians from San Antonio and South Texas who require emergency trauma care. BAMC must meet high standards to retain its Level I designation. These standards include ensuring doctors and medical staff are continuously trained in new trauma care techniques and maintaining its ability to provide on demand medical care,” Congressman Castro wrote. “The current state of BAMC’s sterilization practices is dangerous for patients, delays necessary surgical treatment, and distracts doctors from their ability to do life-saving work. Without a proper sterilization system, I am worried BAMC is in danger of losing its designation and its ability to provide outstanding medical care to my constituents.”

Today’s letter follows earlier work by Congressman Castro to support patients who receive treatment at BAMC. After civilian trauma patients encountered repeated issues with surprise billing at the facility, Congressman Castro secured language in the FY 2021 National Defense Authorization Act (NDAA) and again in the FY2023 NDAA to give the Department of Defense flexibility to waive or reduce extraordinary civilian medical bills. For more information on his work to prevent surprise medical billing at BAMC, click here.

The full letter is here and below.

Colonel Mark Stackle
Brooke Army Medical Center
Fort Sam Houston, Joint Base San Antonio
3441 Roger Brooke Dr,
San Antonio, Texas 78234

Dear Col. Stackle,

I am deeply concerned about Brooke Army Medical Center’s (BAMC) ability to treat patients safely and retain its Level I Trauma designation because of allegations the San Antonio Express-News published yesterday regarding BAMC’s widespread failures to appropriately clean and sterilize surgical equipment.

The Express-News report details 24 cancelled surgeries and four delayed procedures over this past summer because of issues related to contaminated surgical equipment. Egregiously, the report describes an incident where an elderly trauma patient was kept under general anesthesia for three additional hours while surgeons scrambled to find clean surgical tools.

In response to these incidents, nine orthopedic surgeons — the entire orthopedic department at BAMC — recommended that BAMC reduce surgeries until the Sterile Processing Department (SPD) resolves the issue, which would severely impact the availability of trauma care in San Antonio. Hospital leadership must immediately address and remediate these issues before a patient is severely injured — or worse.

As the military’s flagship medical institution and its only Level I Trauma Center, BAMC provides important care to military families, veterans, and civilians from San Antonio and South Texas who require emergency trauma care. BAMC must meet high standards to retain its Level I designation. These standards include ensuring doctors and medical staff are continuously trained in new trauma care techniques and maintaining its ability to provide on demand medical care.

The current state of BAMC’s sterilization practices is dangerous for patients, delays necessary surgical treatment, and distracts doctors from their ability to do life-saving work. Without a proper sterilization system, I am worried BAMC is in danger of losing its designation and its ability to provide outstanding medical care to my constituents.

Six years ago, the Express-News reported that BAMC was forced to temporarily close more than half of its operating rooms and reduce elective surgeries after it found more than 70 instances of improper sterilization, including 16 incidents in which “fragments of organic material such as bone, skin or blood were left on surgical tools.”

In response, BAMC administrators increased staffing and quality checks in the SPD to improve the quality and consistency of the sterilization process. At the time, the chief of the SPD, Lt. Col. Trish O’Neal-Mellen, described the changes as “like night and day.”

If yesterday’s reporting is accurate, BAMC has returned to old habits that put patients at serious risk. The allegations in this reporting must be fully investigated and any systemic issues must be fixed permanently. To that end, I am requesting answers to the following questions by November 17, 2023:

  1. The Express-News quoted Dr. Evan Renz, deputy to the Commander for Quality and Safety at BAMC, as saying “bioburden does not rank very high in the list of things that we have to focus on” and “anything more than zero [reports of bioburden] means that we’re responding to it.”
    • Given the history of contamination issues at BAMC, why is bioburden not a high priority for BAMC leadership?
    • If the allegations in the Express-News are accurate, what actions are BAMC leadership taking to reduce bioburden incidents?
  1. What issues does the SPD currently face that may have caused the allegations described in the Express-News reporting?
  1. Please explain how BAMC will continue to provide its trauma center with the necessary amount of sterilized surgical tools to treat emergency trauma patients.
  1. How many staff currently work at the SPD?
    • If SPD is short staffed, how many staffers does SPD need to fully meet BAMC’s surgical demands?
    • If SPD is short of staff, why?
  1. Please explain why the remedies BAMC implemented in 2017 were not sufficient to prevent these issues from reoccurring.
  1. How many Patient Safety Reports were filed between May 1, 2023 and October 25, 2023 due to improperly cleaned and sterilized surgical tools? Please provide these reports.
    • How does this number compare with reports filed in the same period last year?
    • How many surgeries in total have been cancelled because of these issues?

Thousands of my constituents — both civilians and military families — receive care at BAMC every month. The position BAMC finds itself in again is unacceptable and untenable for the people of San Antonio and our nation’s military heroes.

I appreciate your dedication to ensuring BAMC remains a world-class medical center. I anticipate you will uphold the high standard my constituents rely on and that you will take the necessary steps to ensure this does not occur in the future. Please keep me informed of your progress on this issue.

Sincerely,

Joaquin Castro
Member of Congress