CHOC given $150,000 to treat children sickened in dental clinic infection outbreak

From The Orange County Register

By Courtney Perkes / Staff Writer

Children’s Hospital of Orange County will receive $150,000 in county funds to help provide complex treatment to children who contracted serious infections at an Anaheim dental clinic, the Board of Supervisors decided Tuesday.

So far, 57 children who underwent baby tooth root canals, or pulpotomies, at Children’s Dental Group have been hospitalized at CHOC with confirmed or probable mycobacterial infections, said Dr. Jasjit Singh, a pediatric infectious disease specialist at the Orange hospital. About 21 patients need to take a tightly regulated drug typically used to treat leprosy, she said.

Ordering the oral antibiotic, clofazimine, from the Food and Drug Administration requires a lengthy approval process for each child. CHOC will be expanding a part-time nurse’s hours to full-time to oversee the process.

“It’s a much more rigorous process than writing a prescription for an antibiotic,” Singh said. “That process requires some administrative and logistical work. It requires filling out those FDA forms.”

Singh said the drug, developed in the 1950s, is used for more drug-resistant species of mycobacterium. Singh said the FDA’s process assures the drug is only used when necessary so it remains available for patients with leprosy.

The drug also requires special handling for transport and storage. About 60 percent of the cost of providing the drug and monitoring patient reactions to treatment will not be reimbursed.

Mimi Morales of Orange, whose 7-year-old granddaughter, also Mimi, underwent surgery to remove infected jawbone after contracting an infection following a root canal at the clinic, said she is scheduled to soon begin taking clofazimine.

Currently, Mimi receives intravenous antibiotics three times a day. Morales said she’s regularly missing school because of her many medical appointments to monitor possible drug side effects, including hearing loss.

“This is a nightmare,” Morales said. “I stay awake at times picturing her with a hearing aid or with kidney problems. That’s why I asked the nurse what would happen if we didn’t give this to her. She said she could die.”

The infected patients, ages 3 to 9, underwent the pulpotomies between March 1 and Aug. 5. In all, 842 children who had pulpotomies at the clinic since March, and who may have been exposed, are being asked to undergo exams looking for signs of infection.

Jessica Good, spokeswoman for the Health Care Agency, said the majority of patients have been checked or have appointments scheduled. She said the agency is working to contact those whom the clinic couldn’t reach or who haven’t followed up with the recommended office visit.

Water testing at the dental office found five samples positive for Mycobacterium chelonae/abscessus group. The Health Care Agency ordered the clinic to install a new water system subject to its approval.

On its website, Children’s Dental Group said the water system will be replaced by Monday. The new system, the clinic said, includes “clean water sources, institutional infection control and water routing devices, and ongoing monitoring of purification levels.”

Good said after the system is installed, the agency will “verify water quality, staff training, and plans for ongoing maintenance of the system.”

Singh said the children and their families are doing incredibly well under the circumstances.

“It has been traumatic for them,” she said. “Many of them have had quite a few teeth removed. We’re asking them to swallow pills. It is challenging.”

Contact the writer: 714-796-3686