The state health commissioner says his department followed all its protocols in responding to an adenovirus outbreak at the Wanaque Center for Nursing and Rehabilitation, in which 11 medically fragile children died.

That playbook is now being reassessed and changed. The Health Department has already altered some of its internal practices, and lawmakers appear interested in passing laws that address communication with parents and ways to more quickly separate sick children from well ones in cases of infectious outbreaks.

In the Wanaque center case, the state Health Department was told of the outbreak on Oct. 9 – two weeks after the first symptoms were detected. That was when the first case of adenovirus was confirmed, although by that time 20 children were will and two had died.

But Health Commissioner Shereef Elnahal wasn’t told until Oct. 19, 10 days later, after staff was concerned Wanaque couldn’t implement directed control measures. That’s now been changed, he said.

“I do believe that leadership at the highest levels in the department need to be made aware of severe facility outbreaks immediately in case deviations from protocol are warranted,” Elnahal said.

Elnahal said he now will be notified of all new outbreaks. That averages several a day, so a separate notification was set up for severe outbreaks.

In the last two respiratory virus seasons, the state has managed 350 outbreaks in long-term care facilities, schools, daycare centers and college dorms, Elnahal said. But the version of the adenovirus at Wanaque this fall was more dangerous than others and affected medically fragile children who depend on ventilators and have weakened immune systems.

Elnahal said various alternatives for separating sick patients, or cohorting, were considered. Due to space constraints, the cohorting took more than a month – and in the end was possible because children died, freeing up space.

“Even planning for a mobile emergency room unit normally deployed for medical disasters to achieve cohorting earlier,” Elnahal said. “And this was ultimately not done on the advice of CDC, who advised that it could actually confer an increased risk to these fragile patients.”

Deborah White, president of the Health Professionals and Allied Employees nurses’ union, said a root cause of the problems at the Wanaque Center was inadequate staffing, which she said the state has addressed as part of the response to the crisis.

“But this is reactionary and highlights the need for a more proactive, state-mandated safe-staffing legislation, or a revision of current regulations,” White said.

Some lawmakers pushed back, suggesting that this case seemed to be more about failures by individual nurses to follow safety protocols, rather than staffing levels.

But lawmakers were just as pointed, if not moreso, in their criticism of the leaders of health care facilities invited to testify at the hearing who all declined to come.

“They should have been here today,” said Sen. Joseph Vitale, D-Middlesex. “Legal advice aside, this is too important for what the patients and what the citizens of this state, and for the families who suffered so tragically over the past several weeks.”

Senator Dick Codey, D-Essex, said it seems the company that runs the Wanaque Center put profits over patients and should be asked again to testify.

“And if they refuse again, I think we should seek subpoena power from the full Senate and drag their butts in here and let them explain to the public what happened,” Codey said.

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