A decontamination crew wearing hazmat suits stands outside Ottilie Lundgren’s Oxford, Conn., home after the house was declared a crime scene in late November.

View photos from “The Game”

View photos from a Boston-area reception

Alumni notes

Visit the AYAM and learn about Reunion 2002 (and view photos from 2001 reunions). See which of your classmates are coming to Alumni Reunion Weekend on June 6 to 8.

2001-2002

Association of Yale Alumni in Medicine

Spotlight falls on anthrax case

After the fifth fatal exposure last fall, alumni in Connecticut pieced together the clues behind death of woman, 94.

A case of inhalation anthrax discovered in a small Connecticut hospital in November gave Ramin Ahmadi, M.D., M.P.H. ’97, the scare of his life—and he was 7,000 miles away.

Ahmadi, program director for internal medicine at the 160-bed Griffin Hospital in Derby, Conn., was spending a lonely evening in the small city of Maizuro, Japan, where he’d just arrived to teach a course on health and human rights at the local hospital. Ahmadi had settled down on the sofa with a book and an Asahi beer. He was half watching the news in Japanese when Patrick Charmel, M.P.H. ’83, his boss from back home, appeared on the screen. “I wondered,” said Ahmadi, “if I was having visual hallucinations.”

Charmel, the president and CEO of Griffin Hospital, was on every channel. Searching for a program in English, Ahmadi switched to CNN and soon had an explanation: a 94-year-old woman from the rural town of Oxford, Conn., had been diagnosed with anthrax. She was a patient at the community hospital where Ahmadi worked.

Back in Derby, Charmel and Kenneth J. Dobuler, M.D. ’76, HS ’79, chair of medicine at Griffin, were caught in what Dobuler described as a media maelstrom. The calls from journalists began minutes after word got out on Tuesday, November 20, that a patient at Griffin had inhalation anthrax, and attention intensified when she died the next day. Television satellite trucks encircled the hospital.

When Ottilie Lundgren had arrived at the hospital the Friday before, she seemed to have a mild illness and was admitted largely because she lived alone. Her case looked more complicated by the next morning, a Saturday, when four blood cultures were found to contain sporulating gram-positive bacteria. When Lydia Barakat, M.D., FW ’00, heard about the lab results that morning, she drove to the hospital to have a look. Barakat, who had trained at Yale in infectious diseases the year before, recalls telling the laboratory technician: “This looks exactly like anthrax, but what are the odds?” She didn’t think it was a likely diagnosis for an elderly woman living in a rural town in Connecticut.

She did take the possibility seriously enough to ask Lundgren if she’d opened any powdery mail; Lundgren remembered none. Barakat prescribed three antibiotics, including Cipro. By Monday, with more test results in, Barakat felt pretty sure she was seeing anthrax. Lundgren was getting sicker. Still, the treatment had begun early. “I had hope,” Barakat said.

When State Epidemiologist James L. Hadler, M.D., M.P.H. ’82, heard about the case that Monday morning, he was incorrectly told that only one blood culture had come back positive for the bacillus. “I was a little bit skeptical,” said Hadler, an assistant clinical professor of epidemiology and public health at Yale. He suspected the positive culture might have resulted from contamination on Lundgren’s skin when the blood was drawn.

Since early October, when letters containing anthrax were sent to prominent politicians and journalists, the state health department lab had been working seven days a week on “powder incidents.” “We were already in full anthrax mode without having had a single case of anthrax,” said Hadler. “Since early October, my job had been 100 percent anthrax.” Suspicious substances had included nondairy creamer and powdered sugar.

Despite his skepticism, Hadler arranged for immediate transportation of the organism to the state laboratory, which was able to do confirmatory tests not done in hospitals (a phage test and a direct fluorescence antibody test). By Tuesday morning it seemed clear that Lundgren had anthrax. Hadler called the state health commissioner, the FBI and the Centers for Disease Control and Prevention (CDC). In the next 24 hours the CDC sent a dozen advisors to Hartford, since no one knew if Lundgren would prove to be a lone victim or the first of many.

The CDC wanted to get final confirmation, based on a polymerase chain reaction test. When Hadler tried to send Lundgren’s blood on the next flight from Connecticut to Atlanta, the airline balked. Hadler says there’s no way to get anthrax from bacillus in blood, even if it spills, but the CDC had to send its own plane. Meanwhile, staff from the FBI, the state police and the state Department of Environmental Protection drove to Oxford and cordoned off Lundgren’s house.

Back at Griffin Hospital, Charmel knew he needed to talk to Griffin employees before the story became public. More than 300 of the 1,100 hospital staff members attended a meeting that afternoon. Charmel told them about the case, urged them not to tell anyone the patient’s name if they knew it and reassured them that anthrax could not be spread from one person to another.

At about the same time, word of the case reached the media: Gov. John G. Rowland had announced a 5 p.m. press conference on a Connecticut anthrax case, and “about two minutes after that went out on the [news] wire,” Charmel said, “the phone began to ring off the hook.” He had a plan for responding. “The conventional wisdom is to pick a single hospital spokesman,” said Charmel. “My gut told me that wasn’t right in this situation.” The press, he said, “wanted to talk to clinicians. The public needed to see and hear from credible experts, to be reassured that everything possible was being done for the patient and that they were getting accurate information.” The panel that answered reporters’ questions included Charmel, Dobuler, Barakat and Stephanie Wain, M.D., FW ’89, chair of pathology and laboratory medicine at Griffin. (Ironically, Dobuler is a rarity among American physicians in having seen anthrax outside a textbook. As a Yale medical student, he spent three months studying infectious disease in Iran, where cutaneous anthrax is common among shepherds. Seeing anthrax then was interesting, he said, “but clearly irrelevant to my future.”)

Charmel’s media panel held news conferences and answered reporters’ questions nonstop until 1 a.m. A Washington Post reporter even managed to get Dobuler’s pager number. On the whole, Dobuler said, “the press did a remarkably credible job given the frenzy.” Although the hospital refused to name the patient, it didn’t take long for reporters driving around Oxford to locate a house surrounded by yellow tape and monitored by people in white suits.

Lundgren died Wednesday morning—“a very sweet lady who was beloved by her family … murdered,” said Dobuler. She was the fifth American since early October to be killed by anthrax. Although investigators never found anthrax spores in her house, Hadler said investigators are now “pretty sure” that Lundgren was exposed to contaminated mail. Spores were later found on four mail-sorting machines in the Wallingford, Conn., distribution center, including the bin that contained mail for Lundgren’s route.

Hadler says the case seems to disprove animal studies suggesting that thousands of spores are needed to cause an infection. “In theory,” he said, “one spore, in the right place at the right time, can do it. She seems to have had a low-dose exposure.”

The day that Lundgren died, Ahmadi returned to teaching his course at the Japanese hospital to find himself an object of interest. Physicians, residents, interns—even the cleaning woman—had seen his supervisor on television and were asking about Griffin Hospital by name.

Traveling halfway around the world, said Ahmadi, “you think you are getting away from New Haven and Griffin and Yale and your usual surroundings. You think you are somewhere very far away. Then you are reminded that you’re part of a little global village. It’s kind of unsettling.”

Notes

1940s

Aaron T. Beck, M.D. ’46, professor emeritus of psychiatry at the University of Pennsylvania, was named a Fellow of the American Psychological Association (APA) for 2002. APA fellows are selected for their contributions to the research, teaching or practice of psychology. The APA, headquartered in Washington, is the largest scientific and professional organization representing psychology in the United States.

Richard W. Finner, M.D., HS ’49, a psychiatrist from San Bernardino, Calif., writes to say that he has retired.

Since retiring from the practice of internal medicine eight and a half years ago, David E. Morton, M.D. ’48, HS ’55, has been busy writing books, playing tennis, bowling, motorboating, and traveling around America and Japan. Morton writes that he misses his former patients, colleagues and nurses, but not the stresses of HMOs, malpractice, Medicare and Medicaid.

1960s

Harold J. Alfert, M.D., HS ’65, retired in December from the faculty of the department of urology at The Johns Hopkins University School of Medicine. Alfert writes that he plans to do “gentleman farming” on a newly purchased farm in central Virginia.

John D. Baxter, M.D. ’66, HS ’68, professor of medicine and director of the Metabolic Research Unit at the University of California, San Francisco, has endowed the John D. Baxter Lectureship in Endocrinology at the Yale Medical School. The Baxter Lectureship is given biannually to an individual who has made seminal contributions to the field of endocrinology.

Laurence A. Boxer, M.D., HS ’68, professor and director of pediatric hematology/oncology at the University of Michigan, was named the Norman Kretchmer Professor in September at his alma mater, Stanford Medical School. Boxer was the Grover Powers Lecturer in Pediatrics at Yale in March 2000. His wife, Grace Jordison Boxer, M.D. ’68, is in the private practice of medical hematology/oncology. Their son, David, is on the staff at Columbia Teachers College and is engaged to be married this year.

Alice Cobb Ipsen, M.P.H. ’67, who is retired and has lived in Denmark for the last 29 years, writes to say that “I draw, paint and make lithographs on stones—a far cry from public health.” During her career in public health, Ipsen was at the University of Pennsylvania and the University City Science Center in Philadelphia.

Neal Koss, M.D. ’66, HS ’74, of Palos Verdes, Calif., is still practicing plastic surgery part time, while pursuing his hobbies, which include computers, photography, tennis and travel. Koss also writes that he now has three grandchildren to add to his enjoyment.

Eli H. Newberger, M.D. ’66, HS ’67, assistant professor of pediatrics at Harvard Medical School, child advocate and jazz musician, has been appointed to the Berklee College of Music board of trustees. Newberger plays piano but is best known as a jazz tuba player and has made over 40 recordings with the New Black Eagle Jazz Band and others.

Charles T. Post Jr., M.D. ’68, an ophthalmologist, writes to say that he and his wife, Bonnie, spent three months sailing around Central America last winter. “Too many pals getting heart attacks and cancer, so I took the winter off from ophthalmology, bought a Little Harbor 58 named Flight—and away we went. I kept a journal of my impressions, one of which describes our visit with former classmate Rodrigo Martinez, M.D. ’68, in Honduras. We are both pilots, hence the name of my boat.”

1970s

Robert W. Buckingham, Ph.D. ’78, professor of public health at New Mexico State University, returned recently from a sabbatical in Thailand, where he was a distinguished visiting professor of public health at Mahidol University in Bangkok.

James R. Merikangas, M.D., HS ’73, of Chevy Chase, Md., is director of the neuropsychiatry program at the Georgetown University School of Medicine in Washington. Merikangas, also a lecturer in psychiatry at Yale, has begun a collaboration with the Center for Public Integrity in Washington, D.C., regarding the criminal justice system and prosecutorial misconduct.

Robert M. Pearl, M.D. ’72, a plastic and reconstructive surgeon, is executive director and CEO of The Permanente Medical Group Inc. (PMG), the largest medical group in the nation. Pearl, a member of the Federation Executive Committee of the PMG, is responsible for strategy development and implementation of the national Internet and e-health care efforts for Kaiser Permanente, and on a national level he oversees the health care provided to eight million citizens across the nation. Classmate David Moyer, M.D. ’72, chief of the allergy department at Kaiser Permanente, sent this news to us.

1980s

David A. Cottrell, D.M.D., HS ’88, was named chair of the Department of Oral and Maxillofacial Surgery (OMS) at Boston University School of Dental Medicine (BUSDM) in January. He is also the director of the OMS Residency Program and of OMS Resident Research at BUSDM.

Robert V. Levine, M.P.H. ’80, president and CEO of Peninsula Hospital Center in Far Rockaway, N.Y., received the Award of Distinction from the Metropolitan Health Administrators’ Association (MHAA) in collaboration with the American College of Healthcare Executives at the MHAA annual dinner held in June in Queens, N.Y.

David R. Marks, M.D. ’89, a health reporter for WVIT Channel 30 in Connecticut for the past four years, is now a health reporter on The Today Show on NBC. In 2001, while at Channel 30, Marks won a statewide journalism award from the Connecticut Chapter of the Society of Professional Journalists. The award, the Best In-Depth Television Report of the Year, was for his story about the influence of pharmaceutical representatives on doctors’ prescription writing.

1990s

Brian G. Cole, M.D., M.P.H. ’95, is an internist with the Maui Medical Group in Hawaii, where he runs the Lahaina Clinic on the island of Maui. Cole says that he loves his job, which includes working closely with the board-certified neurosurgeon on the island. He plans to open his own practice this winter in the town of Kihei. Cole lives in Maui, has a second home in Paris and likes to travel.

Alberto Perez Morell, M.D., FW ’98, writes to say “that thanks to [his] visiting research fellowship in plastic surgery at Yale with John A. Persing, M.D., and colleagues, [he is] able to share the knowledge with [his] fellows and students working in reconstructive microsurgery at Padre Rachads Oncology Hospital in Caracas.” While at Yale, Morell completed a research project, Further Investigations on the Effect of Prolonged Clamping and Vascular Stasis on the Patency of Arterial and Venous Microanastomoses, which was presented at the New England Society of Plastic and Reconstructive Surgery.

Paula I. Watnick, M.D. ’91, Ph.D., assistant professor at Tufts University School of Medicine and New England Medical Center in Boston, received the Interscience Conference on Antimicrobial Agents and Chemotherapy Young Investigator Award from the American Society for Microbiology in December in Chicago. Watnick was given the award, which is sponsored by Merck U.S. Human Health, for her research on the environmental survival of Vibrio cholerae, the infectious agent responsible for cholera. Her genetic analysis of V. cholerae has advanced the understanding of bacterial evolution and the emergence of new pathogens and has defined environmental signals and regulatory genes that control the way V. cholerae attaches to surfaces, a process known as biofilm formation.

Send alumni news items to Claire Bessinger, Yale Medicine Publications, P.O. Box 7612, New Haven, CT 06519-0612, or via e-mail to claire.bessinger@yale.edu.


			Originally published in Yale Medicine, Spring 2002. Copyright © 2002 Yale University School of Medicine. All rights reserved.