When Hartford Hospital in Connecticut marked the death of former president Dr. T. Stewart Hamilton in a 2002 employee newsletter, the obituary stated Hamilton "died peacefully on July 29, with his family at his side."
Left unsaid was that Hamilton died at Hartford Hospital from complications brought about by MRSA, a form of bacteria spread through skin contact or an infected open wound, which he may have contracted after being admitted for treatment of a minor head laceration.
"I thought it was stitches and then we go home," said his daughter Jeanne Hamilton of Mystic, recalling what turned into a 12-day ordeal for her father that resulted in the family's decision to take him off life support.
The experience led Jeanne Hamilton to become involved a few years later with the Connecticut Center for Patient Safety, a group dedicated to improving hospital care and preventing the spread of hospital-borne illnesses such as MRSA, methicillin-resistant Staphylococcus aureus.
She is now the organization's president and uses her father's death as a cautionary tale of how any patient can be vulnerable to MRSA.
"If you think you're safe because you've got an 'in' with the hospital, forget it," Jeanne Hamilton said of her father. "He had a pretty big 'in' with the hospital."
A native of Detroit, T. Stewart Hamilton took over administration of Hartford Hospital in 1954, remaining in charge until retiring in 1976.
He helped the hospital recover from a disastrous 1961 trash-chute fire, which killed 16, and was also at the forefront of efforts to pass federal Medicare legislation in the 1960s. The country's first Medicare reimbursement check was issued in 1966 to Hartford Hospital in his honor.
During that same period, he also served terms as president of the Connecticut Hospital Association and the American Hospital Association.
Although her father had turned 91 in June 2002, Jeanne Hamilton said he was living an active life out of his apartment at Duncaster, a continuing-care community for the elderly in Bloomfield, Conn.
In fact, the two were planning a cruise on the Great Lakes when, on July 17, 2002, T. Stewart Hamilton fell at home.
Hospital records state the fall was likely "orthostatic in nature," meaning he may have suffered a dizzy spell.
"He hit the back of his head on the dishwasher and got a 2-inch cut," Jeanne Hamilton said.
The wound was initially treated by nurses at Duncaster, who suggested he visit the hospital for stitches.
An ambulance took him to Hartford Hospital's emergency room, and he was given a private room, where, his daughter said, five hours passed before he received staples for the wound.
"The doctor came in. He said, 'Well, Stewart, we can either give you Novocain (for stitches) or the staples and it will be really quick and over with," Jeanne Hamilton recalled.
She said the hospital decided it would be better to keep her father overnight.
"I thought they were doing us a big favor because of who he was, to rule out strokes and so forth," she said.
Overnight turned into four days, during which time Jeanne Hamilton said her father seemed to be deteriorating. She asked that he be discharged back to the clinic at Duncaster, which she hoped would improve his spirits and recovery.
"I didn't see the reason for him staying any longer and thought being in the hospital wasn't helping," she said.
Her father's July 21, 2002, discharge papers described him as "a pleasant ... white male physician who was president of Hartford Hospital" and stated he was getting "weak and confused." His blood count had dropped, but there was no evidence of gastrointestinal bleeding, according to the paperwork.
There was no mention of a MRSA infection.
Jeanne Hamilton said her father arrived back at Duncaster around 7 p.m. She drove home to feed her dogs and then returned and spent the night at her father's side.
About 12 hours after his discharge, T. Stewart Hamilton was readmitted to Hartford Hospital the morning of July 22 because he needed an oxygen tube inserted into his throat.
It was at this point, according to a hospital summary of his second stay, that MRSA was discovered in cultures taken of his blood upon readmission.
"They said the source of the infection was at the wound," Jeanne Hamilton said.
On July 28, she was approached by Dr. John McArdle, then of Hartford Hospital's intensive care unit, she said.
"On the 28th, the ICU doctor said to me, 'We should talk.' I looked at him and said, 'Should we let him go?'" Jeanne Hamilton recalled. "He just wasn't responding to antibiotics. The doctor said, 'We've thrown at him every antibiotic known and several that are brand-new.' He was getting everything they could do for him."
T. Stewart Hamilton's oxygen tube was removed, and he died about four hours later.
"I knew my dad so well and knew he wouldn't have wanted to go on fighting that and come back and go through months of recovery," Jeanne Hamilton said. "We said, 'You know, he just might surprise us and pull out of this on his own,' but he didn't."
She believes her father likely contracted the MRSA infection while waiting to be treated in Hartford Hospital's emergency room, although she readily acknowledges it would have been hard to prove.
"I suppose he could have gotten it when they were dressing his wounds (at Duncaster) before they sent him off to the hospital in the first place. I don't think so. He could have gotten it in the ambulance, but I doubt it," she said.
Jeanne Hamilton also said her father's cut was freshly bandaged by hospital staff before his brief return to Duncaster and was never touched by anyone at that medical facility before he was readmitted to the hospital July 22.
"I have no definitive proof it was ... in the emergency room. But that's pretty much what I think happened because that's where his wound was open and unattended the longest," she said.
McArdle, who worked at Hartford Hospital from 2001 to 2003 and currently practices at Connecticut's Yale-New Haven Hospital, in a recent interview recalled treating T. Stewart Hamilton.
McArdle said he was not initially familiar with who the man was, but it was made clear he was an important patient.
"All the higher-ups in the hospital knew he was in the hospital, so folks would occasionally come by to talk to the family or check up and so on," McArdle said. "He devoted his life to the hospital. He was a huge force."
McArdle said although he does not remember all the details of the case, the MRSA infection "absolutely" led to the death.
"It's conceivable he got it in the community, but probably much more likely he got it in the health care environment," McArdle said, adding T. Stewart Hamilton's age would have made him more vulnerable.
"Even if you're a healthy 91, you're still not a young person who is healthy," he said.
Jeanne Hamilton said she never pursued any investigation of her father's death. "It didn't occur to me. I've learned so much in the last six years," she said. Filing a lawsuit against Hartford Hospital was never an option.
"I knew we couldn't sue. I knew we shouldn't sue," Jeanne Hamilton said. "He believed in that hospital. He was totally devoted to that hospital and its quality of care."
She added she is not angry with Hartford Hospital, specifically, but is angry at the prevalence of MRSA in health care settings.
"I think it could have happened at any hospital, and that's scary," she said.
McArdle said a lawsuit likely would not have gone anywhere because of the difficulty in proving where and how T. Stewart Hamilton contracted the bacteria.
"MRSA has become such a common infection," McArdle said, adding he did not recall T. Stewart Hamilton's contracting MRSA making any waves within Hartford Hospital, despite who he was.
"(Unless) there was a clear path where MRSA got from 'Patient X' to 'Patient Y,' it's not the kind of thing that would in and of itself prompt an investigation," he said.
Asked for comment, Lee Monroe, a Hartford Hospital spokesman, in an e-mail said T. Stewart Hamilton "was for many years a beloved leader of Hartford Hospital and his loss continues to be mourned among us."
"At the time of his death and continuing into the present the country has been experiencing a dramatic increase in the prevalence of drug-resistant bacteria both in community settings and in healthcare facilities," Monroe wrote. "These organisms can be acquired almost anywhere, even at home."
Monroe said Hartford Hospital recognizes the significant impact MRSA has on the health and quality of life of patients, families and the community and the significant role hospitals play in combating it.
She said Hartford Hospital is "committed to winning the battle against healthcare-associated infections" through a comprehensive program of hand hygiene, contact precautions, attention to the environment and education.
"Our plan for the reduction of MRSA, regardless of its acquisition from the community or healthcare acquired, is thorough and rigorously adhered to," Monroe said.
Asked if her father would be happy with her health care advocacy, Jeanne Hamilton said, "Yes. No doubt. No doubt."
"His whole life was dedicated to making health care better for the patient," she said. "If his death can help ... that may be the final piece of his legacy."