Federal and state authorities are expected to arrive this morning at Anne Arundel Medical Center to begin a joint investigation into how three newborns were given an opiate-like drug that caused breathing difficulties.
Staff members from two agencies that oversee hospitals, the U.S. Health Care Financing Administration and the state's Office of Licensing and Certification Programs, have been monitoring the hospital's internal review.
At a meeting yesterday morning, Anne Arundel County State's Attorney Frank R. Weathersbee learned that the state was bringing in its own research team.
"Both agencies decided together because the situation warrants it," said Carol Messick, spokeswoman for the U.S. Health Care Financing Administration's regional office in Philadelphia, which includes the Annapolis region.
Mr. Weathersbee said he knew the type of opiate found in the systems of the three newborns, but he declined to identify the substance. He said the course of the investigation will be determined by the results of a few remaining medical tests.
"We're still trying to get the final answers," Mr. Weathersbee said. "We've got some good ideas . . . but there's no point in speculating until I get the results and put it together."
The state and federal investigators will review not only the hospital's critical-care nursery, but also all areas of the medical center, said hospital spokesman Carolyn Shenk.
Such investigations, called "surveys," are routinely performed after a serious complaint or incident at a hospital. Last year, state officials received 120 complaints and did 15 on-site reviews, officials said. The rest of the cases were handled by telephone or in writing.
In this case, authorities gave the hospital time to do its own review. The hospital has ruled out the possibility that the drug was transferred from the mothers or resulted from tainted solutions or medications.
"We want to look at the hospital's policies, procedures and systems to make sure that something like this doesn't happen again," said Carol Benner, director of the state's Office of Licensing and Certification Programs.
What happened Jan. 31 has puzzled nurses, physicians and parents.
About 5 a.m., one infant in the critical care nursery had difficulty breathing. Half an hour later, another baby showed the same symptoms. At 8:30 p.m. that day, a third infant struggled to breathe. All ended up on ventilators.
Hospital officials later said traces of opiates -- which had not been prescribed for the babies -- were found in their urine.
None of the babies was harmed. One has gone home, and the other two remain in the hospital in stable condition because of other medical conditions.
To speed the investigation, the state's attorney's office took equipment -- such as syringes and intravenous tubes -- from the critical-care nursery and sent the material to the Anne Arundel County police laboratory for a separate review, said Kristin Riggin, a spokeswoman for Mr. Weathersbee.
"We have their results, and it's helped investigators narrow the possibilities even further," she said.
The tests were designed to determine the concentration of opiates in any substance or medication given to the newborns, she said. The results are likely to show where the drug could have been used in the hospital and how it could have found its way into the babies' systems, said William T. Vosburgh, a chemist with the police lab.
"We're looking at the stuff before it got in the babies' systems," said Mr. Vosburgh, who is testing the samples for the state's attorney's office.
A private medical lab is conducting more sophisticated tests on urine samples to determine the type of opiate and its concentration in the babies' systems.