Moral of tale - ‘don’t get bitten

By Judith Pannebaker

Utopian caught up in rabies vaccine shortage

According to authorities with the Texas Department of State Health Services, the amount of rabies vaccine available to Texas residents bitten by potentially rabid animals is dwindling rapidly.

Last week it was estimated that there was only enough vaccine to treat 29 people.
The following account chronicles a series of missteps that occurred after a Utopia resident’s encounter with a feral kitten. It also illustrates her frustrating efforts to secure the possible life-saving medication.

‘Stupid thing’

The incident began on Friday, July 18, when Susan Duplissey reached out to a furry creature hiding behind latticework that covered an air conditioning unit on her property.

“Just as I touched it, it bit and scratched me and ran off,” Duplissey recalled. “I realized immediately that it was a wild kitten, and that I had done a stupid thing by approaching it.”
According to Duplissey, the kitten joined another kitten already in her yard. “I had no idea which kitten had bitten me,” she said.
Since the wound on her hand was deep and “dripping blood,” Duplissey’s mother suggested that she seek medical treatment at a health clinic in Utopia.

“I told my mother we needed to catch the cats when we returned from the clinic. Since they were wild, I wanted to have them tested for rabies. When the cat bit me, they had been trying to get into the garbage I had dropped, so I hoped that would occupy them for a while.”

At the health clinic, a receptionist advised Duplissey “to call the Bandera animal control folks so that they could catch the cats and have them tested for rabies.”

“When I heard that, I decided it was more important to go home and try to catch the cats,” she said. While Duplissey’s husband attempted to catch the kittens, she called the Bandera County Sheriff’s Office.

“I spoke with a lady who said she would send out the animal control officer to pick the kittens up if we could catch them,” Duplissey said, adding, “The woman also told me if we suspected the kittens were rabid, not to attempt to trap them.” As it turned out, Duplissey’s father and husband successfully caught both kittens shortly before BCSO Deputy James Bondanza arrived at their residence.

‘Help’ arrives

“Deputy Bondanza told us that the actual animal control officer was on another call, so they had sent him out to get the animals,” Duplissey said. “Since he’s allergic to cats, he seemed appreciative that we had caught them. We laughed that he’d gotten stuck with a call involving cats.”

Duplissey’s husband helped Bondanza maneuver the kittens into separate cages in the back of the animal control truck. According to Duplissey, the deputy wore thick gloves animal control officers often don when handling aggressive animals. Bondanza informed Duplissey he would take the kittens to a county veterinarian clinic for observation or testing for rabies. Clinic personnel, he said, would call her with the results.
Dr. Conrad Nightingale, DVM, serves as Bandera County rabies control officer. Bondanza gave Duplissey the office telephone numbers of Nightingale and the sheriff’s office.

So, far, so good, Duplissey believed.

Then, a short time later, she received a call from Nightingale’s office advising her that she would have to undergo the rabies vaccination process because the deputy had only delivered one kitten to the vet clinic. Since both cats could not be tested, Duplissey had no choice but to take the series of shots.

Deputy dawg

“You can imagine how upset I was to hear that news - and in utter disbelief. There is no possible way that either of those two kittens could have escaped from the cages,” Duplissey said. “If you’ve ever seen the animal control vehicle, you know exactly what I mean. Those cages are metal and built to contain strong and powerful animals. There is no way either of those two cats could possibly have opened their cage by themselves.”

Bondanza filed a BCSO offense report about the incident. He wrote: “While en route to the office, one of the kittens was seen by Deputy Bondanza walking on top of the cages in the bed of the truck of the animal control truck. Deputy Bondanza stopped the vehicle as soon as possible and began to look for the kitten. Though Deputy Bondanza searched the area, he was unable to locate the kitten. Deputy Bondanza then continued to the animal hospital.

“Deputy Bondanza arrived at the hospital with the remaining kitten and informed Dr. Nightingale of the situation. Dr. Nightingale’s staff then called Duplissey and advised her that she should begin the rabies vaccinations due to the situation.”
Monday, July 21, after the incident, Duplissey consulted her physician, who advised her to contact Bandera since the rabies vaccine is administered through the health department. After contacting Bandera authorities, Duplissey was given the telephone number of Health and Human Services in Uvalde.

Enter Tull

Duplissey eventually spoke with Catharine Tull, DMV, regional director of zoonosis for the Texas Department of State Health Services Region 8. Tull informed her there are very few confirmed cases of rabies in animals and that people are highly resistant to the virus.

“I also learned that the incubation period for rabies in humans is anywhere from one week to three years,” Duplissey said.
Tull also said that the vaccine for human rabies is in very short supply - not just in Texas, but also worldwide - and must be ordered directly from the manufacturer. Apparently the vaccine used in Texas is made in France.

“Dr. Tull assured me that I did not really need to take the vaccine, and that Dr. Nightingale’s office should never have told me that since they treat animals, not humans,” Duplissey recalled. She later discovered that Tull herself is, of course, a veterinarian not a physician.

After spending an anxious couple of hours, she received a call from one of Tull’s assistants.

“The assistant was sympathetic to my story. I really felt quite foolish admitting that I stuck my hand out to a wild animal, but she made me feel compassionate instead of stupid,” Duplissey said. “She knew from living in the ‘country’ that nature is not always kind to wild animals and that, as a consequence, we’d like to be.”

‘You die’

Duplissey was informed she needed to begin treatment since there was no certainty that the cat tested was the one that had bitten her. “I asked her what happens if you contract rabies.”
According to Duplissey, the reply was, “You die. It’s almost always fatal. There’s nothing they can do if you get it. So you cannot take the chance - period.”

That information ended Duplissey’s dilemma. “I knew I had to take the shots but I didn’t know how to get them.”
Apparently the Human Rabies Immune Globulin (HRIG) is normally given in conjunction with the human rabies Vaccine. By isolating any rabies virus in the body, the globulin prevents it from spreading. The HRIG dose is determined by weight, and based on Duplissey’s weight, she needed three and a half vials. As much as possible of the globulin is injected at the wound site; any leftover is administered in the arms or hips.

Additionally, the first dose of the vaccine should be administered at the same time as the HRIG in five doses, the day of the first dose then during intervals of three, seven, 14 and 28 days after the bite, Duplissey learned. Since the HRIG was available at Health and Human Services in Uvalde, she arranged to pick it up the next day, Tuesday, July 22.

Health department personnel faxed the information about the administration of the HRIG and the vaccine to her and the Utopia Medical Clinic, where the injections would be given. “Literally all day on Monday, I was either on the phone or waiting for someone to call me back with all the information. It was exhausting,” Duplissey said.

HRIG injections

Tuesday morning, she filled out paperwork in Uvalde to obtain the HRIG. “Basically I authorized the health department to bill my health insurance for the cost, then me if the insurance company failed to authorize the expense,” she explained. She had been given two copies of the instructions, one for herself and the other to take to the clinic.

“While I was speaking with the assistant, she took a call from another woman who had been bitten in the lip in June by a stray dog in a parking lot,” Duplissey said. “This poor woman had gone to the ER, where they gave her a tetanus shot, but not the rabies vaccine. She explained the procedure to her as well, so I’m not the only one who has been bitten by a stray or wild animal.”

Duplissey went to the health clinic in Utopia where a nurse and physician’s assistant gave her three HRIG injections in her finger and two others in each of her arms. “I was so happy not to have to have shots in my stomach the way they used to have to give them, but I would gladly have taken them there if need be,” she said.

Health department personnel had also given the clinic instructions for ordering the vaccine from France, which would be delivered directly to them within 24 to 48 hours, so Duplissey could start the series.

At least, that’s what she thought.
SNAFU

When she returned home, a message from the clinic asked her to call them. Apparently, the clinic could not order the human rabies vaccine because they had “no way to bill for it.”

“Clinic personnel told me I could probably get it online, but I knew that wasn’t going to be possible,” Duplissey said. “I called my doctor back but they didn’t want to be involved with it at all. They don’t handle that, they said, the Health Department does. As you might have guessed, this medicine is not inexpensive; each globulin vial is $135 and each shot costs $145.”

She continued, “I didn’t know what I was going to do or how on earth I could get this stuff. I had even offered to pay the clinic and my own doctor up front, yet neither would order the vaccine.”

Additionally, a callback from the health department confirmed that Tull would not authorize the health department to issue vaccine to Duplissey - even though they had it on hand.
It took someone from a higher pay grade to finally free up the needed vaccine. According to Duplissey, she was called back on Wednesday, July 23. Apparently, an unnamed supervisor had countermanded Tull’s order and said, “Give it to her. She needs it.”

“I drove back to Uvalde that morning and picked up my five vials of Human Rabies vaccine. I stopped at the Utopia clinic and they gave me my first shot,” Duplissey said. She added, “I took the remaining vials home with me and kept them in the fridge. No way was I letting anyone else take possession of them.”

Incompetence all around

Duplissey anticipates that her health insurance will not pay for the globulin or vaccine or for the cost of the injections. In that case, she will have to come up with $1,265 - for the medications alone. “The incompetence of the sheriff’s department could potentially cost me a lot of money,” Duplissey noted.

“All of this happened because Deputy Bondanza failed to deliver two kittens to Dr. Nightingale to be tested for rabies. If it had ever crossed my mind - or my husband’s mind - that those cats wouldn’t make it to the vet, we would have gladly taken them. We are still in disbelief that a trained officer could allow this to happen,” Duplissey said.

Regarding Tull’s actions, she offered, “I’m sure that if she or a loved one of hers were in my situation, she would have been sure they had the shots,” Duplissey commented. “If there’s any uncertainty, you don’t risk your life.”

Duplissey received her last Human Rabies injection last week.
The single kitten Bondanza delivered to Nightingale’s tested negative for rabies.

At this time, Duplissey is still considering all her legal options.