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A patient who had heart surgery at WellSpan York Hospital in 2010 was diagnosed with an infection from a rare bacteria in 2012.

That patient later died, but the hospital didn't investigate the case because nobody thought it had been related to his or her health care, a hospital spokesman told The York Dispatch recently.

That would turn out to be the first of four deaths of patients who were diagnosed with the rare infection, later linked to a device used by the hospital during open-heart surgery. At least eight York Hospital patients have been diagnosed with the infection, caused by bacteria that was able to grow because of improper cleaning of the machine.

WellSpan didn't start to investigate until July 2015, though the manufacturer of the device, Sorin Group, claims it sent WellSpan a letter warning of the risk — if the machine were improperly cleaned — a year earlier, in July 2014.

That's several months before the surgery of at least one man who died after contracting the infection. Officials haven't blamed the bacteria but said it was a likely contributor.

WellSpan hasn't directly confirmed receiving that first letter but contends the manufacturer's later (June 2015) Field Safety notice was the "official" means by which medical device manufacturers notify health care organizations that an action is required to correct a safety issue.

We read that to mean WellSpan wouldn't have been "officially" wrong — as in liable, perhaps in the eyes of a court that decides such issues — unless it ignored that second letter.

It's too late now, unfortunately, for WellSpan to go back and pay attention before it "officially" mattered.

But we hope the health care giant will use its vast network to make things as right as it can for the patients who might be harboring this slow-growing bacteria.

Last week, the hospital sent some 1,300 letters to open-heart patients who might've been affected.

The wife of at least one of those patients told the Dispatch she felt she shouldn't have read about the life-threatening infection in the news before receiving a letter at her home.

We agree.

And while we're airing the hindsight, we'll note that WellSpan staff should've been cleaning the machine according to the manufacturer's recommendations. They had not been.

But regardless of where or whether blame should be assigned, this is WellSpan's misfortune to manage — and we hope they do.

It is appropriate that WellSpan will be, as it has announced, fielding any associated costs for patients who have the infection because of their heart surgery.

We also hope hospital workers are immediately responsive to patients and family members who call the hotline that has been established for them.

Staff the phones appropriately.

It's bad enough these vulnerable people need to endure the uncertainty of standing by to see if they eventually develop the symptoms of infection.

Don't make them wait for other answers.

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