Current News |
Patients Were Not Told of
Misuse of Syringes
By PAUL VITELLO and SARAH KERSHAW
Published: November 16, 2007
http://www.nytimes.com/2007/11/16/nyregion/16doctor.html?ex=1195880400&en=db628
2a04cd82c3d&ei=5070&emc=eta1
State health officials notified 628
patients this week that they should be
tested for hepatitis and H.I.V.
infection because they were treated
years ago
by an anesthesiologist in Nassau County
who used improper procedures for
preventing the spread of blood-borne
diseases.
The anesthesiologist, Dr. Harvey
Finkelstein, of Plainview, first became
the
focus of a state health investigation in
2005 after two of his patients
contracted hepatitis C. His name was
reported by Newsday.
Yesterday, county and state officials
traded blame over the 34-month delay in
notifying the patients. At the same
time, the incident led state health
officials to seek a meeting with the
Centers for Disease Control and
Prevention
to address an issue of drug packaging
that was apparently at the heart of the
problem.
In 2005, investigators found that, in
violation of widely accepted practices
recommended by the C.D.C., Dr.
Finkelstein, 52, who specializes in pain
management, was reusing syringes when
drawing doses of medicine from vials
that
hold more than one dose.
He would use a new syringe for each
patient. But when giving one patient
more
than one type of drug by injection, his
practice of using the same syringe to
draw medicine from more than one vial
led to the potential contamination of
the
vials. The blood of a patient who was
infected with hepatitis C could, by
backing up through the syringe and
entering the vials, infect another
patient
when the same vial of medicine was used
again. This is what happened in at
least one case, health officials said.
State health officials said yesterday
they hoped to get the C.D.C.’s support
in
seeking the elimination of such
multidose vials.
Any fix would come too late for Raymond
Bookstaver, 49, a Hicksville mechanic
who was one of two patients initially
identified as having been infected by
Dr.
Finkelstein’s improper use of syringes.
“I feel like I went to a doctor for
help, and what I got instead was a death
sentence,” Mr. Bookstaver said. His
hepatitis is being treated, but erupts
unpredictably, causing him to suffer
flulike symptoms including nausea,
vomiting and aching that leaves him
bedridden, he said.
At least one and possibly more doctors
in the state, including a New York City
anesthesiologist, have been reported to
state health officials in the last
several years for reusing syringes.
State officials said they would cite
those
reports in their meetings with C.D.C.
officials.
In 2005, Dr. Finkelstein was instructed
in the proper use of syringes in
administering pain medications by state
health investigators and he has since
been monitored to make sure he complied,
a State Health Department spokesman
said.
For reasons that were unclear yesterday,
his case was not referred to the State
Board for Professional Medical Conduct
of the State Education Department until
nine months after his unsafe practices
were known.
That agency, charged with taking
disciplinary actions against doctors,
found no
evidence of wrongdoing, and recommended
no disciplinary action.
In January 2005, the Health Department
began an epidemiological investigation
to determine how many of Dr.
Finkelstein’s patients were infected by
the vials
of medicine that he had used more than
once.
Investigators notified 98 patients who
had received epidural injections for
pain management in the three weeks
before, during and after Dr.
Finkelstein’s
two patients were infected, telling them
to get tests for blood-borne
infections including hepatitis and H.I.V..
Of the 84 who were tested, no other
cases of infection were traced to Dr.
Finkelstein.
The state then expanded its
investigation to cover the years from
2000 to 2005.
It was in 2000, Dr. Finkelstein told the
investigators, that he began using one
syringe to draw doses from numerous
vials. In a statement released this
week,
the state health commissioner, Richard
Daines, said “the department identified
all 628 patients who had received
injections between Jan. 1, 2000, and
Jan. 15,
2005, after a thorough review of medical
records at all sites where this
physician practiced.”
The Nassau County executive, Thomas R.
Suozzi, called the long delay in making
the notifications “outrageous,” and
blamed Dr. Finkelstein and state health
officials who he said were overly
deferential in their negotiations with
the
physician’s lawyers.
Claudia Hutton, a spokesman for
Commissioner Daines, said that it was
routine
for the department’s staff to negotiate
with a doctor’s lawyers in its
investigations, and added: “We worked
with Nassau County hand in hand. They
were with us all the way. It’s nice that
our partners are now playing 20-20
hindsight, but that’s life.”
State health officials acknowledged that
the process, begun under the previous
health commissioner, could have been
more efficient. But they also said that
before informing large numbers of
patients, they wanted to make sure they
only
informed those who were at risk of being
exposed, to avoid public panic.
“The commissioner wishes it were
faster,” said Ms. Hutton, the department
spokesman, “and it’s something he’s
going to look at and sit down to figure
out
why the things happened the way they did
and how we could have done it more
efficiently.”
But, she added, “epidemiological
investigations do take a while, and what
we
had here — it’s not like we found 25
cases within a two-week time frame — we
thought we should be cautious.”
But patients and consumer advocates said
the delay from January 2005 to
November 2007 was a disservice to the
public.
Though Mr. Bookstaver’s illness was
diagnosed almost immediately by his
family
doctor, he said that other patients —
the 628 notified this week, for example
—
might not have been as lucky. “What if
they have been living with these
diseases all this time untreated? And
thinking they had the flu?” he said.
Joanne Doroshow, director of the New
York-based Center for Justice and
Democracy and a member of a state task
force on medical malpractice, said the
case illustrated “a too-cozy
relationship between the medical
profession and
the people who supposedly regulate
them.”
Michael Duffy, a lawyer who specializes
in medical malpractice cases and vice
president of the New York State Academy
of Trial Lawyers, said that the long
delay in notifying the 628 potential
victims of Dr. Finkelstein’s practice
was
especially troubling because none would
be able to seek damages in court. |
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