CLINTON AND HCV LETTERS
Current mood: Growly
You may have heard or read about the misuse of syringes, spreading disease. HCV is being followed the closest, as it is easier to transmit. (hmmm.. comment from the peanut gallery: So why is there more funding going to HIV than HCV. There are 3 times more cases of HCV than HIV.)
Vegas Clinic May Have Sickened Thousands
By KATHLEEN HENNESSEY (Associated Press Writer)
From Associated Press
March 05, 2008 6:50 PM EST
LAS VEGAS - Nearly 40,000 people learned this week that a trip to the doctor may have made them sick.
In a type of scandal more often associated with Third World countries, a Las Vegas clinic was found to be reusing syringes and vials of medication for nearly four years. The shoddy practices may have led to an outbreak of the potentially fatal hepatitis C virus and exposed patients to HIV, too.
The discovery led to the biggest public health notification operation in U.S. history, brought demands for investigations and caused scores of lawyers to seek out patients at risk for infections.
Thousands of patients are being urged to be tested for the viruses. Six acute cases of hepatitis C have been confirmed. The surgical center and five affiliated clinics have been closed.
"I find it baffling, frankly, that in this day and age anyone would think it was safe to reuse a syringe," said Michael Bell, associate director for infection control at the national Centers for Disease Control and Prevention.
One of the infected patients is retired airplane mechanic Michael Washington, 67, who was the first to report his infection. On the advice of his doctor, he received a routine colon exam in July at the Endoscopy Center of Southern Nevada.
In September, he started to get sick. He was losing weight fast. His urine turned dark. His stomach hurt. By January, it was clear what had happened.
Washington describes his virus as a "creeping death sentence" and worries that others will hear his story and think twice before getting preventive care they need.
In letters that began arriving this week, patients who received injected anesthesia at the endoscopy center from March 2004 to mid-January were urged to get tested for hepatitis B and C, and HIV.
Because all three viruses are transmitted by blood, they could have been passed from one patient to the next by the unsafe practices at the clinic.
The mass notification is the result of a health district investigation that began in January when officials linked an uptick of unusual hepatitis C cases to the clinic.
Health officials say they are most worried about the spread of hepatitis C, which targets the liver but shows no symptoms in as many as 80 percent of infections.
Hepatitis C results in the swelling of the liver and can cause stomach pain, fatigue and jaundice. It may eventually result in liver failure. Even when no symptoms occur, the virus can slowly cause damage to the liver.
Officials estimate that 4 percent of the patients already had the virus when they entered the clinic, compared with 0.5 percent for hepatitis B and less than 0.5 percent for HIV. Hepatitis C also is easier to transmit than HIV, they said.
"You put the two together and hepatitis C is really our big concern," said Brian Labus, senior epidemiologist at the Southern Nevada Health District.
Health inspectors say they observed clinic staff using the same syringe twice to extract anesthesia from a single-dose vial, which was then used to treat more than one patient. The practice allows contaminated blood in a used syringe to taint the vial and infect the next patient.
Of the six patients so far diagnosed with acute hepatitis C, five received treatment at the clinic on the same day in late September.
Since 1999, the CDC counts 14 hepatitis outbreaks in the U.S. linked to bad injection practices.
The largest outbreak occurred in Fremont, Neb., where 99 cancer patients were infected at an oncology center from 2001 to 2002. At least one died. The doctor involved in the case acknowledged reusing syringes and settled scores of lawsuit. But he never explained why the syringes were reused.
Bell said such improper procedures appear to be more common in outpatient surgical centers like the endoscopy center. Unlike hospitals, such centers often do not have employees whose sole responsibility is to monitor and educate staff on best practices.
In Las Vegas, clinic staff told inspectors they had been ordered by management to reuse the vials and syringes. Labus described the practice as an unwritten, but long-practiced policy.
Investigators were told the practice was an attempt to cut costs, according to a letter of complaint from the city, which revoked the facility's business license Friday. Five other facilities affiliated with the Endoscopy Center of Southern Nevada also had their licenses revoked.
The clinic's majority owner, Dipak Desai, a political contributor and member of the governor's commission on health care, has refused to comment on the allegations.
He released a statement expressing concern for the patients and assuring the public the problems had been corrected. He later took out a full-page ad in Sunday's edition of the Las Vegas Review-Journal insisting that needles had not been reused and that the chances of contracting an infection at the center in most of the last four years were "extremely low."
Of the thousands of people who have rushed to be tested, many will get positive results, Labus said. More than 15,000 people already have called the health district for information.
But it takes a more sophisticated test, a complete evaluation of risk factors and a clear pattern of infection to determine whether the virus was caught at the facility.
Plenty of lawyers are wading into the mess. Television ads called "health alerts" are soliciting clients. At least a handful of class-action lawsuits have been filed.
On Tuesday, the office of Las Vegas attorney Ed Bernstein was buzzing with phone calls - nearly 1,000 a day, he said. Bernstein said he represents about 1,200 patients at the facility, eight who have tested positive for hepatitis C.
Washington, the infected airplane mechanic, is one of Bernstein's clients.
His wife, Josephine, a registered nurse, wonders how any health care professional could be so reckless: "To maximize profit? For what? What are you going to save?"
---------------------------------------------------------------------------------Senator Clinton Calls on FDA to Address Hepatitis Risk Linked to Multidose
Medication Vials Washington, DC Today, Senator Hillary Rodham Clinton called on Food and
Drug Administration (FDA) Commissioner Andrew von Eschenbach to address
concerns about recent cases of hepatitis B and C in New York linked to use of
multidose vials, which are used to administer multiple doses of vaccines or
medications, often to more than one patient. In New York, despite the fact
that all health care providers are required to undergo infection control
training, more than 60 cases of hepatitis B and C have been linked to use of
multidose vials since 2001.
These infections raise health and safety concerns that must be
addressed, said Senator Clinton. It is critical that the FDA take
seriously the heightened risk associated with multidose vials and encourage
the use and production of cost-effective alternatives.
---------------------------------------------------------------------------------
From: Robert Heimer
Subject: Re: Clinton and HCV letter
This focus on multi-dose vials actually seems misdirected. If the
administration of vaccines and other medications using multi-dose vials is
linked to transmission, the real culprit has to be re-use of syringes in
administering doses from these vials. The vials can get contaminated only if a
contaminated needle is inserted into the vials. Moving to single use vials may
have the unintended consequence of increasing the cost of vaccines and other
medications and making their administration less likely...all the while being
no safer if syringes are still being reused.
So, the proper answer -- buried in the Clinton letter -- is to advocate for
single use syringe and proper training for medical staff who administer
vaccines. The latter is not difficult. For a recent research study, we
created teams of lay vaccinators who were clearly instructed never to reuse
syringes. We never learned of any breaches in this protocol.
Let's try not to throw out the baby with the bathwater.
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From: Ken Fornataro
Subject: Re: Clinton and HCV letter
I couldn't agree more that money to properly train injectors about syringe use (and make clean needles available at least as easily as alcohol and cigarettes) would decrease the transmission of many diseases, especially HCV. There has to be a way to propel incidents like this into action. Demands for a couple hundred million to start for Hepatitis education, testing, PCR testing, vaccinations by trained staff, and coverage of a full course of treatment for those who opt to do so would be a good start. I hope none of the 40,000 people exposed have to figure out how to pay for the care and treatment they need - because help in that area practically doesn't exist.
Ken
