Wednesday, December 7, 2011

The Risk - Contracting Hepatitis C In A Nonhospital Setting

The Risk - Contracting Hepatitis C In A Nonhospital Setting

The main mode of hepatitis C transmission outside the United States is attributed to unsafe injections using contaminated equipment. According to The World Health Organization( WHO ) countries with high rates of chronic hepatitis C infection are Egypt (22%), Pakistan (4.8%) and China (3.2%). WHO reports 16 billion injections are administered every year in developing countries. Most of them are either not required or not sterilised properly.

Recently in eastern China a clinic is suspected of having infected at least 180 people with Hepatitis C with unclean needles.

In the United States the risk for contracting hepatitis C while undergoing medical procedures at a nonhospital medical setting is rare. However, it's been reported over the last few years that at free-standing clinics for colonoscopies and dialysis its increasing.

Today on the blog I have summarized a few of the recent hepatitis C outbreaks at these clinics. When we break down these patterns three common factors are present. The first factor of the pattern is route of transmission. In most clinical transmissions the route of transmission is an irresponsible healthcare provider. The pattern continues with a second common factor, the affliction of drug addiction plaguing the previously mentioned healthcare provider. This catalyst leads to the third and final factor of the pattern, the point of origin of the outbreak. In the majority of the scenarios we are examining the drug or anesthetic administered is contaminated due to human error. This is a clear cycle of negligence that perpetuates itself time and time again.


Point Of Origin - Drug Fentanyl

At the following medical facilities, Rose Medical Center, Mayo and Riverside Regional patients were infected with hepatitis C by the reuse of contaminated syringes by medical providers. In all three outbreaks employees admitted to stealing syringes filled with Fentanyl and injecting themselves with the drug replacing the syringes with saline to be used on future patients.

Route Of Transmission - Scrub Tech With Hepatitis C
Catalyst -Drug Addiction
Point Of Origin - Contaminated Anaesthetic-Drug Fentanyl

Kristen Diane Parker who was formerly a Scrub Surgery Tech at Rose Medical Center in Denver and also worked at the Audubon Surgery Center in Colorado Springs, stole syringes to inject herself with the painkiller fentanyl then replacing them with saline to be used on surgical patients. The tech has infected three dozen people with hepatitis C.

Feb 25 2010
Kristen Parker gets thirty years for hepatitis-C infections -- but her victims get life

Yesterday, Kristen Parker, a surgical scrub tech who managed to infect a great many patients with hepatitis-C, was sentenced yesterday to thirty years in prison -- a punishment that U.S. Attorney David Gaouette (who recently spoke in this space about the arrest of Highlands Ranch medical marijuana grower Chris Bartkowicz) sees as wholly justified.

Update; Nov 28 2011
Kristen Parker's hep-C rampage: Doctors deny duty to prevent drug thefts (VIDEO)

Although Kristen Parker, the surgical tech who infected dozens of Rose Medical Center patients with the hepatitis C virus in 2008 and 2009, is now serving a thirty-year prison sentence, the fallout from her crimes continues to keep a scrum of attorneys busy. In recent court filings in a patient lawsuit against the hospital and operating room personnel who worked with Parker, the defense adamantly denies any responsibility for the outbreak -- and even proposes a novel theory of how the virus was transmitted.

Mayo Clinic worker in hepatitis case used patients’ syringes

Route Of Transmission - Radiology Tech With Hepatitis C
Catalyst -Drug Addiction
Point Of Origin - Contaminated Anaesthetic-Drug Fentanyl


In August of 2010 at the Mayo Clinic in Jacksonville Florida radiology tech Steven Larry Beumel admitted he injected himself with the painkiller Fentanyl and like Parker filled the empty syringes with saline and left them to be used on patients.

"As fat back as 2007, Mayo officials noticed an increase in hepatitis C cases inside the hospital and began investigating".

An infected radiology tech injected himself at work; used syringes likely passed on the deadly disease.

The case involves a radiology technologist who had been employed at Mayo’s Jacksonville campus for six years. It started in 2007, when Mayo officials noticed an increase in hepatitis C cases inside the hospital and began investigating the cause, Rupp said.

What they found was “profoundly disturbing,” said John Noseworthy, president and CEO of the entire Mayo organization, which also includes a clinic in Scottsdale, Ariz., and its flagship clinic in Rochester, Minn.

When no one was looking, the man injected himself with doses of a potent painkiller called Fentanyl, Mayo officials say. Afterward, he refilled the syringes with saline and switched out the needles.

But enough of the virus apparently lingered to infect another person, he added.

Update May 24 2011

JACKSONVILLE, FL—United States Attorney Robert E. O’Neill announces the unsealing of an indictment charging Steven Beumel, (48, Orange Park) with five counts of tampering with a consumer product, resulting in death or serious bodily injury, and five counts of obtaining a controlled substance by fraud. If convicted on all counts, Beumel faces a maximum penalty of life in federal prison.

According to the indictment, Beumel was a radiology technician at Memorial Hospital from May 1992 through October 2004. Beumel also worked as a radiology technician at Mayo Clinic from October 2004 through August 2010. The indictment alleges that Beumel, before patients’ procedures, took syringes of Fentanyl and replaced them with used syringes contaminated with his own Hepatitis C Virus. According to the indictment, five different patients contracted Hepatitis C from Beumel. The indictment alleges that one patient died as a result from Beumel’s tampering.

An indictment is merely a formal charge that a defendant has committed a violation of the federal criminal laws, and every defendant is presumed innocent unless, and until, proven guilty.

This case was investigated by the Federal Bureau of Investigation, the Food and Drug Administration, the Florida Department of Financial Services, and the Jacksonville Sheriff’s Office, Homicide Unit. It will be prosecuted by Assistant United States Attorney Frank Talbot.

Nurse May Have Infected 300 in Virginia With Hepatitis C

Route Of Transmission - Nurse With Hepatitis C
Catalyst -Drug Addiction
Point Of Origin - Contaminated Anaesthetic-Drug Fentanyl

In the spring of 2008; Assoicated Press

Jones spread the disease in 2004 during surgeries at an El Paso military hospital by diverting fentanyl - a powerful painkiller often used for anesthesia - from patients to himself.

At least 15 military service members or their relatives are believed to have been infected with hepatitis by a nurse suspected of stealing their painkillers during surgery. The nurse, retired Army captain Jon Dale Jones, was arrested this month in Miami on federal charges of assaulting three of those patients and possession of a controlled substance by fraud. Federal prosecutors said they believe Jones spread the disease in 2004 during surgeries at an El Paso military hospital by diverting fentanyl - a powerful painkiller often used for anesthesia - from patients to himself. The outbreak - and the nearly three-year-long criminal investigation that followed - apparently did not prevent Jones from continuing to work as nurse in Texas and at least two other states and Washington, D.C.

Officials at Riverside Regional Medical Center in Newport News said Jones worked there from July through December. Staff members have identified 310 patients who came into contact with Jones and asked them to return for tests for hepatitis C.

Update 2009

By Alicia A. Caldwell - The Associated Press
EL PASO, Texas — A former Army nurse who admitted infecting patients at a military hospital with hepatitis C while stealing powerful painkillers from them during surgery was sentenced Tuesday to more than three years in federal prison.

Jon Dale Jones, a 47-year-old retired Army major, admitted in April that he repeatedly stole the intravenous painkiller fentanyl — often used in anesthesia — from surgery patients while working as a civilian nurse anesthetist at William Beaumont Army Medical Center in El Paso.

Assistant U.S. Attorney Bill Lewis said then that investigators believed Jones infected at least 16 patients after pulling fentanyl from a clean vial at the hospital and putting it in a contaminated container he brought from home. He would then give patients the remaining medicine from the hospital’s newly infected vials, Lewis said.

During Tuesday’s hearing, two of Jones’ victims testified that the one-time soldier was remorseful and should be given leniency.

“I believe he deserves a second chance,” Ivan Westrick told U.S. District Judge Frank Montalvo. “I ... believe he’s taken a step forward.”

A Florida psychologist, Karen Gold, testified that Jones has dealt with drug and alcohol addictions since his youth, and suffers from post traumatic stress disorder because of abuses suffered as a teenager. She said he has been forthcoming about both his addictions, which he has been in treatment for, and his guilt in this case.

In asking Montalvo for leniency Jones apologized for what he had done and said he was starting “to put my life back together.”

“Today I know how to ask for help and I do so on a regular basis,” Jones said. “It’s all about service to others; I think that is my new calling in life.”

Still, Lewis, the lead prosecutor in the case, argued Jones repeatedly lied about his involvement in the 2004 hepatitis outbreak at William Beaumont and only admitted his role after being charged with several felony counts. Lewis added that Jones didn’t acknowledge his addiction to painkillers until he was later caught diverting drugs while working at a hospital in Washington, D.C.

Montalvo said he took seriously statements from victims who supported a shorter sentence for Jones, who faced up to 20 years in prison, and his own apologies Tuesday. But he said he sentenced Jones to 41 months in federal prison, followed by three years of supervised release, in part to ensure he was properly punished for abusing his position as a medical professional.

“The message needs to get out that there are serious consequences for people who are in your position who abuse drugs of their patients,” Montalvo said.


Abortion Doctor Infected 54 Patients With Hepatitis C

Route Of Transmission - Physician With Hepatitis C
Catalyst -Drug Addiction
Point Of Origin - Contaminated Anaesthetic

The prosecution alleges Peters was injecting himself first with the intravenously administered drugs he used on his patients, using the same needle. It was also alleged the doctor knew he was infected with hepatitis C at the time.

Update Dec 6 2011

Abortion doctor knew he had hepatitis C, court told

Reported by anaesthetist James Latham Peters, is facing 162 charges of infecting women patients he treated for pregnancy terminations at the Croydon Day Surgery between 2008 and 2009.

"They relate to 54 counts each of conduct endangering life, recklessly causing injury and negligence causing serious injury for ''using and sharing intravenously administered anaesthetic drugs with his surgical patients, whilst knowingly infected with the hepatitis C virus, (which) may have placed person/s in danger of death''.

Video May 2011


Hepatitis C Virus Transmission at an Endoscopy Clinic

Route Of Transmission - Patient-to-patient
Catalyst - Human Error/Negligence
Point Of Origin - Contaminated Anaesthetic-Drug Propofol

Patient-to-patient transmission of hepatitis c resulted from contamination of single-use medication vials of propofo that were used for multiple patients during anesthesia administration.

The resulting public health notification of approximately 50,000 persons was the largest of its kind in United States health care. This investigation highlighted breaches in aseptic technique, deficiencies in oversight of outpatient settings, and difficulties in detecting and investigating such outbreaks.

Fischer GE et al. Hepatitis C virus infections from unsafe injection practices at an endoscopy clinic in Las Vegas, Nevada, 2007–2008. Clin Infect Dis 2010 Aug 1; 51:267.
Medline abstract

According to an article in the Las Vegas Sun Dipak Desai who ran the Endoscopy Center of Southern Nevada was indicted by a grand jury last year along with Keith H. Mathahs and Ronald E. Lakeman both nurse anesthetists.

The felony charges include racketeering, performance of an act in reckless disregard of persons or property, criminal neglect of patients, insurance fraud, theft and obtaining money under false pretenses...continue reading here.

Update Nov. 15, 2011

Lawyers to challenge competency finding for doctor in hepatitis scare

A hearing has been set for January for defense attorneys for Dipak Desai, the Las Vegas doctor at the center of the hepatitis scare in 2007 and 2008, to challenge state medical experts’ findings that Desai is competent to stand trial.


October 2011

Propofol Makers Liable in Hepatitis C Outbreak Lawsuit
Teva, Baxter, McKesson ordered to pay infected patients $183.6 million.

A Nevada jury has awarded 3 patients who contracted hepatitis C through hazardous practices at Las Vegas-area GI clinics $183.6 million in their lawsuit against the companies that supplied the clinics' propofol.

Manufacturer Teva Parenteral Medicines and distributors Baxter Healthcare and McKesson Medical-Surgical owe a combined $162.5 million in punitive and $20.1 million in compensatory damages to plaintiff patients Anne Arnold, Richard Sacks, Tony Devito and 2 of their spouses. Their lawsuit had argued that the companies' packaging of propofol in 50mL and 100mL vials without single-use-only warnings encouraged the clinics' staffs to reuse the drugs on multiple patients, spreading the disease..Continue Reading...

Dr. Joseph Perz, a Center for Disease Control and Prevention (CDC) official who investigates hepatitis outbreaks reported that in the United States from 1998-2008 related outbreaks in outpatient clinics and nursing homes has infected close to 450 people, with more reported since then.

Nursing homes are one problematic setting for the transmission of viral hepatitis, in one outbreak healthcare providers misused a medical device for blood glucose monitoring. These devices require finger pricking and unfortunately were the route of transmission in the 2010 outbreak of hepatitis B at a nursing home in North Carolina. In July of 2011 a Fine was Proposed For The Deadly Hepatitis B Outbreak

A state panel recommended a $16,000 fine Thursday for an assisted living center where six died from Hepatitis B. The Glen Care facility in Mount Olive was the center of the outbreak that hospitalized eight clients. Several people who knew the hepatitis victims said the fine is not strong enough.

In this country the risk of transmitting bloodborne pathogens in a healthcare setting remains low, although, drug abuse among healthcare providers is on the rise. These outbreaks due to irresponsible providers, unsafe injection, vial medication practices, and improper use of medical devices are unacceptable. It's essential to verify the competency of those providers who are testing patients with the mentioned devices, in particular the handling of medications. Aggressive screening and diagnostic testing for the latter must be in place to determine possible drug abuse.

Related Information

NATAP has a collection of explicit data on HCV & Re-Use of Syringes

No comments:

Post a Comment