Attorney: Hepatitis C outbreak mishandled by state, Exeter Hospital
By JIM HADDADIN jhaddadin@fosters.com |
Friday, June 8, 2012
EXETER — An attorney and former cardiac surgeon blasted administrators at Exeter Hospital Thursday for their handling of a hepatitis C outbreak linked with the hospital.
Boston attorney Domenic Paolini, of the law firm Paolini & Haley, questioned why Exeter Hospital has not hired independent hospital experts to review its procedures in the wake of the outbreak. Paolini also said the hospital should have moved more quickly to close down the cardiac catheterization laboratory at the center of the investigation after concerns arose regarding the spread of hepatitis C in mid-May.
In a statement released Thursday, Paolini, a self-described patients' rights advocate, called Exeter Hospital's response to the outbreak "irresponsible" and "unacceptable."
"Having handled situations like this during my time as a cardiac medical consultant, I can tell you they are not following the commonly known best practice standards for this type of incident," he said.
Believed to be the first of its kind in New Hampshire, the hepatitis C outbreak was announced publicly by the hospital last Thursday, May 31.
The cause remained a mystery this week as officials from the New Hampshire Department of Health and Human Services continued to search for additional patients who might have contracted the virus.
As of Thursday, at least nine patients and one hospital employee were diagnosed with an identical strain of the virus. The hospital began formally investigating the first three cases of hepatitis C with a possible connection to the facility on Monday, May 14. A fourth person was linked with the cluster later in the day.
The fourth person linked with the cluster was an Exeter Hospital employee, the state's public health director, Dr. Jose Montero, told Foster's Daily Democrat earlier this week.
Hospital administrators then contacted state health officials on Tuesday, May 15, to report the potential outbreak, Dr. Richard Hollister, Exeter Hospital chief of medicine, said at a news conference last week. The cardiac catheterization laboratory was allowed to remain open as the state conducted genetic testing to study the hepatitis C infections.
Results for the first three patients came back on Friday, May 25, and indicated the patients were suffering from a virus with a common genetic fingerprint, Hollister said. The hospital voluntarily suspended operations at the cardiac catheterization laboratory that day.
Paolini believes waiting until May 25 to halt procedures at the cath. lab was an oversight on the part of the hospital. In Paolini's opinion, the hospital should have ceased procedures May 14 at not only the cardiac catheterization laboratory, but at all points where blood contact is possible.
"They should have known that chances were these were all the same strain," he said. "I mean, if you had to bet a nickel, you would assume that these were all the same strain, because it would be a total coincidence to have four cases."
Paolini also opined the hospital should have sought help from independent experts. He said many state health departments do not have staffers with the expertise or the resources to investigate hospital procedures.
Before he became an attorney, Paolini earned an MBA from the University of New Hampshire, and did consulting work in quality assurance for hospitals in Texas, Georgia and South Carolina.
He graduated from Harvard Medical School in 1978, and trained in cardiac surgery at the Harvard teaching hospitals, going into practice as a doctor until 1996.
Paolini, a medical malpractice attorney, said he is not representing any of the patients affected by the outbreak at Exeter Hospital, nor has he been contacted by any. Addressing the question of whether Paolini intends to represent patients in future litigation, a spokeswoman helping him to publicize his critique of the hospital said Paolini has not ruled out that option.
"The right thing to do is to usually bring in a group of outside experts — people that have experience in sterilization procedures, cath. lab procedures, quality control, quality assurance," he said. "Usually one person can do all that, but preferably it's better to bring in a team of two or three people and have this team review what was going on."
Paolini also called it "highly unusual" Exeter Hospital was cleared by the New Hampshire Department of Health and Human Services to reopen the cardiac catheterization laboratory this week, even though an investigation has yet to determine the means by which hepatitis C was spread in the lab.
DHHS allowed the lab to reopen for emergency procedures last Friday, June 1, and the lab resumed scheduled operations on Tuesday morning, June 5, with the permission of the state.
Paolini said before the cath. lab reopened, the source of the outbreak should have been identified, people should have been retrained, and every piece of equipment should have been cleaned.
"The cath. lab shouldn't be open," he said.
However, Paolini's suggestion doesn't appear to be enforced by any nationally-recognized hospital guideline.
Contacted this week, a representative from the Society for Healthcare Epidemiology of America, which publishes widely-used hospital guidelines, was unable to locate information relating to outbreak management.
The Centers for Disease Control does not have published guidelines addressing the circumstances under which a hospital or clinic should cease operations, according to Dr. Scott Holmberg, senior epidemiologist in the CDC's Division of Viral Hepatitis.
In the event of a viral hepatitis outbreak, the CDC does provide a tool kit to help state and local health authorities in the investigation, but the tool kit doesn't mention shutting down any part of the hospital.
Instead, the authority falls to state health officials to gauge the severity of the outbreak and request assistance from the CDC as necessary.
"Because the prevalence of hepatitis C in adults, particularly the baby boom age, is so high ¿ finding a cluster of a few cases does not automatically mean that those cases are related, so some investigation needs to take place before a decision is made," he said. Similarly, the CDC does not have any published recommendation for hospitals to bring in an independent investigator to look into an outbreak, Holmberg said.
"We always work through, and with, the state health department," he said.
Montero, the state's public health chief, said the task of investigating the outbreak at Exeter Hospital is being undertaken by the infectious diseases control group and the state's public health laboratory.
Health officials have consulted with the CDC several times for feedback and advice, Montero said, and the CDC is also performing genetic testing on some samples taken from patients. In an interview with Foster's, Montero brushed off the notion the state is ill-equipped to investigate the circumstances at the hospital.
"We have expertise in the investigations," he said. "This is what we do for a living, so I do feel confident that we have the level of expertise that we need, and that we have access to technical support when we consider that we need it."
Asked why the state believes it is safe for the catheterization lab to reopen, Montero said all employees who will be working in the lab have tested negative for hepatitis C."We have confidence that even if there is a failure in infection control, they are not going to give hepatitis C to their patients," he said.
Montero said the state is still working with the hospital to review its procedures, including how the procedures are implemented by individual workers. As of now, the state has no reason to suspect procedures are being carried out incorrectly, he said.
Discussing the decision to allow the catheterization lab to remain in operation while the genetic testing was under way last month, Montero said he has no evidence to suggest the state should have acted more aggressively in response to the outbreak.
"We are doing our best, and I feel, and I strongly believe, that we are making the right decisions, looking for advice and expertise elsewhere when we feel we don't have it, and working to protect the health of the public," he said.
http://www.fosters.com/apps/pbcs.dll/article?AID=/20120608/GJNEWS_01/706089909/-1/fosnews
Boston attorney Domenic Paolini, of the law firm Paolini & Haley, questioned why Exeter Hospital has not hired independent hospital experts to review its procedures in the wake of the outbreak. Paolini also said the hospital should have moved more quickly to close down the cardiac catheterization laboratory at the center of the investigation after concerns arose regarding the spread of hepatitis C in mid-May.
In a statement released Thursday, Paolini, a self-described patients' rights advocate, called Exeter Hospital's response to the outbreak "irresponsible" and "unacceptable."
"Having handled situations like this during my time as a cardiac medical consultant, I can tell you they are not following the commonly known best practice standards for this type of incident," he said.
Believed to be the first of its kind in New Hampshire, the hepatitis C outbreak was announced publicly by the hospital last Thursday, May 31.
The cause remained a mystery this week as officials from the New Hampshire Department of Health and Human Services continued to search for additional patients who might have contracted the virus.
As of Thursday, at least nine patients and one hospital employee were diagnosed with an identical strain of the virus. The hospital began formally investigating the first three cases of hepatitis C with a possible connection to the facility on Monday, May 14. A fourth person was linked with the cluster later in the day.
The fourth person linked with the cluster was an Exeter Hospital employee, the state's public health director, Dr. Jose Montero, told Foster's Daily Democrat earlier this week.
Hospital administrators then contacted state health officials on Tuesday, May 15, to report the potential outbreak, Dr. Richard Hollister, Exeter Hospital chief of medicine, said at a news conference last week. The cardiac catheterization laboratory was allowed to remain open as the state conducted genetic testing to study the hepatitis C infections.
Results for the first three patients came back on Friday, May 25, and indicated the patients were suffering from a virus with a common genetic fingerprint, Hollister said. The hospital voluntarily suspended operations at the cardiac catheterization laboratory that day.
Paolini believes waiting until May 25 to halt procedures at the cath. lab was an oversight on the part of the hospital. In Paolini's opinion, the hospital should have ceased procedures May 14 at not only the cardiac catheterization laboratory, but at all points where blood contact is possible.
"They should have known that chances were these were all the same strain," he said. "I mean, if you had to bet a nickel, you would assume that these were all the same strain, because it would be a total coincidence to have four cases."
Paolini also opined the hospital should have sought help from independent experts. He said many state health departments do not have staffers with the expertise or the resources to investigate hospital procedures.
Before he became an attorney, Paolini earned an MBA from the University of New Hampshire, and did consulting work in quality assurance for hospitals in Texas, Georgia and South Carolina.
He graduated from Harvard Medical School in 1978, and trained in cardiac surgery at the Harvard teaching hospitals, going into practice as a doctor until 1996.
Paolini, a medical malpractice attorney, said he is not representing any of the patients affected by the outbreak at Exeter Hospital, nor has he been contacted by any. Addressing the question of whether Paolini intends to represent patients in future litigation, a spokeswoman helping him to publicize his critique of the hospital said Paolini has not ruled out that option.
"The right thing to do is to usually bring in a group of outside experts — people that have experience in sterilization procedures, cath. lab procedures, quality control, quality assurance," he said. "Usually one person can do all that, but preferably it's better to bring in a team of two or three people and have this team review what was going on."
Paolini also called it "highly unusual" Exeter Hospital was cleared by the New Hampshire Department of Health and Human Services to reopen the cardiac catheterization laboratory this week, even though an investigation has yet to determine the means by which hepatitis C was spread in the lab.
DHHS allowed the lab to reopen for emergency procedures last Friday, June 1, and the lab resumed scheduled operations on Tuesday morning, June 5, with the permission of the state.
Paolini said before the cath. lab reopened, the source of the outbreak should have been identified, people should have been retrained, and every piece of equipment should have been cleaned.
"The cath. lab shouldn't be open," he said.
However, Paolini's suggestion doesn't appear to be enforced by any nationally-recognized hospital guideline.
Contacted this week, a representative from the Society for Healthcare Epidemiology of America, which publishes widely-used hospital guidelines, was unable to locate information relating to outbreak management.
The Centers for Disease Control does not have published guidelines addressing the circumstances under which a hospital or clinic should cease operations, according to Dr. Scott Holmberg, senior epidemiologist in the CDC's Division of Viral Hepatitis.
In the event of a viral hepatitis outbreak, the CDC does provide a tool kit to help state and local health authorities in the investigation, but the tool kit doesn't mention shutting down any part of the hospital.
Instead, the authority falls to state health officials to gauge the severity of the outbreak and request assistance from the CDC as necessary.
"Because the prevalence of hepatitis C in adults, particularly the baby boom age, is so high ¿ finding a cluster of a few cases does not automatically mean that those cases are related, so some investigation needs to take place before a decision is made," he said. Similarly, the CDC does not have any published recommendation for hospitals to bring in an independent investigator to look into an outbreak, Holmberg said.
"We always work through, and with, the state health department," he said.
Montero, the state's public health chief, said the task of investigating the outbreak at Exeter Hospital is being undertaken by the infectious diseases control group and the state's public health laboratory.
Health officials have consulted with the CDC several times for feedback and advice, Montero said, and the CDC is also performing genetic testing on some samples taken from patients. In an interview with Foster's, Montero brushed off the notion the state is ill-equipped to investigate the circumstances at the hospital.
"We have expertise in the investigations," he said. "This is what we do for a living, so I do feel confident that we have the level of expertise that we need, and that we have access to technical support when we consider that we need it."
Asked why the state believes it is safe for the catheterization lab to reopen, Montero said all employees who will be working in the lab have tested negative for hepatitis C."We have confidence that even if there is a failure in infection control, they are not going to give hepatitis C to their patients," he said.
Montero said the state is still working with the hospital to review its procedures, including how the procedures are implemented by individual workers. As of now, the state has no reason to suspect procedures are being carried out incorrectly, he said.
Discussing the decision to allow the catheterization lab to remain in operation while the genetic testing was under way last month, Montero said he has no evidence to suggest the state should have acted more aggressively in response to the outbreak.
"We are doing our best, and I feel, and I strongly believe, that we are making the right decisions, looking for advice and expertise elsewhere when we feel we don't have it, and working to protect the health of the public," he said.
http://www.fosters.com/apps/pbcs.dll/article?AID=/20120608/GJNEWS_01/706089909/-1/fosnews
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