Health authorities in New York said that another patient of Long Island anesthesiologist Dr Harvey Finkelstein has tested positive for hepatitis B. It will be some weeks before investigations reveal whether the infection resulted directly from Finkelstein’s treatment, but in the meantime, another 200 of his patients are being urged to have tests for hepatitis and HIV, according to a report in the New York Times earlier today, Tuesday 20th November.
Last week the state health authorities alerted 628 of Finkelstein’s patients, after finding out that by practising inadequate infection control between 2001 and 2005, for instance by reusing syringes, he may have put them at risk of contracting blood-borne diseases.
In 2005, Finkelstein changed his methods to comply with the infection control standards required by the US Centers for Disease Control and Prevention (CDC).
The authorities started investigating Finkelstein in 2005 after two epidural patients of his became infected with hepatitis C. Another 98 patients were traced by the health authorities at the time, and none of the tests done revealed further infections.
There has been much criticism in the media about the length of time it has taken since the discovery of the lapse in infection control practices and the messages getting to the patients at risk.
Health officials had planned to inform patients of the risk over a year ago, said Long Island paper Newsday, but Finkelstein had hired lawyers to stop all the patients’ names being released to Nassau county officials who decided against issuing subpoenas. A spokesperson for New York State Department of Health said that at first Finkelstein was cooperative, but then he hired an attorney and became less so.
A spokesperson for Finkelstein said that the request for patient records was almost impossible to meet because it would require scouring through several thousand records covering more than 10 years. It took several months of negotiation by both parties before a list of names emerged about 5 months ago. It took another 5 months to transfer the records to the state’s computer system, hence the apparent delay, reported by Long Island Newsday on the 16th November.
New York Governor Eliot Spitzer issued a statement on 16th November where he admitted the Health Department did not act quickly enough to allegations of infection control lapses. He said that a new Health Commissioner has been appointed since the time of the incident, Dr Richard Daines.
“I have directed Commissioner Daines to conduct a thorough investigation of this matter and to report back to me. I have every confidence that Commissioner Daines will give this matter the vigorous review that is critically needed. He will oversee the implementation of corrective measures and other proactive controls to ensure that something like this never happens again,” said Spitzer.
According to a report in injuryboard.com, Finkelstein said he used a different needle for each patient, but occasionally used the same needle to give extra injections to the same patient. This practice introduces a risk of cross contamination from multidose bottles. The anesthesiologist said he stopped this practice when it was noted by health officials.
A CDC leaflet issued in 2000 about infection control and safe injection practice states “use single-dose medication vials, pre-filled syringes, and ampules when possible. Do not administer medications from single-dose vials to multiple patients or combine leftover contents for later use”.
An editorial in the New York Times on 17th November urged state health officials to hurry up and get rid of multidose bottles as a way to reduce the risk of cross contamination by doctors who are ignorant or careless in their medical practice. It also referred to the nearly three year delay in alerting Finkelstein’s patients as “inexcusable”.
Click here for New York Times report.
Written by: Catharine Paddock