Feds finally on alert after other scares

By Brian Eckhouse (contact), Lisa Mascaro (contact)

Thursday, March 13, 2008 | 2 a.m.

The unfolding hepatitis crisis prompted calls Wednesday by Nevada’s political leaders for a federal response. And with interest by the FBI and the Centers for Disease Control and Prevention, we may have the government’s attention.

But when infectious disease outbreaks and scares have occurred elsewhere over the years, Washington has remained mostly silent.

Consider New York, where state officials have lobbied the Food and Drug Administration to ban multiuse vials, which are blamed for infecting at least 60 people with forms of hepatitis since 2001 as well as putting about 630 Long Islanders at risk for the disease.

There’s been no FDA response.

In late February — after the Nevada crisis won national headlines — Sen. Hillary Clinton, D-N.Y., encouraged the FDA to promote the use of single-dose vials over those that hold multiple doses.

She hasn’t gotten a response either.

Among the discrepancies between the crises in Clark County and Long Island: The very solution sought by Clinton — the use of single-dose vials of medicine to help prevent the spread of disease — is blamed here for the spread, because single-dose vials here were used for multiple patients.

But among the similarities between the two situations: They were spawned in clinics and involved reused syringes.

The Southern Nevada Health District has advised 40,000 patients who underwent procedures at the Endoscopy Center of Southern Nevada between March 2004 and January — the largest notification of its type in the country — to be tested for infectious diseases because of improper injection practices at the clinic. Health authorities have connected six cases of hepatitis C to the facility, which has been closed and is the center of federal, state and county criminal investigations.

Patient vigilance urged

“It’s the same problem (in both locations): failure to use new syringes ... and therefore contaminated syringes are used,” said Claudia Hutton, a spokeswoman for the New York State Health Department. “In this era of AIDS ... it shouldn’t have to occur to people to ask doctors, ‘Is this a new syringe?’ ”

Although the full might of the federal government has yet to be mobilized, the CDC and Nevada’s congressional delegation are weighing in.

“These errors are more common than anyone would have expected,” said Julie Gerberding, director of the CDC, in a telephone conference call Wednesday. Federal officials, she said, still “don’t have a national picture.”

Rep. Jon Porter, R-Nevada, said last week he may ask the Government Accountability Office to investigate what happened at these clinics, how problems can be prevented and what recourse could be taken. He also wants the Pentagon to help, noting that the Air Force operates mobile medical units that could be used to test those possibly exposed to hepatitis and HIV.

Rep. Shelly Berkeley, D-Nevada, has called for a congressional hearing and Sens. John Ensign and Harry Reid said they might try to secure extra money for the Nevada State Health Division when Congress returns in April from its spring recess.

Calls for federal intervention in infectious disease emergencies go back years.

In 2002, about 100 people were infected with hepatitis B at a cancer outpatient center in Nebraska. That year, a survey by the American Association of Nurse Anesthetists found 3 percent of anesthesiologists responding indicated they reused needles or syringes. The association shared its findings with the CDC and others but failed to generate enough interest to prompt a summit among health care organizations and the government.

Seeking lessons

The CDC is now on alert, helping Nevada health authorities investigate the situation here with the intent of learning lessons that can be applied nationwide.

Gerberding said Wednesday that although inspectors play a role in identifying and preventing the spread of infectious disease, “I’m not impressed that inspection per se is the piece of the puzzle most likely to do the most good.”

“You’re just getting a brief snapshot of what’s going on in a facility,” she said. “Creating tip lines or opportunities for people to raise issues is going to be an important part of the solution.”

Hospitals have more people on hand than ambulatory centers do to detect problems and typically promote a more open culture that allows for the reporting — and correcting — of mistakes, she said. In outpatient facilities, there are usually just one or two people in the room, Gerberding said.

Sun librarian Rebecca Clifford contributed to this story.