About 628 New York Patients Seek HIV Testing

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New York state health officials this week notified 628 people thatthey should seek testing for HIV, hepatitis and other bloodbornediseases because between 2000 and 2005 they were treated by a NassauCounty, N.Y., anesthesiologist who reused syringes when injectingpatients with more than one drug, the New York Times reports.

Statehealth officials began investigating anesthesiologist HarveyFinkelstein of Plainview, N.Y., in 2005 after two of his patientscontracted hepatitis C. According to the Times,Finkelstein would use a new syringe for each patient. However,Finkelstein told investigators that in 2000 he began using the samesyringe to draw medicine from more than one vial when giving a patientmore than one type of drug by injection, which caused the potentialcontamination of multidose vials. The blood of a patient with one viruscould, by backing up through the needle and entering the vials, betransmitted to another person when that vial of medicine was reused.

Investigatorsin 2005 notified 98 of Finkelstein's patients who had received epiduralinjections in the three weeks before, during and after his two patientswere infected, that they should seek testing for bloodborne diseases.Of the 84 who were tested, no other cases of infection were traced toFinkelstein. The state then expanded its investigation to examinerecords from 2000 to 2005. New York Health Commissioner Richard Dainesin a statement released this week said that "the department identifiedall 628 patients who had received injections between Jan. 1, 2000, andJan. 15, 2005, after a thorough review of medical records at all siteswhere this physician practiced" (Vitello/Kershaw, New York Times, 11/16).

Timing of Notification

State health department officials said Thursday that they had plannedas early as October 2006 to notify all of Finkelstein's patients thatcould have been infected with HIV, hepatitis B and hepatitis C, Long Island Newsdayreports. However, Finkelstein hired attorneys to avoid submitting allthe names of the patients to state and Nassau County officials, andofficials then decided against issuing subpoenas. "Initially Dr.Finkelstein was very cooperative," Claudia Hutton, spokesperson for theNew York State Department of Health, said, adding, "Then later on he retained an attorney and was not as cooperative."

AndyKraus, a spokesperson for Finkelstein, said that the state healthdepartment's initial request was "nearly impossible" to fulfill becauseit asked for "thousands" of records going back more than 10 years.After several months of negotiations with Finkelstein's lawyers, thefirm supplied the names electronically to the state in June and July.The state took four months to convert the records to its computersystem and to have its notification letter approved by lawyers beforethey were sent to his patients this week, Newsday reports (Amon, Long Island Newsday, 11/16).

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Nassau County Executive Thomas Suozzi called the long delay in makingthe notifications "outrageous," adding that state health officials wereoverly deferential in their negotiations with the physician's lawyers (New York Times,11/16). Hutton said the health department staff "truly don't believe"that they could have notified patients and the public faster than theydid. "There are some who would argue we went overboard by doing thisletter because the risk of transmission is so low," Hutton said,adding, "We would argue that patients have a right to know if they areput at any risk."

State Sen. Kemp Hannon (R), chair of theSenate Health Committee, announced Thursday that he would hold hearingsin December to determine why the notification process was delayed forso long, Newsday reports (Long Island Newsday, 11/16). Michael Duffy, a lawyer who specializes in medical malpractice cases and vice president of the New York State Academy of Trial Lawyers,said that the long delay in notifying Finkelstein's patients isparticularly troubling because they will not be able to seek damages incourt (New York Times, 11/16).

Finkelstein lastweek said that he stopped reusing syringes when health officials tooknote of it. "We have reviewed everything," he said, adding, "The truthwill come out" (AP/Syracuse Post-Standard, 11/16).

Editorial

Finkelstein's "lax approach to infection control has raised troublingquestions about the adequacy of medical oversight in New York state," aNew York Times editorial says. According to the Times,state and county health officials have been "justifiably" criticizedfor moving too slowly to alert Finkelstein's patients of the possibletransmission of HIV and hepatitis.

It "seems inexcusable" thatit took the state almost three years to notify people underFinkelstein's care that they should be tested for HIV and hepatitis,the editorial says, adding that it will be necessary to determine ifthe state's investigatory and disciplinary process is "tilted too muchtoward protecting doctors rather than any patients who may have beenharmed." Plans by state officials to eliminate multidose vials "wouldprovide the surest protection against such contamination and not leavepatients at the mercy of a doctor's ignorance or carelessness," theeditorial concludes (New York Times, 11/17).

Reprinted with permission from kaisernetwork.org. You can view theentire Kaiser DailyHIV/AIDS Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily HIV/AIDS Report ispublished for kaisernetwork.org, a free service of The Henry J. Kaiser FamilyFoundation.

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