Cause of Infection - Report: Anesthesiologist contaminated medicine vial

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Cause of Infection - Report: Anesthesiologist contaminated medicine

vial

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Cause of Infection

Report: Anesthesiologist contaminated medicine vial

By Margaret

STAFF WRITER

July 3, 2002

A city Health Department investigation of a hepatitis C outbreak at a

Brooklyn medical clinic last year found that at least 19 patients

were infected during anesthesia by medication vials that were

contaminated through the reuse of needles.

A 22-page report, obtained yesterday by Newsday under a Freedom of

Information request, details the results of tests on more than 2,000

patients who were treated at the Bayridge Endoscopy and Digestive

Health Center between September 2000 and April of last year.

After initially saying in June of last year that eight patients who

underwent endoscopic exams there had later tested positive for the

hepatitis C virus, the city investigators found that an additional 11

patients also had been infected at the clinic.

Dr. , a city Health Department epidemiologist, said

in the internal report completed June 25 that the outbreak most

likely began when one " source patient " with chronic hepatitis C

underwent a medical procedure at the clinic in March or April of last

year.

The report said the anesthesiologist, Marvin Chiumento, reused

needles and vials to administer the patient's anesthesia.

said Chiumento knew that the patient had the blood-borne virus, which

can lead to cirrhosis of the liver.

Chiumento told investigators, if a patient needed more anesthesia, he

would dip into the same medication vial without changing needles.

believes that when the needle from the source patient was

reinserted into the same medication vial, the vial became

contaminated. That contaminated anesthesia in the vial continued

infecting subsequent patients, and the outbreak started.

" Every time that needle comes out of the patient and goes back into

the vial, some contamination has occurred, " said. " The

proper procedure is that any time a needle goes into a multi-use

vial, you should always reach for a new needle. "

said health officials looked at all possible modes for

transmission and found their smoking gun in the clinic's invoices for

needles.

From September 2000 through April of last year, the report determined

that 1,530 endoscopies - during which a light-tipped tube is inserted

in the body to inspect the stomach - were performed.

Since a minimum of three needles are used for each procedure, the

total number of needles that would normally be expected to be used

was 4,590. But the investigators, who analyzed clinic invoices, found

that only 600 needles were ordered for the same period.

e , a spokeswoman for the state Health Department, said

no disciplinary action was taken against Chiumento, and the clinic

was allowed to reopen in April.

But said she could not comment on whether the state is

investigating Chiumento. Neither state nor city officials would

comment on whether Chiumento still was working at the clinic. Efforts

yesterday to reach him for comment were unsuccessful, nor could

anyone at the clinic be reached.

At least two infected patients, meanwhile, have filed a class-action

suit against the clinic in State Supreme Court in Brooklyn alleging

medical malpractice. The patients, Deborah and Postler, said

in the suit that they underwent procedures in the spring of last

year.

The report found that 12 patients were infected at the clinic in the

initial cluster in March of last year. But after the city Health

Department expanded the investigation and contacted all 2,192

patients who had been to the clinic since it opened in January 2000,

they found another seven patients who were infected at the clinic.

Seven patients required hospitalization for the virus. The report

found no evidence of HIV transmission.

Hepatitis C is a virus transmitted by blood that may lead to chronic

liver disease. It is the leading reason for liver transplants. Some

patients may not develop symptoms for a decade or more.

Epidemiologists were able to rule out the endoscope procedure as a

source of transmission because the scopes were used on a rotating

basis.

" When one was being used, the second was being cleaned and

disinfected and the third readied for use, " the report said.

Even so, investigators noted several problems at the clinic when a

demonstration endoscopy was performed for them. According to the

report, among the problems were: the biopsy forceps were not

sterilized, the endoscope was not leak-tested after use, and the

anesthesiologist did not wear gloves while placing the IV.

Copyright © 2002, Newsday, Inc.

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