Criminal charges are being considered in a New Hampshire hepatitis C outbreak linked to the Exeter Hospital. Hepatitis C is a viral liver disease that can lead to chronic liver disease, such as cirrhosis, or cancer of the liver.
The virus is spread by contact with infected body fluids. No vaccines exists for hepatitis C, which can be fatal. According to the U.S. Centers for Disease Control and Prevention (CDC), liver disease caused by hepatitis C results in 12,000 deaths in the country every year.
Now, said Fosters, the state’s attorney general, Michael A. Delaney, just initiated an investigation into the matter saying that his office “has worked and continues to work with the Exeter Police Department and the New Hampshire State Police” to determine if criminal acts occurred in relation to the outbreak. As we mentioned yesterday, Dr. José Montero, director of New Hampshire Health and Services, told CNN that the culprit appears to have been an infected hospital employee who moved part of a medication dose by injecting that dose into him/herself and administering the remainder of the medication to patients, using the same needle.
The scenario is called “drug diversion,” explained Fosters and has been at the root of at least three hospital hepatitis outbreaks, nationwide, since 2001, according to a study conducted by the CDC and published in the health care administration journal Medical Care earlier this year.
Blood borne diseases can be transmitted when an infected person is given a shot and either the needle or syringe is reused. Microscopic backflow can enter the syringe from the contaminated person and then also enter the medicine vial, which puts other patients receiving that medication at risk from the needle, the syringe, and drug vial. Hepatitis C is the most common chronic blood borne viral infection in the U.S. said the CDC, with about 3.2 million Americans suffering from lifelong, chronic infection.
The common link is Exeters cardiac catheterization laboratory (CCL) and an adjacent recovery room, said Fosters. To date, 20 employees and patients at the lab tested positive for hepatitis C, said New Hampshire’s public health director. All 20 have been advised. At a news conference this week, Dr. Montero would not describe the evidence that led to the belief that drug diversion was used, but did say investigators collected data from Exeter and interviewed patients and employees. The employee diagnosed with hepatitis C was placed on leave when Exeter’s investigation began last month, said Mark Whitney, vice president of community relations, wrote Fosters.
It has not been confirmed if the employee was the source of the outbreak or a victim, said Whitney. What is known is that the employee worked in the lab but, according to hospital spokeswoman, Debra Vasapoli, did not have a “direct patient care role,” wrote Fosters. In a statement just released by the hospital, it said that, “Exeter Hospital welcomes this investigation, and is planning to cooperate with the Attorney General’s Office as we continue our own investigation into the possible cause.”
Fosters noted that since 2009, two hepatitis C outbreaks led to criminal charges. In one, a Colorado woman infected patients at two hospitals by stealing fentanyl, an anesthesia drug 80-100 times more potent than morphine. She would inject herself, replacing fentanyl with saline, returning contaminated syringes to operating room carts. Her actions led to at least 17 confirmed contaminations and 7-8 suspected contaminations. In the same way, a former Mayo Clinic radiology technician infected two patients with hepatitis C, also related to shooting up fentanyl he stole over two years, said Fosters.
The hospital announced, following state prosecutor involvement that, “We will continue to provide updates on our efforts to reach out to and test all potentially affected patients who were treated in our Cardiac Catheterization Lab between October 1, 2010 and May 25, 2012.” According to Fosters, Exeter contacted all patients sought for testing, including an additional 316 patients treated at the CCL between October 1, 2010 and March 31, 2011. Originally, the state was looking at patients treated in the lab from April; however, the time frame has been expanded. Testing will begin Monday, June 18 at the Exeter Healthcare building, said Fosters.