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Doctor reused syringes while injecting patients with anesthetics
Thursday, November 15th 2007
His job was to relieve suffering, but what a Plainview pain management doctor is accused of doing is enough to make anyone sick.
Dr. Harvey Finkelstein, an anesthesiologist based at a popular pain management clinic on Old Country Road, reused syringes while injecting patients with anesthetics, an illegal practice that leaves hundreds of patients at risk for HIV and two strains of hepatitis, county and state officials said yesterday. At least two hepatitis C cases have been traced to the physician, officials said.
The state and Nassau County health departments alerted about 630 patients by letter this week that they should be tested for HIV, hepatitis B and hepatitis C infection. Health officials want to reach every patient who received injections from Finkelstein between Jan. 1, 2000 and Jan. 15, 2005.
"It's outrageous he didn't receive any disciplinary action for his behavior," Nassau County Executive Tom Suozzi said of Finkelstein, who was seeing patients yesterday at Pain Care of Long Island.
County officials said Finkelstein was caught double-dipping with syringes - using the same syringe repeatedly to dispense pain medication to different patients.
The danger in reusing syringes is that small amounts of a patient's blood can be drawn back into a syringe during an injection, Nassau Health Commissioner Dr. Abby Greenberg said. Blood may have been sucked into the reused syringes and injected into other patients.
The State Health department did not identify Finkelstein because the state disciplinary board had closed a case against him without issuing any violations. But the county saw fit to name him.
Finkelstein did not return calls for comment. The pain doctor was permitted to continue practicing after being instructed by state health officials on proper procedures.
North Shore-LIJ officials issued a statement that said, "Based on information the North Shore-LIJ Health System has received to date, all of the patients who were sent letters by the state Department of Health were treated in Dr. Finkelstein's private office, NOT at the hospital."
About 98 of the patients at risk for infection were notified about two years ago, but other patients could not be contacted until the state completed its three-year investigation.
How nurse led two hepatitis patients to one doctor
One day in December 2004, a nurse with the Nassau County Health Department noted striking similarities between two hepatitis C cases among the county's roughly 1,000 that year.
Both were patients of the same doctor.
And both had received spinal injections for back pain around the same time.
The nurse's sharp eye triggered an ongoing epidemiological dragnet and political storm stemming from improper infection controls practiced by Plainview physician Dr. Harvey Finkelstein and the state's subsequent investigation into the case. The state Department of Health has sent letters to 628 patients, who have been told they might be at risk for hepatitis C, hepatitis B and HIV.
Finkelstein's spokesman said he had improved his infection control practices and "cooperated fully" with state health officials. Several patients, however, came forward and told Nassau health officials he had said they weren't at risk and discouraged from them getting tested, according to the state health department's case-investigation summary. He denied it.
It all began in October 2004. That month, two people who had received injections by Finkelstein were diagnosed with hepatitis C. The first person had received an epidural spinal injection on Oct. 1, 2004, by Finkelstein at an ambulatory surgical center in Melville, Long Island Surgicenter. The second patient
had received two epidural spinal injections in the previous summer. One of those two patients had gone to Finkelstein for chronic back pain. He only found out later he had hepatitis C -- after routine blood work, said his attorney Michael Glass of Hauppauge.
Adter the nurse noticed the two cases, the Nassau health department notified state health authorities on Dec. 1. "... the investigation focused more closely on this physician and his practice."
Finkelstein soon provided the state with a list of patients who had had epidural injections from June 1, 2004 to Oct. 31, 2004, to identify any previously reported cases of the virus by comparing Finkelstein's list with the state database of hepatitis C cases. Apparently the process was slowed, according to the report, because of a backlog of cases not entered into the database by Suffolk County.
Using this method, a third case of hepatitis C diagnosed in December 2004 was found. It was ultimately determined that this case -- also a patient of Finkelstein's -- did not contract hepatitis C because of lapses in the doctor's infection control practices.
In January, 2005, both county and state officials visited Finkelstein's pain management clinic in Plainview, Pain Care of Long Island. They wanted to watch him at work.
There, the report says, they observed "during two separate epidural spinal injections that the physician removed the needle from a previously used syringe (from the same patient), attached a new needle to this syringe and reused the syringe to draw up medications and dye from multidose vials. Backflow of blood was noted during the procedures."
It was this breach of proper infection control procedures that the county and state officials determined was the source of the infection.
Finkelstein was immediately notified and told not to reuse syringes to draw up medications from multiple-dose vials once they have been used on a patient. He was also told to immediately dispose of any needles and syringes right after their use.
The county and state visited the doctor again a week later to ensure he was following proper practices.
They then sent him a letter, dated Jan. 31: "The site visit on January 6, 2005, demonstrated that some of the practices at your clinic could place patients at risk for transmission of blood-borne pathogens," the letter read.
The letter detailed 11 recommendations for Finkelstein to improve his infection control. Among them:
Labeling syringes with "appropriate information."
Making sure that unused portions of medications were discarded.
Providing soap and towels for each handwashing sink.
Because of the hepatitis C cases and "observed breaches in infection control practices" by Finkelstein, the state decided to notify other patients of potential exposure to the virus and to recommend they get tested.
On May 23, 2005, 98 patients who had been treated by Finkelstein on nine dates in 2004 were sent certified letters. Of these, 84 were tested. Seven were found to have hepatitis C, the report said: the initial three cases, three known chronic cases and once newly identified case.
Meanwhile, a patient who had been told of Finkelstein's practices filed a complaint with the Office of Professional Medical Conduct, the state disciplinary board for doctors. He was cleared of any wrongdoing but agreed to be monitored for three years.
Ultimately, based on genetic testing both by the state and the Centers for Disease Control and Prevention, both the third and fourth case were determined not to have been caused by Finkelstein's infection control lapses.
Between May and July 2006, health officials debated internally about whether to expand the investigation and notify all of Finkelstein's patients for five years prior to Jan. 15, 2005, said acting Nassau County Health Commissioner Dr. Abbey Greenberg.
In a July 2006, state health department officials decided to seek out all patients who had received injections between Jan. 1, 2000, and Jan. 15, 2005. That meant they would have to go through Finkelstein's medical records to determine who had received injections, a process that took more than a year.
This week, 628 patients received letters advising them to be tested for hepatitis C, hepatitis B and HIV.
Staff writer Delthia Ricks contributed to this report.
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