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PUBLIC HEALTH CRISIS: 'Message of hope' on hepatitis

Woman to tell how she contracted disease at Nebraska clinic







She's one of 99 to test positive for hepatitis C in 2001 because of unsafe injection practices at a Nebraska clinic, the largest such outbreak in the country to date.

On Monday, Evelyn McKnight will share her experiences with Nevadans worried about whether they were exposed to hepatitis C at a local endoscopy clinic that is the focus of a massive public health notification.


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  • "I just want to bring a message of hope,'' said McKnight, 53. "I want people to see me as someone who got a letter and who has walked that path.''

    Assemblywoman Sheila Leslie and Dr. Lawrence Sands asked McKnight to testify during a Legislative Committee on Health Care hearing at the Sawyer Building because of her experience and her advocacy organization, Hepatitis Outbreaks National Organization for Reform or HonoReform.

    The hearing, which begins at 5:30 p.m., is strictly for the public, Leslie said.

    "I want her to lead off the discussion," she said about McKnight. "There's a lot of fear, a lot of frustration and a lot of anger out there. I know people are going to want to express all that, but what I hope to hear are ideas on moving forward. Evelyn can help us.''

    McKnight was diagnosed with hepatitis C in 2002 while undergoing what she described as aggressive treatment for breast cancer. It was her second bout with the disease since 2000.

    Her previous chemotherapy treatments for breast cancer took place in 2000 and 2001 at a clinic in Fremont, an eastern Nebraska city of about 25,000 just outside Omaha.

    As part of the treatment, McKnight underwent a series of medical tests, one of which revealed she had hepatitis C.

    "I was shocked," the mother of three adult children said. "My husband was shocked. I didn't have any risk factors. I didn't know where this came from."

    Shortly after learning of his wife's diagnosis with hepatitis C, Tom McKnight, a family physician, discovered that four of his patients had the disease and had been treated at the same clinic, the Fremont Cancer Center.

    Tom McKnight alerted the Nebraska Department of Health and Human Service's Office of Epidemiology about the cluster. Several other patients were subsequently diagnosed with hepatitis C and had received treatment at the clinic, Evelyn McKnight said.

    The cases led to an investigation into the clinic's medical practices.

    According to an article about Nebraska's outbreak published in a 2005 issue of the American College of Physicians, the virus is believed to have originated from an infected patient who was treated at Fremont Cancer Center in March 2000.

    Interviews with clinic staff revealed that a nurse who had worked there was dismissed in July 2001 because of breaches in infection control practices.

    The report says the nurse was reusing syringes on the same person to draw solution from a saline bag. That saline bag was used for multiple patients. Evelyn McKnight said the nurse gave a deposition in which she said the clinic's owner had told her to reuse the syringes and share saline bags among patients.

    "He did not come back from Pakistan to testify,'' McKnight said about the owner, Dr. Tahir Ali Javed, who left shortly after it was announced that patients had contracted hepatitis C at his center.

    McKnight said Nevada's hepatitis C outbreak is similar to Nebraska's in that it is believed disease transmission occurred when nurse anesthetists reused syringes on infected patients, contaminating vials of medication that were shared by multiple patients.

    Nevada officials announced the health alert Feb. 27 after linking six cases of hepatitis C to the Endoscopy Center of Southern Nevada on Shadow Lane.

    None of the six patients had a history of the disease. Five underwent procedures on July 25. The other had a procedure on Sept. 21.

    Last week, health district officials announced a seventh case of hepatitis C, this one involving a 2006 male patient at the Desert Shadow Endoscopy Center, a Las Vegas clinic affiliated with the Shadow Lane clinic. It is unknown how the patient might have contracted the disease

    The Southern Nevada Health District has mailed more than 40,000 letters to patients of the Endoscopy Center of Southern Nevada, urging them to be tested for hepatitis and HIV, the virus that causes AIDS.

    Health investigators estimate that 4 percent of the Endoscopy Center's patients will end up testing positive for hepatitis C. But that number would not reflect the number of patients who contracted the disease there, health officials said. The estimate is based on the clinic's older clientele.

    Older adults have a higher rate of hepatitis C because they were more likely to have been infected during blood transfusions conducted before regular screening for the disease began in 1992.

    In Nebraska, health investigators sent notices to more than 600 former patients of the Fremont Cancer Center to get tested for hepatitis and HIV. Of about 500 who were screened, 99 tested positive for hepatitis C and were linked to the clinic.

    Hepatitis C is a leading cause of chronic liver disease in the United States. About 20 percent to 30 percent of those with the disease show symptoms, which include stomach pain, fatigue and jaundice of the skin.

    Even though McKnight tested positive for hepatitis C six months before the investigation in Nebraska, she was screened again by the state's health department.

    That screening, for her and the other patients, took place at one central location in Fremont. Patients were taken into private rooms and were asked to give a complete medical history to health officials.

    Earlier this month, the head of the federal Centers for Disease Control and Prevention called Nevada's hepatitis C outbreak the "tip of the iceberg" nationally.

    McKnight agrees with that assessment.

    Transmission of hepatitis from health care-related exposures are being investigated in Michigan and New York.

    In New York, health officials have notified 11,000 former patients of a Long Island anesthesiologist's office for possible transmission of blood-borne diseases. It is believed transmission occurred because the physician reused syringes on multiple patients.

    In Michigan, state health officials have alerted 13,000 patients of a dermatologist who may have exposed them to hepatitis and HIV because of unsafe practices.

    According to a news release posted on the Michigan Department of Community Health's Web site, the physician routinely reused sutures, scalpel blades and syringes on patients without proper sterilization.

    "Sadly, this is happening across the country," McKnight said.

    Though Nebraska prosecutors brought no criminal charges against the physician or the nurse, McKnight and more than 80 other patients sued the cancer center.

    They settled for an undisclosed amount.

    McKnight, an audiologist, used her settlement money to co-found HonoReform.

    The advocacy group, which hosted a national conference in Washington this year, is calling on lawmakers to take action to mandate better infectious disease control in outpatient settings.

    "One thing I have done as part of my personal healing is work toward patient safety," McKnight said. "I know everyone is at such a high emotional state right now, but I do want to plant that seed."

    Contact reporter Annette Wells at awells @reviewjournal.com or (702) 383-0283.

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    hcv-POSITIVE wrote on April 17, 2008 11:06 AM: BLACK MARKET FOR CUSTUMERS NEEDING ORGAN TRANSPLANTS. LAW ENFORCEMENT SHOULD CHECK IF ANY OF LAS VEGAS DR'S ARE INVOLVED IN SETTING UP THESE ILLEGAL ACTS. I WOULDN'T BE SURPRISED IF THERE ARE DR'S IN LAS VEGAS BEING GO BETWEENS IN THIS TRADE. YOU FIGURE IT OUT 40,000 NEW LIVER NEEDED. IT'S LIKE THE TIRE STORE DOWN THE STREET HAVING SOMEONE SLASH 40,000 TIRES FOR MORE $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$


    A Public Servant Forever wrote on April 07, 2008 01:58 PM: What in the world is going on, I am sitting here watching this Las Vegas City Council Meeting held today, and I really have to say that I expect more from our public officials. The Major, I love the Major, but did he and all those others on this board just sell us all out for $500,000 for the City of Las Vegas. Well, I do hope that you cash that check and quick, because these circumstances are much bigger than $500,000 for the City of Las Vegas. This is about people lives, and the blatant disregard of trust in from our physicians, and the role of the physicians and medical staff to do what is right and ethical for the patients. These actions taken today by the City Council are alarming to say the least.


    Sharon Leonard wrote on March 31, 2008 07:33 AM: I'm HepC positive and I wrote to Congress/Senate:

    I am writing to urge you to include funding for Hepatitis C in your Fiscal Year 2009 programmatic appropriations request letter. I would like to ask for your support for increased funding for Hepatitis C activities at the federal level. Hepatitis C advocates are asking for $50 million for Hepatitis funding, which is an increase of $32.4 million over the current funding of $17.6 million. As you are aware the President’s FY2009 budget flat funds the CDC Division of Viral Hepatitis (DVH).

    There are over 4 million Americans impacted by Hepatitis C but the only dedicated federal funding stream provides a mere $17.6 million through CDC. This is insufficient to provide the most basic public health services such as education, counseling, testing, or medical management.

    § HCV is the most common, chronic, blood-borne viral infection in the United States.

    § Chronic liver disease is among the top ten killers of Americans 25 years of age and older. Hepatitis C is the most common cause of chronic liver disease in the U.S. accounting for 40-60% of all cases.

    § HCV-related end-stage liver disease is a leading cause of death among people coinfected with HIV.

    § Without intervention, the Hepatitis C epidemic is expected to result in 3.1 million years of life lost by 2019. The projected direct and indirect costs of the current HCV epidemic, if left unchecked, will be over $85 billion for the years 2010 through 2019.

    I would also like to respectfully urge you to support H.R. 2552 and S. 1445, the Hepatitis C Epidemic Control and Preventation Act.

    § This bill that would establish a comprehensive federal Hepatitis C research and prevention program.

    § This bill also provides increases for other vital health and social service


    All They Have Is The Truth wrote on March 23, 2008 06:15 PM: Does anybody know how/where to get a copy of the governor's emergency regulations?


    doon coon wrote on March 23, 2008 02:32 PM: Third world country doctors without the third world prices.


    All They Have Is The Truth wrote on March 23, 2008 01:55 PM: Furious, you're correct. The first step would be for the health department to make a good faith effort to find out how the patients at the clinic were infected with hepatitis.

    Ideally, the effort would be undertaken by people who know what they're doing and who would use science and legitimate epidemiological techniques as their tools.


    All They Have Is The Truth wrote on March 23, 2008 01:51 PM: Quacks, there's that old joke: Where do you go to get good healthcare in Las Vegas? (Answer below)

    What I'd really like to know is what motivated the health department to go so far down a dead-end street?

    Answer: McCarren Airport


    Furious wrote on March 23, 2008 01:41 PM: With all due respect to Assemblywoman Leslie, we're far too early in this crisis to "move forward." Moving forward is something you consider after there has been closure, after you've exhausted every attempt to right a wrong and are doing yourself more harm than good by living in the past. We still don't know the extent of the crisis. We still don't know whether these scoundrels will be prosecuted. We don't know if there'll be any substantive changes to the way clinics operate, or whether the Board of Medical Examiners will be replaced. We can't (and shouldn't) move forward until these questions are answered. The victims in this case don't need assurances from similar victims that their lives will turn out okay. We need action. And the actions taken by our elected officials will determined their viability in the next election.


    quacksinLV wrote on March 23, 2008 01:10 PM: You know the article, on your prescriptions, saying they may have some other pills in it? They claim it is 1 in 1000-my neighbor just found 6 in a months supply prescription-
    You want to survive? Quit going to Dr.s


    All They Have Is The Truth wrote on March 23, 2008 01:01 PM: I'm glad you brought that up, Endoscopy Patient. You are correct that reusing a contaminated vial FROM ONE PATIENT TO THE NEXT can spread disease. Unfortunately for the braintrust at the health department, the nurse anesthetists didn't do that either.

    Drug and medical device companies label almost all of their products "single-use." It's a great way to increase sales. The company which makes the drug in question will tell you that it's acceptable practice to share a vial of the medication between two patients USING STERILE ASEPTIC TECHNIQUE. It's rarely done because the drug is usually used for procedures that last longer than five minutes, but it's acceptable practice IF STERILE ASEPTIC TECHNIQUE IS RELIGIOUSLY FOLLOWED. The rule is that the drug in question must be used or thrown out before six hours.

    If you ask the State, they openly admit that their inspectors did NOT observe nurse anesthetists using contaminated vials from one patient to the next. They also openly admit that they did NOT observe syringes being used from one patient to the next.

    If the health department had been more interested in finding the source of the hepatitis infections, instead of becoming "heroes," they would have bothered to call the company that makes the drug and find out if their understanding of the way the drug should be used was correct.

    Instead, they copied inaccurate information from the outdated Internet website of a company that no longer even makes the drug. They then came up with a THEORY that, IF syringes were shared among patients, and IF contaminated vials were shared among patients, then infection MIGHT have been spread, IN THEORY.

    Using their half-baked c0ck-and-bull theory, they then went on to ruin the lives, reputations, and careers of several conscientous healthcare professionals.


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