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【社会人文】美国医生滥用注射器 可能导致多人
Nassau County health officials yesterday reported another positive test for hepatitis among the patients of an anesthesiologist on Long Island whose faulty infection-control practices put hundreds of people at risk.
The officials will not know for several weeks, they said, whether the hepatitis B was contracted in the doctor’s office or somewhere else.
The officials also said that they were urging 200 more patients who were treated by the anesthesiologist, Dr. Harvey Finkelstein, to be tested for two types of hepatitis and H.I.V.
Last week, 34 months after investigators uncovered the doctor’s lapses, state health officials sent out letters to 628 of Dr. Finkelstein’s patients recommending that they be tested for the blood-borne illnesses. The state officials had found that Dr. Finkelstein was misusing syringes, leading to the infection of at least one patient with hepatitis C. Dr. Finkelstein corrected his practices in 2005.
Cynthia Brown, a spokeswoman for the Nassau County Health Department, said that the patient who tested positive for hepatitis B would be retested immediately. If the test result is confirmed, the department will conduct an epidemiological investigation to determine how he was infected.
Consumer advocates said yesterday that Dr. Finkelstein, who has settled 10 malpractice lawsuits with patients in the last 10 years, was among a very small number of doctors in New York who have been sued so often and that his case illustrated the lax monitoring of the medical profession.
“This case perfectly illustrates how poorly the medical profession is watched and regulated,” said Arthur A. Levin, the director of the New York-based center for Medical Consumers.
After Dr. Finkelstein’s lapses were discovered by the State Health Department, an investigation was conducted by the Office of Professional Medical Conduct, the department agency charged with investigating allegations of misconduct against physicians. Dr. Finkelstein was not disciplined by the office because he had changed his infection control methods to conform with recommendations issued by the Centers for Disease Control and Prevention.
The level of scrutiny given to Dr. Finkelstein, Mr. Levin said, means that “no one is really looking very hard.”
The 34-month delay between the discovery of Dr. Finkelstein’s lapses and the notification of the bulk of his patients last week has been widely criticized; Gov. Eliot Spitzer called it “deeply troubling.”
On its Web site, the medical conduct office lists Dr. Finkelstein as having settled 10 malpractice cases from 1998 to 2007. The list does not specify what the suits alleged, or give dollar amounts of the settlements. Of the 10, however, 5 were for amounts described by the office as “above average” for New York anesthesiologists.
Dr. Sidney Wolfe, director of the health research group Public Citizen, a nonprofit organization that has monitored malpractice records nationwide since 1990, said “the smallest fraction” of doctors have such extensive records of payments.
In a 2003 survey of malpractice settlements in New York, Dr. Wolfe said, doctors with 10 or more settlements in a decade accounted for just a tenth of 1 percent of the total. The survey showed that 81 percent of New York doctors made no malpractice payments in the previous 10 years.
“Ten settlements in 10 years should be a red flag to any medical review board,” he said.
In fact, the office of the state comptroller issued a report in August criticizing the Health Department’s medical conduct office for being “not proactive” enough in seeking out cases of medical misconduct for review.
For instance, the report said, the office does not routinely monitor lists of doctors excluded from Medicaid and Medicare programs because of abuse. It did not routinely review the files of doctors with more than three medical malpractice settlements in 10 years — a standard used in some states — and did not keep up-to-date records of malpractice settlements.
Claudia Hutton, a spokeswoman for the State Health Department, said the agency’s director, Keith Servis, would file a formal reply to the comptroller’s report but would not comment publicly. She pointed out that he had been in charge of the agency only since the start of 2007.
She said the department was conducting an internal review to explore the “gaps in communication” between state epidemiologists’ investigation of the spread of infection and the Office of Professional Medical Conduct’s investigation of doctors who might be the sources of infection, as in the case of Dr. Finkelstein.
“One issue is that since 2004, the number of complaints against physicians has gone up 30 percent, while the number of staff on the O.P.M.C. has remained the same,” she said.
http://www.nytimes.com/2007/11/20/nyregion/20doctor.html?ref=nyregion
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作者:admin@医学,生命科学 2011-03-24 21:15
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