Epidemic Ravages Caregivers; Thousands die from diseases contracted
through needle sticks
Francisco Chronicle; Sunday, April 13, 1998
Holding, William Carlsen, Chronicle Staff Writers
UNIVERSITY OF WISCONSIN HOSPITAL, MADISON, WIS., 1978
Dennis Maki, chief of infectious diseases, was unnerved.
a winter morning a few weeks earlier, a urology technician was
inserting an intravenous needle into a patient's arm when the
device slipped, piercing the 55-year-old medical worker's
long after, the technician fell seriously ill with hepatitis
B, and Maki suddenly realized his hospital -- and perhaps the
rest of the country -- had a serious problem on its hands.
"This totally innocent victim had become sick," he
said, "and we had to try to understand why."
he and nurse Rita McCormick began to do some detective work.
Their groundbreaking research would sound the first alarm over
a deadly epidemic of needle sticks that was striking down
health care workers at a startling rate.
the next 20 years, the epidemic would ravage the nation's
medical workers. Thousands of needle stick victims would die
of AIDS, hepatitis and other blood-borne infections. Tens of
thousands more would contract devastating diseases. Hundreds
of millions of dollars would be spent every year on replacing
and treating dying and infected workers.
now, researchers fear, a new needle stick threat has been
discovered: Untold numbers of female health workers may have
suffered serious birth complications from transmissions of
it didn't have to happen. Needles with simple safety features
-- often costing just pennies more to make -- were available
at least 10 years ago. Today, however, few have reached the
hands of health care workers, even at the nation's most
technologically advanced institutions.
a six-month investigation, The Chronicle has uncovered a
chilling pattern of indifference and neglect within the
nation's medical industry. Scores of interviews and thousands
of pages of documents show that the nation's leading needle
manufacturer suppressed the market for safer needles, at times
using tactics that have raised serious legal and ethical
questions. Health care providers, under intense pressure to
contain costs, balked at purchasing safer needles, calculating
that it was cheaper to buy conventional needles than to save
their workers' lives.
perhaps most troubling of all, government watchdog agencies
failed to enact and enforce regulations that would have
protected health care workers from danger.
disgusting that we can allow people to die when we can easily
prevent it," said Andrew Stern, president of the Service
Employees International Union, the nation's largest health
care workers' union.
a crane falls or a mine caves in, the government rushes to do
something about it. But when health care workers are dying,
decades after Maki's unsettling discovery, the needle stick
epidemic rages on. This year, the nation's 6 million nurses,
doctors, laboratory technicians and hospital housekeepers will
suffer 1 million needle injuries.
of them will get hepatitis and other lethal diseases. This is
the story of an epidemic that could have been prevented -- how
it emerged, why calls for action went unanswered and how
health care workers were betrayed by the people who were
supposed to protect them.
DICKINSON HEADQUARTERS, FRANKLIN LAKES, N.J.
Dickinson and Company, a small medical device import business,
was founded in 1897, about 50 years after the first hypodermic
syringe entered the market.
then, medical experts realized they had a problem:
Blood-contaminated hollow-bore needles could transmit
infectious diseases with deadly efficiency.
would soon report cases of diphtheria, malaria and syphilis
from needles. The variety of diseases would grow into the
dozens, with herpes, tuberculosis,
even Ebola, joining the list.
the 1960s, executives of Becton Dickinson knew that hepatitis
B could be transmitted by needles -- through both the reuse of
contaminated needles and through accidental needle sticks.
was probably the reason Becton Dickinson is a $2 billion
company today," said company executive Joseph Welch at a
deposition eight years ago.
explained that the soaring number of hepatitis B cases created
a huge market for disposable syringes, which would make
reusable needles obsolete. With cash raised from the first
public offering of its stock in 1962, Becton Dickinson began
producing tens of millions of the disposable products.
new disposable syringes reduced infectious transmissions
between patients but did nothing to decrease the accidental
needle sticks that were spreading diseases to health care
the company's attention soon turned to making needles sharper,
reason: In the late 1970s the Japanese firm Terumo had begun
to flood the U.S. market with cheaper, sharper needles.
two years, Becton Dickinson overhauled its manufacturing
facilities and was mass-producing razor-sharp needles that, in
the words of a company advertisement, go through the skin
"like butter. Every time."
OF WISCONSIN HOSPITAL, MADISON, WIS., 1981
Maki and nurse McCormick were ready to publish the first
systematic study of needle sticks in the United
had studied 316 reported needle stick injuries over a 47-month
period between 1975 and 1979. They investigated how the
injuries occurred, who the victims were and how the number of
accidents could be reduced.
researchers were stunned by the high rate of needle sticks at
their hospital -- an average of one out of every 12 workers
reported being injured every year.
we believe," they wrote, "these figures
underestimate the magnitude of the problem."
was the first indication that needle sticks were a far more
serious problem than anyone had known.
for the first time, health care workers were warned not to
recap needles -- a practice Maki and McCormick found
frequently led to needle sticks.
DICKINSON HEADQUARTERS, FRANKLIN PARK, LAKES, N.J.
were good for Becton Dickinson.
company had overcome the threat from Terumo. Its strategy of
signing needle distributors to exclusive, long-term contracts
kept Terumo and other competitors at bay and helped establish
Becton Dickinson as the world's largest needle manufacturer.
It is a position the company maintains today with an estimated
70 percent share of the U.S. market.
by the early 1980s the dangers of needle sticks had begun to
spawn new ideas for making needles safer.
1981, for example, Becton Dickinson engineer Michael Bennett
filed a patent for a new needle shield. At the same time, his
colleagues developed designs for oversized needle covers that
make syringes easier to recap as well as devices for clipping
off needle points.
Becton Dickinson did not produce any of the devices, even
though "the needle stick problem was obvious at that
point," said former Becton Dickinson engineer Robert
Stathopulos, an independent consultant who now works for rival
company thought that customers would not pay extra money for
any of these safety measures, and they would just cut down on
a 1990 suit filed by a needle stick victim, Becton Dickinson
Medical Director Edward Duffie offered a candid assessment of
the company's response to the needle stick epidemic:
don't think we did anything, specifically."
FRANCISCO GENERAL HOSPITAL, SAN FRANCISCO
June Fisher believes she would have been wasting her time if
in the 1970s she had tried to persuade convince hospital
administrators that needle injuries were a problem.
we had had a meeting on sticks at that point, no one would
have come," said Fisher, a medical device expert who set
up a health and safety project at San Francisco General
Hospital in 1978.
approach would have been to modify behavior," she said,
"to tell health care workers to be careful, to take their
attitude persisted across the nation throughout the decade,
undermining efforts to measure the epidemic's scope and
leading hospitals to issue orders simply telling employees to
be more cautious -- or worse, writing them up if they stuck
critics insist that the epidemic was ignored because of who
the victims were: mostly nonunionized female or minority
nurses, housekeepers and orderlies with little power.
are not considered important," laundry worker and
multiple-stick victim Gwyen Spruill told a congressional
committee in 1992. "Our work is not considered anything
medical workers with clout rarely complained of their
injuries, let alone demanded protection.
stick has always been viewed as a right of passage, a battle
scar, a point of pride -- as in, "I've been stuck six
times and never been infected," said Patricia Wetzel, a
Texas doctor who contracted the AIDS virus from a needle stick
attitude is that if you think about yourself and get
protective equipment, you're a sissy."
AND DRUG ADMINISTRATION, ROCKVILLE, MD.
1976 lawmakers gave the FDA
the authority to regulate medical devices. The agency's
mandate was to ensure the "efficacy and safety" of
any items marketed before 1976 were exempt from review, which,
in effect, allowed manufacturers to continue producing
conventional needles. By 1983 the agency knew conventional
needles could be made to be safer, because entrepreneurs had
begun asking the agency to review new syringes with safety
the agency took no action to compel the manufacturers of
conventional needles to make their devices safer.
SAFETY AND HEALTH ADMINISTRATION, WASHINGTON, D.C.
issued voluntary guidelines on hepatitis B to the nation's
health care employers in 1983.
agency's notice described the viral disease in detail and
recommended work practices including hand washing and the use
of a new hepatitis B vaccine.
OSHA failed to mention the hazards of recapping needles or to
convey the urgency of the needle stick problem.
FOR DISEASE CONTROL, ATLANTA
the early 1980s, CDC officials knew they had a serious problem
with accidental needle sticks.
of health care workers were contracting hepatitis B from
needle sticks every year -- and hundreds were dying.
1985, CDC officials came out with their recommendations to
health care workers: Use gowns, gloves, masks and the
hepatitis vaccine as protections against infection.
by then, needle sticks were already spreading a new disease
through hospitals and the ranks of health care workers -- a
mysterious infection with no known cure that was killing its
victims with brutal, tragic efficiency.
appearance of the AIDS virus did what the hepatitis crisis
could not: It put the government and the medical industry on
AIDS not happened onto the scene," testified Dr. Edward
Duffie, Becton Dickinson's medical director, in a needle stick
victim's 1990 lawsuit against the company, "little or
nothing would have been made of the ... ongoing risks ... to
the health care workers."
February 1982, a 33-year-old housekeeper at Sinai Hospital in
Baltimore was taking out the garbage when a discarded needle
pricked the palm of his hand.
months later, he checked into the hospital's outpatient center
complaining of fever, chills, shortness of breath and a cough
that wouldn't go away.
were run; his history was checked. The final diagnosis: He had
AIDS, and the only way he could have gotten it was from the
needle stick a year before.
June 12, 1983, the housekeeper died, leaving behind a
9-year-old child and a girlfriend six months' pregnant. A
letter in the March 1984 issue of the medical journal Lancet
noted that he was the first health care worker known to have
contracted the AIDS virus from a needle stick. The news jolted
the medical community. Hospitals and manufacturers began to
rethink their passive responses to the dangers of conventional
Becton Dickinson was cautious. Standard needles had lifted the
company to the top of the industry, and a sudden move toward
alternative products could open the market to rival firms and
erode Becton Dickinson's market share -- or worse, expose the
company to lawsuits over its unshielded needles.
OF DR. DAVID ATEFI, ROSSVILLE, GA.
April 15, 1985, medical assistant Jenia Hamley was stuck in
the left index finger while recapping a Becton Dickinson
needle. Five months later, she tested positive for hepatitis
B. Worse, Hamley had been five months' pregnant at the time of
the stick, and she claimed the infection caused brain damage
in her newborn son.
contended that she had merely followed the product's
instructions, which recommended recapping before throwing the
needle away. So she sued Becton Dickinson, arguing that its
product was unreasonably dangerous.
company responded that its instructions to recap the needle
met industry guidelines in 1985 -- even though four years
earlier the study by Maki and McCormick had specifically
warned that recapping was a leading cause of needle sticks.
company also argued that Hamley was a trained medical expert
who needed no warning because she knew the dangers of needles
better than the company did. It is a defense the company uses
to this day.
Dickinson settled the case confidentially and denied
OFFICES, SAN FRANCISCO GENERAL
at San Francisco General Hospital were in the forefront of
treatment of AIDS patients, opening the nation's first full
AIDS ward in 1985.
they responded to employee concerns about contaminated needles
by merely urging workers to use more caution around needles
and to slow down.
was the premier AIDS center in the world, and there was such
resistance -- they just kept downplaying the risk to health
care workers," said John Mehring, a health and safety
officer for the Service Employee International Union.
and his union, which represented more than half a million
medical workers across the country, finally realized that the
battle for greater needle safety would never be won piecemeal,
hospital by hospital.
in September 1986, with several other unions that represented
health care workers, SEIU petitioned OSHA to issue emergency
regulations that would force hospitals to provide greater
protections for their employees.
months would pass before the agency finally responded to the
petition. On Oct. 22, 1987, Assistant Labor Secretary John
Pendergrass rejected it, stating that there was insufficient
data to grant the emergency request.
OSHA said it would develop tough new workplace regulations to
protect health care workers -- a process that would involve
sending notices to 600,000 employers, gathering comments and
holding public hearings. The process would be lengthy, but
health care workers were optimistic that the agency was at
last paying attention to the needle stick epidemic. WARD 86
July 1987, a young nurse who asks to be identified only as
Jane Doe was finishing the 11th hour of her 12-hour shift in
the AIDS unit at San Francisco General.
was exhausted as she withdrew an unsheathed needle from an
intravenous line connected to a patient.
line connectors with recessed needles were already in use at
hospitals across the country. But they were unavailable at San
Francisco General, where intravenous lines were still joined
with a hypodermic needle held by adhesive tape.
Jane Doe held up the intravenous fluid bag, the needle went
through the bag and into her finger.
think I said, "Oh, shit," she said, recalling the
horror of the moment. "I was struck by the irony that in
my three years as a nurse, I never had a needle stick."
weeks later, Jane Doe tested positive for the AIDS virus and
became the first documented case of a medical worker at the
hospital to be infected with HIV through a needle injury.
was the 13th confirmed case in the nation.
JOSEPH'S HOSPITAL, ORANGE, CA.
Norma Sampson was concerned about the constant exposure of
health care workers to hepatitis B through needle sticks.
when I read about AIDS," she recalled, "I thought,
"Oh, boy, this is worse than hepatitis. People will
Sampson came up with her own solution: A syringe with a simple
plastic shield that could slide over a needle. With the help
of two relatives and a South Carolina engineer, Sampson
refined her product.
1987, Becton Dickinson bought the rights to the device.
manufacturer now had the technology in hand to produce a safer
product --one that could slash the number of needle sticks and
save thousands of health care workers' lives.