Patients of Brooklyn Clinic Are Sought After Outbreak of
Hepatitis C


June 9, 2001


Patients of Brooklyn Clinic Are Sought After Outbreak of Hepatitis C

By DIANE CARDWELL



Shannon Stapleton for The New York Times
Eight patients who had endoscopic exams at a clinic in Brooklyn have tested
positive for a condition that can lead to cirrhosis and liver cancer.


health officials are trying to contact more than 2,000 patients who
underwent gastrointestinal exams at a Brooklyn medical clinic, after eight
patients tested positive for hepatitis C.

It was the first time such an outbreak related to the procedure had occurred
in the city, officials said yesterday.

The infected patients all underwent endoscopic exams, in which a flexible
lighted instrument is used to inspect the stomach or bowel lining, over a
three- to four-day period at the end of March at the Bay Ridge Endoscopy and
Digestive Health Center, said Dr. Neal L. Cohen, the city's health
commissioner. Seven of them were hospitalized within a few weeks of the
procedures for what was later determined to be acute hepatitis C, a liver
disease caused by a blood-borne virus.

Chronic hepatitis C can lead to cirrhosis and liver cancer and, according
the
Centers for Disease Control and Prevention, is the No. 1 reason for liver
transplants in the United States.

Dr. Cohen said that while the exact source of the infection had not yet been
determined, he believed that it was transmitted during the procedures.

Mayor Rudolph W. Giuliani cautioned that the outbreak was confined to the
Bay
Ridge clinic, at 8501 Seventh Avenue, and that there was no cause for alarm.
"We have the names of all the patients that were treated there during the
relevant period and are in contact with them individually," he said. "But
since some information about this is now floating around, we don't want
people to panic."

Officials said that a physician at the center first notified the State
Health
Department of illnesses among a cluster of patients at the beginning of May,
and that he voluntarily stopped performing the exams. The health department
began by investigating 50 patients who had come in for tests around the end
of March. After what Dr. Cohen called "a very labor-intensive review" of the
patients' medical histories, blood tests confirmed hepatitis C in eight
patients. Health officials said they were only able to identify the
connection between the patients and the clinic this week.

Health department investigators also sent blood samples to the Centers for
Disease Control for genetic sequencing to determine whether the infections
had taken place at the clinic.

Officials have also learned of another infected patient who underwent an
exam
at the clinic in January, but have not yet established whether that
infection
was connected to the procedure. Still, Dr. Cohen said, officials decided it
would be prudent to expand the investigation to all 2,200 patients who have
undergone the procedures since the clinic opened in January of 2000.

Dr. Cohen did not rule out the possibility that the disease could have been
transmitted from one infected individual, but suggested that the more likely
agents were needles or scopes.

"At this time we can't pinpoint how it happened," Dr. Cohen said of the
eight
infections. The procedures, he continued, "are carried out safely on
thousands of New Yorkers weekly, and certainly we wouldn't want people to
believe that these procedures are dangerous to them."

Officials said that hepatitis C transmissions through this type of exam were
extremely rare.

"We would expect that there was some other way in which there was
contamination introduced by infected blood or other material and not the
scopes or the instruments by themselves," Dr. Cohen said.

There have been complaints over the years of improper or inadequate
sterilization practices at clinics across the country.

Jeffrey Klein, an assemblyman from the Bronx, issued a report in March
examining unsanitary practices at clinics. Along with State Senator Guy J.
Velella, he has introduced legislation that would mandate stricter
cleanliness standards.

Barbara Reynolds, a spokeswoman for the Centers for Disease Control, said
that they did not track the rate of hepatitis C infections in connection
with
endoscopic exams. In general, she said, hepatitis A and B outbreaks are more
common, because they are more easily transmitted.

The disease, she said, was of increasing public health concern because it
can
linger without creating symptoms for decades. "The incidence is going down,"
she said, "but we're seeing an epidemic of old cases with liver damage."

The health department has opened an information phone line, 212-788- 2222,
and is urging patients who have had exams at the clinic to be tested for
hepatitis C, hepatitis B and H.I.V. At this point, Dr. Cohen said, his
department had no evidence of infections other than hepatitis C, but that it
was prudent to test for other blood- borne viruses.

In Bay Ridge, residents were alarmed at news of the infections and flooded
the office of City Councilman Martin J. Golden with calls, he said. One
woman, who would not give her name, said that she was terrified she had been
infected there even though she had no symptoms.

Carmen Feliciano, 46, a patient who was informed that her exam would take
place at a nearby hospital rather than at the clinic as planned, said she
did
not think anything of the change. "I had no idea there was a problem here,"
she said. "I feel terrible for the doctor, and I feel equally bad for the
people. Hepatitis C is a very serious thing."

Ms. Feliciano said that there was no indication of anything amiss at the
clinic, which she described as spotless.

"I know this is going to sound silly," she added, "but even the magazines
were new."
 

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