Hepatitis C crisis at Rose

RECENT reports that some 4,700 surgical patients at Rose Medical Center may have been exposed to the chronic liver disease hepatitis C — the result of a technician with the disease who allegedly switched syringes at the hospital — have sent shockwaves through the Denver Jewish community.

Although impossible to ascertain even a rough estimate of how many of the potentially affected patients are Jewish, the community’s sustained attachment to the hospital it founded 60 years ago suggests that the number is likely significant.

Rose was founded in 1949 as General Rose Memorial Hospital, named after WW II hero General Maurice Rose, a member of the Denver Jewish community who was killed in action in the war’s final days.

The majority of the hospital’s founders were Jewish and in its early days it served as a haven for Jewish physicians and healthcare workers who were often denied employment at other Denver hospitals.

Although the hospital was sold in 1995 to the Columbia-HCA national chain and is now managed in partnership with the non-profit HealthOne network, much of the Denver Jewish community has long remained attached to Rose as the community’s unofficial hospital.

The hospital is keenly aware of its connection to the Denver Jewish community, president-CEO Kenneth Feiler indicated in a statement released to the Intermountain Jewish News this week. Read the related IJN editorial on medical privacy

“Sixty years ago, Rose was built on the vision and support of the Jewish community and their faith in our mission and values,” Feiler said.

“We hope that despite this terrible situation that we can continue to rely on the Jewish community’s support for years to come as we work to always affirm our origins in Jewish teachings, traditions and community.”

THE potential infections became regional and national news last week, when it was reported that a Rose employee who has hepatitis C, identified as surgical room technician Kristen Diane Parker, switched syringes containing the powerful narcotic fentanyl with others filled with saline solution.

The switched, and contaminated, saline syringes were then allegedly used on patients who had been prescribed the painkiller. Rose was contacted by the Colorado Department of Health after two patients who had had surgery at the hospital were diagnosed with the chronic liver disease.

Some 4,700 Rose Medical Center patients were scheduled to receive letters from the hospital this week, advising them to come to the hospital to be tested for hepatitis C.

Recipients  include patients who had surgery at Rose Medical Center or at the hospital’s outpatient surgery unit in the Wolf Building between Oct. 21, 2008 and April 13, 2009.

According to statements issued last week by Rose, women who gave birth at the hospital during that period, and those who received treatment in its emergency room, do not need to be tested. In addition, those who received treatment in the hospital’s endoscopy, cardiology and oncology departments are not at risk, the hospital said.

A statement on the RMC website this week said, “We have been working diligently with the Health Department in their investigation to identify who might have been exposed to hepatitis C by the terminated surgical scrub technician, and to take care of them as quickly as we can. Our only concern has been our patient’s safety, health and privacy.”

The statement went on to say, “most of the patients who receive letters will not have been exposed to hepatitis C.”

Rose spokeswoman Cara Harshberger told the IJN this week that the figure of 4,700 was based on the total number of patients who had surgery in the hospital’s main operating rooms and the Wolf facility within the designated timeframe.

“We just wanted to cast the widest safety net possible, just to make sure that we’re covering all of our bases and taking all the precautions we can for our patients,” she said.

The list of surgical patients was finalized by the hospital in agreement with the Colorado Health Dept., Harshberger added, as was the Oct 21-April 13 timeframe. That was based on the earliest and latest dates during which the surgical technician could have had any opportunities to switch syringes.

Harshberger emphasized that these dates were very carefully considered and that patients whose surgery came after the date of April 13 have no cause for concern regarding contracting hepatitis C.

There are some missing gaps in the story — including the precise methods by which Parker was able to switch syringes and whether it was done in pre-op, during surgery or post-op.

The hospital declined to comment on those matters.

“The investigation being conducted by the Colorado Health Department will determine how some surgical patients could have been exposed to hepatitis C,” Harshberger said. “Until that investigation is complete, it would be irresponsible of us to speculate. So unfortunately I don’t have information about where the employee got needles, the drug or when she was doing this.”

ONE member of the Jewish community potentially exposed to the virus contacted by the IJN this week suggested that Rose will indeed have to regain her trust, and perhaps that of many other patients.

Anita Fricklas, who spent 30 years as a Jewish community professional working for Temple Sinai and the American Jewish Committee, underwent surgery at Rose on April 13, 2009 — ironically, the very last day on which the hospital says patients might have been exposed.

“I found out through the media,” Fricklas said.

“At first I thought, well this is interesting. Then I realized that the date I had surgery was included in the timeframe. I thought, this was a terrible thing to put people through.

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“Although it’s unlikely that I have contracted the disease, or really that anybody has, still there’s all the worry and the unknown, particularly at a low time in  your life when you’re recovering from surgery. It’s unfortunate. Actually, it’s much more than unfortunate.”

Fricklas didn’t wait for her letter from the hospital to arrive, but went in for her blood test early this week.

Although the workers at Rose were “very professional and courteous,” Fricklas says she was a bit disturbed that it would take two weeks to receive the results of her test.

“Isn’t there a way to find out sooner? Time is of the essence in treating this disease.”

From what she’s read recently, Fricklas said that the chances of actually curing the disease are far greater in the first few weeks and months after infection.

She fears that this early window of opportunity has probably already closed for her and most of the other Rose patients.

“So if I have this disease, it will probably be chronic,” Fricklas said, “and if I have to have a liver transplant, I’m not doing that. My children would probably have to be the donors and I’m not going to put them through that.”

Despite this grim stance, Fricklas insists that she is not worried, partly because of a “fatalistic but realistic” perspective that “it is what it is,” as well as the knowledge that the odds are highly in her favor.

Her surgeon increased her confidence this week when he told her that he has no memory of Parker having ever worked in his operating room.

She remains, however, “very angry,” she says, particularly at HIPPA and other laws that allowed a technician with hepatitis C into hospital areas where drugs and syringes could be accessed.

“I understand the laws,” she says, adding that she realizes that there is a need for employees to have reasonable measures of privacy and protection from discrimination in the workplace.

“On the other hand, when you’re working in a hospital and putting people at risk for a disease, I think there has to be a different way to handle those people.

“And I don’t think that universal precautions, where everybody has to wear gloves and wash their hands all the time, are going to work.”

Fricklas does not count herself among those Denver Jews who are sentimentally loyal to Rose Medical Center.

“It was not my hospital of choice,” she says. “I went there because the doctor who was to perform my surgery is there. I realize that it’s so unlikely that it would ever happen again and that they’re doing everything they can to make it right, but it still makes me nervous. Unless they change their procedures, I’m not sure that I would ever go there again.”

As to Parker, the technician who triggered the whole series of events, Fricklas is surprisingly understanding.

“Obviously she was desperate,” Fricklas says. “She found a good way to get the drugs she needed. If she is an addict, which I assume she is, people who are addicts have a need that’s probably greater than any one of us can imagine, so I am angry but I also sympathize with her.

PARKER was terminated by Rose in April, after she tested positive for the narcotic. This was before any connection was discovered between the technician and Rose patients who may have contracted hepatitis C.

The Denver Post reported this week that state health officials made the first link between two new cases of hepatitis C to surgeries at Rose in April.

It would take another two months, however, before state investigators were able to make a definitive link between those and other hepatitis C cases — now believed to total 10 — and Parker’s alleged practice of switching syringes at Rose.

After her firing from Rose, Parker was able to find work at a Colorado Springs facility, the Audubon Ambulatory Surgery Center, where authorities fear she may have exposed as many as 1,000 more patients to her disease.

Parker is currently in custody facing federal charges, including tampering with a consumer product, creating a counterfeit substance and obtaining a narcotic by deceit.

She could face a sentence of more than 30 years on those charges, and up to a life sentence if jurors believe that her actions caused serious physical harm or death to patients.

According to the Gazette of Colorado Springs, Parker admitted to switching syringes to a Denver police investigator, apparently by exchanging them from anesthesia carts.

In its statement released to the IJN this week, Rose president-CEO Feiler apologized to all those who may have been affected by the technician’s actions during the nearly six months of her employment, and reiterated the hospital’s commitment to caring for those who may have contracted the virus.

“At Rose Medical Center, our first concern is the safety, care, health and privacy of our patients,” Feiler said.

“We are deeply sorry and angry that the unconscionable acts of one terminated employee may have put some of our patients at risk. Rose has said all along that we are going to take care of our patients, so if we find any were infected with hepatitis C as a result of their surgery here, we will work with that patient’s physician to provide appropriate treatment. Rose Medical Center is committed to fulfilling the trust that patients place in our hospital.”