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Patients Were Not Told of Misuse of Syringes

Published: November 16, 2007

State health officials notified 628 patients this week that they should be
tested for hepatitis and H.I.V. infection because they were treated years ago
by an anesthesiologist in Nassau County who used improper procedures for
preventing the spread of blood-borne diseases.

The anesthesiologist, Dr. Harvey Finkelstein, of Plainview, first became the
focus of a state health investigation in 2005 after two of his patients
contracted hepatitis C. His name was reported by Newsday.

Yesterday, county and state officials traded blame over the 34-month delay in
notifying the patients. At the same time, the incident led state health
officials to seek a meeting with the Centers for Disease Control and Prevention
to address an issue of drug packaging that was apparently at the heart of the

In 2005, investigators found that, in violation of widely accepted practices
recommended by the C.D.C., Dr. Finkelstein, 52, who specializes in pain
management, was reusing syringes when drawing doses of medicine from vials that
hold more than one dose.

He would use a new syringe for each patient. But when giving one patient more
than one type of drug by injection, his practice of using the same syringe to
draw medicine from more than one vial led to the potential contamination of the
vials. The blood of a patient who was infected with hepatitis C could, by
backing up through the syringe and entering the vials, infect another patient
when the same vial of medicine was used again. This is what happened in at
least one case, health officials said.

State health officials said yesterday they hoped to get the C.D.C.’s support in
seeking the elimination of such multidose vials.

Any fix would come too late for Raymond Bookstaver, 49, a Hicksville mechanic
who was one of two patients initially identified as having been infected by Dr.
Finkelstein’s improper use of syringes.

“I feel like I went to a doctor for help, and what I got instead was a death
sentence,” Mr. Bookstaver said. His hepatitis is being treated, but erupts
unpredictably, causing him to suffer flulike symptoms including nausea,
vomiting and aching that leaves him bedridden, he said.

At least one and possibly more doctors in the state, including a New York City
anesthesiologist, have been reported to state health officials in the last
several years for reusing syringes. State officials said they would cite those
reports in their meetings with C.D.C. officials.

In 2005, Dr. Finkelstein was instructed in the proper use of syringes in
administering pain medications by state health investigators and he has since
been monitored to make sure he complied, a State Health Department spokesman

For reasons that were unclear yesterday, his case was not referred to the State
Board for Professional Medical Conduct of the State Education Department until
nine months after his unsafe practices were known.

That agency, charged with taking disciplinary actions against doctors, found no
evidence of wrongdoing, and recommended no disciplinary action.

In January 2005, the Health Department began an epidemiological investigation
to determine how many of Dr. Finkelstein’s patients were infected by the vials
of medicine that he had used more than once.

Investigators notified 98 patients who had received epidural injections for
pain management in the three weeks before, during and after Dr. Finkelstein’s
two patients were infected, telling them to get tests for blood-borne
infections including hepatitis and H.I.V.. Of the 84 who were tested, no other
cases of infection were traced to Dr. Finkelstein.

The state then expanded its investigation to cover the years from 2000 to 2005.
It was in 2000, Dr. Finkelstein told the investigators, that he began using one
syringe to draw doses from numerous vials. In a statement released this week,
the state health commissioner, Richard Daines, said “the department identified
all 628 patients who had received injections between Jan. 1, 2000, and Jan. 15,
2005, after a thorough review of medical records at all sites where this
physician practiced.”

The Nassau County executive, Thomas R. Suozzi, called the long delay in making
the notifications “outrageous,” and blamed Dr. Finkelstein and state health
officials who he said were overly deferential in their negotiations with the
physician’s lawyers.

Claudia Hutton, a spokesman for Commissioner Daines, said that it was routine
for the department’s staff to negotiate with a doctor’s lawyers in its
investigations, and added: “We worked with Nassau County hand in hand. They
were with us all the way. It’s nice that our partners are now playing 20-20
hindsight, but that’s life.”

State health officials acknowledged that the process, begun under the previous
health commissioner, could have been more efficient. But they also said that
before informing large numbers of patients, they wanted to make sure they only
informed those who were at risk of being exposed, to avoid public panic.

“The commissioner wishes it were faster,” said Ms. Hutton, the department
spokesman, “and it’s something he’s going to look at and sit down to figure out
why the things happened the way they did and how we could have done it more

But, she added, “epidemiological investigations do take a while, and what we
had here — it’s not like we found 25 cases within a two-week time frame — we
thought we should be cautious.”

But patients and consumer advocates said the delay from January 2005 to
November 2007 was a disservice to the public.

Though Mr. Bookstaver’s illness was diagnosed almost immediately by his family
doctor, he said that other patients — the 628 notified this week, for example —
might not have been as lucky. “What if they have been living with these
diseases all this time untreated? And thinking they had the flu?” he said.

Joanne Doroshow, director of the New York-based Center for Justice and
Democracy and a member of a state task force on medical malpractice, said the
case illustrated “a too-cozy relationship between the medical profession and
the people who supposedly regulate them.”

Michael Duffy, a lawyer who specializes in medical malpractice cases and vice
president of the New York State Academy of Trial Lawyers, said that the long
delay in notifying the 628 potential victims of Dr. Finkelstein’s practice was
especially troubling because none would be able to seek damages in court.



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