Washington Scrutinizes Nursing Homes
quality at nursing homes was declining
Patients Were Not Told of Misuse of Syringes
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.
Multimedia
City Room Blog
The latest news and reader discussions from around the five boroughs and the region.
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 problem.
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 said.
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 efficiently.”
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.
與蔡醫師的一席話（1998年元月26日午；澄清醫院咖啡屋）
蔡醫師仍然很風趣，他帶領我們看看中港路澄清醫院的設計（日本人設計）。他把病房的門打開再關上，閉上時都會慢慢地閉合，不會夾到手，也不會發出聲音。
我們試用一下兒童病房內的洗手間，我注意到尺度考慮過兒童的身材大小，只是，天呀！連衛浴器材都用TOTO牌的，未免太…。其它如大廳、鐘面、椅子等等之色彩的講究，結帳的等待室，在在有日本人的細心。
蔡醫師說，醫院管理受到建築設計影響極大，例如他們高階主管在高樓，無法與主治醫師們一起，他認為不好。
醫院很大的問題是各專科設備投資愈來愈大（近視手術設備就要二千多萬元，耳鼻喉科五百多萬元…）所以究竟專門或綜合，對人才（近來有八位主治醫師會加入，他面談醫師極重視背景的了解…）及資源（有限）都有很大的影響。
醫院就專職管理者而言，發展其實很有限，而且這行要先有專業知識，才能與人講專業語言。
現在很大的問題是要使現場人員能對人微笑，知道他們所面對的是人，而不要只自顧忙 他的工作，做完後就下一號。標準作業程序（SOP）沒用，這些應對進退SOP都有，可是尚未能做到。〝May I Help You ?〞的主動協助心態仍待建立，現場的人要對排隊等待的人的心理了解。
現在醫院很競爭，所以無法像一般工廠或單位安排放長假，這點員工很不諒解。蔡醫師問杜邦怎麼做，我向他解釋杜邦全球所有的員工，不分等級，大家有相同的200股認購權。
蔡醫師提一個例子，某組助理二人中有一人要請長假，所以工作要由一人擔，他認為那做事的可以多拿點錢，上級不同意，說為何別人不會來幫忙。問題之一是大家都很專，不願意走出自己的領域，沒有「多能工」的概念。
主治醫師如果肯用心，五十餘位，很容易吸引百位病人，那麼病床使用率就會大大提高（每間平均設施百萬元）。他們現在把主治醫師的開會改成Club的方式，每月請人來講一些修養的東西，例如「如何欣賞抽象畫…」等等，有機會請鍾老師談談「顧客之聲」。
蔡醫師談日本的管理特色是Follow (up)、做；美國是存疑，要將一套理論改改再用；我們則是莫不關心（Indifference）。
我向他說日本的成功之道有三套半，一是頂級負責人承諾要做好；二是大規模的教育訓練，品質教育要從頭來、自己來，要能找出如何貫徹團隊一體的心，上級的願景方式；三是要有持續改善，一件接一件不斷合作改善的習慣（合作團隊學習）。
蔡醫師的碩士論文是《主治醫師的滿意度調查》，彰化基督教醫院的百位中有七十多人與他談過，我認為這是很符合「新人才資源管理」的主題，希望他可以為我們發表摘要。
沒有留言:
張貼留言