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Health commissioner: We took too long to notify patients

BY MICHAEL AMON AND RIDGELY OCHS | michael.amon@newsday.com
ridgely.ochs@newsday.com

11:36 PM EST, November 27, 2007

State Health Commissioner Richard Daines said Tuesday that he is considering a range of institutional changes following public uproar over the state's handling of the Dr. Harvey Finkelstein case.

"There is a clear opportunity for improvement," Daines said, "to improve the timeline and to improve public communication."

Among the changes on the table: Making faster public notification a top priority, moving more aggressively against bad doctors and strengthening the state's authority to obtain medical records.

But he said the changes would be no guarantee that the public would be informed immediately.

"These investigations simply take a certain amount of time," Daines said.

Doctor no longer the issue

As hundreds of Finkelstein's patients now await test results, Daines also explained that state authorities are no longer trying to trace new hepatitis C cases back to Finkelstein. Because the department has already determined that a transmission has occurred, Daines said its role now is simply to notify the public of the risk. Infected patients must find out for themselves where they got the virus and, Daines said, "whether they have claims against a physician."

The Health Department has come under withering criticism for taking nearly three years to tell the public after learning about Finkelstein's contamination of multidose vials in January 2005.

It wasn't until Nov. 10 that letters were sent to 628 of Finkelstein's patients, urging them to get tested for hepatitis B and C and HIV. Since then, the state has sent information to more than 300 additional people the department determined were patients of the Dix Hills doctor.

Daines' boss, Gov. Eliot Spitzer, called the response "unacceptably slow" and ordered an investigation.

Part of the lag time, Daines said, can be attributed to a "world-class" scientific investigation carried out by the department's epidemiologists and the state's public health lab. Using cutting-edge genetic testing, scientists needed more than a year to confirm that hepatitis C had been transmitted from one patient to another during back-to-back appointments at Finkelstein's office in July 2004.

From there, said Deputy Health Commissioner Guthrie Birkhead, the case landed in investigators' routine "workload queue" and was not made a priority. "It's not like people were spending full time only on this," said Birkhead, who added that the department in the summer of 2005 also was working on a major outbreak upstate of a parasite that had sickened 3,000 people.

Changes under way

The commissioner said he had already initiated some changes, including establishing a team to oversee ongoing investigations to ensure they are being done in a timely fashion.

"I want these things to surface earlier," said Daines, the former chief executive of St. Luke's-Roosevelt Hospital Center in Manhattan. Daines took over the Health Department in March and oversaw the final stages of the notification process in the Finkelstein case.

He said he will appoint an expert panel to look at issues, including exactly how far back in time the state should go when notifying patients of their risk for an infectious disease.

And he said he was looking forward to State Senate Health Committee Chairman Kemp Hannon's (R-Garden City) hearing scheduled Dec. 6 on the Finkelstein case.

The commissioner said he was interested in strengthening regulations that would give the department more authority to obtain records from doctors. In the Finkelstein case, Daines said, public notification was delayed in part by the eight months of "back and forth" between the state and Finkelsteins' attorney over investigators' access to patients' records, some of which Finkelstein would not release.

He said the Finkelstein case also raised questions about the health department's Office of Professional Medical Conduct, which investigates and sanctions doctors. The OMPC issued a "nondisciplinary" finding effective Sept. 7 against Finkelstein. Daines said the office was too slow and he was open to change, such as naming doctors under investigation, as most states do.

Arthur Levin, head of the Manhattan-based Center for Medical Consumers, said he was heartened by the commissioner's comments. "This is the right attitude," he said. "That's all we can ask right now. The proof will be in the pudding."