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Hepatitis alerts sent to 500 patients of Bullhead City clinic

The Arizona Department of Health Services confirmed that nearly 500 letters have been sent to patients of the Ear & Sinus Center of the Southwest in Bullhead City in an effort to warn them about possible infections by unsterile surgical equipment.

"We have been working with the facility since the start of this to make sure individuals are tested," said Shoana Anderson, ADHS program manager for Infectious Disease.

Anderson said the clinic reported problems to ADHS as soon as it found out that its method of cleaning its endoscope was not adequate.

Two patients treated at the clinic in 2012 tested positive for Hepatitis C and filed lawsuits against the clinic earlier this month.

The clinic sent out letters as soon as it found out about the problem, she said. The large number of letters was because they didn't know how many people may have been affected. They notified as many patients as they could find, even those who were treated two or three years ago.

An endoscope is a flexible tube with a camera and, sometimes, surgical instruments. Doctors use it to check the inside of the sinuses, throat, windpipe and colon.

Endoscopes require a higher level of disinfection than other equipment because they cannot be heated to a high enough temperature to kill microbes without damaging the equipment, Anderson said. Each endoscope manufacturer has its own preferred method of sterilization, but it usually consists of washing the scope inside and out with soap and water and then soaking it in a disinfectant.

In this case, it appears that staff scrubbed the scopes with soap and water but may not have always used a disinfectant rinse before using the instrument on another patient, she said. Because medical facilities aren't required to keep records of exactly how a piece of equipment was cleaned, there is no way of knowing how frequently clinic staff used the disinfectant rinse.

But even just cleaning the equipment with soap and water would have minimized some of the risk of transmitting diseases from one patient to another, Anderson said.

"It's hard to determine if those two cases of Hepatitis C are related to this clinic," she said. "Usually, in situations like this, the risk of infection is pretty low because you're not cutting into anything."

Hepatitis C requires direct blood-to-blood contact in order to infect someone, Anderson said. The disease can also lie dormant in a person for many years without showing any symptoms.

Both patients have claimed that they did not have the disease before being treated at the clinic.

While Anderson's office is working with the Ear & Sinus Center of the Southwest to determine what happened, it is not responsible for inspecting medical facilities in the state. That job falls to ADHS' Medical Facilities Licensing Office.

However, the Medical Facilities Office does not inspect facilities that are run by physicians as part of their private practice, said Kathy McCanna, the program manager for the office. The office only inspects facilities that are run by corporations or medical groups, not independent physicians.

Physician's offices fall under the jurisdiction of the Arizona Board of Medicine, she said.

ADHS does have a record of Ear & Sinus Center of the Southwest being inspected in October.

McCanna explained that a larger corporation might have bought out the clinic in 2012. If so, that single inspection report would have been the first time her office was required to inspect the facility.

She said more and more doctors are selling their private practices to corporations and medical groups in order to avoid having to deal with billing paperwork and hiring office staff. They then become employees of the company.

Once that happens, the Medical Facilities Licensing Office is required to inspect the facility, McCanna said.


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