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Hep C outbreak traced to nurse

By Marty Clear and Carol Gentry
3/18/2010 Health News Florida

 Public health officials have determined that an outbreak of hepatitis C was caused by a nurse at a holistic medical clinic in Brandon, but they declined to identify her or say whether she is still allowed to practice in Florida.

Hepatitis C is a serious, sometimes fatal, viral infection. It is most commonly transmitted through contaminated needles.

Epidemiologist David Atrubin of the Hillsborough County Health Department said the outbreak is unusual. 

“Anytime we see a significant outbreak of disease that is chronic and ... potentially fatal that originates at a health care facility we take it very seriously," he said. "This isn’t something we see routinely or even every year." 

Yet it is unclear whether the nurse who triggered the outbreak is still practicing. Her license would still be clear and active, unless she had relinquished it or the Secretary of the Florida Department of Health had issued an emergency suspension.

The outbreak occurred at the Wellness Works clinic in Brandon, which notified authorities in November. Together the staff and health officials determined the exposure occurred last year among patients who had undergone “chelation therapy,” a sometimes controversial blood treatment. The nurse who had given the treatments was fired, clinic and health officials say. 

Atrubin said he didn’t have the authority to reveal the nurse’s name or the status of her license. He referred the matter to the Department of Health press office in Tallahassee, but an urgent call and e-mail to the press office this morning had not been returned as of 2 p.m. 
Ordinarily, DOH keeps complaints about health practitioners confidential until an investigation is complete and a committee of health-care professionals review the evidence. If the committee decides there is “probable cause” to believe that a violation has occurred, the matter becomes public with an official “administrative complaint.”

However, DOH does not post the public information on its consumer information site. This has led to situations in which physicians who were arrested or even in prison were still listed on the Web site as having “clear and active” licenses, as described in previous articles by Health News Florida.

If a health practitioner is deemed a threat to public health and safety, DOH Secretary Ana Viamonte Ros can issue an emergency suspension order. Ordinarily the DOH press office issues a release on such suspensions; Health News Florida has not received such a release on the Hepatitis C outbreak. 

Wellness Works clinic director Carol Roberts, a medical doctor, said in an interview that the clinic has adjusted procedures to help ensure that the situation never arises again. 

“Somebody got sloppy and bad things happened,” Roberts said. “This is the first time something like this has happened in the 16 years the clinic has been in business. But that’s one time too many.” 

Atrubin praised Wellness Works for cooperating with the health department and CDC: “We absolutely applaud them for coming forward with the information.”
Wellness Works alerted the health department after two patients, both of whom had been to the clinic for chelation therapy during a single week in April of last year, said they were sick. The staff initially suspected contaminated medicine, but further investigation linked the cases to the former nurse. 

Wellness Works contacted every patient who had had received an intravenous treatment at the clinic during the time the nurse worked there and asked them to come in for hepatitis testing. The nurse had worked there for about a year, and about 175 patients had received intravenous treatment during that period. The clinic paid for all the testing. 

Eight of those patients tested positive for hepatitis C. One of those patients may have had the disease before coming to the clinic, Roberts and Atrubin said, and unwittingly become the source of the outbreak when the supplies were re-used. 

Preliminary genetic testing performed by CDC has indicated that several of the cases are related, which supports the theory that all the patients contracted the disease at Wellness Works. So far none of the cases have been shown to have a different source.
However, because hepatitis C can take months to incubate, it’s also possible that patients who initially tested negative will later test positive, Atrubin said. Also, further genetic testing may show that some of the eight cases are unrelated. 

--Marty Clear is an independent journalist in Tampa. Carol Gentry, Editor, can be reached at 727-410-3266 or by e-mail.