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Nurse in hepatitis outbreak named

By Marty Clear and Carol Gentry
5/27/2010 © Health News Florida

The nurse accused of causing an outbreak of hepatitis C in Hillsborough County last year through sloppy practice has finally been identified by state health authorities in an order suspending her license.

She is Brandy Elizabeth Medeiros, according to a Department of Health order suspending her license.  DOH's web site lists her address as an apartment in Seminole; a Facebook page that appears to be hers says she is from Tampa. It is not clear whether she has been working as a nurse in the past year.

The “emergency” suspension of Medeiros, who is both a registered nurse and a licensed practical nurse, is dated May 7, almost a year after the outbreak was discovered at the Wellness Works Clinic in Brandon and about six months after health authorities traced it to Medeiros. 

Allowing her to continue practicing as a nurse "constitutes an immediate serious danger to the health, safety or welfare of the public," the suspension order says.
 
Such a conclusion is necessary for the DOH secretary to suspend a license before a case works its way through the system and comes before the Board of Nursing. Suspensions can be appealed.
 
Despite months of requests from Health News Florida for the nurse’s name, DOH officials withheld it for 19 days after it had legally become a matter of public record. A DOH press spokeswoman sent it by e-mail Wednesday night without explanation for the delay.   

Miami attorney Tom Julin, a specialist in First Amendment law who was not involved in this case, said today that a 19-day delay in releasing public information is not allowed under Florida law; he called it "a ridiculously long period of time." 

In fact, he said, DOH should have released the name sooner, given the serious nature of the information and its possible implications for public health.

No information was available Thursday on whether Medeiros has been working elsewhere in health care since she was fired last year from Wellness Works, an “alternative” health clinic run by Carol Roberts, M.D.

At least nine Wellness Works patients contracted hepatitis C after Medeiros gave them intravenous treatment, including chelation and vitamin infusions.

The emergency suspension order, signed by State Surgeon General Ana Viamonte Ros, says Medeiros caused the outbreak by reusing syringes and single-use medication vials. Such vials are marked for single use because they don’t contain chemicals necessary to fight bacterial growth after they’re opened.

It was one of the hepatitis-infected patients, the report said, who first suspected that Medeiros was the cause. The patient -- a male, identified only as a plumbing contractor with the initials W.G.  -- first came to Wellness Works in June of 2008, with concerns about high lead exposure in his occupation.
In April of 2009 he began receiving chelation treatments. 

Chelation -- a metal detoxification process that infuses strong chemicals into the bloodstream -- is an accepted treatment for acute cases of heavy metal exposure. Some alternative treatment centers also offer it for other uses, from autism to heart disease, a practice that has drawn heavy criticism from mainstream medicine.

The emergency suspension order says that W.G. received 10 chelation treatments from Medeiros between April and June of last year. After the fourth treatment, during his routine annual physical from his primary care physician, he tested negative for hepatitis C.

Six weeks and two chelation treatments later, he felt ill, with weakness, nausea and brown urine – all symptoms of hepatitis C infection. A Wellness Works physician ordered a test, which came back positive.

Hepatitis C has an incubation period of up to six months, so the initial negative test does not rule out the possibility that W.G. had the disease at that point.)

W.G. returned to Wellness Works to have his hepatitis treated with intravenous injections of glutathione. He was to have two treatments a day for two weeks.

On the second day, W.G. reported that Medeiros gave him an injection, but instead of discarding the contaminated syringe, which would be standard practice, she set it on a counter next to another syringe. The syringes rolled into each other and the needles touched.

That led W.G. to suspect he had contracted hepatitis C through Medeiros’s injections.

Two other patients were mentioned in the DOH order:

--G.B., an 81-year-old ovarian cancer patient who received vitamin and mineral infusions at Wellness Works in April 2009 and who was found positive for hepatitis C the following month. 

G.B.’s daughter, who was present during the treatments at Wellness Works, observed the nurse using the same needle and syringe for several tasks, instead of bringing out fresh ones.

--M.F., a woman whose age was not stated in the records, came to Wellness Works in April 2009 for a second opinion on getting hormone treatments and ended up getting a vitamin infusion for “energy.”

M.F. later told investigators that the nurse used the same syringe and needle to draw fluid out of several vials, and did not cleanse the tops with an alcohol wipe, as is accepted practice. M.F. tested positive for hepatitis C in June 2009.

In July, after an alert from Dr. Roberts, the Hillsborough County Health Department instructed the clinic to notify patients about the outbreak and bring them in for testing at no charge. In all, 129 patients were tested and 11 were found to be positive for the hepatitis C virus; however, two were found to have been infected prior to receiving treatment at the clinic.

Epidemiologists concluded that Medeiros’ failure to use a new, sterile needle and syringe each time she drew medication from vials led to the spread of the infection from one clinic patient to others. 

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