After weeks of investigation, New Hampshire public health officials now suspect a drug-abusing hospital employee spread hepatitis C to patients at Exeter Hospital by swapping sterile needles with contaminated ones. So far, 20 people have tested positive for the same strain of the harmful virus - including a hospital employee.
Investigators believe that an infected worker pilfered sterile syringes containing drugs intended for patients, then replaced them with used syringes filled with water or saline to conceal the theft.
If the suspicions prove true, the Exeter case would echo a smattering of other episodes around the country in recent years and highlight how the combination of privileged access and desperation can turn one health care worker’s personal addiction into a disease outbreak.
“People who are drug users - they are not necessarily the cleanest people in the world,’’ said New Hampshire’s public health director, Dr. José Montero. Intravenous drug users face a high risk of infection with hepatitis from sharing needles with other addicts.
More than 700 of the hospital’s patients have been tested for the hepatitis C virus, and former patients dating back to Oct. 1, 2010 may have been exposed. A patient may carry the virus for one to six months before developing antibodies that can be detected by blood tests. As a result, many patients who initially tested negative have been contacted for retesting. A genetic test is used to determine whether initial positive results match the outbreak strain of the virus.
The virus inflames the liver and is typically transmitted through the blood. Newly infected people rarely show symptoms, but over time, about 60 to 70 percent develop chronic liver disease. About 3.2 million Americans live with chronic hepatitis C infections, according to the US Centers for Disease Control and Prevention.
The hepatitis virus survives on surfaces for only a few days, according to Montero. So, when investigators found infected patients whose hospital visits were sprinkled across months and years, they suspected a single person as the source.
“It doesn’t happen every time and in every procedure. It’s an individualized, occasional event,’’ said Montero.
All infected patients had been treated in the hospital’s cardiac catheterization lab, which performs heart procedures and other surgeries. Exeter Hospital agreed to close the lab May 25 but reopened it June 5 after investigators from the state Division of Public Health Services found no evidence of contaminated equipment.
New Hampshire officials would not comment on whether the infected employee is the suspected source of the outbreak. No regulations prohibit hepatitis carriers from working in health care, but Montero said that employees who have been allowed back to the lab have all tested negative for the particular viral strain carried by the infected patients.
In an interview with WMUR-TV this week, the hospital’s president, Kevin Callahan, apologized to patients affected by the outbreak. “If it is determined that we’re responsible for this outbreak, we will be responsible for that cost,’’ he said.
The CDC reported 13 outbreaks of hepatitis C related to health care between 2008 and 2011. Many episodes involved double-dipping syringes into drug vials used for multiple patients. Two of those outbreaks involved medical professionals abusing patient medications - in both cases, the injectable painkiller fentanyl. The drug is similar to but more potent than morphine.
In 2010, Kristen Parker, a former hospital technician addicted to fentanyl, was sentenced to 30 years in prison after she infected at least 18 patients at Rose Medical Center in Denver.
“I would get a bottle of sterile saline out of the cabinet and just pull out . . . five [milliliters] worth, and I’d put a label on it and then usually wait till the anesthesiologist walked out of the room and just switch them,’’ Parker said in a videotaped interview with police.
On a number of occasions, she kept multiple syringes in her pocket - used and clean - and would swap the syringes quickly. “There’s no knowing if that was the clean one or if it was the dirty one,’’ Parker said.
In an ongoing federal case, Steven Beumel, a radiology technician formerly of the Mayo Clinic in Jacksonville, Fla., admitted to stealing fentanyl syringes during patients’ procedures and replacing them with hepatitis-contaminated saline syringes between 2006 and 2008.
The hospital tested thousands of patients for the virus. Two had infections linked to Beumel, one of whom died of complications related to hepatitis C.
In the Exeter Hospital case, Montero said in an interview that it was quite possible the thefts also occurred during patient procedures, without arousing suspicion.
“People are looking at the procedure, the monitors, the patient,’’ he said.
Parker told investigators she rationed her drug use to avoid detection. “I knew how much it would take in order for me to be obvious or that somebody would catch on or that, you know, I wasn’t able to do my job.’’
Few studies have systematically measured the problem of drug addiction among health workers. Some researchers have estimated that between 10 and 15 percent of all health workers abuse drugs at least once during their careers.
New Hampshire’s attorney general, Michael Delaney, said Thursday that his office is working with local and state law enforcement agencies to determine whether the Exeter case involved criminal actions.
Patients there have already contacted several law firms in New Hampshire.
“The phones are ringing off the wall,’’ said Concord lawyer Peter McGrath, who has filed one lawsuit in Rockingham County Superior Court and is preparing another. McGrath said Friday that he had been retained by more than 10 clients.
“It’s really a negligent supervision issue,’’ he said. “The hospital has a duty to maintain the safety and security and training of people.’’
McGrath said the second lawsuit is being filed on behalf of a 44-year-old Rockingham County man who reported feeling unusually strong pain related to a heart procedure at the hospital.
The suit will allege that patients did not receive all their prescribed medications because of the alleged drug thefts.