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She carried a syringe loaded with 5 cc of saline — but labeled fentanyl — in her scrubs. There were plenty of unlocked cabinets with needles and saline, and plenty of occasions when nobody was paying attention. Not every shift, maybe, but often enough. After shooting up a patient's fentanyl, she frequently refilled the syringe with saline and used it to replace the next stolen needle, possibly because it was too much trouble to label a new one every time.
According to court records, the first instance of suspected hep C contamination of a surgery patient at Rose Medical Center occurred on October 22, 2008.
It was Kristen Parker's second day on the job.
4567 E. 9th Ave.
Denver, CO 80220
Category: Medical Facilities
Region: East Denver
"THERE WAS NO EMPATHY"
Call her Ruth. Like most of the Rose patients who had their pain medication replaced by pure anguish, she asked that her real name not be used.
This has not been her best year. Already on disability because of health problems, including depression and migraine attacks, in March the 51-year-old woman went for surgery at Rose to repair breast reconstruction following a bout with cancer. She thought the operation went well.
But in July, a registered letter arrived from Rose, informing her that she might have been exposed to hepatitis C. The letter urged her to arrange for a free blood test while assuring her that the test was simply a precaution; most of the patients contacted probably weren't exposed at all, it said.
No big deal, Ruth figured. She took the test. Then weeks went by, and nobody called her with the results. The waiting seemed interminable. When someone finally did call, it turned out they were looking for another patient and had mixed up the phone numbers.
"At that point I was starting to get paranoid," she says. "Then, on July 27, I got the phone call. Two nurses on the phone. The first thing they say is, 'How was your weekend?' Sweet, perky voices."
The nurses told her they were putting Dr. Edward Septimus, an infectious-disease specialist, on the phone to explain her test results. Ruth had never heard of him.
"How are you?" Septimus asked.
"I don't know," Ruth replied, her voice shaking.
But she already knew the news wasn't going to be good. As soon as Septimus told her she had hepatitis C, she started crying. It was five in the afternoon, too late to get in touch with her own doctor. She didn't know the man on the phone. She didn't want to talk to him. And what he had to say just kept getting worse.
"He said my genotype is 1a, and it's not related to the scrub nurse at Rose," she recalls. "I broke down again. I couldn't see how that was possible.... There was no empathy. I mainly got the sense that, 'This is the news, we're delivering it, and because you're not her genotype, we're not going to take care of you.'"
Ruth is one of the 47 patients from Rose and Audubon who have the hep C virus but are considered "not associated" with the infection spread by Parker. There are six basic genetic strains, or genotypes, of the virus, numbered one through six, and several subcategories. Unless the tests come back as genotype 1b, the same as Parker's, health officials don't count the case as part of the outbreak. Patients and their attorneys have disputed that conclusion, questioning the testing methodology and Dr. Septimus's role in the notification process.
Septimus, a much-quoted authority on swine flu and other infectious diseases, is the medical director of infection prevention for the Hospital Corporation of America, which has an ownership interest in HealthONE and Rose Medical Center. "We wanted to be sure that patients had a physician who was an expert, so they could ask questions and be referred to their appropriate physician," says HealthONE's Garvin.
But Septimus has also served as a defense witness in medical malpractice cases, and several patients say they felt put on the defensive by his questions about past blood transfusions, tattoos, surgeries or other factors that might explain their virus. The conversation confused Ruth, who found herself mentally reviewing five surgeries and various trips to the ER, worrying how she was going to tell her longtime boyfriend — and wondering if the doctor was trying to do damage control for the hospital. "It was a horrible, horrible way to find out," she says.
Ruth is in a peculiar limbo now. She doesn't think she can afford the expensive 48-week interferon treatment regimen that is successful in roughly half of hep C cases. The side effects of the medications can be serious, too, especially for someone already wrestling with depression. She feels healthy at the moment — "I don't have any symptoms. All I have are nightmares, lots of crying and just feeling alone" — but she still doesn't know how she got the virus. Parker admitted taking needles home, she points out, and perhaps she shared them with others, leading to a different genotype in Ruth's test result.
"I think I got it from Rose," she says. "I really do. I had these other surgeries, but there was never any situation where people came out with hep C."