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Lisa Miller, the director of the disease-control division of the Colorado Department of Public Health and Environment, says the number of patients testing positive for hep C who weren't infected by Parker reflects what one would expect in the general population. Approximately four million Americans have the virus — and half don't know it yet.
"Those numbers aren't surprising," Miller says of the test results. "We estimate that 1.6 percent of the population is infected, so those numbers are in the ballpark."
As for the theory that other genotypes were introduced by Parker sharing needles with other drug users? "There's no evidence that occurred," Miller says. "That never came up in the investigation as a possibility."
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Even patients whose tests reveal the 1b genotype still face weeks of uncertainty before DNA testing at the Centers for Disease Control labs determines a definitive match with Parker's virus. "There are few labs that are able to do that kind of detailed genetic sequencing," Miller explains. "They've made us aware from the beginning that it will take a long time."
That adds another layer of uncertainty for patients like one 61-year-old woman — call her Diane — who had two hip replacement surgeries at Rose while Parker worked there, doubling her chances in a lottery nobody wants to win.
Diane got the call from Dr. Septimus while sitting alone in the waiting room of her internist's office: positive for hepatitis C, genotype 1b. "He told me that my genotype matched hers, and they were going to do more viral testing that was going to take weeks or months," she recalls. "Then he asked me if I'd ever had a blood transfusion. I told him, 'No, but I had two surgeries at your hospital.' I felt he was trying to put the onus back on me."
Diane now faces difficult decisions about whether to undergo the interferon treatment, which could complicate an autoimmune condition she's had for years. She worries that Rose could renege on its promise to pay for her treatment if the DNA sequencing fails to establish that Parker was the source of the virus — even though she, like Ruth, has no other apparent risk factors for hepatitis C.
"I'm afraid they're going to say that if you don't match 100 percent, they're not going to cover it," she says. "What do you do if you're halfway through this treatment and they say they're not paying? There are so many unknowns, and I hate being in the middle of this quagmire. I resent having to read between the lines and wonder what they're really saying. I want to deal with being healthy, not with the rest of this."
She doesn't think being angry at Parker helps her condition. But she is willing to testify against her if needed. "She changed my life," she says, "and I think the hospital should have had better safety precautions in place. I mean, can't you tell from the behavior of someone like her that she has problems?"
"BE MORE AWARE OF WHAT YOU LEAVE LYING AROUND"
On March 23, a Rose employee found Parker in an operating room to which she was not assigned. As Parker brushed past her, the employee felt something prick her arm. An uncapped syringe was sticking out of Parker's scrubs. Parker quickly dropped the needle into a sharps box. The other employee complained, and Parker was suspended and required to take a drug test.
She passed the test and was back at work a week later.
Rose spokeswoman Harshberger and HealthONE's Garvin say they can't provide any other details about the incident. It's not known whether the other employee was tested for possible infection or whether anyone tried to retrieve the needle to see if it contained anything. Presumably the drug test would have included a screen for opiates such as fentanyl, but that's not clear, either. Scrub techs don't administer intravenous drugs, but Garvin says Parker's possession of a syringe wouldn't necessarily be suspicious, because techs sometimes use them to irrigate wounds or for other procedures.
Two weeks after she returned to work, Parker was again caught in an OR where she didn't belong. She later claimed to have been looking for another employee to tell her about a car she'd just bought, but her supervisors weren't buying the story. She was suspended and required to submit another urine sample, which came back positive for fentanyl. On April 22, Rose terminated her by certified letter.
Parker tried unsuccessfully to resign before the test came back, but it didn't matter. It took her only twelve days to find another job that gave her access to fentanyl. Audubon Surgery Center snapped her up and honored her request not to contact her previous employer.
Parker's firing from Rose triggered reports about suspected drug diversion to the Drug Enforcement Administration and state health and pharmacy officials. But none of that information reached Audubon, where Parker continued her syringe-swapping ways until investigators caught up with her in late June. And it took almost two months for state investigators to link a hep-C-positive, fired employee with the inexplicable outbreak of the virus among Rose surgery patients.