Miami Herald - Friday, April 17, 2009
Fred Tasker, ftasker@MiamiHerald.com

The VA confirmed the number in a press release Friday but cautioned that there is no way to know if the veterans contracted the viruses from the VA equipment or in other ways.

In its news release, the VA said that of 3,341 Miami veterans who had colonoscopies with the improperly cleaned equipment, 3,184 have been notified, 2,038 have asked for testing, 1,880 were tested and 1,639 so far have been notified of their results.

The problem came to light in late March, after the Miami VA sent letters to more than 3,000 veterans who had received colonoscopies there between May 2004 and March 12, warning that improperly sanitized equipment might have exposed them to the three dangerous viruses.

All three viruses to which veterans might have been exposed are serious and contagious under some circumstances.

Hepatitis B is a liver disease that can range from mild, temporary illness to serious chronic conditions, and hepatitis C can lead to cirrhosis of the liver and liver cancer. HIV, or the Human Immunodeficiency Virus, can lead to AIDS.

Dan Shannon, a Broward veteran who had two colonoscopies at the Miami VA hospital, got a letter saying his tests were negative but wasn't entirely reassured.

"I'm going to go outside and get a second opinion from a private doctor, just as a precaution," he said.

"Wow, that's a bummer," said Stuart McLees, Vietnam vet and commander of a Davie VFW post, who had six colonoscopies at the Miami VA after an operation for colon cancer. McLees also received a letter from the VA that his test was negative.

"I'm still a little shaky," he said. "But I've been treated well at the VA hospital, so I really have no complaints."

NEWS FROM VA

VA officials in Washington and Miami did not immediately respond to calls for further comment. It isn't known whether colonoscopies, which were suspended in Miami when the problem came to light, have resumed.

The VA announcement said: "Although the risk of cross-contamination and exposure to these infections is exceptionally low, our directive is to treat all veterans potentially affected, regardless of risk, and regardless of cause."

Miami VA hospital chief of staff Dr. John Vara later said a staffer apparently had been rinsing parts of the equipment instead of chemically sanitizing them between uses, as recommended by the manufacturer.

Similar problems took place at VA medical facilities in Murfreesboro, Tenn., where nearly 6,400 veterans were told they might have been infected, and in Augusta, Ga., with nearly 1,100 veterans.

At those facilities, the VA on Friday reported that in Murfreesboro, 6,387 were potentially exposed, five tested positive for hepatitis B, seven for hepatitis C and one for HIV. In Augusta, 1,069 were potentially exposed, one tested positive for hepatitis B, five for hepatitis C and one for HIV.

The problem was first detected in Murfreesboro in December. In March, the national VA directed all 153 VA medical facilities to do a formal "step-up" inspection and retraining program. That's when the problem was discovered in Miami.

A team of doctors and administrators from the national VA has been at the Miami VA hospital since the last week of March poring over records, interviewing staffers, and trying to figure out how the Miami VA Medical Center, which won a Best in VA award in 2007, could have made such a fundamental error as rinsing instead of disinfecting the equipment.

Dr. David Greenwald, a gastroenterologist at Montefiore Medical Center in New York and a spokesman for the American Society for Gastrointestinal Endoscopy, said that despite the apparent breach of protocol, people should not fear getting colonoscopies at civilian medical facilities.

'EFFECTIVE' TOOL

"Colonoscopy is a very effective procedure for cancer screening," he said. "It's important to note that if the guidelines are followed, there should be no fear of infection."

All civilian hospitals and clinics -- but not the VA centers and clinics -- are inspected periodically by the Florida Agency for Health Care Administration, which also responds to patient complaints. Hospitals must report "adverse incidents" to the state agency.

Doctors and staffers at local hospitals also say procedures are in place to catch such problems immediately.

"We have such a culture of constant observation here that that kind of thing would not happen," said Barbara Russell, spokeswoman for Baptist Hospital in Kendall.
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