The New York Times - November 16, 2007
Paul Vitello and Sarah Kershaw

The anesthesiologist, Dr. Harvey Finkelstein, of Plainview, first became the focus of a state health investigation in 2005 after two of his patients contracted hepatitis C. His name was reported by Newsday.

Yesterday, county and state officials traded blame over the 34-month delay in notifying the patients. At the same time, the incident led state health officials to seek a meeting with the Centers for Disease Control and Prevention to address an issue of drug packaging that was apparently at the heart of the problem.

In 2005, investigators found that, in violation of widely accepted practices recommended by the C.D.C., Dr. Finkelstein, 52, who specializes in pain management, was reusing syringes when drawing doses of medicine from vials that hold more than one dose.

He would use a new syringe for each patient. But when giving one patient more than one type of drug by injection, his practice of using the same syringe to draw medicine from more than one vial led to the potential contamination of the vials. The blood of a patient who was infected with hepatitis C could, by backing up through the syringe and entering the vials, infect another patient when the same vial of medicine was used again. This is what happened in at least one case, health officials said.

State health officials said yesterday they hoped to get the C.D.C.'s support in seeking the elimination of such multidose vials.

Any fix would come too late for Raymond Bookstaver, 49, a Hicksville mechanic who was one of two patients initially identified as having been infected by Dr. Finkelstein's improper use of syringes.

"I feel like I went to a doctor for help, and what I got instead was a death sentence," Mr. Bookstaver said. His hepatitis is being treated, but erupts unpredictably, causing him to suffer flulike symptoms including nausea, vomiting and aching that leaves him bedridden, he said.

At least one and possibly more doctors in the state, including a New York City anesthesiologist, have been reported to state health officials in the last several years for reusing syringes. State officials said they would cite those reports in their meetings with C.D.C. officials.

In 2005, Dr. Finkelstein was instructed in the proper use of syringes in administering pain medications by state health investigators and he has since been monitored to make sure he complied, a State Health Department spokesman said.

For reasons that were unclear yesterday, his case was not referred to the State Board for Professional Medical Conduct of the State Education Department until nine months after his unsafe practices were known.

That agency, charged with taking disciplinary actions against doctors, found no evidence of wrongdoing, and recommended no disciplinary action.

In January 2005, the Health Department began an epidemiological investigation to determine how many of Dr. Finkelstein's patients were infected by the vials of medicine that he had used more than once.

Investigators notified 98 patients who had received epidural injections for pain management in the three weeks before, during and after Dr. Finkelstein's two patients were infected, telling them to get tests for blood-borne infections including hepatitis and H.I.V.. Of the 84 who were tested, no other cases of infection were traced to Dr. Finkelstein.

The state then expanded its investigation to cover the years from 2000 to 2005. It was in 2000, Dr. Finkelstein told the investigators, that he began using one syringe to draw doses from numerous vials. In a statement released this week, the state health commissioner, Richard Daines, said "the department identified all 628 patients who had received injections between Jan. 1, 2000, and Jan. 15, 2005, after a thorough review of medical records at all sites where this physician practiced."

The Nassau County executive, Thomas R. Suozzi, called the long delay in making the notifications "outrageous," and blamed Dr. Finkelstein and state health officials who he said were overly deferential in their negotiations with the physician's lawyers.

Claudia Hutton, a spokesman for Commissioner Daines, said that it was routine for the department's staff to negotiate with a doctor's lawyers in its investigations, and added: "We worked with Nassau County hand in hand. They were with us all the way. It's nice that our partners are now playing 20-20 hindsight, but that's life."

State health officials acknowledged that the process, begun under the previous health commissioner, could have been more efficient. But they also said that before informing large numbers of patients, they wanted to make sure they only informed those who were at risk of being exposed, to avoid public panic.

"The commissioner wishes it were faster," said Ms. Hutton, the department spokesman, "and it's something he's going to look at and sit down to figure out why the things happened the way they did and how we could have done it more efficiently."

But, she added, "epidemiological investigations do take a while, and what we had here - it's not like we found 25 cases within a two-week time frame - we thought we should be cautious."

But patients and consumer advocates said the delay from January 2005 to November 2007 was a disservice to the public.

Though Mr. Bookstaver's illness was diagnosed almost immediately by his family doctor, he said that other patients - the 628 notified this week, for example - might not have been as lucky. "What if they have been living with these diseases all this time untreated? And thinking they had the flu?" he said.

Joanne Doroshow, director of the New York-based Center for Justice and Democracy and a member of a state task force on medical malpractice, said the case illustrated "a too-cozy relationship between the medical profession and the people who supposedly regulate them."

Michael Duffy, a lawyer who specializes in medical malpractice cases and vice president of the New York State Academy of Trial Lawyers, said that the long delay in notifying the 628 potential victims of Dr. Finkelstein's practice was especially troubling because none would be able to seek damages in court.

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