Hep C outbreak: Good to explore foul play, say experts
SGH files police report, all options being considered as search for cause of hep C outbreak continues
Human error may be the most common reason for a hepatitis C outbreak to occur within a hospital, but it is good to explore other possibilities such as foul play, said medical and legal experts.
The news of the hep C outbreak at Singapore General Hospital (SGH) was revealed two weeks ago and on Tuesday the hospital filed a police report, "so that the police may ascertain if there was any foul play," SGH said in a statement to the media.
Dr Jarrod Lee, a gastroenterologist in private practice, told The New Paper: "This means that SGH is being transparent and wants to get to the bottom of the outbreak, even looking at foul play.
"But I would be very surprised if it does turn out to be a deliberate act."
In the outbreak at SGH, 22 kidney patients contracted hep C infections. Eight had died, with five of the deaths possibly linked to the infection.
Dr Lee said it was really unusual to have such a cluster of hepatitis C infections at SGH "since the hospital is JCI (Joint Commission International) accredited and already has its safety protocol firmly in place".
JCI works to improve patient safety and quality of healthcare in the international community by offering education, publications, advisory services, and international accreditation and certification.
Despite the accreditation, there still can be breaches to the practices, said another gastroenterologist, Dr Desmond Wai.
Citing hep C data from 2008 to 2014 from the US Centers for Disease Control and Prevention, Dr Wai said the possibilities of the outbreak then included reuse of syringes that contaminated medication vials and failure to separate clean and contaminated workspaces.
"If there is a system in place at SGH where medical staff can record errors without the fear of being accorded blame, then perhaps the one who made the error might just come forward," he said.
Lawyers TNP spoke to said with SGH as the complainant, the police will be able to carry out proper investigations.
Lawyer Luke Lee said even if someone was found guilty of the act and charged, it would be under section 270 of the Penal Code where whoever carries out any act which is likely to spread a deadly infection will face jail time of up to four years, a fine, or both.
"But with as many as five deaths, I'm sure the DPP (deputy public prosecutor) will push for harsher punishment," he said.
Lawyer Chia Boon Teck felt if intent were proven, the person may be found guilty of voluntarily causing grievous hurt and face a mandatory jail term of up to 10 years, as well as either a fine or caning.
"But because there were deaths, the person may face murder charge where he will be punished with the mandatory death sentence; or that of causing death by a rash act not amounting to culpable homicide, which would warrant a sentence of imprisonment of up to five years and/or a fine,"he said.
"However, given the severity of the situation, the court is unlikely to find that the person's actions were merely rash ones." Mr Chia added.
"If there is a system in place at SGH where medical staff can record errors without the fear of being accorded blame, then perhaps the one who made the error might just come forward."
- Dr Desmond Wai
The two experts
Two international advisers have been appointed to the independent review committee looking into the spread of hep C in SGH
DR SCOTT DEWEY HOLMBERG
FROM US Centers for Disease Control and Prevention
POSITION Dr Holmberg heads the Epidemiology and Surveillance Branch of the Division of Viral Hepatitis at the National Center for HIV, Hepatitis, STD, and TB Preventionin Atlanta.
EXPERIENCE His unit is responsible for national surveillance, outbreak investigations and research projects in viral hepatitis.
A preventive medicine physician, he has been in practice for 36 years.
PROFESSOR TRISH PERL
FROM Johns Hopkins University.
POSITION Prof Perl is a professor in the departments of Medicine (Infectious Diseases) and Pathology at Johns Hopkins University School of Medicine and in Epidemiology at the Bloomberg School of Public Health.
She is also Senior Epidemiologist for The Johns Hopkins Health System.
EXPERIENCE She has extensive practical and research experience in the field of healthcare-associated infections and is recognised worldwide for her innovation and research in the field.
She has been asked to help with management of international outbreaks including Sars and Mers-CoV and consults with international governments on guideline development and strategies to prevent healthcare-associated infections and antimicrobial resistance.
Two jailed for other hep C outbreaks
Former doctor Dipak Desai was convicted of second-degree murder in the US state of Nevada for infecting at least nine patients with hepatitis C and sentenced to life in prison.
The outbreak, tied to Desai's Las Vegas endoscopy clinic, was discovered in 2007. He had re-used syringes to try and save money. Investigations also found that another 105 people may have been infected.
Former New Hampshire hospital worker David Kwiatkowski was sentenced to 39 years in prison for causing a multistate outbreak of hepatitis C in 2012.
Kwiatkowski, a drug addict and hep C sufferer, stole syringes filled with painkiller fentanyl and used them on himself. He refilled the tainted syringes with saline. Thirty patients were infected by the hep C virus.
About the case
In June, the Singapore General Hospital (SGH) stepped up checks for the hepatitis C virus infection and started thorough investigations once they became aware of the cluster of cases of hepatitis C virus infection in Ward 67.
To date, 22 kidney patients, hospitalised between April and June, have been diagnosed with the infection. Eight died, but only five of the deaths could be linked to the infection.
There was an initial internal investigation, but the hospital was unable to determine the cause of the outbreak.
An Independent Review Committee appointed by the Ministry of Health is looking into the matter, with the help of international advisers.
A police report was filed on Tuesdayto ascertain if there was any foul play.
SGH revealed yesterday that one of the 598 people screened for Hepatitis C has tested positive for the virus.
What hep C is & how it is transmitted
Hepatitis C is a liver disease caused by the hepatitis C virus, according to the World health organisation.
It can cause both acute and chronic hepatitis infections, ranging in severity from a mild form of the illness that lasts a few weeks to a serious, lifelong ailment.
The hepatitis C virus is a blood-borne virus. The most common modes of infection are:
- unsafe injection practices
- inadequate sterilisation of medical equipment and
- transfusion of unscreened blood and blood products