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More Support for Multi-Dose Syringe Ban

Feb 5, 2008 | Parker Waichman LLP A multi-dose syringe ban appears to be gaining momentum in New York State.  Many feel that medical malpractice involving the irresponsible use of multi-dose syringes by Dix Hills doctor Harvey Finkelstein and Manhasset obstetrician-gynecologist E. Jacob Simhaee are cause to ban the use of multi-dose vials and hope the U.S. Food and Drug Administration (FDA) will take this next step.  State Health Commissioner Richard Daines is part of this growing group.

Daines made his recommendation known at a discussion on infection control at Hofstra University last week.  Although medical experts warn that syringes and needles are not to be used more than once when dispensing medication from multi-dose vials, some doctors ignore these sound medical procedures.  Daines said that despite "numerous guidelines and recommendations," some doctors continue to misuse needles and syringes, leading to contamination of multi-dose vials.  When using multi-dose vials, both the needle and the syringe are to be used once and each disposed of accordingly.  If either or both the needle or syringe are reused, they are contaminated and contaminate the contents of the vial.  Stopping the use of multi-dose vials would eliminate one possible contamination source.

Earlier this month, the state announced that Manhasset obstetrician-gynecologist, Dr. E. Jacob Simhaee, reused syringes in a multi-dose vials when administering at least 36 flu vaccines.  As with Finkelstein, Simhaee used a single syringe, which held up to six doses, on multiple patients.  No infections have been linked to Simhaee’s syringe practices.

The health department was not as prompt—exacerbating an already dangerous situation—when it was spotlighted this past November after having been found to have waited three years before advising the public that Finkelstein reused syringes in multi-dose vials, exposing patients to blood-borne pathogen infections such as hepatitis B and C and HIV/AIDS because of his shoddy injection practices.  The state Department of Health contacted nearly 11,000 of Finkelstein’s patients, urging them to be tested.  Because of Finkelstein’s practices, one patient contracted hepatitis C; six other patients tested positive for hepatitis B and six more for hepatitis C.  Finkelstein has had significantly more malpractice settlements than any other pain-management specialist on Long Island and, in 1995, was sued, on average, once or twice yearly.

Daines acknowledged the ban must allow for exceptions, as some medicines require multi-dose vial usage, explaining that doctors must sometimes use multi-dose vials to deliver the correct dosage.  Daines acknowledged that "engineering out" the possibility of human error is the best way to ensure infection control.  Using single-dose vials may cost more and leads to more waste when the correct dosage for a patient is greater than one vial but less than two vials; however, their use helps eliminate at least some contamination issues that some physicians—like Finkelstein and Simhaee—seem unable to control, not to mention waiting for the Health Department to catch up with these nefarious practitioners.

New York is the only state that requires infection prevention training every four years as well as strict infection control requirements in hospitals and office-based surgeries.  Despite this, Daines listed five hepatitis C and B outbreaks caused by poor infection control in NY since 2001.

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